Spurious,marked leukocytosis in 2 cats with Heinz body hemolytic anemia

Two domestic shorthair cats were presented with anorexia and dehydration following ingestion of caramelized onions. Shared key findings from a CBC (ADVIA 2120), serum biochemistry, and urinalysis included a spurious, marked leukocytosis with discordant basophil (BASO) channel and peroxidase channel WBC counts, normal manual leukocyte counts, mild, non-regenerative anemia with discrepancies between automated and manual reticulocyte counts, an abundance of large Heinz bodies (HBs), and highly irregular scattergrams. Case 1 also demonstrated a markedly elevated mean corpuscular hemoglobin concentration (MCHC) and discrepancies between RBC hemoglobin indices. Spurious leukocyte results were confirmed through re-analysis of samples (including the acquisition of a new sample, use of an alternate analyzer (Sysmex XT-2000iV; Case 1 only), and evaluation of scattergrams and blood films (Cases 1 and 2). Repeatedly discrepant reticulocyte counts were also identified. In both cases, the erroneous BASO WBC counts, discrepancies in reticulocyte counts and RBC indices, and atypical scattergrams were interpreted to result from various effects of the HBs. These cases emphasize the importance of reviewing blood films, interpreting scattergrams, and the usefulness of duplicate methods for determining various measurands on hematology analyzers.     

Antioxidant prevention of Heinz body formation and oxidative injury in cats

OBJECTIVE: To determine the effectiveness of 3 antioxidants in preventing Heinz body anemia in cats. DESIGN: Prospective study. ANIMALS: 44 specific-pathogen-free healthy cats. PROCEDURE: Cats were housed individually, divided randomly into 4 groups, and given the following orally every 12 hours: empty gelcaps (control cats), N-acetylcysteine (NAC, 100 mg/kg of body weight), vitamin E (d,l-alpha-tocopherol; 400 IU), or ascorbate (250 mg). After 2 weeks, Heinz bodies were induced by dietary onion powder (OP; 1% or 3% of dry matter) or propylene glycol (PG, 8% wt/vol in drinking water) for an additional 3 weeks. Intake of treated water or food was recorded daily. Body weight, PCV, Heinz body and reticulocyte percentages, reduced glutathione concentration, and total antioxidant status were measured twice weekly in all cats. RESULTS: Heinz body percentage and degree of anemia did not differ significantly among cats receiving antioxidants and control cats except in cats that ingested water containing PG, in which antioxidant supplementation was associated with a decrease in water intake. Of cats that were fed a diet that contained OP, cats that received NAC had significantly higher reduced glutathione concentrations, compared with other cats in the experiment. Total antioxidant status did not consistently correlate with antioxidant supplementation or type of oxidant administered (ie, OP or PG). CONCLUSIONS AND CLINICAL RELEVANCE: Although the effect of antioxidant supplementation on Heinz body anemia in cats was minimal, antioxidants may have subclinical biochemical effects such as GSH sparing that may be important against milder forms of oxidative stress.     

Effect of diet on Heinz body formation in kittens

Heinz body formation was examined in kittens, in response to consumption of a variety of diets. A commercial salmon-based diet containing 16.5 mg of nitrite, 39 mg of histamine, and 210,000 IU of vitamin A/kg of diet (dry-matter basis) was found to induce Heinz body formation. Purified experimental diets--containing nitrite up to 405 mg/kg; histamine, 50 mg/kg; histamine 50 mg/kg plus nitrite, 45 mg/kg; or vitamin A, 250,000 IU/kg--failed to induce Heinz body formation. The effect of propylene glycol (PG) on Heinz body formation was examined by giving groups of 6 kittens purified diets containing 5 or 10% PG for 12 weeks. Two additional kittens were fed a commercial soft-moist diet containing PG for 12 weeks. All kittens fed PG developed Heinz bodies, with peak values for erythrocytes containing Heinz bodies being: 28% for kittens of the 10% PG group; 20% for kittens of the 5% PG group; and 36% for kittens of the soft-moist diet group. Kittens did not develop anemia or methemoglobinemia. Heinz body percentage required 6 to 8 weeks to decrease to the pretreatment value of less than 1% after diets containing PG were discontinued. 51Chromium-labeled erythrocytes were used to evaluate erythrocyte survival in 4 kittens of the 10% PG-fed group and in 4 control kittens. Kittens with Heinz body formation induced by 10% PG had significantly (P less than 0.001) decreased erythrocyte-survival, compared with that for controls, with half-life of 8.3 days for kittens of the PG group, compared with 12.6 days for kittens of the control group.     

Heinz body anemia in a dog that had been sprayed with skunk musk

A 5-year-old pit bull-type dog was examined because of lethargy and black feces, and a presumptive diagnosis of methemoglobinemia was made on the basis of grossly visible brown discoloration of the mucous membranes and urine. Heinz body formation was seen on examination of blood smears, and severe anemia developed 3 days later. The dog did not have any history of exposure to toxins or drugs that have been associated with Heinz body formation. The only remarkable historical finding was that the dog had been wandering loose the day prior to initial examination and returned home smelling strongly of skunk spray. Skunk spray contains thiols and other compounds that are strong oxidizing agents. It was speculated that the methemoglobinemia and Heinz body anemia were a result of exposure to these compounds. Skunk interactions with dogs usually have malodorous but otherwise harmless results. However, findings in this dog suggest that more serious consequences may develop in isolated cases.     

Heinz body hemolytic anemia associated with high plasma zinc concentration in a dog

Acute zinc toxicosis from the ingestion of pennies was diagnosed in a dog with Heinz body hemolytic anemia (PCV = 14%), leukocytosis (51,000 cells/ml) with a left shift (3,060 band neutrophils; 37,740 segmented neutrophils) and monocytosis (4,080 cells/ml), azotemia (BUN = 60 mg/dl), bilirubinemia (total bilirubin = 5.3 mg/dl), hypokalemia (3.0 mEq/L), high serum alkaline phosphatase activity (691 U/L), high total plasma solids (8.1 g/dl), hemoglobinuria, and proteinuria. Despite aggressive medical treatment, renal failure ensued, and the dog died of cardiac arrest. The clinical signs, clinical course, and laboratory findings in this dog were similar to what has been reported in other cases of acute zinc toxicosis in dogs, with the exception of a history of generalized seizures and the findings of Heinz bodies. Although a causative relationship between plasma zinc values and Heinz body formation cannot be proven, their association suggests that oxidative damage to erythrocyte hemoglobin and cell membrane proteins may be involved in the pathogenesis of zinc-induced hemolysis.     

Relation of endogenous Heinz bodies to disease and anemia in cats: 120 cases (1978-1987)

Disease diagnosis, age, sex, and selected hematologic variables were evaluated retrospectively in a population of feline patients with high number of circulating Heinz bodies. By comparing these cats with a control population and results of additional hematologic investigation on a subsample of the cats, we tested the hypotheses that endogenous Heinz body formation is increased in specific disease states and that endogenous Heinz bodies may contribute to anemia. There was strong correlation between diabetes mellitus, hyperthyroidism, and lymphoma and Heinz body formation. Diabetic cats, in particular, consistently had marked Heinz body formation. These diseases together accounted for nearly 40% of cats with Heinz body formation, but for less than 12% of cats of the control group. The PCV of cats with Heinz bodies (29.77 +/- 9.32%) was significantly (P less than 0.001) lower than that of control cats (35.33 +/- 8.08%). Polychromasia and punctate reticulocyte number were slightly increased in cats with Heinz body formation and correlated significantly (P less than 0.001) with PCV. A subsample of 13 of the cats had significant (P less than 0.006) inverse correlation between Heinz body percentage and erythrocyte reduced glutathione (GSH) concentration. Mean GSH concentration was significantly lower in cats with Heinz bodies, compared with that in a random cat population (5.28 +/- 1.67 mumol/g of hemoglobin vs 7.06 +/- 2.10 mumol/g of hemoglobin), in which GSH values followed normal distribution. Cats with Heinz body formation were older, and were more likely to be spayed.     

Association of maximum voluntary dietary intake of freeze-dried garlic with Heinz body anemia in horses

OBJECTIVE: To characterize hematologic and clinical consequences of chronic dietary consumption of freeze-dried garlic at maximum voluntary intake in horses. ANIMALS: 4 healthy sex- and age-matched horses. PROCEDURE: An initial garlic dose (0.05 g/kg, twice daily) was fed to 2 horses in a molasses carrier as part of their normal ration and was gradually increased to maximum voluntary intake (0.25 g/kg, twice daily) over 41 days. Dietary supplementation then continued for a total of 71 days. Two control horses were fed molasses with no garlic with their ration. Blood samples were collected weekly and analyzed for hematologic and biochemical changes, including the presence of Heinz bodies. Recovery of affected blood values was followed for 5 weeks after termination of dietary supplementation with garlic. RESULTS: At a daily dose of > 0.2 g/kg, horses fed garlic developed hematologic and biochemical indications of Heinz body anemia, as characterized by increases in Heinz body score (HBS), mean corpuscular volume (MCV), mean corpuscular hemoglobin, platelet count, and serum unconjugated and total bilirubin concentrations and decreases in RBC count, blood hemoglobin concentration, mean corpuscular hemoglobin concentration, and serum haptoglobin concentration. Recovery from anemia was largely complete within 5 weeks after termination of dietary supplementation with garlic. Heinz body score and MCV remained high at the end of the 5-week recovery period. CONCLUSIONS AND CLINICAL RELEVANCE: Horses will voluntarily consume sufficient quantities of garlic to cause Heinz body anemia. The potential for garlic toxicosis exists when horses are chronically fed garlic. Further study is required to determine the safe dietary dose of garlic in horses.     

Hemolysis and Heinz body formation associated with ingestion of red maple leaves in two alpacas

Two adult female alpacas were evaluated for acute onset of weakness, pale mucous membranes, and signs of depression of unknown etiology. Both alpacas had intravascular hemolysis, anemia, and Heinz body formation and had been fed wilted red maple leaves. Clinical signs developed several days after ingestion of the leaves. No other toxin exposure was reported, and no parasites were detected. Dietary copper and nitrate-nitrite concentrations were evaluated and determined to be within reference limits. Both alpacas continued to become profoundly anemic with continued hemolysis. This necessitated blood transfusion as a life-saving intervention; however, prior to whole blood being available, transfusion with bovine hemoglobin glutamer was necessary. Both alpacas recovered without complications.     

Erythrocyte pathology and mechanisms of Heinz body-mediated hemolysis in cats

Despite the frequency of both oxidant drug-induced and spontaneous Heinz body formation in cats, the cellular and biochemical mechanisms by which Heinz bodies result in red blood cell (RBC) destruction and hemolytic anemia in this species remain unknown. Feline spleens are non-sinusoidal and inefficient at removing Heinz body-containing RBC from the circulation; therefore, alternative mechanisms must be involved in accelerated RBC destruction. Propylene glycol (PG) ingestion causes dose-dependent Heinz body formation and decreased RBC survival in cats. We investigated several aspects of Heinz body-containing RBC from three cats ingesting diets that provided 8.0 g PG/kg body weight for up to 3 weeks, in order to characterize cellular lesions that are associated with the presence of Heinz bodies and that might contribute to chronic, accelerated RBC destruction, as well as to gain insight into the mechanism by which PG induces Heinz body formation. Erythrocytes with PG-induced Heinz bodies had decreased levels of reduced glutathione and adenosine triphosphate and reduced deformability. There was no change in hemoglobin isoelectric focusing or membrane lipid peroxidation. Electrophoretic patterns of Heinz body-containing RBC membranes were significantly altered, and membrane surface charge distribution was disturbed. Progressively protruding Heinz bodies suggested that extrusion of Heinz bodies may be a means of cell healing and/or destruction in the absence of splenic pitting. When compared to results obtained using RBC from cats treated with the oxidant drug phenylhydrazine, significant differences were noted in packed cell volume, turbidity index, membrane heme, and morphologic appearance of Heinz bodies. Our results indicate that multiple cellular abnormalities develop in RBC with PG-induced Heinz bodies that do not cause acute hemolysis but that may shorten RBC survival. Propylene glycol-induced Heinz bodies provide an ideal model for studying the chronic effects of Heinz bodies on RBC structure and function and may be useful in understanding the mechanisms of formation and the consequences of endogenous Heinz bodies in cats.     

Effects of propylene glycol-containing diets on acetaminophen-induced methemoglobinemia in cats

Soft-moist cat foods contain 7 to 13% propylene glycol (PG) on a dry-weight basis. These diets induce Heinz body formation in feline RBC. In this study, we evaluated cats on a control diet and on a commercial diet containing 8.3% PG. All cats on the PG diet developed an increase in the number of circulating Heinz bodies. We then administered acetaminophen to cats on each diet to determine whether RBC from cats on PG diets were more susceptible to oxidant stress. Methemoglobin concentrations were significantly greater in cats in PG diets after acetaminophen administration. These data indicate that RBC from cats fed PG diets are more susceptible to oxidative stress.     

Post-parturient haemoglobinuria in cattle: A Heinz body haemolytic anaemia

Abstract

Extract

During the late summer and spring of the four years 1967 to 1970 many dairy herds throughout the Northland region? ? The Northland region is here regarded as that part of the North Island of New Zealand lying north of Auckland city. There are about 600,000 dairy cattle in this region. experienced outbreaks of a form of post-parturient haemoglobinuria. Clinically the disease was indistinguishable from that reported overseas. In 1970 the first cases occurred in mid-July and the incidence declined sharply towards the end of September, although in both 1969 and 1970 cases were still occurring towards the end of October. In some herds over 40% of the cows showed clinical evidence of the disease. Younger lactating cows, particularly 2- and 3-year-olds, were the more severely affected and most cases occurred 2 to 4 weeks post-partum. The most characteristic clinical feature of the disease was an anaemic state. Practising veterinarians reported that affected animals frequently showed haemoglobinuria, hyperpnoea, pyrexia, icterus, anorexia and decreased milk yield (either singly or in combination), and that occasional animals died with the disease. Intercurrent infectious disease (usually mastitis) was present in some of these fatal cases, while in others there was a history of forced exercise (usually droving with dogs) immediately prior to death.     

Risk of hemolytic anemia with intravenous administration of famotidine to hospitalized cats

BACKGROUND: Famotidine administered IV has been associated anecdotally with hemolysis in cats, and some veterinarians recommend using injectable famotidine only by the subcutaneous (SC) route for cats. However, the actual risk of such a reaction is not known. HYPOTHESIS: We hypothesized that famotidine, when given IV slowly, would not be associated with a clinically significant drop in packed cell volume (PCV) in hospitalized cats. ANIMALS: One hundred and forty-two hospitalized cats. METHODS: A retrospective medical record review was performed for hospitalized cats prescribed famotidine IV (n = 56), famotidine SC (n = 48), or no famotidine (n = 38) at a veterinary medical teaching hospital over the period from January 2004 through December 2006. RESULTS: Baseline signalment, observation times, and famotidine dosage (in treated cats) were similar among groups. Median baseline PCVs were significantly lower in the IV (31.5%) and SC (32.0%) groups compared with the control group (35.0%; P= .04). The median percent drop in PCV (3-4%), however, was no different in cats that received famotidine by either route compared with the control group (P= .90), and no cats in either famotidine group were observed to have any clinical signs of hemolysis. CONCLUSIONS AND CLINICAL IMPORTANCE: We conclude from this retrospective study that famotidine IV was given to 56 hospitalized cats without evidence of hemolysis, and that the IV route appeared safe when famotidine was administered over 5 minutes. We could not document a safety advantage of SC versus IV administration in this group of cats.     

Heinz body hemolytic anemia with eccentrocytosis from ingestion of Chinese chive (Allium tuberosum) and garlic (Allium sativum) in a dog

A 4-year-old, intact male miniature schnauzer was presented with anorexia. The dog had ingested some Chinese steamed dumplings 2 days before, which contained Chinese chive (Allium tuberosum) and garlic (Allium sativum). Hematological examinations revealed severe Heinz body hemolytic anemia with eccentrocytosis and an increased concentration of methemoglobin, which was thought to result from oxidative damage to erythrocytes by constituents in these Allium plants. In this case, eccentrocytosis was a hallmark finding and could be detected easily, suggesting that this hematological abnormality is useful in diagnosing Allium plant-induced hemolysis.