This new resource offers veterinary professionals and students an opportunity to earn RACE-approved CE credit via a series of informative online webinars.

dvm360 launches online CE center amid pandemic

dvm360®, the No. 1 multimedia platform in the veterinary industry, in partnership with Banfield Pet Hospital, today announced that they will host a free virtual career fair for recent veterinary graduates, current veterinarians and hospital team members on Thursday, June 4, from 6:00 pm-8:30 pm EDT.

The virtual career fair will be moderated 

“We here at the Fetch dvm360 family are proud to be hosting a virtual veterinary career event. We have had the pleasure of chatting with many of you in the field (recent graduates, veterinarians and support team members). We know how challenging these times are and how difficult it is to physically interview during this pandemic. We heard you and we are excited to host several FUN, engaging and interactive virtual live recruiting events,” Dr. Christman said.

“We couldn’t be more excited to partner with Banfield to give the veterinary class of 2020 an opportunity to connect with a major employer in the veterinary industry,” said Mike Hennessy Jr., president and CEO of MJH Life Sciences™, the parent company of dvm360®. “Due to COVID-19, many students across the U.S. weren’t able to have traditional graduation ceremonies, and we look forward to celebrating their accomplishments by surprising them with shout-outs from celebrities and key opinion leaders in the veterinary community.”

Attendees will have the “op-paw-tunity” to “fetch” some cool discounts and deals from Door Dash, Veterinary Mentor Solutions, caninearthritis.org, WhiskerCloud and more!

This one-day event will include four live Q&A presentations that will give important advice to guide aspiring veterinary professionals in their careers. Topics include resume writing, interview tips, strategies for managing student debt, and understanding the importance of inclusion and diversity in the workplace, as well as provide a unique opportunity for prospective veterinary professionals to learn and network with Banfield executives.

Health and Well-being When It Matters Most

Why Inclusion & Diversity Matter in the Workplace

“We’re always looking to connect with talented veterinarians and credentialed veterinary technicians,” said Melissa Marshall, vice president of people and organization at Banfield Pet Hospital.

Be sure also to check out an incredible graduation video montage created by dvm360’s Chief Veterinary Offer, Dr. Adam Christman. You will be pleasantly surprised to see very familiar faces saluting the graduating class of 2020!

To ask questions or learn more information about career opportunities, contact 

Articles

dvm360 is partnering with Banfield to host this exciting event.

Virtual Career Fair to kick off next week

As for many veterinary practice owners, COVID-19 has been a monumental challenge for Dr. Jill Well. Over the past 17 years, she built a large suburban hospital with six veterinarians and a staff of 40. The clinic offers grooming, a retail center and home delivery. But the pandemic has devastated many in her community, and her practice was no exception.

All of the clinic’s elective options were put on hold, with only essential care being provided. Dr. Well understood this was the only way that the pandemic would be brought under control, but her practice nevertheless was turned upside down.

At the height of the shutdown, practice volume dropped to 35% of normal. No one except masked staff entered the clinic, and curbside service and Zoom consultations were the new normal. For the first time in her career she had to lay off nonessential team members. In consultation with her administrators, Dr. Well had to manage a dwindling clinic bank account, panicky clients and a hospital staff afraid both of COVID-19 and of not being able to give proper care to their patients. Dr. Well knew that eventually government financial aid would come and the virus would subside, but she’d did not know when or even if the practice would survive. It was, in short, her worst nightmare.

The receptionists, technicians and veterinarians who continued to work at the practice each day were devoted and committed to patient care. They observed all CDC recommendations, and clinic hygiene was ramped up to the maximum. This, combined with the fact that patients entered the clinic unaccompanied by their human caretakers, allowed the staff to remain as safe as possible. Dr. Well saw this group of employees as truly heroic.

For the practice to succeed, Dr. Well had to manage the immediate crisis while simultaneously conducting short- and long-term planning. Part of her long-term plans include rehiring staff and restoring practice normalcy when the virus subsides. She also decided to provide what she called “hero rewards” for those staff members who remained on the front lines during the worst of the COVID-19 pandemic. She had not decided whether this would be a bonus, gift or some other token of well-earned appreciation. But when she presented her proposal to her administrators she received some unexpected resistance.

Both the hospital’s medical director and nonmedical staff director were opposed to the idea of a “hero reward,” noting that staff members who were quarantined, thrust into mandatory home childcare or over age 60 had no choice but to stay home. They all wanted to work and do their part at the clinic during the crisis but were refused the opportunity. Why, the administrators wondered, should some of their coworkers be labeled heroes and given rewards for doing work that others were denied?

Dr. Well responded by saying that despite the circumstances and restrictions on some staff members, those who worked the front lines must be acknowledged. Her advisors first recommended that she remove the title “hero” from her proposal. All of her staff members could be and would be heroes if given the opportunity. In addition, the virus recovery period could be celebrated by the entire reunited workforce post COVID-19 in the form of an appropriate group gesture.

In the end, Dr. Well decided that the entire staff should be congratulated for the commitment and sacrifice they made to help patients during the pandemic. Those who worked in the practice would receive “hazard” pay and those working from home would be acknowledged and thanked for supporting their coworkers. Dr. Well went on to assure her staff that the hospital would survive this challenge as a team.

Do you think Dr. Well’s idea of honoring front-line staff was fair to those who were unable to work in the practice during the pandemic, or do you think her decision to honor the entire team was the wise one? What would you have done? Email us your thoughts at 

COVID-19 has placed veterinary practices—indeed, all of veterinary medicine—in uncharted waters. Our focus and crisis preparation have always been directed toward animal disease outbreaks, such as parvovirus, canine influenza and various viruses that affect herd health. A human pandemic was not in our game plan.

Dr. Well’s instincts told her to reward those troops on the front lines, but she was reminded that all staff members were doing their jobs as part of a team effort and advised that staff accolades not be one-sided. Dr. Well did the best she could in a crisis, and I agree with her ultimate decision, but what is more important is that she wisely sought the advice of her administrative staff to assist her in making that decision. We should not act alone in a crisis because 21st-century veterinary medicine is a team effort.

Dr. Rosenberg is director of the Voorhees Veterinary Center in Voorhees, New Jersey. Although many of the scenarios Dr. Rosenberg describes in his column are based on real-life events, the veterinary practices, doctors and employees described are fictional.

The dilemma: Should you give special recognition to your front-line veterinary practice team in light of the fact that others were unable to work during COVID-19?

Is a ‘hero award’ appropriate for front-line veterinary staff?

The Lamesa, Texas landscape is so flat that on a cold night you can see the lights of Midland about 60 miles away. We get about 16 inches of rain a year, most of which falls on one evening in mid-May. The dirt here is a drab clay-orange color, and the wind blows so hard that I have seen many a tumbleweed stuck in the highline wires of telephone poles.

We’ve got our share of creatures, from coyotes, lizards, roadrunners and meadowlarks to a quail, horned toads, rabbits, hawks and snakes. Most of these critters are just fine with me. I like to shoot guns, but not usually at animals. My grandfather said I was a crybaby because I wouldn’t shoot anything but, heck, my job is to fix critters, not kill them.

One of my very first cases as a veterinarian was a horse that had been bitten by a rattlesnake. Oh my, that poor horse was about to die by the time it was brought to the clinic. I could not imagine how toxic that venom must have been to make a 1,000-pound horse’s head swell so much that it couldn’t breathe. I remember standing there imagining what a snake like that would have done to me had I been the recipient of that dose of venom.

I have since seen hundreds, maybe thousands, of animals that have received an inoculation with the juice from the fangs of these evil monsters. We have mostly Western diamondbacks and prairie rattlers here, and that Western diamondback, well, it is a beast.

One of my good friends narrowly escaped with his life after being bitten by one a few years ago. He spent weeks in the hospital and had to have skin grafts and dialysis for a while because of the venom's effects on his kidneys. I am scared to death of those things. I'd estimate that my kids spent less than a third of the typical time playing outside when they were small because these monsters roam the plains of west Texas.

No snake bothered us for years on Brock Hill thanks to Hank, a big mutt that hated all snakes. Hank would grab the tail in his mouth and swing them around until they were dead. He had been bitten so many times that he barely even swelled up after a bite. He was like mongoose with a cobra. The venom he had been exposed to over years of being bitten had immunized him like a vaccine. When he saved me once from being bitten, he and I were bonded for life.

When Hank got old and eventually died, it was one of the saddest days of my life. And once Hank was gone, the snakes started coming in by the billions. OK, maybe there weren’t that many, but last year we killed 45 of them in the vineyard. If you are reading this and thinking we are inhumane for killing animals, well, I don’t care. Until you have seen how devastating the venom of these snakes is to people and animals, don’t judge.

One recent Saturday a windstorm came through and broke a bunch of branches off a tree in our yard. The next day I was out picking up branches when the following event occurred.

I always keep an eye out for snakes and usually wear “snake boots” when working outside. It was a bit early in the season, so I hadn’t broken out the snake boots just yet. Instead I was just wearing my regular boots while I picked up branches. I was looking around closely while walking across the yard when I felt something smack up against my right leg.

I figured I had stepped on one of the branches and it had swung around and hit my other leg. But when I looked down, I saw a three-foot Western diamondback stuck to my britches. I never saw that rascal coming, and it never rattled at all.

As I am getting close to 60 and am way too fat, I had no idea that I could jump so high. Some sort of sympathetic response in my subcerebral brain, fueled by adrenalin, caused me to jump so high that I was clinging to a tree branch with my own feet four feet off the ground. It all happened so fast that I looked around and wondered what I was doing hanging from a branch so high off the ground.

I don’t wear skinny jeans (most of the people I know say that is a wonderful idea) and, boy, am I glad I don’t. The fangs of that snake had penetrated the material of my baggy, fat man jeans, and the snake actually had those fangs lodged in the denim fabric for a second before it could release.

As I hung from the branch I tried to direct my brain to the area of fang penetration. Could I feel heat? Could I feel swelling starting? Was there pain like my friend had described? How far was it between my jeans and my flesh? How long are a rattlesnake’s fangs? Is it possible that my leg was bitten but I just couldn’t feel it yet? How could I have not seen the snake coming? Why didn’t it warn me with a rattle?

Just as I had that thought the rattle started, adding to my terror. If I let go of the branch, I was going to fall down into striking range. I managed to shimmy around the tree and let myself down a good distance from the evil, legless beast.

I ambled over to a safe spot next to the house and analyzed what had just happened. I was a tight-fitting jeans moment away from a trip to Lubbock in an ambulance. All I could picture was my friend’s leg after he was bitten. I tried to picture what that critter might have done to one of my grandkids had they been playing in the yard. That was it: No more snake.

I can assure you that snake will never bite one of my grandkids. I can also assure you that I have learned what I am a really afraid of: the effects of a mean rattlesnake on an old veterinarian.

Bo Brock, DVM, owns Brock Veterinary Clinic in Lamesa, Texas. His latest book is 

Crowded in the middle of nowhere: tales of humor and healing from rural America.

How do you feel about ghosts, clowns, drowning, bankruptcy, heights and Freddy Kruger? This Texas veterinarian recently had occasion to analyze his own worst fears, and here’s what he learned. 

What are you scared of?

Many horse owners have heard about parasite resistance from other equine professionals, members of the horse community and internet sources but may not be familiar with the most up-to-date recommendations for responsible equine internal parasite control programs. Veterinarians continue to play a key role in educating horse owners about comprehensive parasite control strategies designed to keep horses healthy and limit parasite resistance.

To help veterinarians stay abreast of current recommendations, the AAEP Infectious Disease Committee and Parasite Control Subcommittee collaborated in 2019 to update the AAEP Parasite Control Guidelines (initially published in 2013). The updated guidelines offer a concise review of clinically relevant equine intestinal parasites, explain several key terms that are central to understanding the basis of modern parasite control and highlight the following important components of a comprehensive internal parasite program:

Methods of estimating parasite burden and degree of resistance

Environmental measures for controlling internal parasites

Judicious use of anthelmintic drugs (i.e. dewormers)

Gone are the days when blanket administration of a dewormer to every horse on a strict bimonthly or trimonthly schedule, often using a rotation of multiple classes of anthelmintics, was considered the best practice for controlling equine internal parasites. Today’s approach reflects what the equine veterinary and scientific communities have since learned: Horses, even those residing on the same property, are not uniform in their internal parasite profiles or their need for anthelmintic treatments. A major feature of modern parasite control recommendations is targeted treatment of young horses, horses showing clinical signs consistent with parasite infections and horses shedding high numbers of eggs in their feces.

To establish an idea of which horses are moderate or high egg shedders (relevant for devising individualized deworming plans), fecal egg counts (FECs) should be performed on fresh or recently collected and refrigerated manure samples obtained after the effective period of previously administered anthelmintics is expected to be over (typically 8 weeks post deworming for most anthelmintics). Because the intent of FEC testing is to provide information about a specific horse’s innate ability to regulate parasite burden, collecting fecal samples too soon after deworming can interfere with interpretation of basal FEC, although intentional repetition of FEC testing before and two weeks after anthelmintic administration is useful for assessing parasite resistance.

Ideally, FEC testing should be completed on all horses because the egg shedding profile is individualized for each horse (low, moderate or high shedding for adult horses; strongyle-type eggs versus ascarid eggs for young horses). Conducting several FEC tests over time may yield a more complete idea of a particular horse’s egg shedding status. However, there is evidence that an adult horse’s FEC category is typically stable given systemic health, a consistent environment and appropriate pasture management, so once an egg shedding category has been established, the usefulness of annual or semiannual FEC testing is uncertain in adult horses maintained in the same environment.

When interpreting FECs, it is important to keep the following in mind:

Eggs of certain parasites (e.g. tapeworm, pinworm) are not readily detected in standard fecal flotation protocols.

Large strongyle and small strongyle (i.e. cyathostomin) eggs cannot be differentiated without fecal culture to yield larvae that can then be identified, although a vast majority of strongyle-type eggs tend to be from small strongyles.

Only patent infections, with adult female worms laying eggs into the gut lumen, will be evident.

FEC testing can provide information about the shedding status of strongyle-type or ascarid eggs in horses, but the results should not be interpreted as reflecting the total adult strongyle or ascarid burden.

The most widely used method for evaluating the efficacy of an anthelmintic is fecal egg count reduction testing (FECRT) to determine the number of eggs per gram of feces (epg) prior to deworming and again 10 to 14 days later.

FECRT results can be averaged within a group of tested horses on the same property. FECRT findings should be interpreted at the farm level, not on an individual horse basis, as percentage reduction in FECs can vary widely among individuals.

Exposure to resistant parasites should be similar among horses housed in the same environment, so it likely is not necessary to conduct FECRT on every horse on a property. However, use of post-deworming samples from at least six horses in which parasite eggs were detected prior to deworming is recommended. Horses that have resided on the property for at least one year and have the highest pretreatment egg counts should be prioritized for FECRT sample collection.

Repeating FECRT on the same property at least every three years is suggested for reassessing anthelmintic efficacy.

Veterinarians should keep in mind that low percentage reduction in egg counts after deworming is not definitive for true parasite resistance to a particular drug, as other factors, including incorrect dose (based on inaccurate body weight estimates or due to accidental losses during administration), improper dewormer storage and use of expired anthelmintic products, may also reduce efficacy.

For properties where an anthelmintic appears to be efficacious and clients wish to be proactive, monitoring of the egg reappearance period—the amount of time between deworming and detection of strongyle eggs in feces—can be used to help anticipate the emergence of resistance. When compared with the expected egg reappearance period for a particular drug, a shorter egg reappearance period (i.e. less time elapsed between deworming and reappearance of strongyle eggs) is a harbinger of developing resistance.

Many veterinarians recognize that horses with asthma often respond poorly to appropriate medications when environmental modifications are not implemented as recommended. In the same way, even the most carefully planned and executed deworming protocol can have limited efficacy and may promote parasite resistance if not combined with proper environmental control measures:

Frequent removal of manure piles from pastures or dry lots is ideal for reducing the chance that eggs passed in feces will mature and subsequently expose grazing or browsing horses to infective life stages. However, this is not practical on all horse properties, especially those with large acreage or many horses.

Climate should be considered when making recommendations for other environmental parasite control practices, such as rotation of pastures, as the potential benefits of pasture rotation for reducing the parasite infection risk in horses and the minimum time needed to keep horses off a pasture can vary, depending on temperature and moisture level.

Any manure intended to be spread on pasture should first be properly composted to achieve the high temperature needed to kill parasites.

As with antimicrobial drugs, responsible use of anthelmintics is critical to extend the useful lifespan of available equine dewormers. The guidelines advocate separate approaches to deworming for adult versus younger horses.

In mature horses, the frequency of dewormer administration should be guided primarily by the results of individual FEC testing (i.e. targeted treatment or selective therapy) in an effort to reduce selection pressure for anthelmintic resistance.

Horses classified as low shedders (0-200 epg), which typically constitute a majority of horses in the general equine population, should receive once- or twice-yearly deworming with products predicted to be effective against small strongyles (including encysted forms), large strongyles, tapeworms and bots, along with 

 spp, the causative agents of summer sores.

Timing of anthelmintic treatment should reflect seasonal patterns of parasite transmission (e.g. targeting tapeworms and bots in the late fall/early winter and encysted small strongyles at the end of the grazing season when mucosal burden is often highest); the goal of treating horses when pasture refugia is high is to facilitate maintenance of susceptible parasite populations.

The common spring/fall deworming schedule also avoids administration of anthelmintics during periods of the year (e.g. hot summer, freezing winter) when conditions are not conducive to larval survival and transmission because of temperature extremes.

Additional dewormer treatments during the year are indicated for horses in which FECs demonstrate moderate (200-500 epg) or high (>500 epg) levels of strongyle-type egg shedding, in large part to reduce the number of eggs being released into the environment.

Strategies for deworming young horses (<3 years of age) differ from those used for adult horses in two main ways. First, although FEC is a cornerstone of designing anthelmintic protocols for mature horses and remains important for evaluating predominant egg type (strongyle versus ascarid) as well as anthelmintic efficacy in young horses, current recommendations discourage using FEC findings to decide which young horses should be dewormed. Instead, the guidelines advocate deworming at standardized intervals, beginning at 2 to 3 months of age and continuing every three months through 1 year of age. Regardless of fecal egg densities determined by FEC testing, yearlings and 2-year-olds should be considered high shedders and dewormed three to four times per year with appropriate drugs.

For background information and more specifics on current equine internal parasite control recommendations, including practical aspects of designing and implementing parasite control programs, check out the current AAEP Parasite Control Guidelines, available at 

aaep.org/guidelines/parasite-control-guidelines

Second, because ascarids pose a unique health threat to foals and weanlings, the medications used for the initial deworming should be efficacious against 

 (e.g. benzimidazole class). FEC testing should be conducted prior to deworming at weaning (age 4-6 months) and at 9 months to assess whether ascarid eggs are still present or the primary target for anthelmintics has shifted to strongyles.

The potential for ascarid impaction should be considered when planning anthelmintic programs in foals, especially those with unknown prior management and deworming history. Tapeworms should also remain on the radar in young horses, and use of a cestocidal compound may be beneficial in areas where tapeworms are a recognized problem in adult horses.

Dr. Bayless is an equine veterinarian specializing in internal medicine and a PhD student at North Carolina State University College of Veterinary Medicine. She studies strategies to modulate neutrophil function with the long-term goal of identifying potential novel anti-inflammatory therapeutics for horses, other animals and humans.


This succinct review of equine internal parasite control measures reflects modern strategies now in place to reduce development of resistance. 


Update: AAEP parasite control guidelines 

Even after many years in practice, the dog with immune-mediated hemolytic anemia (IMHA) can still leave us baffled. Should we refer to a specialist, transfer to emergency, or send the dog home on medication? When should we recheck—tomorrow, in a week, in a month? What drugs do we pick? Or should we just run screaming from the building?

IMHA cases usually start out in the emergency room, but sometimes they are caught early during routine bloodwork or the patient presents in general practice with mild early disease. A better understanding of how to manage these cases will help with early diagnosis, catching relapses and even managing them on our own. You don’t need to become an expert to get the ball rolling on a good diagnostic and treatment plan. At a recent Fetch dvm360 conference, Elisa Mazzaferro, MS, DVM, PhD, DACVECC, shared her approach to IMHA cases.

This is the first of two articles on this topic. Here, we discuss the causes and diagnosis of IMHA. The second article will shed light on best practices for short- and long-term therapy as well as monitoring IMHA patients.

IMHA is a disease in which the body attacks its own red blood cells (RBCs). It is among the most common immune-mediated diseases that we see in dogs.

 IMHA has a 30% to 70% mortality rate despite aggressive therapy, Dr. Mazzaferro noted, and relapse rates range from 11% to 15%.

 Upon initial diagnosis, Dr. Mazzaferro said she tells her clients that their hemolyzing pet has roughly a 40% to 50% chance for long-term survival, then she customizes this prognosis based on follow-up diagnostics and response to treatment. Many patients do not make it through the initial hemolytic crisis, but those that do can die later as a result of a thromboembolic disease, renal failure, liver failure, relapse or complications of medical therapy. Dogs with concurrent immune-mediated thrombocytopenia, hypoalbuminemia or very rapid hemolysis can have a significantly worse prognosis.

The median age at presentation is 6 years. Although most cases of IMHA occur in female dogs, males statistically have a worse prognosis. Cocker spaniels, sheepdogs and poodles, among others, are particularly susceptible. IMHA in susceptible breeds is usually far more severe and requires more rapid, aggressive treatment than that in non-predisposed breeds. Pit bull terriers are predisposed to 

Intravascular hemolysis is less common than extravascular hemolysis. The difference between the two—besides the site of RBC destruction—is that with intravascular hemolysis you must be sure to rule out zinc toxicity (and some of the infectious diseases), and you should expect the clinical progression to be more severe, with a higher risk for disseminated intravascular coagulation (DIC). You still treat these patients the same way, but be prepared to be more aggressive, and don’t forget to address the thromboembolic and coagulopathy risks using medication and coagulation testing.

Seventy percent to 80% of canine IMHA cases are idiopathic,

 known as primary IMHA. Secondary IMHA is caused by an immunoglobulin (Ig) M or IgG antibody attack against RBCs in response to infection, neoplasia, an inflammatory condition, drug or toxin, and maybe vaccination. Some toxicities cause direct RBC damage, which can be mistaken for IMHA but is not immune mediated.

Following are potential underlying causes of secondary IMHA:

 Nonsteroidal anti-inflammatory drugs, sulfonamides, cephalosporins

 There is still not substantial evidence that vaccines can cause IMHA, but we suspect that they might, Dr. Mazzaferro said. There is a 2% to 26% incidence of vaccine-implicated IMHA depending on which study you look at,

 she pointed out. It is also not at all clear what the duration from vaccination to onset of IMHA is supposed to be.

 Any malignancy is potentially causal, either directly or indirectly. In patients that are significantly hypoproteinemic, be sure to rule out erythrophagocytic histiocytic sarcoma, Dr. Mazzaferro said.

 Zinc, onions and large amounts of garlic (although these toxicities are not truly immune mediated, they cause Heinz body anemia)

Other infections or inflammatory conditions

 in the body that can overstimulate the immune system (i.e. cholecystitis, pyelonephritis, pancreatitis)

Clinically, patients with IMHA present with lethargy, weakness, vomiting, diarrhea, pale or yellow gums, collapse, discolored urine and petechiae if they have immune destruction of both RBCs and platelets. Alternatively, patients can appear clinically normal with just spherocytes and a mild anemia on routine bloodwork.

They can have a regenerative or non-regenerative anemia. We are encouraged to see regeneration, but it takes the body four to five days to mount a significant regenerative response, so about 30% of cases are nonregenerative on presentation. Spherocytes are present in only 67% to 94% of dogs with IMHA.

 They are not pathognomonic to IMHA, but spherocytes are great markers for diagnosing and monitoring this disease. Very few other things cause this.

This type of test can be tricky. Here’s how to do it right.

Place one drop of blood from a purple-top tube on a slide, visualize it for clumping (agglutination), then add four tiny incremental drops of 0.9% saline with a needle-on syringe to the edges of the blood drop to see if the blood cells disperse or stay clumped. If they stay clumped, the result is positive.

Always look for macroagglutination first (you can see it with your own eyes). If macroagglutination is negative (RBCs either do not clump or disperse quickly with saline), then examine for microagglutination. Microagglutination is the same test but under a microscope, wet and unstained. Use a coverslip, and look for RBCs clinging or clumping together.

For both tests, if the blood cells disperse evenly with the saline, the result is negative. For the microagglutination test it is even more important to use the saline to differentiate agglutination versus rouleaux. Assess the slides immediately; letting the blood sit on the slide for even a few minutes can give the appearance of false-positives as the edges dry out.

If test results are unclear, the ACVIM consensus guidelines recommend washing the blood sample and retesting. Agglutination is caused by cross-linking of IgM immune complexes across RBCs, so it should still be happening after washing.

History is very important. Ask whether the dog is or has:

Eaten something like a penny or other zinc-containing toxin?

To do a platelet estimate, count the number of platelets in each of 10 random views on high-power field (100x oil immersion) near the feathered edge. Add them up, divide by 10 (basically the average number of platelets per high-power field), and then multiply by 10 to 15. That is your platelet estimate range in thousands.

Now look at the feathered edge. If there are huge clumps of platelets, factor these in as best you can as they will falsely lower your total estimate.

The baseline diagnostic workup is more extensive than for most diseases and includes the following:

 Complete blood counts (CBCs) and chemistries, a urinalysis with culture and minimum inhibitory concentration; a pathologist’s review of your CBC is a must.

Packed cell volume/total solids (PCV/TS; in-house).

 Note that the PCV is more accurate than hematocrit because agglutination can interfere with calculated hematocrit.

If both macro- and microagglutination tests are negative, do a Coombs test. If your patient is already auto-agglutinating, a Coombs test will not give you any extra information. (Nobody is going to fault you, though, if you send out a Coombs test because you are unsure of your in-house agglutination test findings. However, there is no good substitute for a slide agglutination test, or for the immediate information that it gives you if it is positive.)

 It should be a smear with a beautiful feathered edge, dried and stained with Diff-Quik. You are looking for reticulocytes, spherocytes, shistocytes and ghost cells in a monolayer near (but not at) the feathered edge—all of which are consistent with IMHA—and using this to do a platelet estimate while you are waiting for the CBC from the lab. 

 for metastatic neoplasia or metallic foreign body ingestion.

to complete your screening for neoplasia.

 send out an infectious disease panel. North Carolina State University’s Vector Borne Disease Lab offers a panel that historically has been the best test, but Idexx offers a similar comprehensive version. The Idexx test does have a polymerase chain reaction (PCR) test for 

 (seen in the Western U.S.) that the NCSU test does not offer. If using Idexx, always test for both antibodies and genetic material (i.e. both PCR and serology).

 This may be of limited availability except at emergency or specialty hospitals. If the lactate level is elevated, your patient may need a transfusion, as elevated lactate can indicate that too little oxygen is getting to the cells (oxygen debt).

For more in-depth information and detailed resources about IMHA diagnosis, the most recent 

ACVIM Consensus Statement on the Diagnosis of Immune-Mediated Hemolytic Anemia in Dogs

Dr. Johnson practices emergency medicine at Berkeley Dog and Cat Hospital in Berkeley, California, and general practice at Cameron Veterinary Hospital in Sunnyvale, California. Her nonveterinary loves are writing, dressage with her Iberian warmblood mare Synergy; watercolor painting on yupo; vinyasa yoga; and running with her dog Tyson. Try as she might, her curly-coated Scottish Fold, Hootie, refuses to go jogging with her.

McCullough S. Immune-mediated hemolytic anemia: understanding the nemesis. 

Piek CJ, van Spil WE, Junius G et al. Lack of evidence of a beneficial effect of azathioprine in dogs treated with prednisolone for idiopathic immune-mediated hemolytic anemia: a retrospective cohort study. 

Weinkle TK, Center SA, Randolph JF, et al. Evaluation of prognostic factors, survival rates, and treatment protocols for immune-mediated hemolytic anemia in dogs: 151 cases (1993-2002). 

Piek C. Immune-mediated hemolytic anemias and other regenerative anemias. In: Ettinger SJ, Feldman EC, Côté E, Eds. 

. 8th ed. St. Louis: Elsevier; 2017:829-837.

Garden OA, Kidd L, Mexas AM, et al: ACVIM consensus statement on the diagnosis of immune‐mediated hemolytic anemia in dogs and cats. 

Day MJ. Immune-mediated anemias in the dog. In: Weiss DJ, Wardrop KJ, Eds. 

. 6th ed. Hoboken: Wiley-Blackwell; 2010;216-225.

If immune-mediated hemolytic anemia makes you crazy, you are not alone. Here’s the lowdown on diagnosing this confounding disease.

Possible IMHA dog—now what?

It's not too late to join Natalie Marks, DVM, CVJ, for insight on how to get the most from your practice’s online pharmacy. This free webinar, worth 1 hour of CE credit, will focus on how you can create an online pharmacy strategy based on your practice’s individual goals.

During this free 1-hour webinar, co-sponsored by Vetsource and Boehringer Ingelheim, Dr. Marks will detail how her practice achieved success with home delivery and share data from thousands of veterinary practices about:

Best practices for implementing and operating a successful home delivery service

The positive impact of employing best online pharmacy practices

Which best practices are most relevant during COVID-19

Choosing which best practices to implement based on your goals

 Proven Approaches to Making Your Online Pharmacy Successful

Dr. Marks has been practicing at VCA Blum Animal Hospital since 2006, currently serving as medical director. She has served on the executive board of the Chicago Veterinary Medical Association, and was a past board member of the Illinois State Veterinary Medical Association. She is also an active volunteer for AVMA and AAHA. Dr. Marks recently received the prestigious Dr. Erwin Small First Decade Award, presented to a veterinarian that has contributed the most to organized veterinary medicine in his or her first decade of practice.

Hint: It’s not a one-size-fits-all approach.

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