Neonatal isoerythrolysis in horse foals and a mule foal: 18 cases (1988–2003)

OBJECTIVE: To assess data regarding clinical features, clinicopathologic and blood gas variables, and outcome from horse and mule foals with confirmed neonatal isoerythrolysis (NI). DESIGN: Retrospective case series. ANIMALS: 17 horse and 1 mule foals. PROCEDURE: Medical records of foals (< 14 days old) with NI were reviewed. Information collected included signalment; clinical examination findings; results of hematologic, serum and plasma biochemical, and venous blood gas analyses and urinalysis; treatments; and outcome. RESULTS: Data from 17 horse foals and 1 mule foal with NI (mean age, 71 hours) were evaluated. Many foals had high serum indirect and direct bilirubin concentrations and sorbitol dehydrogenase activity. Whole blood immunoglobulin concentrations were < 400 mg/dL in 4 of 15 foals. Fresh whole blood transfusions were administered to 10 of 18 foals. Among the blood factors implicated in 11 foals, one (Dg) had not previously been associated with NI. Of 10 foals that received blood transfusions, 7 had significant improvements in Hct and hemoglobin concentration and 2 had significant improvements in central venous oxygen tension. Fifteen foals survived to discharge. CONCLUSIONS AND CLINICAL RELEVANCE: Data suggest that blood factor Dg may be associated with NI in foals. Liver disease may be concurrent with NI in foals, and NI can develop in foals with inadequate passive transfer of colostral antibodies. Whole blood transfusions were successful at increasing oxygen-carrying capacity and improving peripheral tissue oxygenation in NI-affected foals. With appropriate treatment, the prognosis for foals with NI is good.