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A saline agglutination test is a very easy in-house diagnostic procedure

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and should be performed in any patient with suspected hemolytic anemia.

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It is redundant if gross agglutination is noted in the CBC sample or the hematocrit tube.

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Simply place a drop of EDTA blood on to a microscope slide.

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Add a drop of 0.9% NaCl and mix it with the blood.

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Look under the microscope at the red blood cells.

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Check for agglutination, which is characterized by persistent clumping of cells.

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If you disturb the slide, the cells will stay attached to each other.

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It can be difficult to differentiate rouleaux formation from true agglutination because these processes can look similar at first glance.

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However, cells in rouleaux tend to stack rather than clump, and they dissipate when disturbed.

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Remember that a positive saline agglutination test indicates that there are antibodies on the surface of the erythrocytes.

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This supports a diagnosis of immune-mediated hemolytic anemia (IMHA).

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However, positive agglutination tests can occur in patients with other causes of hemolysis, such as zinc ingestion or erythrocyte parasitism.

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Conversely, some dogs with IMHA do not have a positive saline agglutination test, so a negative result does not exclude this diagnosis.