Managing severe anaemia with a blood transfusion in a suspected IMHA case

This article discusses from initial presentation, stabilisation and treatment then relapse, a challenging case with an inconclusive diagnosis and differentials of hemangiosarcoma or immune-mediated haemolytic anaemia. The case progression included intensive medical management and a whole-blood transfusion with an excellent outcome.

Hemangiosarcoma is a common canine neoplasia with a higher prevalence in neutered animals than entire (Robinson et al, 2020). Superficial cutaneous lesions may be excisable while organ tumours are often fatal. However, advances in treatment have been minimal (Kim et al, 2015) and metastasis is common. Symptoms of visceral, often splenic, masses can include: anorexia, lethargy, weakness, cachexia, dyspnoea, syncope, pallor, increased capillary refill time, dehydration, peripheral hypotension, cold limbs, emesis, diarrhoea and hyperthermia (De Nardi et al, 2023). These ambiguous symptoms may resolve and recur frequently during illness due to small ruptures from malformed vessels intermittently leaking in the tumour, then clotting (Kim et al, 2015). Tumour rupture, however, causes haemoabdomen, hypovolemic shock, arrhythmias, respiratory arrest and sudden death (De Nardi et al, 2023).