Heinz body anaemia - what are we missing?

Re: Heinz body anaemia - what are we missing?

Kate Richardson — Tue, 08 Jan 2013 15:01:57 GMT

Do you have an update on this case Alet?

Re: Heinz body anaemia - what are we missing?

Kate Richardson — Thu, 20 Dec 2012 12:09:14 GMT

[quote user="mariette asselbergs"]

Haemobartonella?

A course of doxycycline and a diet with iron (some liver maybe)?

Mariette

[/quote]

Although I can see they can look similar (I'm not a pathologist), haemobartonella (or mycoplasma haemofelis) infection does not cause Heinz bodies to my knowledge. Heinz bodies are caused by denatured haemoglobin whereas the protusions seen with M.felis infection are the actual organisms. I'm not sure if different stains are required though to detect HB and M.felis. Maybe a pathologist out there can answer that? (And correct me if I am wrong!)

Re: Heinz body anaemia - what are we missing?

mariette asselbergs — Thu, 20 Dec 2012 11:07:16 GMT

Haemobartonella?

A course of doxycycline and a diet with iron (some liver maybe)?

Mariette

Re: Heinz body anaemia - what are we missing?

or3155 — Thu, 20 Dec 2012 10:33:53 GMT

Hi Alet,

Without this turning into a list of toxins that can cause HB's (although maybe that is not bad thing). Phenol exposure e.g. TCP may cause HB's. I also remember something about not using propofol (a substituted phenol) every day for multiple days (formulary says 5+) in a row as HB's can arise.

Oli

Re: Heinz body anaemia - what are we missing?

Kate Richardson — Fri, 07 Dec 2012 14:41:04 GMT

Might be worth checking her blood for beta-hydroxybutyrate levels- its the predominant ketone in cats and isn't detectable with urine dipsticks, they measure a different ketone. Have you run any biochemistry? Hypophosphataemia can cause HB, most commonly asscoiated with DKA , but think it has to be fairly low to cause HBs and can't think of any other casues of hypophosphataemia. Liver disease can also cause oxidative damage to RBCs so worth bearing in mind, even if biochem is normal.

Lokoking in the books for other causes, other toxins incl methylene blue, propothiouracil, phenazyopyridine, Vit K1, benzocaine derivatives- all would be iatrogenic though. Propylene glycol as mentioned above can be in some food stuffs and also a carrier in some medications, so worth questioning them further on diet and any medications given at home?

As for treatment, I would suggest none at this stage and keep monitoring, unless you can find a cause, in which case remove it! I guess be very prepared for a haemolytic crisis, discuss the potential problems that may arise, possible necessity for blood transfusion, if owners likely to go ahead with a transfusion, then worth blood typing now and organising a matched donor. If you prepare all in advance, likelihood is the HBs will resolve and the cat won't need it!

Really interesting one, please keep us posted

Re: Heinz body anaemia - what are we missing?

Alet Engelbrecht — Fri, 07 Dec 2012 11:20:36 GMT

Thank Alex, inadequate dietary energy intake is definitely a possibility as many people around here don't even know until quite late that the cat is pregnant...The urine was normal, no ketones (we did a full urinalysis incl sediment). She is thin, but no worse than many other cats at the time of weaning.

No chance apparently of propylene glycol exposure, we have also taken a radiograph to check for coins (Zinc/copper exposure).

Any thoughts on treatment? At the moment we are monitoring her closely, her Ht unchanged for the last few days. Oh, I forgot to mention that the reticulocytes were <1%.

Re: Heinz body anaemia - what are we missing?

Alex Allen — Fri, 07 Dec 2012 10:53:27 GMT

As I remember Heinz bodies are more common in cats but with 90% and mild anaemia I would agree this is clinically significant. Given the recent pregnancy and lactation I would wonder if there was a period of transient ketoacidosis either through DM or inadequate dietary energy intake during these high metabolic demand times.

Propylene glycol can also cause Hz bodies in cats and although banned in cat food now is found in some ear cleaners and shampoos - have these been used by the owner??

In other species genetic disorders have led to increase oxidative stress causing Haemoglobin clumping so this may be possible.