Anaemia – The Story of ‘Steve’
Presenter – Professor Ian Ramsey BVSc Phd DSAM FHEA MRVCS DipECVIM-CA, from The University of Glasgow’s Small Animal Hospital
The topic of anaemia in both dogs and cats is a vast area to cover in such a short space of time but Professor Ian Ramsey managed this with ease by giving us a practical and informative overview. His webinar showed that diagnosing these tricky cases requires a systematic and consistent approach, and although I am not a great fan of memorising lists and following flow charts, these are all crucial steps that we have to make.
When speakers bring subject matter to life using their own interesting and relevant cases, I am easily shaken out of my in lecture ‘zombie’ mode, and find myself taking a lot more on board.
In this case, Professor Ramsey used the example of ‘Steve’ a 6 month old MN DSH that had presented with seizures and pale mucous membranes. The interactive nature of this webinar gave us all an opportunity to ‘chip in’ and help make decisions on the diagnostics that we felt necessary for Steve.
It was clear from some of the questions asked about Steve’s case that we would all take a slightly different approach to his diagnosis. Some of us would start the work up by performing a haematocrit and total protein (TP) whilst others might use an in-house analyser or send bloods away to an outside laboratory.
Professor Ramsey was keen to stress that whatever approach we take it is always necessary to make and examine a blood smear. One of the most important questions that has to be asked when diagnosing these cases is whether the anaemia is regenerative or non-regenerative. The only way we can determine this is by checking a smear for polychromasia, anisocytosis and normoblasts – which explains why this simple technique is so key to the diagnostic process. Unfortunately checking reticulocytes is not so easy and our standard diff quick stain just isn’t up to the job. For this, the use of a new methylene blue stain is necessary and should be made readily available in all in-house laboratories.
Tips were also given on how to differentiate between the causes of anaemia, including the differentiation between haemorrhage and haemolysis assuming that a regenerative anaemia exists. The best way to achieve this is to utilise our clinical skills and be pedantic in our search for haemorrhage. Haemorrhage doesn’t always have to be obvious and can sometimes be subtle. We were advised not to always take our clients word on whether they are noticing clinical signs such as haematuria or melaena and samples should always be obtained and appropriate tests performed.
Professor Ramsey also warned us against relying too heavily on total protein levels to differentiate between haemorrhage and haemolysis as although we might expect them to be low in animals suffering haemorrhage, this is not always the case and normal values are frequently seen.
After providing us with a clear and logical pathway to Steve’s diagnosis, we eventually ascertained that he was suffering from AIHA. He responded really well to steroid treatment and it was a pleasure to see how Professor Ramsey’s methodical and patient approach gave the outcome that we were all looking for – I just hope I can do the same for my own patients.
The Stethoscope (MRCVS)