Multiple splenic infarctions in a dog with immune-mediated hemolytic anemia: therapeutic implications

Document Type : Scientific report

Authors

1 BSc in Veterinary Science, Department of Veterinary Internal Medicine, Konkuk University Veterinary Medical Teaching Hospital, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea

2 MSc in Veterinary Surgery, Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea

3 Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea

4 Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea

Abstract

Background: Splenic infarction (SI) is a rare clinical entity seldom encountered in veterinary medicine. Its most frequent causes include thromboembolic status, splenomegaly, and cardiac disease. Although thrombotic elements from the circulation provide the most common context for thromboembolic SIs, immune-mediated hemolytic anemia (IMHA) has not been reported as an underlying disease in canine SI. Case description: A 2-year-old, female spayed Dachshund, was referred with vomiting, hematochezia, and brown colored urine over the preceding 4 days. Physical examination revealed abnormalities including generalized weakness, jaundice, and splenomegaly; blood work showed pancytopenia and hyperbilirubinemia. Erythrocyte agglutination, polychromasia, and spherocytes on a peripheral blood smear were observed and IMHA concurrent with thrombocytopenia was diagnosed. Findings/treatment and outcome: Although erythrocyte agglutination and leukopenia disappeared after treatment, anemia and thrombocytopenia were unresponsive to oral immunosuppressive drugs and repeated transfusions. Further abdominal ultrasound identified an occlusive splenic vein thrombus. Splenic histopathology found marked multifocal to coalescing necrosis, and hemorrhage consistent with multiple SI. Symptoms resolved following splenectomy combined with 1 month of immunosuppressive medication, and the dog was healthy on follow-up evaluation after 2 years. Conclusion: Immune-mediated hemolytic anemia is an incompletely characterized cause of SI. This report establishes a potential and novel causal role for IMHA in canine SI. We believe it to be the first case report of SI in a dog with refractory IMHA and thrombocytopenia, successfully managed by splenectomy combined with short-term immunosuppressive therapy.

Keywords

Main Subjects

References

Bokman, CL; Sfeir, M; Chahwala, V and Ginzburg, E (2014). Spontaneous massive splenic infarction in the setting of renal transplant and septic shock: a case report and review of the literature. Case. Rep. Med., 2014: 510259.
Carr, AP; Panciera, DL and Kidd, L (2002). Prognostic factors for mortality and thromboembolism in canine immune-mediated hemolytic anemia: a retrospective study of 72 dogs. J. Vet. Intern. Med., 16: 504-509.
Feldman, BF; Handagama, P and Lubberink, AA (1985). Splenectomy as adjunctive therapy for immune-mediated thrombocytopenia and hemolytic anemia in the dog. J. Am. Vet. Med. Assoc., 187: 617-619.
Friedenberg, SG; Balakrishnan, N; Guillaumin, J; Cooper, ES; Lewis, K; Russell, DS and Breitschwerdt, EB (2015). Splenic vasculitis, thrombosis, and infarction in a febrile dog infected with Bartonella henselae. J. Vet. Emerg. Crit. Care., 25: 789-794.
George, MR (2014). Hemophagocytic lymphohistiocytosis: review of etiologies and management. J. Blood. Med., 5: 69-86.
Hardie, EM; Vaden, SL; Spaulding, K and Malarkey, DE (1995). Splenic infarction in 16 dogs: a retrospective study. J. Vet. Intern. Med., 9: 141-148.
Horgan, JE; Roberts, BK and Schermerhorn, T (2009). Splenectomy as an adjunctive treatment for dogs with immune-mediated hemolytic anemia: ten cases (2003-2006). J. Vet. Emerg. Crit. Care., 19: 254-261.
Laurenson, MP; Hopper, K; Herrera, MA and Johnson, EG (2010). Concurrent diseases and conditions in dogs with splenic vein thrombosis. J. Vet. Intern. Med., 24: 1298-1304.
Lv, Y; Lau, WY; Li, Y; Deng, J; Han, X; Gong, X; Liu, N and Wu, H (2016). Hypersplenism: history and current status. Exp. Ther. Med., 12: 2377-2382.
Nores, M; Phillips, EH; Morgenstern, L and Hiatt, JR (1998). The clinical spectrum of splenic infarction. Am. Surg., 64: 182-188.
Ozakin, E; Cetinkaya, O; Baloglu Kaya, F; Acar, N and Cevik, AA (2016). A rare cause of acute abdominal pain: splenic infarct (case series). Turk. J. Emerg. Med., 15: 96-99.
Park, MY; Kim, JA; Yi, SY; Chang, SH; Um, TH and Lee, HR (2011). Splenic infarction in a patient with autoimmune hemolytic anemia and protein C deficiency. Korean J. Hematol., 46: 274-278.
Schattner, A; Adi, M; Kitroser, E and Klepfish, A (2015). Acute splenic infarction at an academic general hospital over 10 years: presentation, etiology, and outcome. Medicine (Baltimore). 94: e1363.
Schnier, LM (2010). A case of splenic torsion with progressive anemia and thrombocytopenia. Can. Vet. J., 51: 527-529.
Spangler, WL and Kass, PH (1999). Splenic myeloid metaplasia, histiocytosis, and hypersplenism in the dog (65 cases). Vet. Pathol., 36: 583-593.
Swann, JW; Garden, OA; Fellman, CL; Glanemann, B; Goggs, R; LeVine, DN; Mackin, AJ and Whitley, NT (2019). ACVIM consensus statement on the treatment of immune-mediated hemolytic anemia in dogs. J. Vet. Intern. Med., 33: 1141-1172.
Swann, JW; Woods, K; Wu, Y; Glanemann, B and Garden, OA (2016). Characterisation of the immunophenotype of
dogs with primary immune-mediated haemolytic anaemia. PLoS One., 11: e0168296.
Usküdar, TH; Karahan, S and Gümüş, U (2012). Splenic infarct in a patient with autoimmune hemolytic anemia. Turk. J. Haematol., 29: 432-433.
Weiss, DJ (2007). Hemophagocytic syndrome in dogs: 24 cases (1996-2005). J. Am. Vet. Med. Assoc., 230: 697-701.
Zamokas, G; Grigonis, A; Babickaitė, L; Riškevičienė, V; Lasienė, K and Juodžiukynienė, N (2016). Extra-medullary hematopoiesis (EMH) and other pathological conditions in dog spleens. Med. Weter., 72: 768-772.

Files

Share

How to cite

Statistics