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Agnoli C, Tumbarello M, Vasylyeva K, Selva Coddè CS, Monari E, Gruarin M, Troìa R, Dondi F. Methylprednisolone alone or combined with cyclosporine or mycophenolate mofetil for the treatment of immune-mediated hemolytic anemia in dogs, a prospective study. J Vet Intern Med 2024; 38:2480-2494. [PMID: 38961558 PMCID: PMC11423485 DOI: 10.1111/jvim.17122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/14/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Benefit of adding a second-line immunosuppressive drug to glucocorticoids for the treatment of non-associative immune-mediated hemolytic anemia (naIMHA) in dogs has not been defined prospectively. HYPOTHESIS/OBJECTIVES Evaluate the effectiveness of different immunosuppressive protocols in naIMHA dogs. ANIMALS Forty-three client-owned dogs. METHODS Open label, randomized, clinical trial. Dogs were treated with methylprednisolone (M-group), methylprednisolone plus cyclosporine (MC-group) or methylprednisolone plus mycophenolate mofetil (MM-group). Dogs were defined as responders by disappearance of signs of immune-mediated destruction and hematocrit stabilization. Frequency of responders was compared between M-group and combined protocols (MC and MM-group evaluated together), and among the 3 different therapeutic groups at 14 (T14), 30 (T30), 60 (T60) days after admission. Frequency of complications, length of hospitalization and relapse were also compared. Death rate was evaluated at discharge, T60 and 365 (T365) days. RESULTS Proportion of responders was not significantly different between M-group and combined protocols (MC and MM-groups), nor among the 3 therapeutic groups at T14, T30, and T60 (P > .17). Frequency of relapse, complications, and length of hospitalization were not significantly different between M-group and dogs treated with combined protocols, nor among the 3 treatment groups (P > .22). Death was significantly more common only for MM-group compared with MC-group at T60 (+42.8%; 95% CI: 11.5-67.4; P = .009), and at T365 (+50%; 95% CI: 17.5-73.2; P = .003). CONCLUSIONS AND CLINICAL IMPORTANCE Combined immunosuppressive therapy did not improve hematological response in naIMHA.
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Affiliation(s)
- Chiara Agnoli
- Department of Veterinary Medical SciencesAlma Mater Studiorum‐University of BolognaBolognaItaly
| | - Michele Tumbarello
- Department of Veterinary Medical SciencesAlma Mater Studiorum‐University of BolognaBolognaItaly
| | - Kateryna Vasylyeva
- Department of Veterinary Medical SciencesAlma Mater Studiorum‐University of BolognaBolognaItaly
| | - Carola S. Selva Coddè
- Department of Veterinary Medical SciencesAlma Mater Studiorum‐University of BolognaBolognaItaly
| | - Erika Monari
- Department of Veterinary Medical SciencesAlma Mater Studiorum‐University of BolognaBolognaItaly
| | | | - Roberta Troìa
- Department of Veterinary Medical SciencesAlma Mater Studiorum‐University of BolognaBolognaItaly
| | - Francesco Dondi
- Department of Veterinary Medical SciencesAlma Mater Studiorum‐University of BolognaBolognaItaly
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Duclos AA, Bailén EL, Barr K, Le Boedec K, Cuq B. Clinical presentation, outcome and prognostic factors in dogs with immune-mediated haemolytic anaemia: a retrospective single-centre study of 104 cases in Ireland (2002-2020). Ir Vet J 2024; 77:16. [PMID: 39054564 PMCID: PMC11270767 DOI: 10.1186/s13620-024-00277-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 07/21/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Immune-mediated haemolytic anaemia (IMHA) has a high mortality rate within the first weeks to months of diagnosis. Identifying dogs at increased risk of death may help guide decision-making for owners and veterinarians. Prior studies have identified several but inconsistent prognostic factors. The objectives of the study were to describe the clinical presentation and outcome of canine immune-mediated haemolytic anaemia in Ireland and to assess for independent factors associated with survival including long-term survival. Medical records from a single centre were reviewed between 2002 and 2020 to identify dogs with immune-mediated haemolytic anaemia using the American College of Veterinary Internal Medicine (ACVIM) consensus statement algorithm. Survival analysis was performed using univariable Cox proportional hazards regression models with Breslow method for ties to identify prognostic factors. RESULTS One hundred and four cases were included. The diagnosis of immune-mediated haemolytic anaemia was classified as definitive, supportive and suspicious in 42 (40%), 50 (48%), and 12 dogs (12%) respectively. Twenty-two dogs (21%) were diagnosed with associative IMHA and 82 dogs were diagnosed with non-associative IMHA (79%). 65% of the cases received more than one immunosuppressive medication during the course of treatment. The mortality rate at one and three months was 16% (95% confidence interval [CI] 9-26) and 31% (95% CI 21-43) respectively. Excluding dogs that died within three months, the median survival time was 2664 days. The relapse rate during the follow-up period was 7%. Survival did not improve over the course of the study period. Thrombocytopenia and hyperbilirubinaemia were identified as negative prognostic indicators (Hazard ratio 2.2 and 2.5, 95% CI 1.1-4.1 and 1.1-5.6, respectively). CONCLUSIONS Excluding dogs that died within three months, the outcome was good in dogs with non-associative immune-mediated haemolytic anaemia in Ireland. The relapse rate was low regardless of the presence of associative causes. Thrombocytopenia and hyperbilirubinaemia were the only independent negative prognostic factors. The one-month and three-month mortality rates were similar compared to prior studies and survival did not improve over time during the study period: the mortality rate of canine immune-mediated haemolytic anaemia remains high in the acute phase.
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Affiliation(s)
- Antoine A Duclos
- Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin 4, Ireland.
| | | | - Kathryn Barr
- Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin 4, Ireland
| | - Kevin Le Boedec
- Internal Medicine Department, Centre Hospitalier Vétérinaire Frégis, Gentilly, France
| | - Benoît Cuq
- Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin 4, Ireland
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3
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Liu PY, Xia D, McGonigle K, Carroll AB, Chiango J, Scavello H, Martins R, Mehta S, Krespan E, Lunde E, LeVine D, Fellman CL, Goggs R, Beiting DP, Garden OA. Immune-mediated hematological disease in dogs is associated with alterations of the fecal microbiota: a pilot study. Anim Microbiome 2023; 5:46. [PMID: 37770990 PMCID: PMC10540429 DOI: 10.1186/s42523-023-00268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The dog is the most popular companion animal and is a valuable large animal model for several human diseases. Canine immune-mediated hematological diseases, including immune-mediated hemolytic anemia (IMHA) and immune thrombocytopenia (ITP), share many features in common with autoimmune hematological diseases of humans. The gut microbiome has been linked to systemic illness, but few studies have evaluated its association with immune-mediated hematological disease. To address this knowledge gap, 16S rRNA gene sequencing was used to profile the fecal microbiota of dogs with spontaneous IMHA and ITP at presentation and following successful treatment. In total, 21 affected and 13 healthy control dogs were included in the study. RESULTS IMHA/ITP is associated with remodeling of fecal microbiota, marked by decreased relative abundance of the spirochete Treponema spp., increased relative abundance of the pathobionts Clostridium septicum and Escherichia coli, and increased overall microbial diversity. Logistic regression analysis demonstrated that Treponema spp. were associated with decreased risk of IMHA/ITP (odds ratio [OR] 0.24-0.34), while Ruminococcaceae UCG-009 and Christensenellaceae R-7 group were associated with increased risk of disease (OR = 6.84 [95% CI 2-32.74] and 8.36 [95% CI 1.85-71.88] respectively). CONCLUSIONS This study demonstrates an association of immune-mediated hematological diseases in dogs with fecal dysbiosis, and points to specific bacterial genera as biomarkers of disease. Microbes identified as positive or negative risk factors for IMHA/ITP represent an area for future research as potential targets for new diagnostic assays and/or therapeutic applications.
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Affiliation(s)
- P-Y Liu
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Royal College Street, London, NW1 0TU, UK
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, 804201, Taiwan
| | - D Xia
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Royal College Street, London, NW1 0TU, UK
| | - K McGonigle
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Spruce Street, Philadelphia, PA, 19104, USA
| | - A B Carroll
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Spruce Street, Philadelphia, PA, 19104, USA
| | - J Chiango
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Spruce Street, Philadelphia, PA, 19104, USA
| | - H Scavello
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Spruce Street, Philadelphia, PA, 19104, USA
| | - R Martins
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Spruce Street, Philadelphia, PA, 19104, USA
| | - S Mehta
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, 380 South University Avenue, Philadelphia, 19104, USA
| | - E Krespan
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, 380 South University Avenue, Philadelphia, 19104, USA
| | - E Lunde
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 South Riverside Drive, Ames, IA, 50011, USA
| | - D LeVine
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 South Riverside Drive, Ames, IA, 50011, USA
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Road, Auburn, AL, 36849, USA
| | - C L Fellman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, 01536, USA
| | - R Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, 930 Campus Road, Box 31, Ithaca, NY, 14853, USA
| | - D P Beiting
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, 380 South University Avenue, Philadelphia, 19104, USA
| | - O A Garden
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Spruce Street, Philadelphia, PA, 19104, USA.
- Dean's Office, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton Rouge, LA, 70803, USA.
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Gianesini G, Drigo M, Zoia A. Immune-Mediated Hemolytic Anemia and Clinically Suspected Acute Pancreatitis in Dogs, a Pilot Study. Top Companion Anim Med 2023; 56-57:100821. [PMID: 37802244 DOI: 10.1016/j.tcam.2023.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/17/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023]
Abstract
Acute pancreatitis can be a complication of massive hemolysis, above all when intravascular in nature. Therefore, the aim of this study was to investigate the association between canine immune mediated hemolytic anemia (IMHA) and clinically suspected acute pancreatitis (CSAP) and the role of calculated free plasma hemoglobin (Hbfp) in CSAP occurrence/development. In this cohort study the records of 95 dogs with IMHA and 95 sick dogs with pathologies other than IMHA were compared for CSAP occurrence/development. At presentation, 12/95 dogs with IMHA met criteria for CSAP, while only 3/95 sick control dogs met these criteria (χ2 =1.58, P = .008). Within 7 days of hospitalization 9 additional dogs with IMHA had developed CSAP. The Hbfp was calculated and compared for dogs with IMHA that had/developed CSAP and for those without CSAP. In dogs with IMHA, a calculated Hbfp concentration ≥ 0.08 g/dL resulted in an increased relative risk (RR) of having/developing CSAP (RR = 2.54, 95% CI, 1.51-4.29; P = .003). No significant effect on short-term prognosis in dogs with IMHA was found between those having/developing CSAP and those without CSAP. This study showed that dogs with IMHA have an increased risk of having CSAP and Hbfp concentration may be involved in the pathogenesis of acute pancreatitis.
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Affiliation(s)
- Giulia Gianesini
- Division of Internal Medicine, San Marco Veterinary Clinic, Veggiano, Italy
| | - Michele Drigo
- Department of Medicina Animale, Produzione e Salute, Padua University, Legnaro, Italy
| | - Andrea Zoia
- Division of Internal Medicine, San Marco Veterinary Clinic, Veggiano, Italy.
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5
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Mektrirat R, Chongrattanameteekul P, Pureeroj N, Duangboon M, Loythong J, Wiset N, Chantarachart S, Lumsangkul C, Pongkan W. Preliminary Study on Treatment Outcomes and Prednisolone Tapering after Marine Lipid Extract EAB-277 Supplementation in Dogs with Immune-Mediated Hemolytic Anemia. Vet Sci 2023; 10:425. [PMID: 37505830 PMCID: PMC10386409 DOI: 10.3390/vetsci10070425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/25/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Immune-mediated hemolytic anemia (IMHA) is a common autoimmune disorder in dogs with a high fatality rate and it remains a therapeutic challenge. The marine lipid extract, EAB-277, is a natural anti-inflammatory nutraceutical product. However, the effects of EAB-277 in IMHA dogs has rarely been investigated. The objective of this study is to assess the clinical effects of EAB-277 and prednisolone dose-tapering for supplemental therapy in IMHA dogs. Prednisolone was given to 18 anemic IMHA dogs according to a standard regimen. Six dogs were supplementally treated with EAB-277 for 28 days and the remaining twelve dogs were a control group of untreated supplementations. The results demonstrate that the supplement group showed slightly better survival rates (66.7 ± 19.2%) than the control group (16.7 ± 0.7%), but the difference was not statistically significant (p = 0.408). When compared to pre-therapy, the supplement group's blood profiles improved (p < 0.05). The EAB-277 treated group showed a moderate decrease in the incidence rate (4.20 times) of prednisolone tapering compared to the control group. The dosage reduction of prednisolone in supplement group was more than that in the control group (p < 0.0001). Our results suggest that EAB-277 supplementation may enhance clinical outcomes and lessen prednisolone dose-tapering in canine IMHA therapy.
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Affiliation(s)
- Raktham Mektrirat
- Department of Veterinary Biosciences and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
- Research Center for Veterinary Biosciences and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
- Center of Excellence in Pharmaceutical Nanotechnology, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Peerawit Chongrattanameteekul
- Department of Veterinary Biosciences and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
| | - Nattanon Pureeroj
- Department of Veterinary Biosciences and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
| | - Metina Duangboon
- Department of Veterinary Biosciences and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
| | - Jarunee Loythong
- Small Animal Hospital, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Natakorn Wiset
- Small Animal Hospital, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sineenart Chantarachart
- Small Animal Hospital, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chompunut Lumsangkul
- Department of Animal and Aquatic Sciences, Faculty of Agriculture, Chiang Mai University, Chiang Mai 50200, Thailand
- Multidisciplinary Research Institute, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wanpitak Pongkan
- Department of Veterinary Biosciences and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
- Research Center for Veterinary Biosciences and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand
- Center of Excellence in Pharmaceutical Nanotechnology, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
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6
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Weng J, Levy NA, Abbott HY, Mix JA, Wills RW, Mackin AJ, Thomason JM, Cridge H. Retrospective analysis of immunosuppressive and anti-thrombotic protocols in nonassociative immune mediated hemolytic anemia in dogs. J Vet Intern Med 2023; 37:528-536. [PMID: 36809664 PMCID: PMC10061171 DOI: 10.1111/jvim.16652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Evidence supporting the effectiveness of therapeutic protocols for nonassociative immune-mediated hemolytic anemia (na-IMHA) is weak. HYPOTHESIS/OBJECTIVES Investigate the efficacy of various drugs in na-IMHA. ANIMALS Two hundred forty-two dogs. METHODS Multi-institutional retrospective study (2015-2020). Immunosuppressive effectiveness was determined by time to packed cell volume (PCV) stabilization and duration of hospitalization through analysis by mixed model linear regression. Occurrence of disease relapse, death, and antithrombotic effectiveness, were analyzed using mixed model logistic regression. RESULTS Use of corticosteroids vs a multi-agent protocol had no effect on time to PCV stabilization (P = .55), duration of hospitalization (P = .13), or case fatality (P = .06). A higher rate of relapse (P = .04; odds ratio: 3.97; 95% confidence interval [CI]: 1.06-14.8) was detected in dogs receiving corticosteroids (11.3%) during follow-up (median: 28.5 days, range: 0-1631 days) compared to multiple agents (3.1%) during follow up (median: 47.0 days, range: 0-1992 days). When comparing drug protocols, there was no effect on time to PCV stabilization (P = .31), relapse (P = .44), or case fatality (P = .08). Duration of hospitalization was longer, by 1.8 days (95% CI: 0.39-3.28 days), for the corticosteroid with mycophenolate mofetil group (P = .01) compared to corticosteroids alone. Use of clopidogrel vs multiple agents had no effect on development of thromboses (P ≥ .36). CONCLUSIONS AND CLINICAL IMPORTANCE Addition of a second immunosuppressive agent did not alter immediate outcome measures but might be associated with a reduction in relapse. Use of multiple antithrombotic agents did not reduce incidence of thrombosis.
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Affiliation(s)
- Jennifer Weng
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan 48824, USA
| | - Nyssa A Levy
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan 48824, USA
| | - Haley Y Abbott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan 48824, USA
| | - Jose A Mix
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan 48824, USA
| | - Robert W Wills
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - Andrew J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - John M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - Harry Cridge
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan 48824, USA
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7
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De Laet N, Fina C, Dhumeaux M, Hrovat A. Diagnostic imaging findings in a referral population of dogs diagnosed with immune-mediated haemolytic anaemia: 50 cases (2015-2018). J Small Anim Pract 2022; 63:890-896. [PMID: 35986647 DOI: 10.1111/jsap.13542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/23/2022] [Accepted: 07/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe and characterise changes documented on thoracic and abdominal imaging of dogs with confirmed immune-mediated haemolytic anaemia. MATERIALS AND METHODS Medical records from a referral hospital were searched from 2015 to 2018 for all dogs diagnosed with immune-mediated haemolytic anaemia that underwent thoracic and abdominal imaging by radiography, ultrasound or computed tomography. RESULTS Fifty dogs were included. Thoracic imaging revealed abnormalities in 10 dogs (20%) of which lymphadenopathy and cardiomegaly were documented in four dogs (8%) each, and pleural effusion and pleural thickening in one dog (2%) each. Abdominal imaging revealed abnormalities in 43 dogs (86%), in which hepatomegaly and peritoneal effusion were documented in 20 (40%) and 19 dogs (38%), gallbladder wall thickening and sludge in 16 (32%) and 14 dogs (28%) and splenic nodules and splenomegaly in 13 (26%) and seven dogs (14%), respectively. Hepatic and splenic abnormalities were further investigated via fine needle aspirates in 18 dogs and revealed extramedullary haematopoiesis in 12 hepatic (66.7%) and 14 splenic (77.8%) fine needle aspirate samples. Cholecystocentesis was performed in nine dogs with gallbladder abnormalities and revealed bactibilia in three samples (33.3%). CLINICAL SIGNIFICANCE In this population of dogs with immune-mediated haemolytic anaemia, thoracic imaging abnormalities were uncommon. Hepatomegaly, peritoneal effusion and gallbladder wall thickening were the most common abdominal imaging findings with bactibilia confirmed in one third of collected bile samples. Hepatosplenomegaly and abdominal lymphadenopathy were not associated with neoplasia in any of the dogs included in this study.
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Affiliation(s)
- N De Laet
- Pride Veterinary Centre, Derby, DE24 8HX, UK
| | - C Fina
- Pride Veterinary Centre, Derby, DE24 8HX, UK
| | - M Dhumeaux
- Pride Veterinary Centre, Derby, DE24 8HX, UK
| | - A Hrovat
- Pride Veterinary Centre, Derby, DE24 8HX, UK
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8
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Bestwick JP, Skelly BJ, Swann JW, Glanemann B, Bexfield N, Gkoka Z, Walker DJ, Silvestrini P, Adamantos S, Seth M, Warland J. Splenectomy in the management of primary immune-mediated hemolytic anemia and primary immune-mediated thrombocytopenia in dogs. J Vet Intern Med 2022; 36:1267-1280. [PMID: 35801263 PMCID: PMC9308443 DOI: 10.1111/jvim.16469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background Current reports about the use of splenectomy for the management of immune‐mediated hemolytic anemia (IMHA) or immune‐mediated thrombocytopenia (ITP) or both in dogs are limited. Objectives To retrospectively describe the use of splenectomy as part of the management for IMHA, ITP, and concurrent IMHA and severe thrombocytopenia (CIST) in dogs. It was hypothesized that splenectomy would be beneficial in allowing for reduction of dose of immunosuppressive drugs or discontinuation in 1 or more of these groups. Animals Seventeen client‐owned dogs (7 with IMHA, 7 with ITP, and 3 with CIST) were identified across 7 UK‐based referral hospitals from a study period of 2005 to 2016. Methods Data were collected retrospectively via questionnaires and included information about diagnosis, management and treatment response before and after splenectomy. Based on clinical outcome, treatment with splenectomy as part of the management protocol was classified as either successful or unsuccessful. Results Six of 7 dogs with ITP were managed successfully with splenectomy as part of their management protocol (3 complete and 3 partial responses), although 1 subsequently developed suspected IMHA. Of the 7 dogs with IMHA, splenectomy was part of a successful management protocol in 4 dogs (2 complete and 2 partial responses). In the CIST group, 1 case (1/3) responded completely to management with splenectomy as part of the management protocol. Conclusions and Clinical Importance Splenectomy was considered successful and well tolerated in most cases of isolated ITP. Whether there is a benefit of splenectomy in cases of IMHA and CIST could not be determined in the current study.
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Affiliation(s)
- Jason P Bestwick
- Animal Health Trust, Newmarket, Suffolk, United Kingdom.,Department of Veterinary Medicine, Univeristy of Cambridge, Cambridge, United Kingdom
| | - Barbara J Skelly
- Queen's Veterinary School Hospital, University of Cambridge, Cambridge, United Kingdom
| | - James W Swann
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, United Kingdom.,Columbia Stem Cell Initiative, Columbia University, New York, New York, USA
| | - Barbara Glanemann
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, United Kingdom
| | - Nick Bexfield
- Queen's Veterinary School Hospital, University of Cambridge, Cambridge, United Kingdom.,Pride Veterinary Centre, Derbyshire, United Kingdom
| | - Zeta Gkoka
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - David J Walker
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - Paolo Silvestrini
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | - Sophie Adamantos
- Langford Vets/University of Bristol, Bristol, North Somerset, United Kingdom.,Paragon Veterinary Referrals, Wakefield, West Yorkshire, United Kingdom
| | - Mayank Seth
- Animal Health Trust, Newmarket, Suffolk, United Kingdom.,Dick White Referrals, Cambridge, United Kingdom
| | - James Warland
- Animal Health Trust, Newmarket, Suffolk, United Kingdom.,Southfields Veterinary Specialists, Part of Linnaeus Veterinary Limited, Laindon, Essex, United Kingdom.,Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, United Kingdom
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9
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Hall GBF, Stoye DQ, Thomas EK, Culshaw GJ. Retrospective evaluation of systemic hypertension in dogs with nonassociative (primary) immune-mediated hemolytic anemia (December 2016 to April 2019): 26 cases. J Vet Emerg Crit Care (San Antonio) 2022; 32:229-235. [PMID: 35080103 DOI: 10.1111/vec.13128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/27/2020] [Accepted: 06/03/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To report the prevalence of arterial hypertension in a population of dogs with nonassociative immune-mediated hemolytic anemia (IMHA) on presentation and during hospitalization. To determine the relationships of systolic blood pressure (SBP) with mortality and a prognostic indicator, the canine hemolytic anemia objective score. DESIGN Retrospective observational study (December 2016 to April 2019). SETTING University teaching hospital. ANIMALS Twenty-six clinical dogs presenting to the ICU with nonassociative (primary) IMHA and a control group of 23 clinical dogs with idiopathic epilepsy hospitalized in the ICU for seizure treatment or monitoring. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Hypertension was defined as SBP ≥ 160 mm Hg and severe hypertension as SBP ≥ 180 mm Hg. Mean SBP was significantly increased in IMHA dogs (161 mm Hg, SD = 21) compared to ICU control dogs (138 mm Hg, SD = 14; P < 0.005). Hypertension was present in 13 of 26 (50.0%) dogs across the period of hospitalization and was severe in three of 26 (11.5%). During at least 1 day of hospitalization, 18 of 26 (69.2%) dogs were hypertensive and eight of 26 (34.6%) were severely hypertensive. Hypertension was not associated with short-term mortality or canine hemolytic anemia objective score. CONCLUSIONS In this retrospective study, hypertension was more prevalent in dogs with nonassociative IMHA than a control population of ICU-hospitalized dogs. An association between autoimmune conditions and hypertension has been previously reported in people but not within a canine population. Hypertension in dogs may have an inflammatory or autoimmune etiology. SBP should be monitored closely in canine IMHA, in case antihypertensive treatment is required.
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Affiliation(s)
- Georgina B F Hall
- Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, UK
| | - David Q Stoye
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Geoff J Culshaw
- Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, UK
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Swann JW, Tayler S, Hall H, Sparrow R, Skelly BJ, Glanemann B. Cross-sectional study of approaches to diagnosis and management of dogs with immune-mediated haemolytic anaemia in primary care and referral veterinary practices in the United Kingdom. PLoS One 2021; 16:e0257700. [PMID: 34543364 PMCID: PMC8452064 DOI: 10.1371/journal.pone.0257700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine whether veterinarians in primary care practices (PCPs) and board-certified clinicians (BCCs) approach treatment of dogs with immune-mediated haemolytic anaemia (IMHA) similarly, and whether practitioners with more experience treat similarly to those with less experience. We hypothesised those in PCPs would show more variation in their approach to similar cases than BCCs. METHODS A cross-sectional study was conducted by distributing a questionnaire to BCCs and veterinarians in PCPs. The questionnaire included direct questions and a number of clinical scenarios intended to capture approaches to common treatment problems. RESULTS Questionnaire responses were received from 241 veterinarians, including 216 in PCPs and 25 BCCs. Veterinarians in both settings used similar tests for diagnosis of IMHA, but BCCs performed more tests to exclude underlying causes of 'associative' disease. All veterinarians reported use of similar initial dosages of glucocorticoids (median 2 mg/kg per day in both groups, p = 0.92) but those used by more experienced practitioners were higher than those with less experience. Most veterinarians made allowances for the weight of dogs, using lower prednisolone dosages in a clinical scenario involving a 40 kg dog compared to a 9 kg dog (p = 0.025 for PCP, p = 0.002 for BCC). BCCs reported greater use of combinations of immunosuppressive drugs (p<0.0001) and of antithrombotic drugs (p<0.0001); use of antithrombotic drugs was also less common among more experienced practitioners compared to less experienced. CONCLUSIONS Approaches to treatment of dogs with IMHA differ between BCCs and those in PCP. These differences may affect design and implementation of future research studies and clinical guidelines.
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Affiliation(s)
- James W. Swann
- Columbia Stem Cell Initiative, Columbia University, New York, NY, United States of America
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
| | - Sarah Tayler
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
| | - Harriet Hall
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Richard Sparrow
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
| | - Barbara J. Skelly
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Barbara Glanemann
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
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11
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Richter P, Fischer H, Dörfelt R. Immunoadsorption in a dog with severe immune mediated hemolytic anemia. J Clin Apher 2021; 36:668-672. [PMID: 34033686 DOI: 10.1002/jca.21913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/08/2021] [Accepted: 05/13/2021] [Indexed: 11/10/2022]
Abstract
Immune mediated hemolytic anemia (IMHA) is a life-threatening disease with severe, acute hemolysis as a result of an autoimmune response directed against erythrocyte surface antigens. In veterinary medicine, IMHA is usually treated with immunosuppressants and often multiple blood transfusions. In human medicine, immunoadsorption (IA) is an established therapy for antibody removal in immune-mediated diseases. A female, spayed, five-year-old, 28 kg Entlebucher Mountain dog was presented with regenerative anemia and positive autoagglutination diagnosed as immune-mediated hemolytic anemia to the veterinary emergency service. Conventional treatment consisting immunosuppression with prednisolone and mycophenolate failed to improve hemolysis. As hematocrit dropped daily, multiple blood transfusions of blood group DEA 1 negative were required. IA was initiated at day 3 with COM.TEC and ADAsorb platforms and a LIGASORBstaphylococcus antitoxin A column. IA with citrate anticoagulation was performed over the treatment time of 77 minutes with a blood flow of 50 mL/min. Total plasma volume of 1.6 L was processed. Complications consisted of vomitus and lid swelling, shivering, excessive clotting in the tubing after a calcium bolus and hypotension. After IA, hemolysis stopped immediately, plasma concentrations of immunoglobulin G, immunoglobulin M and bilirubin decreased, and hematocrit remained stable. The dog was discharged without further hemolysis 4 days after immunoadsorption with immunosuppressive therapy. IA is a promising adjunctive therapy in severe cases of canine IMHA, but it cannot be concluded to which degree IA or concurrent immunosuppression contributed to cessation of hemolysis in the present case.
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Affiliation(s)
- Petra Richter
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Hendryk Fischer
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - René Dörfelt
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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12
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Francey T, Etter M, Schweighauser A. Evaluation of membrane-based therapeutic plasma exchange as adjunctive treatment for immune-mediated hematologic disorders in dogs. J Vet Intern Med 2021; 35:925-935. [PMID: 33571376 PMCID: PMC7995402 DOI: 10.1111/jvim.16049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background Therapeutic plasma exchange (TPE) has been used increasingly to treat immunological diseases in dogs, although data concerning its efficacy are lacking. Hypothesis/Objectives To describe the clinic and the outcome of dogs with immune‐mediated hematological disorders (IMHD) treated with membrane filtration TPE. Animals One hundred forty‐six dogs diagnosed with IMHD, including 17 dogs treated with and 129 control dogs treated without TPE. Methods Retrospective study of cases selected with a search of all medical records for dogs diagnosed with IMHD (2010‐2019). Primary outcomes included the assessment of safety and efficacy of adjunctive TPE compared to medical treatment alone. Results The TPE group included 7 dogs with immune‐mediated hemolytic anemia (IMHA), 5 dogs with immune‐mediated thrombocytopenia (IMT), and 5 dogs with combined IMHA‐IMT; the control group included 63 dogs with IMHA, 47 dogs with IMT, and 19 dogs with IMHA‐IMT. Dogs treated with TPE were more often refractory to initial immunosuppression (71%) than controls (43%; P = .04). Complications were observed in 15/43 TPE treatments (35%). The response rate of dogs treated with TPE was 83% in IMHA (controls, 65%; P = .5) and 80% in IMT (controls, 70%; P = .71). Overall, 12/17 dogs (71%) treated with TPE reached complete remission, 2/17 (12%) partial remission, and 3/17 (18%) died or were euthanized. Eighty‐two percent of the dogs treated with TPE survived to discharge (controls, 69%; P = .4). Conclusions and Clinical Importance Despite a bias toward dogs refractory to initial immunosuppression, dogs treated with adjunctive TPE had a similar outcome as dogs treated medically.
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Affiliation(s)
- Thierry Francey
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Mathieu Etter
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland.,Small Animal Clinic Bolliger Tschuor AG, Oftringen-Zofingen, Switzerland
| | - Ariane Schweighauser
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
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13
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Woolhead VL, Szladovits B, Chan A, Swann JW, Glanemann B. Breed predispositions, clinical findings, and prognostic factors for death in dogs with nonregenerative immune-mediated anemia. J Vet Intern Med 2021; 35:252-260. [PMID: 33617109 PMCID: PMC7848385 DOI: 10.1111/jvim.15986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Breed predispositions, survival, and prognostic factors have not been evaluated in dogs with nonregenerative immune-mediated anemia (nrIMA). HYPOTHESIS/OBJECTIVES To describe clinicopathologic variables, evaluate their associations with survival, and determine breed predispositions for dogs with nrIMA. ANIMALS Fifty-nine client-owned dogs with nrIMA. METHODS Referral hospital records were reviewed retrospectively for dogs with primary nrIMA (PCV ≤30%, corrected reticulocyte percentage (CR%) ≤1.0, bone marrow sampling with evidence of immune-mediated destruction, and underlying causes excluded). Breed predispositions were evaluated by calculation of odds ratios in a case control study; prognostic factors by logistic regression in a cohort study. RESULTS Fifty-nine dogs with nrIMA had a median PCV of 12% (interquartile range [IQR]: 10%-17%) and CR% 0.1 (0%-0.2%). At least ≥1 ACVIM IMHA diagnostic criteria were met by 35 dogs (59%). Whippets, Lurchers, and miniature Dachshunds were predisposed to nrIMA. Median survival time was 277 days (IQR: 37-1925), with 3- and 12-month survival rates 61% and 43%, respectively. Erythroid regeneration and remission were achieved by 88% and 62% of dogs, respectively. Corrected reticulocyte percentage >0.2 was associated with improved survival. CONCLUSION AND CLINICAL IMPORTANCE Although there is overlap of clinical features between dogs with IMHA and nrIMA, the prognosis for those with nrIMA depends predominantly on the severity of reticulocytopenia.
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Affiliation(s)
- Vanessa L. Woolhead
- Eastcott ReferralsSwindonUK
- Department of Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
| | - Balazs Szladovits
- Department of Pathobiology and Population SciencesRoyal Veterinary CollegeLondonUK
| | | | - James W. Swann
- Department of Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
- Kennedy Institute of Rheumatology, University of OxfordOxfordUK
| | - Barbara Glanemann
- Department of Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
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14
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Cuq B, Blois SL, Bédard C, Wood RD, Abrams-Ogg AC, Beauchamp G, Wood GA. Serum interleukin 17 concentrations in dogs with immune-mediated hemolytic anemia. J Vet Intern Med 2020; 35:217-225. [PMID: 33219716 PMCID: PMC7848375 DOI: 10.1111/jvim.15977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Increased serum interleukin 17 (IL‐17) concentration has been associated with the immunopathogenesis of autoimmune hemolytic anemia in humans. No data are available about IL‐17 in immune‐mediated hemolytic anemia (IMHA) of dogs. Objectives Monitor changes in serum IL‐17 concentration during the acute stages of IMHA in dogs, compared with results in healthy dogs, and its relationship with outcome. Animals Thirty‐one client‐owned dogs with primary IMHA and 27 healthy dogs. Methods Quantification of serum IL‐17 concentration using a commercially available ELISA kit at the time of admission (D0), after 48 hours (D2) and after 96 hours (D4) as compared to concentration in healthy dogs. The IMHA dogs were classified as survivors if discharged from hospital, or nonsurvivors for any cause of in‐hospital mortality. Results Mean serum IL‐17 concentration was higher in dogs with IMHA on admission compared with healthy dogs (D0), but this difference was not significant (mean, 19.52 pg/mL vs 10.52 pg/mL, respectively, P = .17). Throughout hospitalization, serum IL‐17 concentration significantly decreased in survivors. Serum IL‐17 concentration at D0 was not different between survivors and nonsurvivors, but surviving dogs had significantly lower serum IL‐17 concentration at D2 and D4 (P = .04 and P = .004, respectively) compared with nonsurviving dogs. No correlation was found between serum IL‐17 concentration and serum total bilirubin or lactate concentrations or CBC parameters. Conclusion and Clinical Importance Serum IL‐17 concentration remained significantly higher in nonsurviving IMHA dogs whereas it significantly decreased during hospitalization in survivors, making serum IL‐17 concentration a potential biomarker for severity and response to treatment in IMHA.
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Affiliation(s)
- Benoît Cuq
- Small Animal Clinical Studies, University College Dublin School of Veterinary Medicine, Dublin, Ireland.,Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Christian Bédard
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, St Hyacinthe, Quebec, Canada
| | - R Darren Wood
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anthony C Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Guy Beauchamp
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, St Hyacinthe, Quebec, Canada
| | - Geoffrey A Wood
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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15
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Goggs R. Therapeutic Strategies for Treatment of Immune-Mediated Hemolytic Anemia. Vet Clin North Am Small Anim Pract 2020; 50:1327-1349. [PMID: 32814628 DOI: 10.1016/j.cvsm.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Immune-mediated hemolytic anemia is a common hematologic disorder in dogs. Disease management involves immunosuppression using glucocorticoids, potentially in combination with other medications such as azathioprine, cyclosporine, or mycophenolate mofetil. Therapeutic drug monitoring may enhance the utility and maximize the safety of cyclosporine and mycophenolate mofetil. The disease is proinflammatory and prothrombotic. Antithrombotic drug administration is therefore essential, and anticoagulant therapy should be initiated at the time of diagnosis. Additional therapies include red blood cell transfusion to support blood oxygen content. Future therapies may include therapeutic plasma exchange, anti-CD20 monoclonal antibodies, and complement inhibitors.
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Affiliation(s)
- Robert Goggs
- Emergency and Critical Care, Department of Clinical Sciences, Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY 14853, USA.
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16
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Weingart C, Thielemann D, Kohn B. Primary immune-mediated haemolytic anaemia: a retrospective long-term study in 61 dogs. Aust Vet J 2019; 97:483-489. [PMID: 31454853 DOI: 10.1111/avj.12875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this study is to describe the course of disease of dogs with primary immune-mediated haemolytic anaemia (pIMHA) with an observation period longer than 90 days in regard to clinical signs, laboratory results and treatment response. MATERIAL AND METHODS Clinical records between January 2003 and December 2011 were reviewed. Diagnosis of pIMHA was based on the presence of haemolytic anaemia with a packed cell volume of <0.35 L/L, a positive Coombs' test and/or erythrocyte agglutination, spherocytosis and exclusion of an underlying disease. Included were dogs which could be monitored for more than 90 days after initial presentation. RESULTS Sixty-one dogs with pIMHA were included. The initial packed cell volume ranged from 0.08 to 0.30 L/L (median 0.16). Immunosuppressive treatment included prednisolone in all the cases; 32 dogs successively received cyclosporine (28), cyclophosphamide (5), leflunomide (2) or human intravenous immunoglobulins (2) in addition. In 33/61 dogs, the drugs were discontinued 67-3372 days (median 334) after beginning of therapy; in 28 dogs, the drug dosage was reduced, but not discontinued until the end of the study. Three dogs developed immune-mediated thrombocytopenia (days 132, 156 and 680). The observation period ranged from 96 to 4147 days (median 628). A total of 22.9% (14/61) of the dogs developed a relapse after 94-3972 days (median 517). Five dogs were euthanased due to a relapse after 96-1188 days (median 628). CLINICAL SIGNIFICANCE Long-term prognosis in dogs with pIMHA is favourable. However, a relapse can occur after many years. Relapse was the most common cause of death in dogs with pIMHA that survive more than 90 days.
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Affiliation(s)
- C Weingart
- Freie Universität Berlin, Faculty of Veterinary Medicine, Clinic for Small Animals, Berlin, Germany
| | - D Thielemann
- Freie Universität Berlin, Faculty of Veterinary Medicine, Clinic for Small Animals, Berlin, Germany
| | - B Kohn
- Freie Universität Berlin, Faculty of Veterinary Medicine, Clinic for Small Animals, Berlin, Germany
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17
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Swann JW, Szladovits B, Threlfall AJ, Garden OA, Chang YM, Church DB, Glanemann B. Randomised controlled trial of fractionated and unfractionated prednisolone regimens for dogs with immune-mediated haemolytic anaemia. Vet Rec 2019; 184:771. [PMID: 31048502 DOI: 10.1136/vr.105104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 02/11/2019] [Accepted: 03/14/2019] [Indexed: 02/06/2023]
Abstract
METHODS A randomised non-blinded non-inferiority trial was conducted to determine whether treatment with an unfractionated regimen of oral prednisolone was inferior to a fractionated regimen for dogs with primary immune-mediated haemolytic anaemia. Dogs received the same total daily dose of prednisolone as unfractionated (group 1, starting at 4 mg/kg orally once daily) or fractionated (group 2, starting at 2 mg/kg orally twice daily) doses. Questionnaires were administered to owners to assess adverse effects and quality of life (QoL). End points included survival to eight weeks, and changes in QoL and clinicopathological parameters over time. RESULTS Thirty-nine dogs were enrolled in the study, of which 5 were withdrawn and 17 were assigned to each group. The number of cases recruited was insufficient to determine whether unfractionated treatment was inferior to fractionated. Total serum bilirubin decreased more rapidly in dogs in group 2, whereas polydipsia improved more rapidly in group 1. Blood pressure and score for polyuria were higher in dogs in group 2 over time, whereas lymphocyte concentration was lower. CONCLUSION Administration of the same total daily dose of prednisolone as an unfractionated dose resulted in fewer adverse effects but the effect on survival could not be assessed in this study.
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Affiliation(s)
- James W Swann
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Balazs Szladovits
- Pathology and Pathogen Biology, Royal Veterinary College, Hatfield, UK
| | - Anna J Threlfall
- Small Animal Internal Medicine, Davies Veterinary Specialists, Higham Gobion, UK
| | - Oliver A Garden
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yu-Mei Chang
- Research Support Office, Royal Veterinary College, London, UK
| | - David B Church
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, UK
| | - Barbara Glanemann
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, UK
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18
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Swann JW, Garden OA, Fellman CL, Glanemann B, Goggs R, LeVine DN, Mackin AJ, Whitley NT. ACVIM consensus statement on the treatment of immune-mediated hemolytic anemia in dogs. J Vet Intern Med 2019; 33:1141-1172. [PMID: 30847984 PMCID: PMC6524099 DOI: 10.1111/jvim.15463] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 01/07/2023] Open
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.
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Affiliation(s)
- James W Swann
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Oliver A Garden
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Claire L Fellman
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Barbara Glanemann
- Royal Veterinary College, University of London, London, United Kingdom
| | - Robert Goggs
- College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Dana N LeVine
- College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Andrew J Mackin
- College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Nathaniel T Whitley
- Davies Veterinary Specialists, Manor Farm Business Park, Huntingdon, United Kingdom
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19
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Garden OA, Kidd L, Mexas AM, Chang YM, Jeffery U, Blois SL, Fogle JE, MacNeill AL, Lubas G, Birkenheuer A, Buoncompagni S, Dandrieux JRS, Di Loria A, Fellman CL, Glanemann B, Goggs R, Granick JL, LeVine DN, Sharp CR, Smith-Carr S, Swann JW, Szladovits B. ACVIM consensus statement on the diagnosis of immune-mediated hemolytic anemia in dogs and cats. J Vet Intern Med 2019; 33:313-334. [PMID: 30806491 PMCID: PMC6430921 DOI: 10.1111/jvim.15441] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/18/2019] [Indexed: 12/21/2022] Open
Abstract
Immune-mediated hemolytic anemia (IMHA) is an important cause of morbidity and mortality in dogs. IMHA also occurs in cats, although less commonly. IMHA is considered secondary when it can be attributed to an underlying disease, and as primary (idiopathic) if no cause is found. Eliminating diseases that cause IMHA may attenuate or stop immune-mediated erythrocyte destruction, and adverse consequences of long-term immunosuppressive treatment can be avoided. Infections, cancer, drugs, vaccines, and inflammatory processes may be underlying causes of IMHA. Evidence for these comorbidities has not been systematically evaluated, rendering evidence-based decisions difficult. We identified and extracted data from studies published in the veterinary literature and developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria for IMHA, comorbidities, and causality. Succinct evidence summary statements were written, along with screening recommendations. Statements were refined by conducting 3 iterations of Delphi review with panel and task force members. Commentary was solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted. The resulting document is intended to provide clinical guidelines for diagnosis of, and underlying disease screening for, IMHA in dogs and cats. These should be implemented with consideration of animal, owner, and geographical factors.
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Affiliation(s)
- Oliver A Garden
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Linda Kidd
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California
| | - Angela M Mexas
- College of Veterinary Medicine, Midwestern University, Downers Grove, Illinois
| | - Yu-Mei Chang
- Royal Veterinary College, University of London, London, United Kingdom
| | - Unity Jeffery
- College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Shauna L Blois
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Jonathan E Fogle
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Amy L MacNeill
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - George Lubas
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Adam Birkenheuer
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Simona Buoncompagni
- Internal Medicine Service, Central Oklahoma Veterinary Specialists, Oklahoma City, Oklahoma
| | - Julien R S Dandrieux
- Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Melbourne, Australia
| | - Antonio Di Loria
- Department of Veterinary Medicine and Animal Production, University of Napoli Federico II, Napoli, Italy
| | - Claire L Fellman
- Cummings School of Veterinary Medicine, Tufts University, Massachusetts
| | - Barbara Glanemann
- Royal Veterinary College, University of London, London, United Kingdom
| | - Robert Goggs
- College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Jennifer L Granick
- College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota
| | - Dana N LeVine
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Claire R Sharp
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | | | - James W Swann
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Balazs Szladovits
- Royal Veterinary College, University of London, London, United Kingdom
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20
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Cuq B, Blois SL, Mathews KA. Anti-thymocyte serum as part of an immunosuppressive regimen in treating haematological immune-mediated diseases in dogs. J Small Anim Pract 2017; 58:348-354. [PMID: 28369956 DOI: 10.1111/jsap.12666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report the outcomes associated with the use of rabbit anti-dog thymocyte serum in dogs with haematological immune-mediated diseases. METHODS Medical records from 2000 to 2016 of patients diagnosed with immune-mediated haemolytic anaemia, immune-mediated thrombocytopenia, pancytopenia and myelofibrosis were reviewed. All dogs had a severe or refractory disease and received rabbit anti-dog thymocyte serum. Lymphocyte counts were used to monitor the immediate anti-thymocyte effect of therapy; long-term patient outcome was recorded. RESULTS A total of 10 dogs were included. All dogs except one had a notable decrease in their lymphocyte count after rabbit anti-dog thymocyte serum; four of nine had a decrease to less than 10% of the initial lymphocyte count and one dog reached 10·8%. All dogs were discharged from the hospital following their treatment. The dog with no alteration of lymphocyte count following therapy with rabbit anti-dog thymocyte serum had refractory immune mediated haemolytic anemia and was euthanised within two weeks. All other cases achieved clinical remission with immunosuppressive therapy eventually being tapered (3 of 10) or discontinued (6 of 10). CLINICAL SIGNIFICANCE Rabbit anti-dog thymocyte serum therapy might be of interest as an adjunctive therapy in refractory immune-mediated diseases and suppressed lymphocyte counts in most dogs.
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Affiliation(s)
- B Cuq
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - S L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - K A Mathews
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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21
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Prognostic factors and efficacy of human intravenous immunoglobulin G in dogs with idiopathic immune-mediated hemolytic anemia: a retrospective study. ACTA ACUST UNITED AC 2016. [DOI: 10.14405/kjvr.2016.56.3.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Swann JW, Skelly BJ. Canine autoimmune hemolytic anemia: management challenges. VETERINARY MEDICINE-RESEARCH AND REPORTS 2016; 7:101-112. [PMID: 30050843 PMCID: PMC6055891 DOI: 10.2147/vmrr.s81869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Immune-mediated hemolytic anemia is one of the most common manifestations of canine immune-mediated disease, yet treatment regimens remain nonstandardized and, in some cases, controversial. The main reason for this, as for most diseases in veterinary medicine, is the lack of large-scale placebo-controlled trials so that the efficacy of one treatment over another can be established. Most of the evidence used for treatment comes from retrospective studies and from personal preference and experience, and because of this, treatment regimens tend to vary among institutions and individual clinicians. Management of immune-mediated hemolytic anemia includes immunosuppression, thromboprophylaxis, and supportive care measures to help prevent and treat concurrent conditions.
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Affiliation(s)
- James W Swann
- Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, Hertfordshire
| | - Barbara J Skelly
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK,
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Morassi A, Bianco D, Park E, Nakamura RK, White GA. Evaluation of the safety and tolerability of rivaroxaban in dogs with presumed primary immune-mediated hemolytic anemia. J Vet Emerg Crit Care (San Antonio) 2016; 26:488-94. [PMID: 27074368 DOI: 10.1111/vec.12480] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 11/16/2014] [Accepted: 11/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the safety and tolerability of rivaroxaban (RIV), an oral direct factor Xa inhibitory drug, in dogs with presumed primary immune-mediated hemolytic anemia (pIMHA). DESIGN Prospective, multicenter, positive-controlled, unblinded clinical trial. Client-owned dogs were enrolled between October 2012 and March 2014. SETTING Private referral centers. ANIMALS Twenty-four client-owned dogs with pIMHA. Enrolled dogs were randomized in 2 treatment groups to receive by mouth RIV or clopidogrel (CL) and low-dose aspirin (LDA). All dogs were monitored for 90 days from the enrollment in the study. INTERVENTIONS Enrolled dogs were given a standardized immunosuppressive protocol and RIV or CL and LDA. MEASUREMENTS AND MAIN RESULTS There was no identifiable adverse drug reaction, evidence of hemorrhage, significant prolongation of prothrombin time or activated partial thromboplastin time, or increase in transfusion requirements associated with RIV therapy compared to CL and LDA in dogs with pIMHA. There was no significant difference between treatment groups with respect to thrombotic events, survival rates to discharge, at 1 month and 3 months from diagnosis. CONCLUSIONS This study suggests that RIV at a median dose of 0.89 mg/kg by mouth once daily was safe and well tolerated in a small group of dogs with presumed pIMHA able to tolerate oral medications and treated with a standardized immunosuppressive treatment protocol. Conclusions regarding the relative efficacy of RIV as compared to CL and LDA cannot be made due to the small size of the treatment groups and because pharmacodynamic effects were not assessed.
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Affiliation(s)
- Alice Morassi
- Internal Medicine Department, College of Veterinary Medicine, Washington State University, Pullman, WA, 99165
| | - Domenico Bianco
- Internal Medicine Department, Advanced Critical Care Emergency and Specialty Services, Woodland Hills, CA, 91364
| | - Ed Park
- Emergency and Critical Care Department, Fresno Veterinary Specialty and Emergency Center, Fresno, CA, 93719
| | - Reid K Nakamura
- Cardiology Department, Southern California Veterinary Specialty Hospital, Irvine, CA, 92614
| | - George A White
- Emergency and Critical Care Department, Fresno Veterinary Specialty and Emergency Center, Fresno, CA, 93719
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Swann JW, Garden OA. Novel immunotherapies for immune-mediated haemolytic anaemia in dogs and people. Vet J 2016; 207:13-9. [DOI: 10.1016/j.tvjl.2015.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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25
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Goggs R, Dennis SG, Di Bella A, Humm KR, McLauchlan G, Mooney C, Ridyard A, Tappin S, Walker D, Warman S, Whitley NT, Brodbelt DC, Chan DL. Predicting Outcome in dogs with Primary Immune-Mediated Hemolytic Anemia: Results of a Multicenter Case Registry. J Vet Intern Med 2015; 29:1603-10. [PMID: 26473338 PMCID: PMC4864895 DOI: 10.1111/jvim.13642] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/18/2015] [Accepted: 09/09/2015] [Indexed: 12/13/2022] Open
Abstract
Background Outcome prediction in dogs with immune‐mediated hemolytic anemia (IMHA) is challenging and few prognostic indicators have been consistently identified. Objectives An online case registry was initiated to: prospectively survey canine IMHA presentation and management in the British Isles; evaluate 2 previously reported illness severity scores, Canine Hemolytic Anemia Score (CHAOS) and Tokyo and to identify independent prognostic markers. Animals Data from 276 dogs with primary IMHA across 10 referral centers were collected between 2008 and 2012. Methods Outcome prediction by previously reported illness‐severity scores was tested using univariate logistic regression. Independent predictors of death in hospital or by 30‐days after admission were identified using multivariable logistic regression. Results Purebreds represented 89.1% dogs (n = 246). Immunosuppressive medications were administered to 88.4% dogs (n = 244), 76.1% (n = 210) received antithrombotics and 74.3% (n = 205) received packed red blood cells. Seventy‐four per cent of dogs (n = 205) were discharged from hospital and 67.7% (n = 187) were alive 30‐days after admission. Two dogs were lost to follow‐up at 30‐days. In univariate analyses CHAOS was associated with death in hospital and death within 30‐days. Tokyo score was not associated with either outcome measure. A model containing SIRS‐classification, ASA classification, ALT, bilirubin, urea and creatinine predicting outcome at discharge was accurate in 82% of cases. ASA classification, bilirubin, urea and creatinine were independently associated with death in hospital or by 30‐days. Conclusions and clinical importance Markers of kidney function, bilirubin concentration and ASA classification are independently associated with outcome in dogs with IMHA. Validation of this score in an unrelated population is now warranted.
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Affiliation(s)
- R Goggs
- School of Physiology and Pharmacology, University of Bristol, Bristol, UK
| | - S G Dennis
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Di Bella
- Vets Now Referrals Kent, Blue Bell Hill, UK
| | - K R Humm
- Department of Clinical Sciences and Services, RVC, North Mymms, UK
| | | | - C Mooney
- University College Dublin, Dublin, Ireland
| | - A Ridyard
- University of Edinburgh, Edinburgh, UK
| | - S Tappin
- Dick White Referrals, Six Mile Bottom, UK
| | - D Walker
- Anderson Moores Veterinary Specialists, Winchester, UK
| | - S Warman
- Companion Animal Studies, University of Bristol, Langford, UK
| | - N T Whitley
- Davies Veterinary Specialists, Higham Gobion, UK
| | - D C Brodbelt
- Production and Population Health, Royal Veterinary College, North Mymms, UK
| | - D L Chan
- Department of Clinical Sciences and Services, RVC, North Mymms, UK
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Ong HM, Witham A, Kelers K, Boller M. Presumed secondary immune-mediated haemolytic anaemia following elapid snake envenomation and its treatment in four dogs. Aust Vet J 2015; 93:319-26. [DOI: 10.1111/avj.12359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/05/2015] [Accepted: 02/09/2015] [Indexed: 01/10/2023]
Affiliation(s)
- HM Ong
- UVet Werribee Animal Hospital, University of Melbourne; 250 Princes Highway Werribee VIC 3030 Australia
| | - A Witham
- UVet Werribee Animal Hospital, University of Melbourne; 250 Princes Highway Werribee VIC 3030 Australia
| | - K Kelers
- UVet Werribee Animal Hospital, University of Melbourne; 250 Princes Highway Werribee VIC 3030 Australia
| | - M Boller
- UVet Werribee Animal Hospital, University of Melbourne; 250 Princes Highway Werribee VIC 3030 Australia
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27
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Panek CM, Nakamura RK, Bianco D. Use of enoxaparin in dogs with primary immune-mediated hemolytic anemia: 21 cases. J Vet Emerg Crit Care (San Antonio) 2015; 25:273-7. [DOI: 10.1111/vec.12286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 11/29/2014] [Indexed: 11/28/2022]
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Swann JW, Skelly BJ. Systematic review of prognostic factors for mortality in dogs with immune-mediated hemolytic anemia. J Vet Intern Med 2015; 29:7-13. [PMID: 25586014 PMCID: PMC4858088 DOI: 10.1111/jvim.12514] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/07/2014] [Accepted: 10/28/2014] [Indexed: 12/31/2022] Open
Abstract
Background Treatment of dogs with primary immune‐mediated hemolytic anemia (IMHA) is difficult and frequently unrewarding. Prognostic factors have been evaluated in a number of previous studies, and identification of such factors would be beneficial to enable selection of appropriate therapeutic regimens and supportive care. Objectives The aim of the current study was to undertake a critical appraisal of the risk of bias in evidence relating to prognostic indicators for mortality in dogs with IMHA. Animals Three hundred and eighty client‐owned dogs with spontaneous primary idiopathic IMHA reported in 6 previous studies. Methods A systematic review was conducted to evaluate evidence relating to prognostic factors for mortality in dogs with primary IMHA. Search tools were employed to identify articles and a validated appraisal tool was used to assess the quality of individual studies by considering inclusion and exclusion criteria, measurement of prognostic, outcome and confounding variables, and statistical methods. Results Few studies evaluated prognostic indicators for IMHA in dogs, and all of these suffered from methodologic flaws in at least 1 major area. Fifteen different variables were identified as prognostic indicators, with 2 variables identified by >1 study. Conclusions and Clinical Importance There are few pieces of high‐quality evidence available to enable estimation of prognosis for dogs presenting with primary IMHA.
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Affiliation(s)
- J W Swann
- Royal Veterinary College, University of London, London, UK
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29
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Yau VK, Bianco D. Treatment of five haemodynamically stable dogs with immune-mediated thrombocytopenia using mycophenolate mofetil as single agent. J Small Anim Pract 2014; 55:330-3. [DOI: 10.1111/jsap.12203] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2014] [Indexed: 12/16/2022]
Affiliation(s)
- V. K. Yau
- Pasadena Veterinary Specialists, Small Animal Internal Medicine; South Pasadena CA 91030 USA
| | - D. Bianco
- Advanced Critical Care, Emergency and Specialty Services; Internal Medicine Department; Woodland Hills CA 91364 USA
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Wang A, Smith JR, Creevy KE. Treatment of canine idiopathic immune-mediated haemolytic anaemia with mycophenolate mofetil and glucocorticoids: 30 cases (2007 to 2011). J Small Anim Pract 2013; 54:399-404. [DOI: 10.1111/jsap.12107] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- A. Wang
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; University of Georgia; Athens GA
| | - J. R. Smith
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; University of Georgia; Athens GA
| | - K. E. Creevy
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; University of Georgia; Athens GA
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31
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Swann J, Skelly B. Systematic Review of Evidence Relating to the Treatment of Immune-Mediated Hemolytic Anemia in Dogs. J Vet Intern Med 2012; 27:1-9. [DOI: 10.1111/jvim.12028] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 08/31/2012] [Accepted: 10/30/2012] [Indexed: 01/11/2023] Open
Affiliation(s)
- J.W. Swann
- Department of Veterinary Medicine; University of Cambridge; Cambridge UK
| | - B.J. Skelly
- Department of Veterinary Medicine; University of Cambridge; Cambridge UK
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