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Skin: cold agglutinin disease
Introduction
- Rare.
- Cause: agglutination of erythrocytes and microthrombus formation in capillary walls.
- Signs: erythema, purpura and necrosis of extremities.
- Diagnosis: signs and cold agglutinin test.
- Treatment: management of temperature and underlying disease.
- Prognosis: good if tissue destruction not too severe.
Presenting signs
- Erythema, purpura and necrosis or ulceration of extremities:
- Ear margins.
- Ear tips.
- Tail tip
. - Nose.
- Digits.
- Hemoglobinuria.
Geographic incidence
- Cold climates.
Age predisposition
- Any age affected.
- In older animals with concurrent disease.
Pathogenesis
Etiology
- Type II hypersensitivity → idiopathic but may be associated with lead poisoning Lead toxicity.
Predisposing factors
General- Cold temperatures increase activity of agglutinins.
- Poor husbandry and cold weather.
- Lead poisoning.
Pathophysiology
- Auto-immune disease → cold reacting IgM erythrocyte auto-antibodies → cryoglobulin and cryofibrinogens precipitated in tissue → microthrombi and vasculitis → tissue necrosis.
- Idiopathic auto-immune disease.
- Cold reacting IgM erythrocyte auto-antibody → agglutination and hemolysis.
- Cold reacting auto-antibody most active at 0-4°C, but may be active at higher temperatures.
- Thrombi in capillaries → hypoxia and necrosis of tissues.
Timecourse
- Acute onset but signs may be insidious.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Burgess K, Moore A, Rand W & Cotter S M (2000) Treatment of immune-mediated hemolytic anemia in dogs with cyclophosphamide. J Vet Intern Med 14 (4), 456-462 PubMed.
- White S D (1994) Diseases of the nasal planum. Vet Clin North Am 24 (5), 887-895 PubMed.
- Dickson N J (1990) Cold agglutinin disease in a puppy associated with lead intoxication. JSAP 31 (2), 105-8 VetMedResource.
- Hasegawa T, Matsuoka K, Ono K et al (1990) Immune-mediated skin lesions in a dog with auto-immune hemolytic anemia. Nippon Juigaku Zasshi 52 (5), 1001-1006 PubMed.