The utility of diagnostic tests for immune‐mediated hemolytic anemia

MacNeill, Amy L.; Dandrieux, Julien; Lubas, George; Seelig, Davis; Szladovits, Balázs

doi:10.1111/vcp.12771

Cited by 11 publications

(7 citation statements)

References 66 publications

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“…In 2019, the American College of Veterinary Internal Medicine (ACVIM) consensus statement offered similar guidelines, but the data substantiating these recommendations were sparse [ 6 ]. There remain disparities regarding the routinely used diagnostic techniques and interpretations of specific test results for diagnosis of IMHA in veterinary clinics as well as in laboratories, as recently illustrated in a small survey by the Veterinary and Comparative Clinical Immunology Society [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparative study of immunohematological tests with canine blood samples submitted for a direct antiglobulin (Coombs’) test

Idalan

Zeitz

Weber

et al. 2021

Canine Genet Epidemiol

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Background A 2019 ACVIM consensus statement on diagnostics for immune-mediated hemolytic anemia (IMHA) in dogs made testing recommendations. As data on the performance of immunohematological tests was lacking, we undertook a comparative analysis. Material and methods Anticoagulated blood samples from 126 dogs suspected of having IMHA submitted to a diagnostic veterinary laboratory for a routine direct antiglobulin test (DAT) and from 28 healthy control dogs were evaluated for spherocytosis and autoagglutination before and after three saline washes. Samples were also subjected to different DATs: a gel minitube and an immunochromatographic strip kit used in clinics; neutral gel column cards, microtiter plates (at 4°, 22°, and 37°C), capillary tubes, and flow cytometry used in laboratories. Results Samples from healthy dogs yielded negative results with all immunodiagnostic tests. Among the 126 samples submitted for DAT 67 were positive by a DAT utilizing microtiter plates with goat anti-dog antiglobulin DAT at 22°C. Notably, DAT results were comparable and consistent across all evaluated methods regardless of antiglobulin and temperature used. DAT+ dogs were more severely anemic and more likely to have erythroid regeneration compared to DAT- dogs. Macroscopic agglutination in tubes or on slides was observed in 48 samples after 1:1 and 1:4 blood to saline dilution, but only persisted in four samples after washing. Among the DAT+ samples, 57% had agglutination, 87% had spherocytosis, and 45% had both. There was good correlation between spherocytosis and DAT results from the six DAT techniques, but the correlation with autoagglutination was only fair. Clinical follow-up was available for 42 dogs. Of the sample from 12 DAT+ dogs collected during treatment, 10 remained DAT+ when tested 1–24 weeks after initial assessment. Conclusions Based upon this comparative prospective survey, all in-clinic and laboratory DAT techniques produced similar results when performed by trained personnel and can therefore be recommended for detection of antibody-coated erythrocytes and immunohematological diagnosis. In addition, use of these tests for monitoring response of IMHA dogs to treatment might be valuable.

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Section: Introductionmentioning

confidence: 99%

“…Indeed, in a recent study of dogs suspected of having IMHA, only 20% were tested by DAT [ 19 ]. As such, a presumptive diagnosis of IMHA is frequently made without evidence of immune-mediated destruction of erythrocytes in anemic dogs [ 1 – 3 , 7 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative study of immunohematological tests with canine blood samples submitted for a direct antiglobulin (Coombs’) test

Idalan

Zeitz

Weber

et al. 2021

Canine Genet Epidemiol

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“…This is because the role of glucocorticoids in the disease is to reduce the production of red blood cell antibodies and prolong the life of red blood cells (Oggier et al 2018). It has been reported that the autocoagulation reaction of normal saline can be used to make a preliminary diagnosis, and the suspected immune-mediated hemolysis can be further confirmed by direct Coomb's test (MacNeill et al 2019). Due to our inexperience at the beginning of the treatment, this was not confirmed by the Coombs test.…”

Section: Discussionmentioning

confidence: 92%

Diagnosis and Treatment of a Cat With Immune Mediated Hemolytic Anemia (Imha)

2021

Agrobiol. Records

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In order to explore the diagnosis and treatment of immune-mediated hemolytic anemia (IMHA) in cats, we diagnosed and treated a cat with IMHA. We made a detailed observation and record of the treatment process for reference to the treatment of IMHA in cats. Our diagnosis was based on the cat’s clinical manifestations, routine diagnosis, laboratory tests, and ultrasound results. We excluded the possibility of common infectious diseases and parasitic infections. The cat was initially diagnosed with hemolytic anemia, fatty liver, hepatocyte injury and cholestasis. The condition did not improve after symptomatic treatment for five days. But the cat gradually improved after the use of immunosuppressants, and was finally diagnosed to be suffering from IMHA. After 32 days of treatment, the cat was basically cured and discharged from the hospital. This paper describes a case study which can serve as the reference for the diagnosis and treatment of feline IMHA.

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“…The indirect antiglobulin (Coombs’) test (IAT) is routinely used in human medicine for the detection of anti-erythrocytic allo- and autoantibodies in plasma and serum to ensure blood transfusion compatibility or to diagnose IMHA, respectively [ 15 , 39 ]. In contrast, little is known about the value of IAT in diagnosing dogs and other domestic animal species suspected of having IMHA [ 17 , 18 ]. When using currently available canine antiglobulin reagents with different in-clinic and laboratory immunodiagnostic techniques to detect anti-erythrocytic autoantibodies in 94 serum samples from DAT+ and DAT− dogs, we show here that the various IAT methods are specific, but less sensitive analytical diagnostic tools to detect anti-erythrocytic autoantibodies compared to the equivalent DAT techniques reported by us recently [ 10 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the potential value of the IAT in the diagnosis of IHMA dogs [ 17 , 18 ] is relatively unexplored. Indeed, the use of IAT to diagnose IMHA dogs in clinical practice is quite rare [ 18 ], presumably due to the fear of interfering with alloantibodies giving false positive results [ 19 , 20 , 21 ]. However, such concerns appear unwarranted, as dogs have no clinically important alloantibodies prior to being transfused [ 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

The Indirect Antiglobulin (Coombs’) Test Is Specific but Less Sensitive Than the Direct Antiglobulin Test for Detecting Anti-Erythrocytic Autoantibodies and Thereby Immune-Mediated Hemolytic Anemia in Dogs

Idalan

Müller

Giger

2023

Veterinary Sciences

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The immunodiagnostic assessment of dogs suspected of having immune-mediated hemolytic anemia (IMHA) is based on persistent autoagglutination of erythrocytes (after three saline washes), marked spherocytosis, and a positive direct antiglobulin (Coombs’) test (DAT). However, the value of using the indirect antiglobulin test (IAT) for the detection of anti-erythrocytic autoantibodies in serum from dogs suspected of having IMHA is unclear. To evaluate the IAT, leftover serum samples from a large cohort of 94 dogs suspected of having IMHA and for which DAT results were known were incubated with DAT− erythrocytes, and five IAT techniques were performed (in part with different reagents and temperatures): microtiter plate (MICRO), microcapillary, laboratory gel column, gel minitube kit (GEL KIT), and immunochromatographic strip kit. Two IAT techniques (MICRO at 37 °C and GEL KIT with rabbit anti-dog polyvalent reagent) detected autoantibodies against erythrocytes in serum from 53% and 57% of DAT+ dogs, respectively, while other IATs performed less well. Moreover, while the analytic specificity of the IAT methods compared to the DAT ranged from 96–100%, the sensitivity range was only 9–57%. Thus, we still recommend DAT for diagnosis and monitoring of IMHA in dogs but conclude that a positive IAT result may aid diagnostically when serum is available, but fresh red blood cells are not.

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The utility of diagnostic tests for immune‐mediated hemolytic anemia

Cited by 11 publications

References 66 publications

Comparative study of immunohematological tests with canine blood samples submitted for a direct antiglobulin (Coombs’) test

Comparative study of immunohematological tests with canine blood samples submitted for a direct antiglobulin (Coombs’) test

Diagnosis and Treatment of a Cat With Immune Mediated Hemolytic Anemia (Imha)

The Indirect Antiglobulin (Coombs’) Test Is Specific but Less Sensitive Than the Direct Antiglobulin Test for Detecting Anti-Erythrocytic Autoantibodies and Thereby Immune-Mediated Hemolytic Anemia in Dogs

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