The diagnosis and management of primary autoimmune haemolytic anaemia

Hill, Quentin A.; Stamps, R; Massey, Edwin; Grainger, John D.; Provan, Drew; Hill, Anita

doi:10.1111/bjh.14478

Cited by 213 publications

(307 citation statements)

References 82 publications

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“…Nevertheless, this evidence base may provide a rationale for use of IVIG as a salvage option in cases unresponsive to the treatments described in recommendations #7‐10. In people, the recommended dosage of IVIG is 0.4‐0.5 g/kg/day administered for 4‐5 days, but the efficacy and safety of treatment beyond 3 days has not been assessed in dogs. Availability of IVIG is limited in many countries, and it is expensive.…”

Section: Results and Recommendationsmentioning

confidence: 99%

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

Swann

Garden

Fellman

et al. 2019

Veterinary Internal Medicne

187

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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.

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Section: Results and Recommendationsmentioning

confidence: 99%

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

Swann

Garden

Fellman

et al. 2019

Veterinary Internal Medicne

187

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“…The presence of these antibodies can be associated with clinical forms of warm AIHA or cold AIHA that includes cold agglutinin disease (CAD) and the paroxysmal cold haemoglobinuria. Mixed types of AIHA (warm/cold) are also described 1. Different antigen/antibody couples are involved in different AIHA types: Rh/anti-Rh IgG in the warm type; I-antigen/anti-I IgM in the CAD; both couples in the mixed type.…”

Section: Aimsmentioning

confidence: 99%

Short preheating at 41°C leads to a red blood cells count comparable to that in RET channel of Sysmex analysers in samples showing cold agglutination

Gioia¹,

Fumi

Fiorini

et al. 2018

J Clin Pathol

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AimsThe presence of cold agglutinin in blood samples can cause a spontaneous agglutination of red blood cells (RBCs) when low temperature occurs. This phenomenon causes a spurious lowering of RBC count on the automated haematological analysers that are detected by incongruous values (≥370 g/L) of the mean cellular haemoglobi concentration (MCHC). A preheating at 37°C can remove the RBC agglutination generally resulting in a reliable count. It has been reported that the same result can be reached by using the optical reticulocyte (RET) channel of Sysmex analysers where the RBC count is not influenced by the presence of cold agglutinin. This study aims to evaluate these data in a larger population, with regard to environmental conditions on Sysmex analysers. We have also evaluated the influence of different thermal pretreatments on the RBC count.MethodsThis study was performed on 96 remnants of peripheral blood samples (48 with MCHC in normal range and 48 with MCHC>370 g/L) which have been analysed in different preanalytical conditions on the Sysmex analysers.ResultsA preheating of samples at 41°C for 1 min leads to a reversibility of the cold agglutination comparable to the one observed in the RET channel and yields better results compared with 37°C for 2 hours.ConclusionsNone of described procedures assure the complete cold agglutination reversibility in every case. Consequently, since the haematological analysers not yet provide reliable parameters to confirm the complete resolution of agglutination, further verification of RBC count accuracy needs to be performed.

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“…She subsequently developed nephrotic-range proteinuria (greater than 5 g over 24 hours) with normal serum creatinine levels. [3] After consultations from hematology, nephrology, and rheumatology, the patient was started on 80 mg of oral prednisone daily for warm AIHA with gradual clinical improvement. She underwent biopsies of both liver and kidney.…”

Section: Case History and Clinical Coursementioning

confidence: 99%

“…Thus, we suspected that both were complications of underlying connective tissue disease and HLH. [3] On the basis of the elevated, speckled antinuclear antibody titer and smooth muscle ribonucleoprotein antigen, the patient met serological criteria for MCTD. The patient also had findings of hand swelling, Raynaud phenomenon, and myositis.…”

Section: Case History and Clinical Coursementioning

confidence: 99%

An unusual association between hemophagocytic lymphohistiocytosis, mixed connective tissue disease, and autoimmune hemolytic anemia

Kelkar

Shah²,

Yong³

et al. 2017

Medicine

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Rationale:In the adult patient, hemophagocytic lymphohistiocytosis (HLH) is uncommon and frequently difficult to diagnose due to its nonspecific presentation and numerous complications.Patient concerns:Herein, we present the case of a 25-year-old female who initially presented for evaluation of persistent fevers and fatigue. She was found to have splenomegaly, generalized lymphadenopathy, pancytopenia, and acute hepatic failure.Diagnoses, Interventions, and Outcomes:Her course was further complicated by the development of nephrotic syndrome and autoimmune hemolytic anemia (AIHA). Antinuclear antibody and ribonucleoprotein were positive, with concurrent physical examination findings, indicating underlying mixed connective tissue disease (MCTD). Ferritin was greater than 40,000 ng/dL. Viral studies, including hepatitis A, B, and C, cytomegalovirus, and Epstein–Barr virus were negative. On the basis of her clinical presentation, a diagnosis of HLH secondary to MCTD was made. This was later confirmed on liver biopsy. She was started on high-dose prednisone and her symptoms completely resolved. She was then transitioned to azathioprine, hydroxychloroquine, prophylactic antibiotics, and a prednisone taper for long-term management.Lessons:This case is notable for the association of both AIHA and MCTD with HLH, providing support for a possible relationship between these 3 conditions.

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The diagnosis and management of primary autoimmune haemolytic anaemia

Cited by 213 publications

References 82 publications

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

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

Short preheating at 41°C leads to a red blood cells count comparable to that in RET channel of Sysmex analysers in samples showing cold agglutination

An unusual association between hemophagocytic lymphohistiocytosis, mixed connective tissue disease, and autoimmune hemolytic anemia

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