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Objective To analyze a case of hyperhemolytic syndrome(HHS) and explore the laboratory diagnostic method and clinical treatment strategy. Methods Serological tests such as blood typing, direct antiglobulin test(DAT), anti-screening and antibody identification were performed, The complete blood count(CBC), as well as hemolysis indicators such as lactate dehydrogenase(LDH) and bilirubin were tested, and the changes and progression of hemolysis were monitored.By using genotyping methods to test 32 common rare blood type antigens in clinical practice, the accuracy of antibody identification results was supported. Results The patient had anti-E antibodies and autoantibodies in her serum. After blood transfusion, LDH and bilirubin increased significantly, but hemoglobin dropped sharply, far lower than before transfusion, presenting with unique manifestations such as hemoglobinuria.The patient made a full recovery after treatment with high-dose intravenous immunoglobulin and corticosteroids. Conclusion HHS is a rare and potentially fatal diseases, which is mainly manifested by hemolysis and severe anemia, and the hemoglobin level after blood transfusion is often lower than that before blood transfusion. This patient had typical clinical manifestations of post-transfusion hyperhemolytic reaction. After timely and correct treatment, the patient recovered completely and was discharged, accumulating valuable clinical experience for the diagnosis and treatment of such disease.

Aflatoxin intoxication has been reported in most species; however, it is infrequently documented in sheep. In this report, three 7-month-old Romane ewe lambs were found with severe icterus, tachypnea, slight fever, diarrhea, anorexia, and lethargy. Two of them were culled, and one recovered after treatment. Necropsy findings showed jaundice, ascites, diffuse hemorrhage on the peritoneum, gall bladder enlargement, and alteration in the color and texture of the liver and kidney. Histopathological evaluation revealed hepatocellular necrosis, megalocytosis, centrilobular to bridging fibrosis in the liver, and hemoglobinuria without nephrotic degeneration in the kidney. The polymerase chain reaction test for leptospirosis as the main differential diagnosis was conducted, and the result was negative. Similarly, the Warthin Starry special staining for spirochetes was negative. Clinical signs and characteristics of microscopic lesions were suggestive of aflatoxicosis in the lambs described in this investigation. As sheep flocks with intensive rearing systems are becoming more common in Iran, the emergence of aflatoxicosis due to fungi-contaminated feedstuff can be a serious health concern in such farms. [ABSTRACT FROM AUTHOR]

Babesiosis is a disease caused by intraerythrocytic protozoal parasites, which occurs in animals and humans. In dogs, babesiosis can be caused by eight species of Babesia gene: i.e., B. canis, B. rossi, B. vogeli, B. coco, B. gibsoni, B. conradae, B., and B. negevi, which are bound to certain geographical areas. The disease has a focal nature and its transmission depends mainly on vectors, which are ticks of various species. Due to transstadial, and transovarial transmission, babesiosis is able to persist in natural foci in several generations of ticks, even without the presence of a susceptible host. Typical clinical signs associated with canine babesiosis are: fever, apathy, weakness, pale mucous membranes, icterus and hemoglobinuria. The disease can have an acute or peracute course, and subclinical and subacute infections have also been described. The clinical manifestations of babesiosis may vary depending on the particular species and strains, and their specific virulence, but also depending on factors that determine the host's response to infection, such as age, individual immune status, and the presence of concurrent infections or other diseases. Medicines, from the group of antiprotozoans, a selected group of antibiotics, or their combinations are used for therapy. There are differences in the therapy of babesiosis depending on the Babesia species, the animal is often cured of the acute phase, but the parasite remains in the organism. [ABSTRACT FROM AUTHOR]

Paroxysmal cold hemoglobinuria (PCH) is a rare autoimmune hemolytic anemia often overlooked as a potential etiology of hemolysis and is challenging to diagnose because of the complicated testing methods required. We performed a systematic review of all reported cases to better assess the clinical, immunohematologic, and therapeutic characteristics of PCH. We systematically analyzed PubMed, Medline, and EMBASE to identify all cases of PCH confirmed by Donath-Landsteiner (DL) testing. Three authors independently screened articles for inclusion, and systematically extracted epidemiologic, clinical, laboratory, treatment, and outcomes data. Discrepancies were adjudicated by a fourth author. We identified 230 cases, with median presentation hemoglobin of 6.5 g/dL and nadir of 5.5 g/dL. The most common direct antiglobulin test (DAT) result was the presence of complement and absence of immunoglobulin G (IgG) bound to red blood cells, although other findings were observed in one-third of cases. DL antibody class and specificity were reported for 71 patients, of which 83.1% were IgG anti-P. The use of corticosteroids is common, although we found no significant difference in the length of hospitalization for patients with and without steroid therapy. Recent reports have highlighted the use of complement inhibitors. Among patients with follow-up, 99% (213 of 216) were alive at the time of reporting. To our knowledge, this represents the largest compilation of PCH cases to date. We discovered that contemporary PCH most commonly occurs in children with a preceding viral infection, corticosteroid use is frequent (but potentially ineffective), and DAT results are more disparate than traditionally reported.

ABSTRACT: The state of Santa Catarina is the largest national producer of onions. The consumption of onion (Allium cepa) by domestic animals can cause hemolytic anemia and hyperhemoglobinemia of Heinz bodies in erythrocytes. The epidemiological data and the pathological clinical picture were obtained during a visit to the property where the disease occurred. A herd of 54 beef cattle from a property in the municipality of Bom Retiro/SC, was placed in an onion crop, which had not been completely harvested because it was outside the desired standard for trade. The animals remained in this field for eight days. At the end of this period, all of them presented apathy, anorexia, brown urine and mucous membranes and an onion odor on expiration. The macroscopic changes observed were pale mucous membranes, blood with decreased viscosity and increased clotting time, liver with an evident lobular pattern and remains of onion in the rumen. The carcass gave off a strong onion odor. By histological analysis, there was central lobular coagulation necrosis in bridging in the liver. In the kidneys, there were intracytoplasmic hyaline droplets in tubular epithelial cells and a deposit of eosinophilic material in the lumen of the tubules. For the diagnosis of onion poisoning, epidemiological data associated with clinical signs, such as pale mucous membranes with evidence of hemoglobin pigmentation (brown mucosa) and hemoglobinuria, should be taken into account. This article seems to be the first report of onion poisoning in cattle in Brazil.

A 7-y-old male Labrador Retriever dog was presented because of acute onset of dark-colored urine after a hunting session the day prior. Moderate hemoglobinemia was observed, associated with transient hemoglobinuria and hematuria with no concurrent evidence of underlying urinary tract disease. The patient's clinical signs resolved within 36 h post-exercise without specific treatment. The concurrent occurrence of exertional hemolysis and hematuria in a dog is uncommon; these conditions are commonly reported separately in human athletes.

Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder characterized by a deficiency of GPIanchored proteins in blood cells. It is associated with hemolysis, thromboembolic events, and bone marrow failure. Management includes complement inhibitors, anticoagulation, and stem cell transplantation. Spontaneous remission of PNH is rarely reported. Case Presentation: A 28-year-old male initially diagnosed with aplastic anemia developed portal vein thrombosis and was subsequently diagnosed with PNH. Due to the unavailability of complement inhibitors, anticoagulation therapy and supportive care were employed. Splenectomy with splenorenal shunt was performed for chronic thrombosis and associated complications. The patient achieved spontaneous remission with normalized blood counts and diminished PNH clone. Conclusion: Managing PNH in resource-limited settings presents challenges due to the unavailability of complement inhibitors. Spontaneous remission of PNH is rarely reported and needs further research. A multidisciplinary approach, accessibility to diagnostic tests, and advanced treatments will enhance PNH management in resource-limited settings. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the cost-effectiveness of ravulizumab compared with eculizumab for the treatment of adult patients with paroxysmal nocturnal hemoglobinuria (PNH) in the Netherlands. Methods: A cost-effectiveness analysis was conducted based on a Markov cohort model simulating the course of patients with PNH with clinical symptom(s) indicative of high disease activity, or who are clinically stable after having been treated with eculizumab for at least the past six months. Costs, quality of life, and the incremental cost-effectiveness ratio (ICER) were estimated over a lifetime horizon from a Dutch societal perspective. Several additional analyses were performed, including a one-way sensitivity analysis, a probabilistic sensitivity analysis, and scenario analysis. Results: When compared with eculizumab, ravulizumab saves €266,833 and 1.57 quality adjusted life years (QALYs) are gained, resulting in a dominant ICER. Drug costs account for the majority of the total costs in both intervention groups. Cost savings were driven by the difference in total treatment costs of ravulizumab compared with eculizumab caused by the reduced administration frequency, accounting for 98% of the total cost savings. The QALY gain with ravulizumab is largely attributable to the improved quality of life associated with less frequent infusions and BTH events. At a willingness-to-pay threshold of €20,000/QALY, there is a 76.6% probability that ravulizumab would be cost-effective. Conclusions: The cost reduction and QALY gain associated with the lower rates of BTH and less frequent administration make ravulizumab a cost-saving and clinically beneficial substitute for eculizumab for adults with PNH in the Netherlands. [ABSTRACT FROM AUTHOR]