• 1. International Species Inventory System. Physiologic data reference values [CD-ROM]. Apple Valley, Minn: International Species Inventory System, 2002.

    • Search Google Scholar
    • Export Citation
  • 2. Crawford GC, Andrews GA, Chavey PS, et al. Survey and clinical application of serum iron, total iron binding capacity, transferrin saturation, and serum ferritin in captive black and white ruffed lemurs (Varecia variegata variegata). J Zoo Wildl Med 2005; 36: 653660.

    • Search Google Scholar
    • Export Citation
  • 3. Williams CV, Campbell J, Glenn KM. Comparison of serum iron, total iron binding capacity, ferritin, and percent transferrin saturation in nine species of apparently healthy captive lemurs. Am J Primatol 2006; 68: 477489.

    • Search Google Scholar
    • Export Citation
  • 4. Williams CV, Junge RE, Stalis IH. Evaluation of iron status in lemurs by analysis of serum iron and ferritin concentrations, total iron-binding capacity, and transferrin saturation. J Am Vet Med Assoc 2008; 232: 578585.

    • Search Google Scholar
    • Export Citation
  • 5. Boraski EA. Renal disease in prosimians. Vet Pathol 1981; 18: 15.

  • 6. Benirschke K, Miller C, Ippen C, et al. The pathology of prosimians, especially lemurs. Adv Vet Sci Comp Med 1985; 30: 167208.

  • 7. Junge RE. Prosimians. In: Fowler ME, Miller RE, eds. Zoo and wild animal medicine. 5th ed. St Louis: Elsevier Science, 2003; 334345.

    • Search Google Scholar
    • Export Citation
  • 8. Grauer GF. Renal failure. In: Nelson RW, Couto CG, eds. Small animal internal medicine. 3rd ed. St Louis: Mosby Inc, 2003; 608624.

  • 9. Nagode LA, Chew DJ, Podell M. Benefits of calcitriol therapy and serum phosphorus control in dogs and cats with chronic renal failure. Both are essential to prevent or suppress toxic hyperparathyroidism. Vet Clin North Am Small Anim Pract 1996; 26: 12931330.

    • Search Google Scholar
    • Export Citation
  • 10. Brunkhorst R, Bommer J, Braun J, et al. Darbepoetin alfa effectively maintains haemoglobin concentrations at extended dose intervals relative to intravenous or subcutaneous recombinant human erythropoietin in dialysis patients. Nephrol Dial Transplant 2004; 19: 12241230.

    • Search Google Scholar
    • Export Citation
  • 11. Chalhoub S, Langston CE, Farrelly J. The use of darbepoetin to stimulate erythropoiesis in anemia of chronic kidney disease in cats: 25 cases. J Vet Intern Med 2012; 26: 363369.

    • Search Google Scholar
    • Export Citation
  • 12. Plumb DC. Plumb's veterinary drug handbook. 7th ed. Stockholm: PharmaVet Inc, 2011.

  • 13. Couto CG. Anemia. In: Nelson RW, Couto CG, eds. Small animal internal medicine. 3rd ed. St Louis: Mosby Inc, 2003; 11561167.

  • 14. Wood C, Fang SG, Hunt A, et al. Increased iron absorption in lemurs: quantitative screening and assessment of dietary prevention. Am J Primatol 2003; 61: 101110.

    • Search Google Scholar
    • Export Citation
  • 15. Gonzales J, Benirschke K, Saltman P, et al. Hemosiderosis in lemurs. Zoo Biol 1984; 3: 255265.

  • 16. Lowenstine LJ, Munson L. Iron overload in the animal kingdom. In: Fowler ME, Miller RE, eds. Zoo and wild animal medicine. 4th ed. Philadelphia: WB Saunders Co, 1999; 260268.

    • Search Google Scholar
    • Export Citation
  • 17. Spelman LH, Osborn KG, Anderson MP. Pathogenesis of hemosiderosis in lemurs: role of dietary iron, tannin, and ascorbic acid. Zoo Biol 1989; 8: 239251.

    • Search Google Scholar
    • Export Citation
  • 18. Mowry CB, Campbell JL. Nutrition. In: Ring-tailed lemur (Lemur catta) husbandry manual. Silver Spring, Md: American Association of Zoos and Aquariums, 2001.

    • Search Google Scholar
    • Export Citation
  • 19. Clauss M, Paglia DE. Iron storage disorders in captive wild mammals: the comparative evidence. J Zoo Wildl Med 2012; 43: S6S18.

  • 20. Glenn KM, Campbell JL, Rotstein D, et al. Retrospective evaluation of the incidence and severity of hemosiderosis in a large captive lemur population. Am J Primatol 2006; 68: 369381.

    • Search Google Scholar
    • Export Citation
  • 21. Loge JP, Lange RD, Moore CV. Characterization of the anemia associated with chronic renal insufficiency. Am J Med 1958; 24: 418.

  • 22. Rivella S. Disorders of red cell production and the iron-loading anemias. In: Anderson GJ, McLaren GD, eds. Iron physiology and pathophysiology in humans. New York: Humana Press, 2012;332333.

    • Search Google Scholar
    • Export Citation
  • 23. Hörl WH. Clinical aspects of iron use in the anemia of kidney disease. J Am Soc Nephrol 2007; 18: 382393.

  • 24. Fudin R, Jaichenko J, Shostak A, et al. Correction of uremic iron deficiency anemia in hemodialyzed patients: a prospective study. Nephron 1998; 79: 299305.

    • Search Google Scholar
    • Export Citation
  • 25. Macdougall IC, Tucker B, Thompson J, et al. A randomized controlled study of iron supplementation in patients treated with erythropoietin. Kidney Int 1996; 50: 16941699.

    • Search Google Scholar
    • Export Citation
  • 26. Markowitz GS, Kahn GA, Feingold RE, et al. An evaluation of the effectiveness of oral iron therapy in hemodialysis patients receiving recombinant human erythropoietin. Clin Nephrol 1997; 48: 3440.

    • Search Google Scholar
    • Export Citation
  • 27. Silverberg DS, Iaina A, Peer G, et al. Intravenous iron supplementation for the treatment of anemia of moderate to severe chronic renal failure patients not receiving dialysis. Am J Kidney Dis 1996; 27: 234238.

    • Search Google Scholar
    • Export Citation
  • 28. Harvey JW. Iron metabolism and its disorders. In: Kaneko JJ, Harvey JW, Bruss ML, eds. Clinical biochemistry of domestic animals. 6th ed. Burlington, Mass: Elsevier, 2008; 259284.

    • Search Google Scholar
    • Export Citation

Advertisement

Iron deficiency anemia in a ring-tailed lemur (Lemur catta) with concurrent chronic renal failure

View More View Less
  • 1 Point Defiance Zoo and Aquarium, 5400 N Pearl St, Tacoma, WA 98407.
  • | 2 Point Defiance Zoo and Aquarium, 5400 N Pearl St, Tacoma, WA 98407.

Abstract

Case Description—A 16-year-old vasectomized male ring-tailed lemur (Lemur catta) with a history of suspected chronic renal failure was evaluated because of extreme lethargy, hyperpnea, and abscess of the right pectoral scent gland.

Clinical Findings—Examination of the anesthetized patient revealed an impacted right pectoral scent gland with serosanguineous exudate. A CBC and serum biochemical analysis revealed severe anemia, marked azotemia, hyperphosphatemia, and hypocalcemia.

Treatment and Outcome—Supportive care (including fluid therapy and phosphorus binder administration) was initiated for renal failure; the affected gland was cleaned, and antimicrobials were administered. The patient received 1 blood transfusion, and darbepoetin alfa was administered weekly to stimulate RBC production. Anemia and azotemia persisted. Three months after treatment started, serum iron analysis revealed that iron deficiency was the probable cause for the lack of a consistent regenerative response to darbepoetin injections. Iron dextran injections resulted in a marked regenerative response; however, serum biochemical analysis results after the second injection were consistent with hepatic injury. Hepatic enzyme activities normalized following discontinuation of iron dextran treatment, but the lemur's Hct declined rapidly despite supplementary iron administration PO. The patient developed severe mandibular osteomyelitis and was euthanized because of poor prognosis. Postmortem evaluation of hepatic iron concentration confirmed iron deficiency.

Clinical Relevance—The family Lemuridae is considered prone to hemosiderosis and hemochromatosis, which delayed rapid diagnosis and treatment of the lemur's disease. Apparent hepatic injury following iron dextran injections further complicated treatment. Findings for this lemur support the use of species-specific total iron binding capacity and total serum iron and ferritin concentrations in evaluation of an animal with suspected iron deficiency.

Abstract

Case Description—A 16-year-old vasectomized male ring-tailed lemur (Lemur catta) with a history of suspected chronic renal failure was evaluated because of extreme lethargy, hyperpnea, and abscess of the right pectoral scent gland.

Clinical Findings—Examination of the anesthetized patient revealed an impacted right pectoral scent gland with serosanguineous exudate. A CBC and serum biochemical analysis revealed severe anemia, marked azotemia, hyperphosphatemia, and hypocalcemia.

Treatment and Outcome—Supportive care (including fluid therapy and phosphorus binder administration) was initiated for renal failure; the affected gland was cleaned, and antimicrobials were administered. The patient received 1 blood transfusion, and darbepoetin alfa was administered weekly to stimulate RBC production. Anemia and azotemia persisted. Three months after treatment started, serum iron analysis revealed that iron deficiency was the probable cause for the lack of a consistent regenerative response to darbepoetin injections. Iron dextran injections resulted in a marked regenerative response; however, serum biochemical analysis results after the second injection were consistent with hepatic injury. Hepatic enzyme activities normalized following discontinuation of iron dextran treatment, but the lemur's Hct declined rapidly despite supplementary iron administration PO. The patient developed severe mandibular osteomyelitis and was euthanized because of poor prognosis. Postmortem evaluation of hepatic iron concentration confirmed iron deficiency.

Clinical Relevance—The family Lemuridae is considered prone to hemosiderosis and hemochromatosis, which delayed rapid diagnosis and treatment of the lemur's disease. Apparent hepatic injury following iron dextran injections further complicated treatment. Findings for this lemur support the use of species-specific total iron binding capacity and total serum iron and ferritin concentrations in evaluation of an animal with suspected iron deficiency.

Contributor Notes

The authors thank Jennifer Donovan, Natalie Davis, Aimee Gibson, Alicia Pike, and Richard Johnson for providing care for the lemur and Jessica Anderson for assistance in obtaining literature.

Address correspondence to Dr. Anderson (Kadie.anderson@pdza.org).