ACVIM consensus statement on the treatment of immune‐mediated hemolytic anemia in dogs

Abstract

Immune‐mediated hemolytic anemia (IMHA) causes severe anemia in dogs and is associated with considerable morbidity and mortality. Treatment with various immunosuppressive and antithrombotic drugs has been described anecdotally and in previous studies, but little consensus exists among veterinarians as to the optimal regimen to employ and maintain after diagnosis of the disease. To address this inconsistency and provide evidence‐based guidelines for treatment of IMHA in dogs, we identified and extracted data from studies published in the veterinary literature. We developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria, explanation of treatment regimens, and validity of statistical methods. In combination with our clinical experience and comparable guidelines for humans afflicted with autoimmune hemolytic anemia, we used the conclusions of this process to make a set of clinical recommendations regarding treatment of IMHA in dogs, which we refined subsequently by conducting several iterations of Delphi review. Additionally, we considered emerging treatments for IMHA in dogs and highlighted areas deserving of future research. Comments were solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted for publication. The resulting document is intended to provide clinical guidelines for management of IMHA in dogs. These guidelines should be implemented pragmatically, with consideration of animal, owner, and veterinary factors that may vary among cases.

Primary immune‐mediated haemolytic anaemia: a retrospective long‐term study in 61 dogs

“…The routine administration of fresh frozen plasma in cases of nonhaemorrhagic DIC is not recommended. 37 When only considering the deaths which occurred due to IMHA after 90 days of treatment, the mortality rate in this study was 8.2% (5/61). Three of these five dogs were euthanased more than 15 months after starting therapy.…”

“…However, only in 5 out of 48 dogs that died or were euthanased within the first 14 days had histopathology performed postmortem. According to the recent consensus statements, the use of antithrombotics is recommended in dogs with IMHA at the time of diagnosis until the patient is in remission, except for dogs with thrombocytopenia <30 × 10 9 / L. 36,37 Nine dogs received fresh frozen plasma and five dogs received whole blood transfusions. These patients suffered from bleeding due to DIC or severe thrombocytopenia.…”

Effects of oral administration of 5 immunosuppressive agents on activated T‐cell cytokine expression in healthy dogs

“…The more common cyclosporine dosage of 5 mg/kg PO twice daily does not reliably induce suppression of IL‐2 and IFN‐γ in all dogs, based on experience from the Clinical Pharmacodynamic Laboratory at Mississippi State University. All other dosages used followed recommended guidelines from the ACVIM consensus statement on the treatment of immune‐mediated hemolytic anemia in dogs …”

Effects of clopidogrel and prednisone on platelet function in healthy dogs

“…Mortality rates in dogs with primary immune‐mediated hemolytic anemia (IMHA) historically have been high (50%‐70%), 1,2 primarily as a consequence of fatal thromboembolism 1‐3 . Standard treatment for dogs with IMHA includes immunosuppression, thromboprophylaxis, and supportive care 1,4,5 . Glucocorticoids are the most commonly used immunosuppressive agent for the treatment of IMHA in dogs 5 .…”

“…Standard treatment for dogs with IMHA includes immunosuppression, thromboprophylaxis, and supportive care 1,4,5 . Glucocorticoids are the most commonly used immunosuppressive agent for the treatment of IMHA in dogs 5 . Unfortunately, glucocorticoid administration can cause hypercoagulability in healthy dogs, 6‐8 and it has been identified as a risk factor for thromboembolism in clinical patients 7,9,10 .…”