Anemia and Pyometra in

Dogs

Medical Literature
ANEMIA
Definition
Anemia is defined as an absolute decrease in the red cell
mass as measured by RBC count, hemoglobin
concentration, and/or PCV.

Classifications
Regenerative anemia- the bone marrow responds
appropriately to the decreased number of red blood cells
by increasing production of new blood cells.
Nonregenerative anemia- the bone marrow responds
inadequately to the increased need for red blood cells.
Anemias due to bleeding or the destruction of existing red
blood cells are usually regenerative.

 Clinical signs
Clinical signs in anemic animals depend on the
degree of anemia, the duration (acute or
chronic), and the underlying cause.

Acute anemia can result in shock and

even death if more than a third of the blood
volume is lost rapidly and not replaced.
In acute blood loss, the animal usually
presents with:
tachycardia
pale mucous membranes
bounding or weak peripheral pulses
hypotension

 The cause of the blood loss may be overt, eg, trauma. If no

evidence of external bleeding is found, a source of internal or
occult blood loss must be sought, eg, a ruptured splenic tumor,
other neoplasia, coagulopathy, GI ulceration, or parasites. If
hemolysis is present, the animal may be icteric.
Animals with chronic anemia have had time to accommodate,
and their clinical presentation is usually more indolent with vague
signs:
Lethargy
Weakness
Anorexia

These animals may have similar physical examination findings

such as pale mucous membranes and weak peripheral pulses.
The lack of expected clinical signs may alert the clinician to the
time frame involved. Splenomegaly, abdominal distention, and/or
heart murmur may be present, depending on the underlying
cause of anemia.

 Diagnosis
A complete history is an important part of the
evaluation of an anemic animal. Questions might
include duration of clinical signs, history of
exposure to toxins (eg, rodenticides, heavy
metals, toxic plants), drug treatments,
vaccinations, travel history, and any prior
illnesses.
A CBC, including a platelet and a reticulocyte
count, will provide information on the severity of
anemia and degree of bone marrow response,
and also allow for evaluation of other cell lines. A
blood smear should be evaluated for
abnormalities in RBC morphology or size and for
RBC parasites.

Types of Anemia
Hemolytic Anemia
Hemolytic anemias occur when red blood cells are
destroyed. They are usually regenerative. Toxins, red blood
cell trauma, infections, immune system defects, and red
blood cell membrane defects can all cause hemolytic
anemias.

Immune-mediated Hemolytic Anemia

In dogs, the most common cause of hemolytic anemia is
immune mediated. This type of anemia can occur on its own
or as a result of tumors, infection, drugs, or vaccinations.
The body no longer recognizes red blood cells as self and
develops antibodies to circulating red blood cells, leading to
their destruction. Dogs with immune-mediated hemolytic
anemia are usually jaundiced, sometimes have a fever, and
may have an enlarged spleen. They can show mild, slow-developing signs and not appear to be in any pain, or they
can suddenly be in severe crisis.

 Nonregenerative Anemias
Nonregenerative anemias can be caused by nutritional deficiencies,
chronic disease, kidney disease, or bone marrow diseases.

Aplastic anemia
Anemia in which the ability of bone marrow to generate all blood cells
is reduced has been reported in dogs. Most cases have no known
cause, but some are caused by infections, drug therapy, toxins, or
total body irradiation.

Myelodysplasia (also called myelodysplastic syndrome)

is a bone marrow disorder in which growth and maturation of bloodforming cells in the bone marrow is defective. This leads to
nonregenerative anemia or shortages of white blood cells or platelets.
It is considered a preleukemic syndrome (occurring before leukemia
fully develops). Myelodysplasia occurs in dogs, cats, and humans.

Myelofibrosis
is a progressive disease leading to anemia and enlargement of the
spleen and liver. It brings on bone marrow failure after it causes
normal marrow elements to be replaced with fibrous tissue. It can be
the initial disease or occur as a result of cancer, immune-mediated
hemolytic anemia

Treatment
Transfusion with packed RBCs is usually required.
The goal of therapy is to stop the destruction of
RBCs by treating with immunosuppressive drugs;
supportive care is also a priority. Prednisone or
prednisolone at a dosage of 12 mg/kg, bid, is
considered first-line therapy, with azathioprine at
2 mg/kg/day (azathioprine is contraindicated in
cats and may be replaced by chlorambucil) or
cyclosporine at 510 mg/kg/day considered as a
possible second agent. In one study, low-dose
aspirin at 0.5 mg/kg/day improved survival times
in dogs treated with azathioprine and prednisone.

PYOMETRA
Definition
Pyometra is a hormonally mediated diestrual
disorder characterized by cystic endometrial
hyperplasia with secondary bacterial infection.
Pyometra is reported primarily in older bitches
(>5 yr old), 46 wk after estrus.

Etiology
Pyometra is a hormonally mediated diestrual
disorder characterized by cystic endometrial
hyperplasia with secondary bacterial
infection. Pyometra is reported primarily in
older bitches (>5 yr old), 46 wk after estrus.

 Etiology
Factors associated with occurrence of pyometra include administration
of longlasting progestational compounds to delay or suppress estrus,
administration of estrogens to mismated bitches, and
postinsemination or postcopulation infections. Progesterone promotes
endometrial growth and glandular secretion while decreasing
myometrial activity. Cystic endometrial hyperplasia and accumulation
of uterine secretions ultimately develop and provide an excellent
environment for bacterial growth. Progesterone may also inhibit the
WBC response to bacterial infection. Bacteria from the normal vaginal
flora or subclinical urinary tract infections are the most likely sources
of uterine contamination .Escherichia coliis the most common
bacterium isolated in cases of pyometra,
althoughStaphylococcus,Streptococcus,Pseudomonas,Proteusspp,
and other bacteria also have been recovered. By itself, estrogen does
not contribute tothe development of cystic endometrial hyperplasia
or pyometra. However, it does increase the stimulatory effects of
progesterone on the uterus. Administration of exogenous estrogens to
prevent pregnancy (ie, mismate shots) during diestrus greatly
increases the risk of developing pyometra and should be discouraged.

Clinical Findings
Clinical signs are seen during diestrus (usually 48 wk after
estrus) or after administration of exogenous progestins. The
signs are variable and include:
Lethargy
Anorexia
Polyuria
Polydipsia
Vomiting.

When the cervix is open, a purulent vulvar discharge, often

containing blood, is present. When the cervix is closed, there
is no discharge and the large uterus may cause abdominal
distention. Signs can progress rapidly to shock and death.
Physical examination reveals lethargy, dehydration, uterine
enlargement, and if the cervix is patent, a sanguineous to
mucopurulent vaginal discharge. Only 20% of affected animals
have a fever. Shock may be present.

 Diagnosis
Pyometra should be suspected in any ill, diestrual bitch or queen,
especially if polydipsia, polyuria, or vomiting is present. The diagnosis can
be established from the history, physical examination, abdominal
radiography, and ultrasonography. Vaginal cytology often helps determine
the nature of the vulvar discharge. A CBC, biochemical profile, and
urinalysis help exclude other causes of polydipsia, polyuria, and vomiting;
they also evaluate renal function, acid-base status, and septicemia. The
uterine exudate should be cultured and sensitivity tests performed.
Differential diagnoses include pregnancy and other causes of vulvar
discharge, polyuria and polydipsia, and vomiting.

Treatment
Ovariohysterectomy is the treatment of choice for pyometra. Medical
management could be considered if preserving the reproductive potential
of the bitch or queen is desired. Fluids (IV) and broad-spectrum,
bactericidal antibiotics should be administered. Fluid, electrolyte, and
acid-base imbalances should be corrected as quickly as possible, before
ovariohysterectomy is performed. The bacterial infection is responsible for
the illness and will not resolve until the uterine exudate is removed. Oral
antibiotics (based on the results of the culture and sensitivity) should be
continued for 710 days after surgery.

Actual Case
Medical History

The animal is diagnosed with Pyometra prior to

the anemia and is scheduled for operation but the
client was not able to pursue with the operation.

Clinical signs
The animal refuses food and water intake for 2
days prior hospital visit.
The animal is lethargic and unilateral epistaxis
is present.
Temperature upon arrival to the hospital is
below reference index.
The animal cannot stand firmly there is
weakness of the hindlegs
The mucuous membrane is severely pale and
the dehydration is prominent since the nose of
the animal is already flaking.

Diagnosis
Blood sample was obtained from the
patient for CBC, the Attending Vet
suggested blood chemistry but the
client refused.

CBC results

Treatment

Control/ Prophylaxis
The animal is subjected for
confinement because critical care is
required since the animals CBC
count results are not good and since
the animals anemic stage is severe
replacement doses of fluid should be
administered.