Thromboelastography shows clotting in dogs with immune anemia

Abstract

OBJECTIVE: To analyze thromboelastograms (TEGs) of naturally occurring cases of immune-mediated hemolytic anemia (IMHA) in order to identify whether a hypercoagulable state was present and whether its presence was associated with differences in survival. DESIGN: Retrospective study spanning January 2000 to June 2008. Medical records of dogs were evaluated. Endpoints were considered death or discharge from the hospital. SETTING: Academic teaching hospital. ANIMALS: Thirty-nine dogs with a diagnosis of IMHA and at least one TEG performed during hospitalization were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Four values were evaluated from the TEG: the R time (R), K time (K), alpha angle (alpha), and maximum amplitude. From these values, a coagulation index (CI) was calculated to classify patients as normocoagulable, hypercoagulable, or hypocoagulable. Thirty-three of 39 patients were hypercoagulable based on the CI. The 6 remaining dogs were normocoagulable. The patients with a normocoagulable CI had an increased mortality rate (100%) when compared with the hypercoagulable patients using Fisher's exact test (P=0.02). Additionally, prolongation of partial thromboplastin time did not preclude hypercoagulable TEG values. CONCLUSIONS: The majority of dogs with IMHA were hypercoagulable as measured by TEG. A normal CI was associated with a worse outcome in this patient population. TEG may provide additional and complementary information to prothrombin time and partial thromboplastin time relating to coagulation status in dogs with IMHA and may help predict prognosis and potentially guide clinical decisions to utilize anticoagulant drugs.