The igg and igm antibodies have dramatically different effects on erythrocyte survival, and these effects explain many of the clinical differences between igg and igm mediated hemolytic diseases. Immune mediated destruction is the most common cause in dogs, although infections, tumors, and other causes also occur. Immune mediated hemolytic anemia is one of the most common immune mediated hematologic disorders in dogs and cats. Immune mediated hemolytic anemia in australian shepherds. Retrospective study of reticulocyte indices as indicators of ironrestricted erythropoiesis in dogs with immunemediated hemolytic anemia. Hemolytic disease of the fetus and newborn american academy. The immune system in a dog is made up of a collection of specialized cells, proteins, tissues, and organs, which all constitute a solid defense system against a variety of infections, including bacterial, fungal, parasitic, and viral infections.
Classification of hemolytic anemias 2 extracorpuscular factors immune hemolytic anemias autoimmune hemolytic anemia transfusion of incompatible blood nonimmune hemolytic anemias chemicals bacterial infections, parasitic infections malaria, venons hemolysis due to physical trauma hemolytic uremic syndrome hus. After completing this article, readers should be able to. Diagnosis of immunemediated hemolytic anemia todays. Autoimmune hemolytic anemia, or aiha, is an immune condition where the immune system destroys red blood cells. New insights in the pathogenesis of autoimmune hemolytic. Microangiopathic hemolytic anemia occurs when the red. Thromboembolism is a major cause of morbidity and mortality in dogs with immunemediated hemolytic anemia imha. In cats however, imha has been reported less often and, in. Sensitization of the mother to fetalnewborn red blood cells requires fetomaternal hemorrhage in.
By far, the most common hemolytic anemia in both pediatric and adult medicine is sickle cell disease see chapter 9. Immune mediated hemolytic anemia also known as autoimmune hemolytic anemia can occur as a primary problem no discernible cause or as a secondary problem to many illnesses and stresses. Symptoms include pale gums, weakness, shallow and rapid breathing, dark stool, rapid pulse. I was incredulous, here was a young, extremely healthy and energetic dog given less. Immunemediated hemolytic anemia imha is a disease in which red blood cells, the cells that carry oxygen, are destroyed by the bodys immune system.
Explain the role of immune reactions, red blood cell membrane defects, red blood cell enzyme defects, or hemoglobin abnormalities in the development of hemolytic anemia. Immunemediated hemolytic anemia is the most common form of acquired hemolytic anemias. Immune mediated hemolytic anemia is the most common form of acquired hemolytic anemias. Feb 03, 2020 evans syndrome is the coexistence of simultaneous or sequential direct coombspositive autoimmune hemolytic anemia aiha with immune mediated thrombocytopenia. Autoimmune hemolytic anemia associated with an iga autoantigerbich. Immunemediated hemolytic anemia can be fatal if not treated. Journal of veterinary internal medicine american college of veterinary internal medicine. New insights in the pathogenesis of autoimmune hemolytic anemia.
Immune hemolytic anemia occurs when antibodies form against the bodys own red blood cells and destroy them. Immunemediated hemolytic anemia hematology american. Immune mediated causes could include transient factors as in mycoplasma pneumoniae infection cold agglutinin disease or permanent factors as in autoimmune diseases like autoimmune hemolytic anemia itself more common in diseases such as systemic lupus erythematosus, rheumatoid arthritis, hodgkins lymphoma, and chronic lymphocytic leukemia. In recent years, as more is known about the immune system, these entities have become better understood and their treatment improved. Immunemediated hemolytic anemia imha is a associated with certain cancers including lymphoma.
Common acquired causes of hemolytic anemia are autoimmunity, microangiopathy, and infection. Diagnosis and treatment of cold agglutinin mediated autoimmune hemolytic anemia. Classification of common hemolytic anemias extravascular hemolysis is mediated by the reticuloendothelial system res of the spleen and liver. Feb 01, 20 hemolytic disease of the fetus and newborn hdfn is the result of immune mediated destruction of fetal or newborn red blood cells when such cells contain antigens that are not present in the maternal blood. Acquired and congenital hemolytic anemia american academy. The disease is most common in middleaged female dogs, especially american cocker spaniels. Microspherocytes on a peripheral smear and a positive direct antiglobulin test are the. Immune mediated hemolytic anemia imha is a condition where the immune system is destroying its own red blood cells. Pathophysiology, clinical signs, and diagnosisce 219 an indepth look primary imha is a diagnosis of exclusion. Immune hemolytic anemia is classified as autoimmune. Jan 01, 2004 hemolytic anemia due to immune function is one of the major causes of acquired hemolytic anemia.
Pathophysiology of immune hemolytic anemia annals of. Other types are treated by addressing the underlying cause. Immune mediated hemolysis, caused by antierythrocyte antibodies, can be secondary to malignancies, autoimmune disorders, drugs, and transfusion reactions. Immune mediated hemolytic anemia imha is a common type of anemia in dogs and cats that results from a type ii hypersensitivity reaction. It has been reported to occur as a side effect of vaccination. This can be the direct result of a drug, toxin, blood parasite, virus or other primary cause or it can be an unexplained immune mediated reaction. A hemolytic state exists whenever the red cell survival time is shortened from the normal average of 120 days. The body misidentifies normal red blood cells as foreign invaders and destroys them faster than they can be replaced. Autoimmune hemolytic anemia aiha is an autoimmune disorder in which autoantibodies are directed against an individuals own red blood cells rbcs, leading to enhanced clearance through fc receptor fcrmediated phagocytosis. It can occur inside the blood stream intravascular hemolysis or outside the bloodstream extravascular hemolysis.
Hemolytic disease of the newborn is a condition that occurs when a mother and baby have incompatible blood types, usually because of rh incompatibility. To the authors knowledge, the role of platelets in thromboembolic events. Immunemediated causes could include transient factors as in mycoplasma pneumoniae infection cold agglutinin disease or permanent factors as in autoimmune diseases like autoimmune hemolytic anemia itself more common in diseases such as systemic lupus erythematosus, rheumatoid arthritis, hodgkins lymphoma, and chronic lymphocytic leukemia. Immunemediated hemolytic anemia imha occurs in cats less frequently than in dogs. Immunemediated destruction is the most common cause in dogs, although infections, tumors, and other causes also occur. Immune hemolytic anemia associated with drug therapy. This usually happens within the first few days to weeks after vaccination, though.
Hemolytic anemia in animals circulatory system merck. Immunemediated hemolytic anemia imha also goes by the name autoimmune mediated hemolytic anemia aiha. Imha can be a primary condition, or it can be caused. Acvim consensus statement on the diagnosis of immune. Data sources computerized searches of pubmed, index veterinarius, and the journal database of the veterinary information network, and a manual search of bibliographies of published. Immune mediated hemolytic anemia also known as auto immune hemolytic anemia can occur as a primary problem no discernible cause or as a secondary problem to many illnesses and stresses. Dark brown urine jaundice pale skin muscle pain headache nausea and vomiting weakness shortness of breath rapid heart beat after ruling out other causes, doctors diagnose. Atypical presentation of acute phase, antibodyinduced haemolytic anaemia in an infant. A coagulation profile completes the diagnostic panel. Hemolytic disease of the fetus and newborn hdfn is the result of immunemediated destruction of fetal or newborn red blood cells when such cells contain antigens that are not present in the maternal blood.
Immunemediated hemolytic anemia imha results from an immunemediated destruction of red blood cells rbcs that causes a decrease in the total rbc mass and often leads to life threatening anemia. Thromboembolism is a major cause of morbidity and mortality in dogs with immune mediated hemolytic anemia imha. Autoimmune hemolytic anemia aiha is caused by the increased destruction of red blood cells rbcs by antirbc autoantibodies with or without complement activation. Immunemediated hemolytic anemia imha is a condition where the immune system is destroying its own red blood cells. In the initial description by evans et al in 1951, the anemia and thrombocytopenia varied with respect to time of onset, course, and duration. Sensitization of the mother to fetalnewborn red blood cells. Acquired hemolytic anemia an overview sciencedirect topics. Andrew mackin bvsc bvms mvs dvsc fanzcvsc dipacvim professor of small animal internal medicine mississippi state university college of veterinary medicine, starkville, ms immune mediated hemolytic anemia imha is a common cause of anemia in dogs and cats. Immunemediated hemolytic anemia imha is a common type of anemia in dogs and cats that results from a type ii hypersensitivity reaction. Transfusion of blood from a donor with a blood type that does not match. With primary imha, your dogs immune system mistakenly produces antibodies that attack its own red blood cells. Immune mediated hemolytic anemia imha or autoimmune. Hdfn is now the preferred term that replaces the historic term erythroblastosis fetalis. Immunemediated hemolytic anemia in cats symptoms, causes.
Hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or lifethreatening. Canine immunemediated hemolytic anemia iliyan manev1. It is caused by a variety of antibodies against antigens expressed or attached to the patients red cell membrane. The immune system normally defends the body from bacteria and virus infections. Imha can be a primary condition, or it can be caused by another illness or event including cancer, certain. In this section, we will discuss three areas in which this progress has been apparent. Associate professor, the university of texas medical branch, galveston, tx. Immunemediated hemolytic anemia is treated with immunosuppressive drugs. Microspherocytes on a peripheral smear and a positive direct antiglobulin test are the characteristic findings.
Rbc destruction may occur both by a direct lysis through the sequential activation of the final components of the complement cascade membrane attack complex, or by antibody. These studies also show that many of the factors that influence the course of autoimmune hemolytic anemia act by altering the level of immunologic. Immunemediated hemolytic anemia imha in dogs and cats is associated with high morbidity and mortality. Other clinical signs, such as vomiting, diarrhea, or respiratory distress, are treated as needed. Acvim consensus statement on the diagnosis of immunemediated. Acquired hemolytic anemias pathophysiology of blood. Part 1 of this 2article series discusses pathophysiology and diagnosis of imha, including patient predilection, history and clinical signs, physical examination, diagnostics, and differential diagnoses. This happens because the immune system mistakenly recognizes these blood cells as foreign. Familiarity with the pathophysiology of this group of disorders is essential because these patients often pose formidable challenges in diagnosis and management.
This condition occurs when your cats immune system mistakenly destroys red blood cells, which are responsible for transporting oxygen throughout the body. Jun 01, 2004 immune hemolytic anemias are mediated by antibodies directed against antigens on the red blood cell surface. The igg and igm antibodies have dramatically different effects on erythrocyte survival, and these effects explain many of the clinical differences between igg and igmmediated hemolytic diseases. Sep 07, 2015 autoimmune hemolytic anemia aiha is caused by the increased destruction of red blood cells rbcs by antirbc autoantibodies with or without complement activation. The role of rituximab in adults with warm antibody autoimmune hemolytic anemia. It can be primary idiopathic or second ary to infectious diseases such as mycoplasmo sis or felv, toxins, medications, neoplasia, and systemic lupus erythematosus. Prothrombotic mechanisms and anticoagulant therapy in dogs. Hemolytic anemia due to immune function is one of the major causes of acquired hemolytic anemia. It should be part of the differential diagnosis for any normocytic or.
Immunemediated hemolytic anemia imha in dogs symptoms. Hemolytic anemia drugs and hemolytic anemia cephalosporins and hemolytic anemia piperacillin and hemolytic anemia fludarabine and hemolytic anemia drug antibodies druginduced immune hemolytic anemia diiha is rare. Immunemediated hemolytic anemia imha in cats part 1. Andrew mackin bvsc bvms mvs dvsc fanzcvsc dipacvim professor of small animal internal medicine mississippi state university college of veterinary medicine, starkville, ms immunemediated hemolytic anemia imha is a common cause of anemia in dogs and cats. Sep 15, 2018 hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or lifethreatening. Most has, such as warm autoimmune hemolytic anemia aiha, sickle cell disease scd, and hereditary spherocytosis hs, are characterized by extravascular hemolysis.
Hemolytic disease of the fetus and newborn american. Autoimmune pathogenesis and autoimmune hemolytic anemia. This condition is also referred to as autoimmune hemolytic anemia aiha. Immunemediated hemolytic anemia in dogs is a disease where the immune system attacks and breaks down the bodys red blood cells.
1622 87 1076 1129 1518 825 612 749 1156 1543 370 1333 243 1445 1160 1625 151 193 345 113 780 231 1333 1191 114 239 265 111 70 819 1438 1454 469 1426 323