management tree

Hemolytic Anemia
Ann E. Hohenhaus, DVM, Diplomate ACVIM (Oncology & Internal Medicine),The Animal Medical Center, New York, New York

MINIMUM DATABASE

CBC, biochemical profile, urinalysis,

heartworm test

Pigmenturia
Elevated Regenerative
(hemoglobinuria,
HEMOLYTIC ANEMIA

bilirubin anemia
bilirubinuria)

Red blood cell

transfusion if
anemia is
symptomatic

Evidence of hemolytic anemia

• Review history for potential drug reactions

• Review phosphorus: If < 2.0 mg/dl, consider
hemolytic anemia secondary to low
phosphorus
• Review heartworm test: Consider
microangiopathic hemolytic anemia if
positive

Diagnosis Treatment Result

4 6 . . . . j a n u a r y. 2 0 0 6 . . . . . N AV C c l i n i c i a n’s b r i e f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m a n a g e m e n t t re e
 Focused diagnostic testing

Review RBC
Abdominal morphology for
Abdominal Babesia canis Ehrlichia canis
ultrasonography Heinz bodies Coombs’ Test
radiography titer or PCR titer or PCR
and
eccentrocytes

Positive =
Splenic mass = Positive = Positive = Positive =
Metal foreign immune-
microangiopathic babesiosis ehrlichiosis Heinz body
body = zinc mediated
hemolytic anemia hemolytic
toxicosis hemolytic
anemia
anemia
No➞ No➞ No➞ No➞ No➞ No➞

Yes Yes Yes Yes Yes Yes

Review history
for onion
Imidocarb or ingestion,
Endoscopic Splenectomy Immuno-
atovaquone acetaminophen,
or surgical and Doxycycline suppressive
and vitamin K
removal histopathology therapy
azithromycin

Acetylcysteine,
supportive
care

Rare causes of hemolytic anemia

• Phosphofructokinase deficiency
• Pyruvate kinase deficiency
• Mycoplasma hemocanis
• Snake bites

m a n a g e m e n t t re e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . N AV C c l i n i c i a n’s b r i e f. . . . . j a n u a r y. 2 0 0 6 . . . . . 4 7