Reported sensitivities for EOS of C-reactive protein (CRP), an acute-phase protein synthesized in response to tissue injury, vary widely; sensitivity is lowest early in the infectious process.  The diagnostic accuracy of a single CRP at the time of initial investigation is poor, and a normal result should not delay initiation of antibiotics for a symptomatic infant. CRP measured serially may be helpful in determining duration of empiric antibiotic therapy. However, multiple conditions can be associated with the inflammatory response and a single elevated CRP should not be used to prolong antibiotic therapy.  Although procalcitonin, a peptide precursor of calcitonin, has shown moderate to good accuracy in the diagnosis of EOS,  -  it is not readily and rapidly available. The utility of other biomarkers, including interleukin-6, interleukin-8, tumour necrosis factor and neutrophil CD64, on their own or combined with WBC indices, requires confirmation.
IMHA is much more common in dogs than in cats. Primary IMHA can occur in any canine breed, but cocker spaniels, English springer spaniels, poodles, Old English sheepdogs, Irish setters, and collies are overrepresented. 4,5,9,16,20,24,25 American cocker spaniels reportedly represent approximately one-third of all dogs with IMHA. 10 One study 24 found an increased incidence of IMHA in bichons frises, miniature pinschers, rough-coated collies, and Finnish spitz breeds, while two studies 15,20 found an increased incidence in miniature schnauzers. Variations in breed predilection found in different case studies may indicate geographic overrepresentation of certain breeds. Most studies 3-5,15,20,25 have found an increased incidence of IMHA in female dogs. The mean age of onset is approximately 6 years, but IMHA can develop at 1 to 13 years of age. 4,5,9,15,20,25 Two studies 5,15 noted an increased incidence of disease in spring and summer, with 40% of cases occurring in May and June. Other studies 4,26 have shown no similar seasonal prevalence. The possibility of higher rates of IMHA during the warmer months may suggest an undiagnosed infectious cause, including tick-borne disorders.
Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education , American Society of Clinical Oncology , American College of Clinical Pharmacology , American Federation for Medical Research , American Society of Hematology , New York Academy of Sciences
Disclosure: Nothing to disclose.