activity is usually accompanied by the presence of erythrocyte precursors in peripheral blood (erythroblasts, occasionally polychromatophils).
Hemoparasites may also lead to increased numbers of erythroblasts and polychromasia.
Polychromasia may also occur in the absence of anemia as has been reported in shedding reptiles.
Erythrocytic Mitoses
When detected in peripheral blood as an anecdotal finding, it is not a manifestation of anemia.
Anemia should only be considered when mitoses appear in erythrocytes together with the presence of abundant erythroblasts and other markers described, such as altered hematocrit and irregular erythrocytic nucleus.
Erythrocyte Counts
Total erythrocyte counts are lower than in mammals and birds.
Erythrocytes in chelonians are larger compared with other reptiles; they tend to have counts below 500,000/μl.
Fecal Occult3 Blood Test and Urinalysis
May allow for the detection of small amounts of blood in an animal’s urine or feces.
Fecal occult test may return false positives in carnivorous species.
PATHOLOGICAL FINDINGS
Pathologic findings will be specific to the underlying cause of anemia.
APPROPRIATE HEALTH CARE
Anemia is often a chronic presentation in most reptiles.
A slower metabolism and physiologic adaptation mechanisms allow reptiles to compensate better than birds or mammals.
Treatment is often not needed on an emergency basis, but is rather focused on addressing the underlying diseases and providing supportive therapy.
NUTRITIONAL SUPPORT
Proper nutrition is key for the prevention and treatment of anemia.
The diet should be as varied as possible and adapted to each species.
Diet should be balanced and contain natural sources of vitamin B12 and iron.
Nutritional support via gavage feeding should be implemented in very ill and/or anorectic animals.
CLIENT EDUCATION/HUSBANDRY RECOMMENDATIONS
It is recommended to perform annual health evaluations of the animals at risk.
These evaluations should include blood tests and fecal exams.
Any treatments must be performed based on the results of the exams and the historical data for the collection.
These tests should also be done on newly acquired and quarantined animals.
A proper nutritional plan is also essential for good health.
DRUG(S) OF CHOICE
Hemorrhagic anemia: control bleeding by applying pressure. Efficacy of blood replacers or transfusions has not been well studied.
Use of hemostatic agents such as D‐aminocaproic acid or ethamsylate has not been reported in reptiles; doses are empirical (0.1 ml/kg).
Fluid therapy: isotonic fluids should be administered at a rate of 20–30 ml/kg IV, IO, or SC for maintenance.
Fluid losses can be replaced but be careful not to overhydrate the patient.
Colloids may also be used at a rate 10–20 ml/kg with a bolus of 3–5 ml/kg IV or IO as needed.
Blood transfusion: homologous transfusions are preferred over heterologous. Blood volume of up to 1% body weight is extracted from the donor, by means of syringes and needles filled with anticoagulant at a ratio of 1:6 to 1:9 anticoagulant to blood. The blood is administered to the recipient by means of an infusion pump at 5 ml/hour flow rate. True efficacy is not well documented but clinical experience suggests some short‐term benefits.
Maladaptation syndrome: treatment consists of fluid therapy and stimulation of blood regeneration by means of iron dextran (12 mg/kg, IM every 7 days) and cyanocobalamin (vitamin B12; 0.5 mg/kg or 10–2000 iu according to the animal weight as single IM or SC dose).
Availability of blood replacers varies across the world. If available, products like Oxyglobin® (bovine hemoglobin glutamer) 1 ml/100 g IV for 5 minutes by means of perfusion; repeat 4 hours later) may improve success in severe anemia.
Epoietin alfa (EPOGEN®, Amgen Inc., Thousand Oaks, CA) erythropoeisis stimulating agent is reported as safe and effective in Chelonia mydas and Caretta caretta when used at 100 U/kg SC 3 times weekly over 2 weeks. Similar dosing has not been useful in Testudo hermanni.
PRECAUTIONS/INTERACTIONS
N/A
PATIENT MONITORING
Because of the small size of some chelonians, monitoring should rely on assessment of the behavior and clinical signs of the affected animal, not just on blood sampling.
If the treatment is appropriate, the lizard should become progressively more active and alert, with interest in hunting, seeking shelter or mating behaviors.
Normal attitude and feeding behavior are two common aspects that can be monitored in chelonians after the start of treatment, because they are related to the overall health.
In addition, signs of healing of the other diseases that have contributed to the animal’s anemia should be observed.
EXPECTED COURSE AND PROGNOSIS
Repeated blood samplings after 1 week and 1 month may show early signs of regeneration.
Repeated
