Anemia can be divided into blood loss anemias, decreased production of red blood cells, or destruction of red blood cells.
Blood Loss Anemia is the loss of red blood cells from the vascular space. This can occur as a result of trauma, ulcers, post-surgical hemorrhage, intestinal worms, bleeding tumors, clotting disorders, or iron deficiency. Clinical signs include weakness, lethargy, collapse, anorexia, bloody stools, abdominal distention, and pale gums. Diagnostic tests involve bloodwork, a coagulation blood panel, x-rays, ultrasound, and thoraco- or abdominocentesis. Therapy includes cessation of blood loss, medical therapy, blood or plasma transfusions, and supportive care.
Anemia secondary to decreased production of red blood cells is a result of aplasia, or nonregeneration of red blood cells from the bone marrow. This can occur only to red blood cells, or to all blood cells produced in bone marrow. There can be numerous causes to this condition; however, sometimes an underlying cause is not found. Clinical signs include pale gums, lethargy, inappetance, weakness, elevated respiratory rate, fever, or collapse. Diagnosis is based on bloodwork, bone marrow aspirate, and infectious disease testing. Therapy is directed at resolving the underying cause and treating the anemia. Blood transfusions and immunosuppressive medications may be indicated in some cases.
Anemia from destruction, or hemolysis, of red blood cells can be a result of inherited red blood cell defects (PFK or PK deficiencies), infection, certain toxins, cancer, low phosphorus, or immune-mediated disease. Clinical signs of pale gums, lethargy, anorexia, weakness, elevated respiratory rate, fever, or collapse. Diagnosis is based on bloodwork, infectious disease testing, hereditary disease testing, x-rays, or cytology. Therapy targets correcting the underlying cause and addressing the anemia. Blood transfusions may be indicated in some cases.
Disseminated Intravascular Coagulation (DIC) is abnormal coagulation that is inappropriately activated as a result of an underlying disease process. This can occur secondary to shock, cancer, sepsis, organ dysfunction syndrome, and severe inflammatory and immune reactions. Clinical signs vary depending on the underlying disease, but progress to include collapse, pale gums, diffuse bruising, bloody stools, or icterus. Diagnostic testing includes bloodwork, coagulation testing, urine analysis, and chest and abdominal x-rays. Therapy is directed toward treating the underlying disease, fluid therapy, oxygen therapy, blood or plasma transfusions, and anticoagulation therapy.
Hemophilias are hereditary defects that impair clotting factors from being produced. As a result, severe bleeding disorders can be seen at 6 to 12 months of age. The symptoms reflect the inability to clot appropriately: hematomas, a large amount of bleeding from minor wounds, nose bleeds, or prolonged bleeding after surgery or a traumatic injury. Diagnostics include bloodwork and coagulation screening tests. Therapy involves controlling active bleeding, transfusions, and medical care. Long term care includes avoidance of surgery and trauma.
Hyperviscosity Syndrome is an increase in blood viscosity due to an increase in the blood components (plasma proteins, white blood cells, or red blood cells) which leads to sludging of the blood. Various underlying causes exist. Cinical signs include lethargy, weakness, weight loss, neurologic signs, and blindness. Diagnostic testing involves bloodwork, retinal exam, blood pressure, chest and abdominal x-rays, ultrasound, serum protein electrophoresis, coagulation testing, bone marrow aspirate, and testing for infectious diseases. Treatment of the underlying disease process is indicated. Plasmapheresis or phlebotomy may also be required to decrease the viscosity of the blood.
Immune-Mediated Neutropenia is destruction of neutrophils (a type of white blood cell) by the immune system as a result of medication, infection, or unknown cause. Clinical signs include weakness, lethargy, anorexia, and fever. Bloodwork, urine analysis, abdominal ultrasound, and infectious disease blood testing may be performed to assess for an underlying cause. Treatment may include antibiotic or steroid therapy. Sepsis is a potential complication.
Platelet Dysfunction is a defect in the platelet activation which can lead to bleeding tendencies. Dysfunction of the platelets can be inherited or acquired. Acquired disease can occur secondarily to systemic disease, certain medications, or disseminated intravascular coagulation. Diagnostic testing includes bloodwork and coagulation testing. Therapy is directed at treating the underlying disease, discontinuing medication, blood and/or plasma tranfusions, and controlling hemorrhage.
Immune-Mediated Polyarthritis occurs when there is inflammation of two or more joints because of attack by the immune system as a result of medication, vaccination, or unknown cause. Clinical signs include limping, stiffness, weakness, loss of appetite, lethargy, and weight loss. Bloodwork, urine analysis, x-rays, arthrocentesis for joint fluid analysis and culture, tick titers, and antinuclear antibody and rheumatoid factor testing are often performed for a diagnosis. Therapy includes immunosuppressive medications.
Shar-pei Fever is an inherited sterile inflammatory disorder in Shar-pei dogs that causes recurrent fever, swelling of the tibiotarsal joint, and amyloid deposition. It is diagnosed by excluding other potential causes for the clinical signs. This includes bloodwork, urine analysis, blood pressure measurement, tick titers, abdominal ultrasound, and kidney or liver biopsies. Treatment may include intravenous fluid therapy, anti-inflammatory medication, and antihypertensive medication.
Systemic Lupus Erythematosus is an inherited autoimmune disorder causing inflammation of at least two different organ systems. If the skin is affected, it may worsen with exposure to UV light. Clinical signs include skin lesions, oral ulcers, lameness, poor appetite, and fever. Diagnostic testing involves bloodwork, urine analysis, biopsies, x-rays, arthrocentesis, antinuclear antibody titer, LE cell testing, tick titers, and other infectious disease testing. Treatment with immunosuppressive or anti-inflammatory medications, antibiotics, and intravenous fluid therapy may be necessary.
Immune-Mediated Thrombocytopenia is an autoimmune destruction of the platelets that occurs secondary to medication, vaccination, or unknown cause. This leads to the inability to clot appropriately and bleeding tendencies. Diagnostic testing includes bloodwork, urine analysis, coagulation blood testing, tick titers, x-rays, and abdominal ultrasound. Therapy may involve blood or plasma transfusion and immunosuppressive medication.
von Willebrand Disease is a hereditary defect caused by a deficiency in von Willebrand factor (vWF), which is necessary for proper clot formation. Clinical signs include prolonged bleeding and may involve mild bleeding tendencies or more severe hemorrhage. This condition may occur in any breed, but Doberman pinschers may be over-represented. Bloodwork, coagulation testing, and vWF concentration testing are performed for diagnosis. Treatment may include blood or plasma transfusion, cryoprecipitate therapy, or administration of desmopressin acetate for preoperative therapy. Medications that prolong bleeding time should be avoided.