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Case Report
Haemolytic anaemia as a complication following colic
surgery in a 10-year-old Arabian stallion
C. U NDERWOOD * AND L. L. S OUTHWOOD
The Department of Clinical Studies, Section of Surgery and Emergency and Critical Care, New Bolton Center,
University of Pennsylvania School of Veterinary Medicine, 382 West Street Road, Kennett Square, Pennsylvania
19348, USA.
Keywords: horse; haemolysis; colic; anaemia; autoimmune; volvulus
422
Summary
Immune-mediated haemolytic anaemia is rare in the
horse. This case report discusses the clinical
presentation and treatment of this condition in an
Arabian stallion following abdominal surgery for large
colon volvulus. On Day 10 of hospitalisation the
stallion?s PCV dropped by 10% whilst his total solids
remained stable, consistent with haemolytic anaemia.
The stallion was treated with whole blood transfusions
and dexamethasone and recovered to be discharged
on Day 42. This is an interesting example of
immune mediated haemolytic anaemia associated
with a complicated gastrointestinal condition. It
demonstrates the wide variety of potential aetiologies
underlying a haemolytic episode and the necessity for
expedient treatment.
Introduction
Immune-mediated haemolytic anaemia (IMHA) is rare in the
horse (Jain 1986). It has been described as a primary
autoimmune disease and secondary to various aetiologies.
Secondary IMHA has been reported in association with:
lymphosarcoma (Reef et al. 1984; Mair et al. 1990); malignant
melanoma and splenic sarcoma (Mair et al. 1990); clostridial
infections (Reef 1983; Weiser et al. 1983); penicillin therapy
(Tennant et al. 1981; Blue et al. 1987; McConnico et al. 1992;
Robbins et al. 1993; Wilkerson et al. 2000); and trimethoprim-
sulphamethoxazole therapy (Thomas and Livesey 1998). IMHA
may cause intra- or extravascular haemolysis. Intravascular
haemolysis is characterised by haemoglobinaemia and
haemosiderinuria/haemaglobinuria. In cases with extravascular
haemolysis there is usually a high serum bilirubin
concentration, with only mild or no haemoglobulinaemia.
This case report discusses the clinical presentation and
treatment of IMHA in an Arabian stallion following abdominal
surgery for large colon volvulus.
Case history
A 10-year-old Arabian stallion was referred to the New Bolton
Center with signs of abdominal discomfort of 6 h duration. He
had no previous history of colic.
Clinical findings
On presentation the stallion was extremely painful,
hypovolaemic, and dehydrated. The horse?s heart rate was
56 beats/min. Intestinal borborygmi were absent. No reflux
was obtained following nasogastric intubation. Abdominal
palpation per rectum could not be performed due to the
horse?s violent behaviour. Blood lactate concentration was
3.6 mmol/l (reference range [rr]