Neutropenie beim Hund: Ätiologie und prognostische Faktoren

Zusammenfassung

Ziel der retrospektiven Studie war, Häufigkeit, prognostische Faktoren und Unterschiede verschiedener Ätiologien einer Neutropenie beim Hund zu untersuchen. Material und Methoden: In die Studie wurden 391 Hunde mit einer Neutrophilenzahl < 2,78 × 10⁹/l (Januar 2008 bis Dezember 2012) eingeschlossen und entsprechend der Ätiologie der Neutropenie sieben Diagnosegruppen zugeordnet: Nichtbakterielle Infektionserkrankung, Gewebeverbrauch, Medikamentenassoziiert, Knochenmarkerkrankung, Immunvermittelt, Physiologisch, Verschiedene. Verglichene Parameter waren Neutrophilenzahl, Vorliegen von Granulozyten mit Toxizitätsanzeichen oder Linksverschiebung, Vorstellungsgründe, Körperinnentemperatur zum Zeitpunkt der Neutropenie, Hospitalisierung und Überleben. Ergebnisse: Gewebeverbrauch (90/391, 23%) und nichtbakterielle Infektionserkrankungen (70/391, 18%) stellten die häufigsten Ursachen einer Neutropenie dar, gefolgt von medikamentenassoziierter Neutropenie (43/391, 11%) und Knochenmarkerkrankungen (32/391, 8%). Immunvermittelte und physiologische Neutropenien traten selten auf (je 16/391, 4%). Fast ein Drittel der Hunde fiel in die Diagnosegruppe Verschiedene (124/391, 32%). Die Neutrophilenzahl in den Gruppen Physiologisch und Verschiedene war höher (p < 0,01) als in den übrigen Gruppen. Hunde mit nichtbakterieller Infektionserkrankung oder immunvermittelter Neutropenie hatten niedrigere Neutrophilenzahlen als Hunde mit einem Gewebeverbrauch (p < 0,001) und wurden am häufigsten wegen gastrointestinaler Symptome (52/70, 74%) oder Fieber (11/16, 69%) vorgestellt. In der Gruppe Gewebeverbrauch waren Toxizitätsanzeichen und Linksverschiebung am häufigsten (60/90 und 25/90, 67% und 28%) und die Mortalität am höchsten (32/90, 36%). Schlussfolgerung: Vorliegen von Toxizitätsanzeichen und Linksverschiebung können auf einen Gewebeverbrauch und eine schlechtere Prognose hinweisen. Mit zunehmendem Schweregrad der Neutropenie wird eine immunvermittelte Ursache wahrscheinlicher. Klinische Relevanz: Eine Neutropenie sollte im Kontext mit Anamnese, klinischer Untersuchung und Granulozytenmorphologie beurteilt werden.

Summary

Objective: The aim of this retrospective study was to evaluate frequency, prognostic factors, and differences for various etiologies of neutropenia in dogs. Material and methods: A total of 391 dogs with neutrophil counts < 2.78 × 10⁹/l (January 2008 to December 2012) were included and, depending on the etiology of neutropenia, assigned to seven diagnostic groups: nonbacterial infectious disease, increased demand due to marked inflammation, drug-associated, bone-marrow diseases, immune-mediated, physiologic, miscellane - ous. Absolute neutrophil counts, evidence of neutrophil toxicity or left shift, case history, rectal temperature, hospitalization, and survival were compared among groups. Results: Increased demand due to marked inflammation (90/391, 23%) and nonbacterial infectious disease (70/391, 18%) were the most common causes for neutropenia, followed by drug-associated neutropenia (43/391, 11%) and bonemarrow disease (32/391, 8%). Immune-mediated and physiologic neutropenia (both 16/391, 4%) were uncommon. Almost one third (124/391, 32%) of dogs were assigned to the miscellaneous group. Absolute neutrophil counts were significantly higher (p < 0.01) in dogs of the physiologic and miscellaneous groups than in the other groups. Dogs with immune-mediated neutropenia or nonbacterial infectious disease displayed significantly lower absolute neutrophil counts than dogs with neutropenia due to an increased demand (p < 0.001) and were most commonly referred with a history of fever (11/16, 69%) or gastrointestinal signs (52/70, 74%), respectively. Neutrophil toxicity and left shift were most commonly associated with an increased demand due to marked inflammation (60/90 and 25/90, 67% and 28%, respectively) and the mortality rate was highest in this group (32/90, 36%). Conclusion: Neutrophil toxicity and left shift are associated with an increased demand due to marked inflammation and may indicate a poor prognosis. The lower the absolute neutrophil count, the greater the probability of an immune-mediated neutropenia. Clinical relevance: Neutropenia should be assessed in context with case history, clinical examination, and neutrophil morphology.

Schlüsselwörter

Granulozyten mit Toxizitätsanzeichen - Linksverschiebung - Entzündung - immunvermittelt - Gewebeverbrauch - Überlebensrate

Keywords

Toxic neutrophils - left-shift - inflammation - immune-mediated - increased demand - survival rate

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