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The hemoglobin dimers that remain in circulation are oxidized to methemoglobin, which disassociates into a free heme and globin chains. The oxidized free heme (met-heme) binds to hemopexin (a β-globulin, Hpx) and the met-heme and hemopexin complex (met-heme/Hpx) is taken up by a receptor on hepatocytes and macrophages within the spleen, liver and bone marrow (only hepatocyte uptake is illustrated in the image above). Similarly, the hemoglobin/h…

…ulation is triggered in DIC via the extrinsic pathway, when FVII binds extravascular or intravascular tissue factor (TF), forming an autocatalytic complex. This binds to and activates FX; the TF-FVIIa-FXa complex then converts small amounts of prothrombin to thrombin. Thrombin amplifies its own production via the intrinsic pathway through FXI, which in turn activates FIX. Thrombin also activates the cofactors, FVIII and FV. Factor IXa forms a pot…

…e premature removal of RBCs, typically by extravascular hemolysis (intravascular hemolysis contributes a little to bilirubin production – the small proportion of free hemoglobin that is bound to haptoglobin is taken up by macrophages as a hemoglobin-haptoglobin complex, and the hemoglobin is degraded to unconjugated bilirubin; any unbound or free hemoglobin is excreted in the urine). The unconjugated bilirubin binds to albumin and is taken…

…r membranes, or a parasite such as Babesia exits the cell, rupturing as it goes), the hemoglobin is liberated into the circulation, resulting in hemoglobinemia. Some of this free hemoglobin binds to proteins called haptoglobulin (shown) and hemopexin and the hemoglobin complexed to these proteins is taken up by macrophages and hepatocytes, who have receptors for the binding proteins (e.g. CD163 for haptoglobin). Both the macrophage and hepatocyte…

…e premature removal of RBCs, typically by extravascular hemolysis (intravascular hemolysis contributes a little to bilirubin production – the small proportion of free hemoglobin that is bound to haptoglobin is taken up by macrophages as the hemoglobin-haptoglobin complex, and the hemoglobin is degraded to unconjugated bilirubin; any unbound or free hemoglobin is excreted in the urine). The unconjugated bilirubin binds to albumin and is take…

Figure 4: A large amount of free gas is displacing the intestines. In the lower aspect of the abdomen, there is an obvious fluid line (yellow arrow) and loss of serosal detail, indicating accumulation of free fluid within the abdomen.

…um and maximum (whiskers) were created. The gray shaded area represents the population-based reference interval for each test. For creatinine, the variation within dog (width along the Y-axis between the top and bottom whisker for each dog) is lower than the variation between dogs (width along the Y-axis spanning the top whisker and bottom whisker from all dogs combined). This indicates that the variation within animals is less than the variation…

…d increased clot strength (high MA). In hypocoagulable states (C, any of the following may be seen: Slower time for fibrin formation to start (long R), slower rate of fibrin formation (long K, low α) and decreased clot strength (low MA). Note that similar results are obtained with thromboelastrometry (ROTEM) although the terminology of results is different. There is variability among investigators as to the individual or combination of test resul…

…ogs with classic IMHA (the regenerative variant) are frequently hypercoagulable (high fibrinogen, high D-dimer) and some are in concurrent disseminated intravascular coagulation. They are considered at risk of fibrosis. Hemostasis abnormalities and hyper coagulability do not appear to be as common in dogs with the non-regenerative forms of the anemia (PIMA or PRCA), however subsequent corticosteroid therapy can predispose all dogs to thrombosis….