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RVC RESEARCH    STUDY    VETERINARY SERVICES       RVC.AC.UK
         Emergency case
        COMPLEX IMMUNO-MEDIATED HAEMOLYTIC
        ANAEMIA CASE


        Clara Mattavelli, Emergency and Critical Care Resident

             ollowing  a  stick  ingestion,  Daphne,                             We  suspect  the  IMHA  may  have  been
             a  four-month-old  whippet  puppy,                                 triggered  by  the  penicillin-based  antibiotic
        F had  a  gastrotomy  at  her  local  vets.                             and/or  systemic  inflammatory  response
        A few hours later she was referred to RVC                               syndrome  (SIRS)  associated  with  the
        Small Animal Referrals due suspected post-                              recent sepsis. As a consequence, Daphne’s
        operative pyothorax.                                                    antibiotic  was  changed  to  marbofloxacin.
          On her first admission to the RVC, Daphne                             Given  that  her  packed  cell  volume  (PCV)
        was presented to our Emergency Referral                                 remained static, and Daphne was clinically
        Service  with  lethargy  and  dyspnoea.  She                            stable,  we  decided  to  monitor  her  rather
        was  diagnosed  with  a  diaphragmatic                                  than commence immunosuppression at that
        tear,  causing  a  septic  abdomen  and                                 point.
        concurrent  pyothorax,  with  evidence  of                               Daphne  rapidly  improved,  appeared
        pneumoperitoneum  and  pneumothorax                                     bright  and  demonstrated  a  good  appetite.
        and the presence of a gastric foreign body                              A very mild positive in-saline agglutination
        (Figure 1).                                                             was  still  present  at  the  point  of  discharge
                                                                                three  days  later.  However,  the  anaemia
                                                                                was strongly regenerative and there was a
                                                                                progressive increase in Daphne’s PCV.
                                                                                 In the following weeks, Daphne went for
                                             Figure  2:  Daphne’s  severely  pale  mucous   periodical  rechecks  at  her  local  practice.
                                             membranes,  due  to  her  anaemia  on
                                             readmission                        Blood tests showed a progressive resolution
                                                                                of her anaemia and normalisation of her
                                            Second RVC admission                white blood cell count and morphology. She
                                            Haematology  showed  marked  anaemia   completely recovered (Figure 3) and never
         Figure 1: Transversal CT image (post-contrast   with positive in saline agglutination and mild   required immunosuppressive treatment.
         lung window) showing mild pneumothorax and
         pneumoperitoneum,  pleural  and  peritoneal   evidence of intravascular and extravascular
         effusion and gastric foreign material     haemolysis,   suggestive   of   immune-
                                            mediated destruction (IMHA). Point-of-care
          Daphne    successfully   underwent   emergency  ultrasound  excluded  severe
        exploratory laparotomy, gastrotomy and   post-operative haemorrhage.
        diaphragmatic  tear  repair.  She  recovered   Daphne   received   an   emergency
        well  from  the  procedure  and  was  initially   packed  red  blood  cell  transfusion  upon
        discharged. However, Daphne represented   her  readmission.  Due  to  her  recent
        the next day critically ill (Figure 2) as she   history  of  bicavitary  sepsis  and  major
        had developed severe anaemia.       surgery, the team opted not to commence
                                            immunosuppressive steroid treatment.


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                                                                                       For small animal referrals, please call:
                                                                                     01707 666399
                                                                                       Email:
                                                                                     qmhreception@rvc.ac.uk

        4   Summer 2024
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