Ataxia in horses refers to a neurological condition characterized by a lack of coordination and balance, often manifesting as unsteady or abnormal gait. The condition can result from various underlying causes, including spinal cord compression, brain lesions, or peripheral nerve damage. Ataxia is typically classified into three types: cerebellar, vestibular, and proprioceptive, each associated with different parts of the nervous system. Diagnosis involves a combination of clinical examination, neurological assessment, and diagnostic imaging. This page compiles peer-reviewed research studies and scholarly articles that explore the causes, diagnostic approaches, and management strategies for ataxia in equine patients.
Kamphues J, Meyer H, Liebler EM, Johannsen A.Anamnesis and clinical signs of horses form five different stables after ingestion of ionophores are reported and techniques of feed examination are described. Within a few hours or days after feeding of new types or batches of concentrates horses fell ill. They showed colic-like symptoms with intense sweating and ataxia. Most of the sick animals died within a short time span. Samples of the concentrates were analysed and different types and amounts of ionophores were detected. In four cases contamination by monensin in concentrations of less than 5 mg to 679 mg/kg feed were found. One feed sa...
Brock N, Hildebrand SV.After sedation with xylazine (0.3 mg/kg intravenously [IV]), anesthesia was induced in six healthy horses with ketamine (2.0 mg/kg IV) and guaifenesin (100 mg/kg IV), diazepam (0.05 mg/kg IV), or diazepam (0.10 mg/kg IV). Anesthesia was maintained with halothane for 30 minutes. Heart rate, respiratory rate, direct arterial blood pressure, arterial blood gas, and pH measurements were made before, and at set intervals after, induction of anesthesia. Quality and characteristics of induction and recovery were evaluated objectively by an independent observer unaware of the protocol used. There were...
Carter SW, Robertson SA, Steel CJ, Jourdenais DA.Six healthy foals underwent instrumentation for measurement of the cardiopulmonary effects of sedation with 1.1 mg/kg bodyweight xylazine hydrochloride given intravenously. Responses to xylazine in foals at 10 and 28 days of age were not significantly different. Foals became sedate and markedly ataxic, and four of the six foals became recumbent. Heart rate decreased significantly but no arrhythmias were detected. Arterial blood pressure increased initially and then fell significantly below pre-injection values. Changes in respiratory airflow, upper airway obstruction and respiratory noise were...
Valverde A, Boyd CJ, Dyson DH, Pascoe PJ.Dantrolene, a drug used in the prevention and treatment of malignant hyperthermia, was believed responsible for prolonged postanesthetic recumbency in a horse. Prophylactically, dantrolene was given orally before induction of anesthesia. Dantrolene has been recommended for use in horses at risk of developing postanesthetic myopathy. Side effects, including ataxia, may result from dantrolene administration.
Baumgärtner W, Frese K, Elmadfa I.Neuroaxonal dystrophy and minimal diffuse degenerative myelopathy was diagnosed in two female full sibling, 1- and 2-year-old, Haflinger horses. Both animals developed slowly progressive ataxia from the age of 4 months. Clinical signs, which were more prominent in the hind legs, included hypermetria and dysmetria. Histological examination revealed neuroaxonal dystrophy characterized by spheroid formation, vacuolation, astrogliosis and lipofuscin pigment deposition in macrophages and neuronal perikarya. These changes were restricted to the gracilis and cuneate nuclei, nucleus of the solitary tr...
Ekman S.Lesions in the cervical spine of 28 young horses (Standardbred Trotters and Swedish Warmbloods), killed because of longstanding or severe ataxia, are described. The material consists of all horses with ataxia available for necropsy and presented to the large animal clinic of the School of Veterinary Medicine, Uppsala and the Animal Hospital in Helsingborg during 1981 through 1983. After a clinical and radiographic examination, including myelography in all but 2 cases, the horses were killed and necropsy was performed. The cases were divided into three categories based on the radiographic and p...
McCrindle CM, Ebedes H, Swan GE.Two Arabian horse stallions with behavioural problems were treated with long-acting neuroleptics in order to facilitate corrective training. Perphenazine enanthate, administered intramuscularly at a dose of 0.5 mg kg-1 had an effect for 30 d. Pipothiazine palmitate (1 mg kg-1) induced tranquilization of 30 d duration as well as extra-pyramidal clinical signs, ataxia and aphagia. Neither horse showed prolapse of the penis or haemolysis.
Nappert G, Vrins A, Breton L, Beauregard M.A retrospective study of 19 ataxic horses admitted to the College of Veterinary Medicine of the University of Montreal during the period of January 1985 to December 1988 is presented. There were 11 cases of cervical vertebral malformation, four of equine degenerative myeloencephalopathy, two of equine protozoal myeloencephalitis, one each of vertebral osteomyelitis and intervertebral disc protrusion. The clinical diagnosis of ataxia in horses requires neurological, radiographic, myelographic, and laboratory examinations.
Gerber H, Ueltschi G, Diehl M, Schatzmann U, Straub R.For various anamnestic reasons the cervical vertebral column of 78 horses was examined radiologically. Statistical comparisons showed that male "warmbloods" were more frequently affected than was expected. Our horses were older than comparable animals in the international literature. Independently of their history the radiologic diagnosis of "cervical spondylarthrosis" was established in 56 horses. Arthrosis and other conditions were clinically manifested by spinal ataxia (44 horses) or mechanical impairment of the neck's mobility (21 horses). 10 of the arthrotic patients had synovial cysts ca...
Fikes LW, Lin HC, Thurmon JC.Xylazine (0.35 mg/kg) or lidocaine (0.35 mg/kg) was injected into the epidural space of six ponies to compare their effectiveness as epidural analgesics. Each pony received both treatments at 1 week intervals with the order of treatments randomized. Xylazine produced analgesia of significantly longer duration (247 +/- 58 minutes) than that produced by an equal dose of lidocaine (135 +/- 22 minutes). Mild transient ataxia of no clinical significance developed in all ponies with both treatments. Spinal cords were removed from two ponies and examined histologically. No discernible pathologic chan...
LeBlanc PH, Caron JP, Patterson JS, Brown M, Matta MA.Local anesthetics given in the epidural space of a horse may cause hind limb weakness in addition to analgesia. Because alpha 2 agonists given by epidural injection cause sensory blockade without motor effects in human beings and other species, their use in veterinary anesthesia is appealing. This study was designed to examine the effectiveness of xylazine HCl, an alpha 2 agonist commonly used in horses. Xylazine, 0.9% NaCl, and lidocaine were given by epidural injection to horses subjected to perineal electrical stimulation. Administration of xylazine (0.17 mg/kg of body weight, diluted to a ...
Hubbell JA, Reed SM, Myer CW, Muir WW.The records of 131 horses undergoing general anaesthesia and positive contrast cervical myelography with metrizamide were examined to determine the effect of the procedure on the 'patient'. Three per cent of minimally ataxic and moderately ataxic horses had serious complications after myelography. Thirty-two per cent of severely ataxic horses died or were destroyed after general anaesthesia and myelography. Although general anaesthesia and myelography are essential components of a complete neurological evaluation of a horse, they impose a significant risk.
Taylor PM, Browning AP, Harris CP.Combinations of detomidine (mean dose rate 13 micrograms/kg) and butorphanol (mean dose rate 26 micrograms/kg) were used to sedate 61 horses for a variety of surgical or diagnostic procedures in general equine practice. Three horses were sedated on more than one occasion. The degree of sedation was graded from 3 to 0 (deep sedation to no effect) and any side effects were recorded. Forty-three per cent of the horses were graded 3, 46 per cent were graded 2, 8 per cent were graded 1 and 3 per cent were graded 0. Bradycardia and ataxia were the major side effects. The combination was judged to be...
Nixon AJ, Stashak TS.Malalignment of the atlas and axis was seen in 4 horses with an idiopathic form of atlantoaxial subluxation characterized by spinal cord compression on extension. The bone structure and density of the atlas and axis were radiographically normal in 3 of the 4 horses. Clinical signs appeared when the horses were 6 to 30 months old, and 3 of the 4 horses had a history of trauma. Although a congenital anomaly could not be ruled out, the cause was thought to be trauma. The horses were moderately to severely ataxic at the time of examination. Myelography revealed compression of the spinal cord at th...
Clarke KW, Paton BS.The effects of administration of one of four opiates (pethidine 1 mg/kg bodyweight (bwt), morphine 0.1 mg/kg bwt, methadone 0.1 mg/kg bwt, and butorphanol 0.05 mg/kg bwt) given intravenously to horses and ponies already sedated with detomidine (10 micrograms/kg bwt) were investigated. Behavioural, cardiovascular and respiratory effects of the combinations were compared with those occurring with detomidine alone. Addition of the opiate increased the apparent sedation and decreased the response of the animal to external stimuli. At doses used, butorphanol produced the most reliable response. Sid...
Oijala M, Katila T.Detomidine was administered twice to six foals (14 to 94 days old) using three different doses (10, 20 and 40 micrograms/kg bodyweight intravenously) in a double blind trial. Sedation, analgesia, heart rate and clinically observed side-effects were recorded. Detomidine showed strong sedative effects at all doses tested. Sedation deepened very little by increasing the dose from 10 to 40 micrograms/kg bodyweight, but the duration of the effect was longer. Analgesia was considered good with the largest dose (40 micrograms/kg), and moderate or non-existent with the lower doses. Detomidine caused a...
Mendel VE, Witt MR, Gitchell BS, Gribble DN, Rogers QR, Segall HJ, Knight HD.Nine adult horses were fed alfalfa hay cubes containing approximately 10% Senecio vulgaris until all horses had consumed approximately the same amount of toxic components of S vulgaris, pyrrolizidine alkaloids (PA). The amount of PA consumed was determined by the amount that induced clinical signs of PA toxicosis in 3 horses. The 6 other horses were given similar amounts per kilogram of body weight. An initial decrease of feed intake was observed when horses' diets were changed from alfalfa cubes to alfalfa/Senecio cubes, and feed intake was decreased further over 89 to 98 days. From 50 to 159...
Stadler P, van den Berg SS, Tustin RC.A Hansen type I cervical intervertebral disc prolapse was diagnosed in a 16-year-old American Saddler showing clinical signs of paresis and ataxia. An ante-mortem diagnosis was made by means of plain radiographs and a myelogram. The horse was euthanased and the diagnosis confirmed on a post-mortem examination.
Buonanno AM, Carlson GP, Kantrowitz B.Portosystemic shunt was diagnosed in a 6-month-old Quarter Horse filly with acute onset of apparent blindness and a 3-month history of depression, lethargy, and ataxia. Clinicopathologic test results indicated slightly high gamma-glutamyl transpeptidase activity and serum total bilirubin concentration. Sulfobromophthalein half time was prolonged, and plasma ammonia and serum bile acid concentrations were high as well. Histopathologic findings of percutaneous liver biopsy included widespread hepatocyte atrophy and numerous prominent small arterioles in the area of the portal triad. On the basis...
van den Hoven P, Meijer AE, Breukink HJ, Wensing T.Muscle biopsies from six horses with clinical histories of muscle atrophy, muscle tremors, myopathic symptoms, unsteadiness of pelvic limbs and progressive ataxia were examined. Muscle biopsies were studied with enzyme histochemical techniques to evaluate the diagnostic values of these methods in cases suspected of suffering from neuromuscular disorders. Hypertrophy, atrophy, fibre splitting, waxy degeneration, phagocytosis and necrosis were seen in haematoxylin eosin stained sections of the different cases. Fibre type predominance and fibre type grouping were seen in the calcium ion stimulate...
Kannegieter NJ, Alley MR.A 20-month-old, Standard-bred colt was presented with an acute onset of hindlimb ataxia. Clinical and radiographic examination identified a compressive lesion affecting the spinal cord at the level of the 17th to 18th thoracic vertebrae. After euthanasia, post-mortem examination revealed a tumour in the epidural space, diagnosed histologically as a lymphosarcoma. Neoplastic lymphoid cells were also present in the abdominal lymph nodes and brain. Because of the disseminated nature of lymphosarcoma in the horse, involvement of the central nervous system is likely to be more common than is presen...
Rollinson J, Taylor FG, Chesney J.Six cases of accidental salinomycin poisoning in horses are described. The horses were fed a contaminated ration and presented clinical signs which were extremely varied in nature and severity. However, the range of signs, including anorexia, colic, weakness and ataxia bore similarities to those described in horses poisoned with the related ionophore monensin. Other similarities became apparent in serum biochemical profiles of the clinical cases. Although ionophore toxicity is rarely reported in horses they appear to be particularly susceptible, and it should therefore be considered as a diffe...
Beech J.This article discusses the history and signalment, clinical signs, differential diagnosis, pathology, etiology and pathogenesis, and treatment and prevention of equine degenerative myeloencephalopathy.
DeBowes RM, Leipold HW, Turner-Beatty M.Cerebellar abiotrophy is a degenerative condition of Arabian horses that produces signs of head tremors and ataxia. Affected foals demonstrate clinical signs between the time of birth and 6 months of age. The condition is untreatable, although some animals have reportedly improved to varying degrees. The disease is believed to be inherited; however, definitive evidence is lacking at this time.
Plotka ED, Seal US, Eagle TC, Asa CS, Tester JR, Siniff DB.Forty-eight newly captured free-ranging feral stallions (Equus caballus) from two different locations and six captive stallions were immobilized using combinations of etorphine hydrochloride, xylazine hydrochloride and atropine sulfate with or without acepromazine. Six animals were immobilized twice, 1 mo apart. The drugs were administered either intramuscularly (n = 13) or intravenously (n = 44). Mean immobilization time (+/- SE) after intravenous (i.v.) injection of etorphine, xylazine and atropine was 55 +/- 4 sec (range 20 to 185 sec) compared to 708 +/- 131 sec (range 390 to 1,140 sec) fo...
Dart AJ, Hutchins DR, Begg AP.A 12-year-old Thoroughbred mare, with a history of anorexia, dramatic weight loss, fluctuating pyrexia and intermittent diarrhoea after an episode of colic, was presented for examination with depression, emaciation and ataxia. Thoracic and abdominal paracenteses yielded copious quantities of inflammatory exudate. Palpation per rectum revealed an enlarged spleen. The primary alterations in haematology included a severe leucocytosis with a left shift, and a hyperproteinaemia characterised by hypoalbuminaemia and hypergammaglobulinaemia. Post-mortem examination revealed a low grade pleurisy and p...
Madigan JE, Gribble D.Case records of horses with equine ehrlichiosis (Ehrlichia equi) at the University of California Veterinary Medical Teaching Hospital and Ackerman Creek Large Animal Clinic were analyzed for evaluation of clinical signs, time of onset, hematologic values, response to treatment, and recovery. Equine ehrlichiosis was found to be seasonal in horses in the foothills of northern California, with higher incidence than reported previously. The horses developed fever, anorexia, depression, limb edema, icterus, and ataxia. Hematologic changes were leukopenia, thrombocytopenia, icterus, anemia, and incl...
Ziemer EL, Parker HR, Carlson GP, Smith BP.Two horses were admitted separately for evaluation and treatment of profound hyperchloremic metabolic acidosis without azotemia. One, an 11-year-old Quarter Horse mare, had been depressed and ataxic for 2 days. The other, a 2-year-old Quarter Horse colt, had a 6-week history of depression, anorexia, and weight loss. Both horses responded to fluid and electrolyte therapy, but required daily oral administration of sodium bicarbonate for maintenance. In each case, the diagnosis was renal tubular acidosis.
Mayhew IG, Brown CM, Stowe HD, Trapp AL, Derksen FJ, Clement SF.Two horse farms, on which there was a high incidence of proven and suspected equine degenerative myeloencephalopathy (EDM), were studied. Symmetric ataxia and paresis, along with laryngeal adductor, cervicofacial, local cervical, and cutaneous trunci hyporeflexia, characterized the syndrome. Serum vitamin E concentration reflected a deficient state in affected and unaffected horses on both farms when compared with selected reference groups and with published values. A high incidence of the disease was evident in offspring of two particular sires on one farm. Vitamin E supplementation resulted ...
Clarke KW, Taylor PM.Detomidine, given intravenously at doses of 5 to 30 (mean 13) micrograms/kg bodyweight (bwt), provided adequate sedation for a variety of clinical procedures in 93 per cent of administrations, and improved the ease of handling in the remaining animals. Side effects of ataxia and bradycardia were minimal at the lower dose rates. Higher doses were required for intramuscular use. In experimental trials 10 and 20 micrograms/kg bwt resulted in deep sedation and also significant hypertension and bradycardia of over 15 mins duration. Current literature on the use of detomidine in horses is reviewed.
Vasconcelos de Sousa AL, Riet-Correa F, Botelho de Castro M, Machado M.We reviewed the history, epidemiology, clinical signs, pathology, pathogenesis, treatment, control, and prophylaxis of Sorghum poisoning in livestock. Economic losses in the livestock industry associated with sorghum have been reported since the 19th century. Hyperacute/acute poisoning associated with cyanide (HCN) or nitrate/nitrite frequently occurs in ruminants that consume high quantities of growth and regrowth sorghum after drought, followed by rainfall, respectively. Chronic cystitis-ataxia syndrome primarily affects horses after weeks of grazing on sorghum pastures, while congenital art...
Arantes JA, Rabelo IP, Bermudes L, Lacerenza MD, Mendes RP, Corrêa RR, Yamada DI, Valadão CAA, Dória RGS.This study aimed to compare the sedation quality and cardiorespiratory and behavioral effects of detomidine administered intravenously, either in intermittent boluses or as a continuous rate infusion, with butorphanol in horses pre-medicated with acepromazine for odontoplasty procedures. Unassigned: A prospective clinical study was conducted with fifteen adult horses randomly assigned to two groups: Bolus group (BG, = 7) and Infusion group (IG, = 8). Both groups received acepromazine premedication, followed by detomidine administration (bolus or infusion). Butorphanol was administered either...
de la Cuesta-Torrado M, Velloso Alvarez A, Cárdenas-Rebollo JM, Neira-Egea P, Vitale V, Cuervo-Arango J.Understanding of equine herpesvirus-1 (EHV-1) myeloencephalopathy (EHM) is complicated by disparities among studies. Objective: Compare clinical findings and outcome in horses involved in 2 recent EHM outbreaks. Methods: Twenty-five and 10 horses affected during 2 natural EHM outbreaks were admitted to a veterinary teaching hospital (VTH) in 2021 and 2023, respectively. Methods: Data collected from the VTH and surveys completed by riders and horse owners were analyzed retrospectively. Results: No risk factors associated with EHM development showed significant differences between the outbreaks;...
Mannini A, Ellero N, Urbani L, Balboni A, Imposimato I, Battilani M, Gialletti R, Freccero F.A 17-year-old mare presenting with acute fever, weakness and bladder dysfunction was diagnosed with equine herpesvirus myeloencephalopathy (EHM). The mare become transiently recumbent, underwent parenteral fluid therapy, plasma infusion, steroidal/nonsteroidal anti-inflammatory drugs (SAID/NSAIDs) and bladder catheterization. After 10 days the mare was hospitalized. Neurological evaluation revealed ataxia and proprioceptive deficits mainly in the hind limbs. The mare was able to stand but unable to rise from recumbency or walk. Secondary complications included Escherichia coli cystitis, cornea...
Hughes KJ, Hodgson DR.The research article discusses the case of a 7-year-old Thoroughbred stallion presenting symptoms such as ataxia, a leftward head tilt and a cloudy left eye, revealing a diagnosis of temporohyoid […]
Acland HM, Mann PC, Robertson JL, Divers TJ, Lichtensteiger CA, Whitlock RH.Six foals of three different breeds, born to healthy mares, appeared normal at birth, and died at two to five days of age with icterus, ataxia, head pressing, and terminal hepatic coma. Their livers were less than one-half normal weight. Most of the liver was dark red-brown and slightly rubbery. Histologically, these areas were characterized by severe bile ductule proliferation, mild portal tract fibrosis, and massive hepatocellular necrosis and lobular collapse. A small proportion of the liver, usually on the peripheral part of the lobes, was grossly light brown and slightly raised. Histologi...
Licka TF.The differentiation of ataxia and orthopedic disease can be facilitated by the use of several additional tests, not commonly part of either neurologic or orthopedic examination protocols. However, a full neurologic and orthopedic examination and suitable diagnostic imaging will of course also be necessary in such cases. The common association of orthopedic and neurologic disease makes it even more necessary to correctly attribute movement or posture abnormalities to potentially treatable structures.
Duarte PC, Paz CFR, Oliveira APL, Maróstica TP, Cota LO, Faleiros RR.To investigate the nociceptive and clinical effects of buffering a lidocaine-epinephrine solution with sodium bicarbonate in caudal epidural block in mares. Methods: Prospective randomized controlled trial. Methods: Six mixed-breed mares weighing 350-440 kg. Methods: Each animal was administered two caudal epidural injections, 72 hours apart, using different solutions prepared immediately before injection. The control solution was 7 mL 2% lidocaine hydrochloride with epinephrine hemitartrate (1:200,000) added to 3 mL sterile water for injection (pH 2.9). The alkalinized solution was 7 mL o...
Davies PC.An 11-year-old mare presented with neuromuscular deficits and what resembled shivering in the left hind limb. On necropsy, there was no evidence of denervation atrophy of the left hind gastrocnemius muscle. The spinal cord had a small, right-sided lesion at C3-C4 and C4-C5. Tests for equine herpesvirus-1 and Sarcocystis spp. were negative.
Abdelhakiem MAH, Hussein HA.Diseases of the central nervous system are a well-recognized cause of morbidity and mortality in equine. Collection and analysis of cerebrospinal fluid (CSF) give information about the type and stage of degenerative and inflammatory diseases in central nervous system (CNS). The present research aimed to assess the clinical complications of CSF collections and to establish range values of cytological and biochemical parameters of CSF in adult healthy donkeys (Equus asinus). The CSF samples were collected from fifty healthy donkeys at the lumbosacral (LS) and atlanto-occipital (AO) sites. Result...
Palmisano M, Bender S, Johnson AL.We describe the unique clinical presentation of a central nervous system neoplasm in a 6-month-old draft horse cross gelding. Based on the neurologic examination at admission, neurolocalization was most consistent with a mildly asymmetric cervical, multifocal, or diffuse myelopathy. Mild vestibular involvement also was considered, but no cranial nerve deficits were observed. The gelding was negative for Sarcocystis neurona or Neospora hughesi based on paired serum and cerebrospinal fluid (CSF) samples analyzed, with no evidence of cervical compression based on contrast myelography. The horse w...
Olsen TF.A 14-year-old, quarter horse stallion was presented in lateral recumbency, unable to rise. Equine herpesvirus myeloencephalopathy was diagnosed, based on presentation, clinical signs, and the ruling out of other possibilities. After initial rapid improvements, ataxia remained, as did chronic cystitis secondary to bladder paralysis. He was euthanized after 2 months.
Doige CE.A midsagittal centrum cleft of T5-6, malformation and fusion of T3-7, intra- and extraspinal cyst, and myelodysplasia were found in a 3-month-old female Arabian foal that had experienced posterior ataxia since birth. Based on studies in other species, ecto-endodermal adhesions early in embryogenesis leading to formation of an enterogenous cyst is the most probable pathogenesis.
Bathe AP.Three horses with an apparent neurological disorder resulting from nettle rash showed signs of ataxia, distress and muscle weakness, and two of them had urticaria. In each case the condition resolved within four hours, with no long term problems or recurrence.
Hobo S, Aida H, Yoshida K.The present study was carried out to assessing the sedative effect of medetomidine and determining its optimal dose in thoroughbred horses. Excessive ataxia after sedative treatment is dangerous for horses. Therefore three doses which may cause sufficient sedation with only mild ataxia were examined. Response to stimulation and the severity of ataxia suggested that 7.5 micrograms/kg BW, i.v., is optimal.
Derossi R, Medeiros U, de Almeida RG, Righetto FR, Frazílio FO.The aim of the study was to evaluate and compare the effects of caudal epidural administration of meperidine (MP), lidocaine (LD), and a combination of the two (MPLD) in six mature saddle horses. Horses were randomly assigned to receive three treatments (MP 0.3 mg/kg; LD 0.2 mg/kg; and MPLD: MP 0.3 mg/kg and LD 0.2 mg/kg), with at least 1 week between treatments. Drugs were injected into the epidural space between the first and second coccygeal areas in conscious standing horses. Analgesia, ataxia, sedation, cardiovascular and respiratory effects, and rectal temperature were recorded at differ...
McCrindle CM, Ebedes H, Swan GE.Two Arabian horse stallions with behavioural problems were treated with long-acting neuroleptics in order to facilitate corrective training. Perphenazine enanthate, administered intramuscularly at a dose of 0.5 mg kg-1 had an effect for 30 d. Pipothiazine palmitate (1 mg kg-1) induced tranquilization of 30 d duration as well as extra-pyramidal clinical signs, ataxia and aphagia. Neither horse showed prolapse of the penis or haemolysis.