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Zoia A, Busato F, Drigo M. Retrospective evaluation of the short-term response of human intravenous immunoglobulin therapy in the management of canine immune-mediated thrombocytopenia (2010-2015): 27 cases. J Vet Emerg Crit Care (San Antonio) 2024. [PMID: 39037266 DOI: 10.1111/vec.13408] [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: 01/22/2022] [Revised: 05/05/2023] [Accepted: 06/25/2023] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To describe the short-term response, early prognostic markers, and survival after treatment of canine immune-mediated thrombocytopenia (ITP) with human intravenous immunoglobulin (hIVIG) and methylprednisolone. DESIGN Retrospective cohort study. SETTINGS Private referral veterinary medical center. ANIMALS Twenty-seven client-owned dogs with primary or secondary ITP. INTERVENTIONS All dogs received 2 mg/kg IV methylprednisolone once daily and a single infusion of 5% hIVIG administered over 6-12 hours. MEASUREMENTS AND MAIN RESULTS A substantial increase in platelet count within 60 ± 12 hours post-hIVIG infusion (T60) was observed in 19 of the 27 (70%) dogs with ITP (responders). Thirty-four variables, including serum immunoglobulin (Ig) G concentration 24 ± 12 hours post-hIVIG infusion (T24IgG) and increase in serum IgG concentration 24 ± 12 hours post-hIVIG infusion (T24ΔIgG), were compared between responders and nonresponders at 5 different time points. Mortality rates of responders and nonresponders were evaluated 14 days post-hIVIG infusion. Serum T24IgG and serum T24ΔIgG were both significantly higher at T60 in responders. All responders were alive 14 days post-hIVIG infusion, and their mortality rate was significantly lower compared with nonresponders. CONCLUSIONS Responder dogs had an excellent 14-day survival rate. Serum T24IgG and serum T24ΔIgG concentrations accurately predicted response status at 60 hours post-hIVIG infusion.
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Affiliation(s)
- Andrea Zoia
- Division of Internal Medicine, San Marco Veterinary Clinic, Veggiano, Italy
| | - Francesca Busato
- Division of Internal Medicine, San Marco Veterinary Clinic, Veggiano, Italy
| | - Michele Drigo
- Department of Medicina Animale, Produzione e Salute, Padua University, Legnaro, Italy
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LeVine DN, Goggs R, Kohn B, Mackin AJ, Kidd L, Garden OA, Brooks MB, Eldermire ERB, Abrams‐Ogg A, Appleman EH, Archer TM, Bianco D, Blois SL, Brainard BM, Callan MB, Fellman CL, Haines JM, Hale AS, Huang AA, Lucy JM, O'Marra SK, Rozanski EA, Thomason JM, Walton JE, Wilson HE. ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats. J Vet Intern Med 2024; 38:1982-2007. [PMID: 38779941 PMCID: PMC11256181 DOI: 10.1111/jvim.17079] [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: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence-based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell-containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence-based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non-PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.
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Affiliation(s)
- Dana N. LeVine
- Department of Clinical Sciences, College of Veterinary MedicineAuburn UniversityAuburnAlabamaUSA
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Barbara Kohn
- Small Animal Clinic, School of Veterinary MedicineFreie Universität BerlinBerlinGermany
| | - Andrew J. Mackin
- Department of Clinical Sciences, College of Veterinary MedicineMississippi State UniversityMississippi StateMississippiUSA
| | - Linda Kidd
- Linda Kidd Veterinary Internal Medicine ConsultingCarlsbadCaliforniaUSA
| | - Oliver A. Garden
- School of Veterinary MedicineLouisiana State UniversityBaton RougeLouisianaUSA
| | - Marjory B. Brooks
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Erin R. B. Eldermire
- Flower‐Sprecher Veterinary Library, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Anthony Abrams‐Ogg
- Department of Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | | | | | - Domenico Bianco
- College of Veterinary MedicineWestern University of Health SciencesPomonaCaliforniaUSA
| | - Shauna L. Blois
- Department of Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Benjamin M. Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary MedicineUniversity of GeorgiaAthensGeorgiaUSA
| | - Mary Beth Callan
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Claire L. Fellman
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Jillian M. Haines
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineWashington State UniversityPullmanWashingtonUSA
| | | | | | | | - Shana K. O'Marra
- Northwest Veterinary Critical Care ServicesVancouverWashingtonUSA
| | - Elizabeth A. Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - John M. Thomason
- Department of Clinical Sciences, College of Veterinary MedicineMississippi State UniversityMississippi StateMississippiUSA
| | - Jenny E. Walton
- Veterinary Apheresis Service UKWashingtonTyne and WearUnited Kingdom
| | - Helen E. Wilson
- Langford VetsUniversity of BristolLangfordSomersetUnited Kingdom
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3
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Ryu M, Kim J, An J, Seo K, Oh Y, Youn H. Romiplostim for treatment of thrombocytopenia in dogs: A retrospective assessment and clinical outcomes. J Vet Intern Med 2024; 38:2158-2164. [PMID: 39023218 PMCID: PMC11256157 DOI: 10.1111/jvim.17131] [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: 08/07/2023] [Accepted: 05/31/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Romiplostim, a thrombopoietin analog, is commonly used to treat immune-mediated thrombocytopenia (ITP) in humans, but its use in dogs remains limited. OBJECTIVES Evaluate the effects and adverse events of romiplostim administration in dogs with thrombocytopenia caused by various underlying diseases. ANIMALS Forty-two client-owned dogs with naturally occurring thrombocytopenia at 2 referral animal hospitals. METHODS Retrospective, multi-institutional analysis to evaluate the outcomes of romiplostim treatment in dogs. RESULTS Among the dogs treated with romiplostim, 27 experienced an increase in platelet count and 26 maintained a platelet count within the reference range. Platelet count improvement was observed in various conditions: primary ITP (90%, n = 18/20), pancytopenia of unknown etiology (42.9%, n = 3/7), chemotherapy-induced thrombocytopenia (50%, n = 3/6), babesiosis (100%, n = 1/1), radiotherapy-induced thrombocytopenia (0%, n = 0/1), and disseminated intravascular coagulopathy (33.3%, n = 2/6). The median time for platelet recovery (>50 000/μL) after romiplostim administration was 4 days, and the median time for platelet count normalization was 7 days. Median hospitalization time for the improvement group (I) was 5 days. The survival-to-discharge rates were 85%, 40%, and 28.6% for dogs with primary ITP, secondary thrombocytopenia, and thrombocytopenia of unknown etiology, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE Romiplostim is a well-tolerated and promising treatment for primary ITP in dogs, suggesting its potential as a valuable therapeutic option for dogs with thrombocytopenia caused by various underlying conditions. These findings emphasize the need for further research to optimize romiplostim dosing and understand its role in treating secondary thrombocytopenia and pancytopenia of unknown etiology.
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Affiliation(s)
- Min‐Ok Ryu
- Laboratory of Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Science and Research Institute for Veterinary ScienceSeoul National UniversitySeoul 08826Republic of Korea
| | - Jin‐Kyung Kim
- Haemaru Companion Animal Medical FoundationSeongnamRepublic of Korea
| | - Ju‐Hyun An
- Department of Veterinary Emergency and Critical Care Medicine and Institute of Veterinary Science, College of Veterinary MedicineKangwon National UniversityChuncheon‐siRepublic of Korea
| | - Kyoung‐Won Seo
- Laboratory of Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Science and Research Institute for Veterinary ScienceSeoul National UniversitySeoul 08826Republic of Korea
| | - Ye‐In Oh
- Department of Veterinary Internal Medicine, College of Veterinary Medicine & Institute for Veterinary Biomedical ScienceKyungpook National University, Daehakro 80DaeguRepublic of Korea
| | - Hwa‐Young Youn
- Laboratory of Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Science and Research Institute for Veterinary ScienceSeoul National UniversitySeoul 08826Republic of Korea
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Stikeman E, Bianco D. Use of human intravenous immunoglobulin for the treatment of 12 dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia. J Small Anim Pract 2024; 65:338-345. [PMID: 38239177 DOI: 10.1111/jsap.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To evaluate the safety and efficacy of human intravenous immunoglobulin in dogs with newly diagnosed malignancy and presumed secondary immune-mediated thrombocytopenia. MATERIALS AND METHODS Twelve client-owned dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia were prospectively enrolled to receive a single infusion of human intravenous immunoglobulin at a dose of 0.5 to 1 mg/kg intravenous over 8 hours. A complete treatment response was defined as a platelet estimation of ≥40,000 platelets/μL within 24 hours and a partial response within 48 hours from the completion of human intravenous immunoglobulin infusion. No treatment response was defined as a platelet estimation remaining <40,000 platelets/μL over 48 hours from the completion of the human intravenous immunoglobulin infusion. This pilot study had a prospective, open-label, uncontrolled design. RESULTS Out of the 12 enrolled dogs, seven completed the study. A complete treatment response to human intravenous immunoglobulin was identified in one lymphoma dog and a partial response was noted in another lymphoma dog. The remaining 10 dogs had no response to human intravenous immunoglobulin. No clinically relevant adverse reactions to human intravenous immunoglobulin occurred in any of the 12 initially enrolled dogs during the infusion and over a 3-month follow-up period for the seven surviving dogs. CLINICAL SIGNIFICANCE The results of this study suggest that the use of human intravenous immunoglobulin in dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia appears safe, but not effective for the treatment of thrombocytopenia. Larger multi-centre, prospective, double-blinded, placebo-controlled, outcome-based, malignancy-specific studies are needed to further evaluate these preliminary findings.
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Affiliation(s)
- E Stikeman
- Internal Medicine Department, Metropolitan Animal Specialty Hospital, 6565 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
| | - D Bianco
- Internal Medicine Department, Metropolitan Animal Specialty Hospital, 6565 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
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5
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Williams M, Shropshire S, Chornarm N, Brewer M, Hawley J, Khorsand M, Lappin M. Effects of canine influenza infection and DA2PP vaccination on the development of platelet-associated immunoglobulins and platelet counts in dogs. Vet Clin Pathol 2024; 53:47-56. [PMID: 38433107 DOI: 10.1111/vcp.13333] [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: 01/16/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is commonly associated with platelet-associated immunoglobulins (PAIg). Demonstration of PAIg can help determine etiologies for thrombocytopenia. In humans, ITP and thrombocytopenia have been associated with various vaccinations and influenza infections, respectively. OBJECTIVES We aimed to evaluate platelet counts and PAIg in research dogs with H3N2 and in research and client-owned dogs routinely vaccinated for distemper, adenovirus-2, parainfluenza, and parvovirus (DA2PP). The hypotheses were that H3N2 infection but not DA2PP vaccination would decrease platelet counts, and neither would result in the detection of PAIg. METHODS Three pilot studies. Platelet counts and PAIg, measured by direct flow cytometry as %IgG, were evaluated in eight research Beagles following experimental infection with H3N2 (experiment 1), nine research Beagles vaccinated for DA2PP (experiment 2), and thirty client-owned dogs vaccinated for DA2PP (experiment 3). All animals were considered healthy at the start of the experiments. RESULTS Transient, self-resolving decreases in platelet counts and increases in %IgG occurred following H3N2 infection, and one dog became thrombocytopenic and positive for PAIg. Following DA2PP vaccination, %IgG increased in research and client-owned dogs, but only one dog was considered positive for PAIg with a concurrent increase in platelet count. Mean PAIg increased from baseline in client-owned dogs following vaccination. CONCLUSIONS Transient PAIg and thrombocytopenia can occur following H3N2 infection, while routine vaccination for DA2PP in this group of dogs was not associated with the development of thrombocytopenia or clinically relevant formation of PAIg.
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Affiliation(s)
- Maggie Williams
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Sarah Shropshire
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Nida Chornarm
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Melissa Brewer
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Jennifer Hawley
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Matthew Khorsand
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Michael Lappin
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
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6
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Sparrow R, Swann JW, Glanemann B. Comparison of timing of relapse in dogs with nonassociative immune-mediated hemolytic anemia, thrombocytopenia, or polyarthritis. J Vet Intern Med 2024; 38:1035-1042. [PMID: 38308396 PMCID: PMC10937512 DOI: 10.1111/jvim.17004] [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: 05/29/2023] [Accepted: 01/22/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Relapse is a clinical concern in dogs diagnosed with immune-mediated hemolytic anemia (IMHA), thrombocytopenia (ITP), or polyarthritis (IMPA). The average time to relapse is unknown, and evidence that vaccination is associated with disease relapse is lacking. HYPOTHESIS/OBJECTIVES Compare the incidence of relapse in groups of dogs with IMHA, ITP, or IMPA over a 24-month period after diagnosis and compare proportions of dogs that received vaccines in those dogs that did and did not relapse. ANIMALS One hundred sixty client-owned dogs (73 with IMHA, 55 with ITP, 32 with IMPA). METHODS Medical records of dogs were reviewed with the goal of following cases for a minimum of 2 years. Incidence of relapse was calculated for each disease, and relapse rates in dogs that were or were not vaccinated after diagnosis were compared. RESULTS Relapse rates at 12 months differed significantly among disease groups (P = .02), with a higher rate for IMPA (35%) compared to IMHA (11%) or ITP (11%). Relapse rate at 24 months was 41% for IMPA, 18% for IMHA, and 23% for ITP. Ninety percent of IMPA relapses occurred in the first 12 months after diagnosis, compared with 56% for IMHA and 50% for ITP. Vaccine administration after diagnosis was not associated with relapse (P = .78). CONCLUSIONS AND CLINICAL IMPORTANCE Risk of disease relapse in IMPA is highest in the first year after diagnosis, with a higher relapse rate compared with IMHA and ITP. The role of vaccination in disease relapse remains unclear.
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Affiliation(s)
- Richard Sparrow
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - James W. Swann
- Columbia Stem Cell InitiativeColumbia UniversityNew YorkNew YorkUSA
| | - Barbara Glanemann
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
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7
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Saint-Pierre LM, Farrell KS, Hopper K, Reagan KL. Retrospective evaluation of fresh platelet concentrate administration in dogs: Patient characteristics, outcomes, and transfusion practices in 189 transfusion episodes (2008-2019). J Vet Emerg Crit Care (San Antonio) 2023; 33:360-370. [PMID: 36799875 DOI: 10.1111/vec.13281] [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: 02/14/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To describe patient characteristics, underlying disease processes, clinical outcomes, transfusion dose and type (therapeutic or prophylactic), platelet count changes, and adverse events associated with platelet concentrate (PC) administration in dogs. DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS A total of 149 dogs, representing 189 PC transfusion episodes. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In this population, 39 of 149 dogs (26.2%) were diagnosed with primary immune-mediated thrombocytopenia, 22 of 149 (14.8%) had decreased bone marrow production, 12 of 149 (8.0%) received PC during a massive transfusion, 3 of 149 (2.0%) had congenital thrombocytopathia, 59 of 149 (39.6%) had severe thrombocytopenia of other causes, and 14 of 149 (9.4%) underwent transfusion for miscellaneous causes without a documented severe thrombocytopenia. In 117 of 149 dogs (78.5%), >1 site of hemorrhage was noted. The most common sites of hemorrhage were the gastrointestinal (GI) tract in 89 of 149 (59.7%) and the skin in 78 of 149 (52.3%). Overall survival to discharge was 59.1% (88/149). The median PC dose was 0.8 units per 10 kg of body weight per transfusion episode (range: 0.2-6.7). Of 189 episodes, 29 of 189 (15.7%) were prophylactic, and 158 of 189 (83.6%) were therapeutic. For 99 of 189 transfusion episodes, paired pre- and postplatelet counts were available within 24 hours. The median platelet count change was 5.0 × 109 /L (5000/μL; range: -115 × 109 /L to 158 × 109 /L [-115,000 to 158,000/μL]); the posttransfusion platelet count was significantly higher than pretransfusion (P < 0.0001). The increase in platelet count after transfusion was greater in the prophylactic group than the therapeutic group (P = 0.0167). Transfusion reactions were suspected during 2 of 168 episodes (1.2%). CONCLUSIONS Immune-mediated thrombocytopenia was the most common disease process that resulted in PC transfusion. PC was more frequently administered to animals with active hemorrhage rather than prophylactically, and most dogs had evidence of hemorrhage in multiple organ systems, particularly the GI tract and skin. PC transfusions typically appeared safe, and the median platelet count increased after transfusion.
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Affiliation(s)
- Laurence M Saint-Pierre
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, California, USA
| | - Kate S Farrell
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Krystle L Reagan
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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Robertson AL, Black VL, Villedieu E, Clarke KE, Faux I, Major A, Adamantos S. Presenting signs and clinical outcome in dogs with metaphyseal osteopathy: 39 cases (2009-2018). J Small Anim Pract 2023; 64:35-42. [PMID: 36123814 PMCID: PMC10087536 DOI: 10.1111/jsap.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To describe the presenting signs, concurrent conditions, treatment and outcome of dogs with metaphyseal osteopathy. MATERIALS AND METHODS Multi-centre retrospective review of medical records from January 2009 to September 2018 at four referral centres to identify dogs with a radiographic diagnosis of metaphyseal osteopathy. RESULTS Thirty-nine dogs were identified. The median age at onset was 14 weeks old (range, 8 to 32 weeks old). There was a higher proportion of male dogs (29 of 39 male entire, nine of 39 female entire, one of 39 female neutered and no male neutered dogs). Where information was available, median time from the most recent vaccination was 20 days (range, 2 to 144 days). The most commonly recorded clinical signs were pyrexia (34 of 39), lethargy (32 of 39), pain (30 of 39), and being non-ambulatory (17 of 39). Thirty-five dogs required hospitalisation for analgesia and supportive care, 19 of 39 were discharged on prednisolone (median dose 2.0 mg/kg/day; range, 0.9 to 2.6 mg/kg/day), 18 of 39 were discharged on non-steroidal anti-inflammatories, two of 39 did not receive NSAIDs or prednisolone at any time point. The median duration of hospitalisation for those admitted was 5 days (range, 1 to 21 days). Where follow-up was available, relapse occurred in eight of 25 cases before reaching skeletal maturity. At the time of metaphyseal osteopathy diagnosis, five of 39 cases had concurrent conditions. Where follow-up was available, four of 25 developed future immune-mediated conditions. CLINICAL SIGNIFICANCE Metaphyseal osteopathy should be considered in non-ambulatory painful young dogs. Some dogs developed future immune-mediated conditions, which may support the hypothesis that metaphyseal osteopathy is an autoinflammatory bone disorder. Further studies with a larger cohort are required to determine the clinical significance of this.
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Affiliation(s)
- A L Robertson
- Bristol Veterinary School, University of Bristol, Bristol, BS8 1TH, UK.,The Ralph Veterinary Referral Centre, The Ralph Veterinary Referral Centre, Marlow, SL7 1YG, UK
| | - V L Black
- Bristol Veterinary School, University of Bristol, Bristol, BS8 1TH, UK
| | - E Villedieu
- Willows Veterinary Centre and Referral Service, Willows Veterinary Centre and Referral Service, Shirley, B90 4NH, UK
| | - K E Clarke
- Davies Veterinary Specialists, Davies Veterinary Specialists, Shillington, SG5 3HR, UK
| | - I Faux
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, EH25 9RG, UK
| | - A Major
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford, BS40 5DU, UK
| | - S Adamantos
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford, BS40 5DU, UK
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Kristiansen PS, Nielsen LN. Immunomodulatory and immunosuppressive drug protocols in the treatment of canine primary immune thrombocytopenia, a scoping review. Acta Vet Scand 2021; 63:54. [PMID: 34961516 PMCID: PMC8721564 DOI: 10.1186/s13028-021-00620-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022] Open
Abstract
Primary immune thrombocytopenia (ITP) is a cause of severe thrombocytopenia in dogs. Immunosuppressive corticosteroid drugs are frequently used in the management of ITP, but treatment failure may occur. Immunomodulatory and non-corticosteroid immunosuppressive drugs might improve outcomes from therapy either alone or in combination with corticosteroids. The objectives of this scoping review were (1) to evaluate the current evidence relating to immunomodulatory and immunosuppressive drug protocols in the treatment of canine ITP, and (2) to answer the clinical question, whether or not therapy with immunomodulatory or non-corticosteroid immunosuppressive drugs alone or in combination with corticosteroids could improve outcome, compared to therapy with corticosteroids alone. A literature search was performed in the electronic databases of Agricola, CAB Abstracts, Embase, Medline and Web of Science for publications in November 2019 and again February 1, 2021. Selection criteria were relatively strict and included peer-reviewed research papers reporting outcome measures from immunomodulatory and immunosuppressive drug protocols in the treatment of canine ITP with a pre-therapeutic mean or median platelet count < 50,000/µL as a strict criterion for inclusion. Studies were evaluated if they had an appropriate diagnostic work up to exclude underlying conditions. Outcome measures and adverse events were compared between drug protocols both within studies and between studies. The search identified 456 studies, with six studies being eligible for inclusion. The studies were mostly case series while two were randomized controlled trials. Level of evidence varied with an overall uncertain subject enrollment, small groups, inadequate description and variable use of drug protocols or outcome measures. For outcomes such as platelet recovery time and duration of hospitalization, an improvement was observed using adjunctive therapy (human intravenous immunoglobulin) compared to therapy with corticosteroids alone. For outcomes of complete platelet recovery time, survival (6-month), mortality and relapse, no improvement was observed using adjunctive drugs compared to corticosteroids alone. Specifically, therapy with mycophenolate mofetil alone and adjunctive azathioprine were associated with more severe adverse events compared to other drug protocols. Evidence relating to immunomodulatory and immunosuppressive drug protocols in the treatment of canine ITP was of variable quality. Future larger case-controlled trials are required for determination of optimal treatment protocols in canine ITP.
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Affiliation(s)
| | - Lise Nikolic Nielsen
- Department of Clinical Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, 1870 Frederiksberg C, Denmark
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Bergmann M, Freisl M, Hartmann K. [Prevention of canine parvovirosis - Part 3: Vaccine-associated adverse events]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2021; 49:294-299. [PMID: 34425608 DOI: 10.1055/a-1543-4632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although nowadays vaccines, especially those against canine parvovirus (CPV), are considered to be safe, vaccine-associated adverse events (VAAEs) can occur in rare cases. Some VAAEs are mild and manifest shortly (within a few days) after vaccination (e. g. gastrointestinal signs, fever, reduced general condition, lymphadenopathy). These signs are likely a result of vaccine virus replication and indicate a good immune response. Anaphylactic reactions can also occur promptly following vaccine administration and might be life threatening. Affected dogs show clinical signs such as edema, salivation, vomiting, diarrhea, hypotension, and/or shock. Since it is often unclear which component of the vaccine carries responsibility for the anaphylactic reaction it is important to limit future vaccinations of these dogs to indispensable components only. When revaccination is unavoidable, e. g. because antibodies against CPV cannot be detected, combined vaccines should not be used and CPV (and other components, if needed) should preferably be vaccinated separately. Changing the vaccine manufacturer might also prevent further anaphylactic reactions. Finally, there are VAAEs occurring after a prolonged period of time. In dogs, it is discussed that autoimmune diseases, such as immune-mediated hemolytic anemia (IMHA), can be a consequence of excessive vaccination or in the least be triggered by vaccination. Numerous dogs with IMHA are reported to have a history of receiving a vaccination within a few weeks before the onset of clinical sings. In such dogs, further vaccinations should generally be avoided.
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Affiliation(s)
- Michèle Bergmann
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
| | - Monika Freisl
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
| | - Katrin Hartmann
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
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Polydoros T, Ioannidi OM, Korsavvidis I, Stefanidis S, Antoniadis T, Mylonakis ME. Romiplostim as Adjunctive Treatment of Refractory Amegakaryocytic Immune Thrombocytopenia in a Dog. Top Companion Anim Med 2020; 42:100488. [PMID: 33115689 DOI: 10.1016/j.tcam.2020.100488] [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: 05/06/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
A 9-year-old, intact male, mixed-breed dog was admitted with a 3-day history of severe thrombocytopenia and bleeding diathesis. Physical examination revealed mucosal and cutaneous petechiae and ecchymoses, melena, and gross hematuria. Clinicopathologic evaluation indicated severe thrombocytopenia, anemia, and panhypoproteinemia. Serology for common endemic vector-borne pathogens was negative and thoracic and abdominal imaging was unremarkable. Bone marrow aspiration cytology revealed aplasia of the megakaryocytic lineage, in the context of a mildly hypoplastic myeloid and a normal erythroid series. A diagnosis of presumptive primary amegakaryocytic immune thrombocytopenia (ITP) was established. Treatment with vincristine, prednisolone, and mycophenolate mofetil along with several whole blood transfusions failed to achieve clinical and clinicopathologic remission. As an adjunct treatment, romiplostim was administered at a cumulative dose of 15 μg/kg, subcutaneously, in 2 sessions, 1 week apart, and complete clinical and hematological remission was noted 8 days postinitiation of romiplostim. Thirty-eight months later, the dog remains clinically healthy with no evidence of hematological relapse. Romiplostim could be a promising adjunctive treatment option in dogs with refractory ITP.
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Affiliation(s)
- Thomas Polydoros
- Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Olympia M Ioannidi
- Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Theocharis Antoniadis
- Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mathios E Mylonakis
- Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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12
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LeVine DN, Brooks MB. Immune thrombocytopenia (ITP): Pathophysiology update and diagnostic dilemmas. Vet Clin Pathol 2019; 48 Suppl 1:17-28. [PMID: 31538353 DOI: 10.1111/vcp.12774] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/28/2019] [Accepted: 05/20/2019] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenia (ITP) is a common autoimmune bleeding disorder. The understanding of ITP pathogenesis is rapidly evolving. We now recognize ITP as a complex and heterogeneous syndrome that results from a combination of humoral and cell-mediated attacks on platelets peripherally and megakaryocytes in the bone marrow. Autoantibody-mediated ITP also varies in the pathway used to clear platelets, which depends on the platelet glycoprotein being targeted. Moreover, ITP patients present with variable bleeding severities and treatment responses that do not closely correlate with platelet count. A gold standard diagnostic test for ITP is lacking, and biomarkers to assess disease severity are in their infancy. This review provides an update on the immunopathogenesis of ITP and summarizes currently available tests for ITP diagnosis, prediction of disease severity, and treatment responses. Given the heterogeneous pathogenesis and clinical presentation of ITP, we highlight the need for the development of diagnostic and prognostic tests that would allow for the individualized management of a complex disease.
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Affiliation(s)
- Dana N LeVine
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Marjory B Brooks
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
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13
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Moon A, Veir J. Vaccination and Associated Adverse Events in Dogs Previously Treated for Primary Immune-Mediated Hemolytic Anemia. J Am Anim Hosp Assoc 2018; 55:29-34. [PMID: 30427712 DOI: 10.5326/jaaha-ms-6868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study described the rate of vaccine reactions in a population of dogs receiving vaccines after diagnosis of primary immune-mediated hemolytic anemia (IMHA). A secondary objective was to describe the time elapsed between vaccination and initial diagnosis of IMHA. A medical record search identified cases meeting criteria for primary IMHA. Owners and referring veterinarians were surveyed regarding vaccination of the dog following diagnosis. Referring veterinarians were surveyed regarding vaccination prior to diagnosis of IMHA. A completed survey was returned in 44 cases. Twenty-two dogs received vaccinations after diagnosis, and 22 dogs did not. The median time elapsed between vaccination and initial diagnosis was 280 days. No dog was vaccinated within 30 days of diagnosis. Two of the following possible reactions were noted out of 22 dogs vaccinated: vomiting and urticarial eruption in a dog administered a rabies and canine distemper vaccine, and recurrent anemia in a dog administered a rabies vaccine. The rate of vaccine reactions was higher than previously reported, although the time period evaluated was longer than in previous studies. The relationship between initial vaccination and development of IMHA, and between vaccination and vaccine reaction, in this population is uncertain and may reflect coincidence or differences in susceptibility.
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Affiliation(s)
- Alaina Moon
- From the Department of Small Animal Internal Medicine, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon (A.M.); and Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado (J.V.)
| | - Julia Veir
- From the Department of Small Animal Internal Medicine, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon (A.M.); and Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado (J.V.)
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14
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Makielski KM, Brooks MB, Wang C, Cullen JN, O'Connor AM, LeVine DN. Development and implementation of a novel immune thrombocytopenia bleeding score for dogs. J Vet Intern Med 2018; 32:1041-1050. [PMID: 29681130 PMCID: PMC5980571 DOI: 10.1111/jvim.15089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/05/2018] [Accepted: 01/31/2018] [Indexed: 01/19/2023] Open
Abstract
Background A method of quantifying clinical bleeding in dogs with immune thrombocytopenia (ITP) is needed because ITP patients have variable bleeding tendencies that inconsistently correlate with platelet count. A scoring system will facilitate patient comparisons and allow stratification based on bleeding severity in clinical trials. Hypothesis/Objectives To develop and evaluate a bleeding assessment tool for dogs, and a training course for improving its consistent implementation. Animals Client‐owned dogs (n = 61) with platelet counts <50,000/μL; 34 classified as primary ITP, 17 as secondary ITP, and 10 as non‐ITP. Methods A novel bleeding assessment tool, DOGiBAT, comprising bleeding grades from 0 (none) to 2 (severe) at 9 anatomic sites, was developed. Clinicians and technicians completed a training course and quiz before scoring thrombocytopenic patients. The training course was assessed by randomizing student volunteers to take the quiz with or without prior training. A logistic regression model assessed the association between training and quiz performance. The correlation of DOGiBAT score with platelet count and outcome measures was assessed in the thrombocytopenic dogs. Results Clinicians and technicians consistently applied the DOGiBAT, correctly scoring all quiz cases. The odds of trained students answering correctly were higher than those of untrained students (P < .0001). In clinical cases, DOGiBAT score and platelet count were inversely correlated (rs = −0.527, P < .0001), and DOGiBAT directly correlated with transfusion requirements (rs = 0.512, P < .0001) and hospitalization duration (rs = 0.35, P = .006). Conclusions and Clinical Importance The DOGiBAT and assessment quiz are simple tools to standardize evaluation of bleeding severity. With further validation, the DOGiBAT may provide a clinically relevant metric to characterize ITP severity and monitor response in treatment trials.
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Affiliation(s)
- Kelly M Makielski
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Marjory B Brooks
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York
| | - Chong Wang
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa.,Department of Statistics, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Jonah N Cullen
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Annette M O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Dana N LeVine
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
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15
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Jeffery U. Urban environment: a risk factor for canine immune-mediated disease? J Small Anim Pract 2017; 58:639-644. [PMID: 28833203 DOI: 10.1111/jsap.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/05/2017] [Accepted: 05/16/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate whether dogs living in urban areas are more likely to develop immune-mediated disease than those in rural areas. MATERIALS AND METHODS A case-control study comparing the prevalence of urban home location between dogs with immune-mediated disease and matched controls. Dogs diagnosed with immune-mediated haemolytic anaemia, immune-mediated thrombocytopenia, immune-mediated polyarthritis or meningoencephalomyelitis of unknown origin were identified by case record searches. Breed-matched dogs presenting to the same hospital during the same year as cases were randomly selected as controls. Home locations were classified as rural or urban using the population density of the relevant census tract and conditional logistic regression was used to examine association between home location and immune-mediated disease. RESULTS In the 137 cases and 137 breed-matched controls, the odds ratio for any immune-mediated disease for dogs living in urban (versus rural) areas was 0·94 (95% confidence interval 0·58 to 1·55, P=0·80). Odds ratios for development of immune-mediated haematological diseases, immune-mediated polyarthritis or meningoencephalomyelitis of unknown origin were also not significantly different from the null value. Multivariable analysis including age, gender and season of presentation did not suggest confounding of effect of home location by these additional variables. CLINICAL SIGNIFICANCE This study does not support an association between urban environment and immune-mediated disease in dogs.
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Affiliation(s)
- U Jeffery
- Veterinary Microbiology and Preventative Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
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16
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Cummings FO, Rizzo SA. Treatment of presumptive primary immune-mediated thrombocytopenia with mycophenolate mofetil versus cyclosporine in dogs. J Small Anim Pract 2017; 58:96-102. [DOI: 10.1111/jsap.12621] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- F. O. Cummings
- Practice Limited to Internal Medicine; Louisville Kentucky 40223 USA
| | - S. A. Rizzo
- Practice Limited to Internal Medicine; Louisville Kentucky 40223 USA
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17
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Cooper SA, Huang AA, Raskin RE, Weng HY, Scott-Moncrieff JC. Clinical data, clinicopathologic findings and outcome in dogs with amegakaryocytic thrombocytopenia and primary immune-mediated thrombocytopenia. J Small Anim Pract 2016; 57:142-7. [PMID: 26799165 DOI: 10.1111/jsap.12441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 11/29/2022]
Affiliation(s)
- S. A. Cooper
- Department of Veterinary Clinical Sciences; Purdue University College of Veterinary Medicine; West Lafayette IN 47907 USA
| | - A. A. Huang
- Department of Veterinary Clinical Sciences; Purdue University College of Veterinary Medicine; West Lafayette IN 47907 USA
| | - R. E. Raskin
- Department of Comparative Pathobiology; Purdue University College of Veterinary Medicine; West Lafayette IN 47907 USA
| | - H.-Y. Weng
- Department of Comparative Pathobiology; Purdue University College of Veterinary Medicine; West Lafayette IN 47907 USA
| | - J. C. Scott-Moncrieff
- Department of Veterinary Clinical Sciences; Purdue University College of Veterinary Medicine; West Lafayette IN 47907 USA
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18
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Friedenberg SG, Buhrman G, Chdid L, Olby NJ, Olivry T, Guillaumin J, O'Toole T, Goggs R, Kennedy LJ, Rose RB, Meurs KM. Evaluation of a DLA-79 allele associated with multiple immune-mediated diseases in dogs. Immunogenetics 2015; 68:205-17. [PMID: 26711123 DOI: 10.1007/s00251-015-0894-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/18/2015] [Indexed: 11/30/2022]
Abstract
Immune-mediated diseases are common and life-threatening disorders in dogs. Many canine immune-mediated diseases have strong breed predispositions and are believed to be inherited. However, the genetic mutations that cause these diseases are mostly unknown. As many immune-mediated diseases in humans share polymorphisms among a common set of genes, we conducted a candidate gene study of 15 of these genes across four immune-mediated diseases (immune-mediated hemolytic anemia, immune-mediated thrombocytopenia, immune-mediated polyarthritis (IMPA), and atopic dermatitis) in 195 affected and 206 unaffected dogs to assess whether causative or predictive polymorphisms might exist in similar genes in dogs. We demonstrate a strong association (Fisher's exact p = 0.0004 for allelic association, p = 0.0035 for genotypic association) between two polymorphic positions (10 bp apart) in exon 2 of one allele in DLA-79, DLA-79*001:02, and multiple immune-mediated diseases. The frequency of this allele was significantly higher in dogs with immune-mediated disease than in control dogs (0.21 vs. 0.12) and ranged from 0.28 in dogs with IMPA to 0.15 in dogs with atopic dermatitis. This allele has two non-synonymous substitutions (compared with the reference allele, DLA-79*001:01), resulting in F33L and N37D amino acid changes. These mutations occur in the peptide-binding pocket of the protein, and based upon our computational modeling studies, are likely to affect critical interactions with the peptide N-terminus. Further studies are warranted to confirm these findings more broadly and to determine the specific mechanism by which the identified variants alter canine immune system function.
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Affiliation(s)
- Steven G Friedenberg
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607, USA. .,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, 27607, USA.
| | - Greg Buhrman
- Department of Molecular and Structural Biochemistry, North Carolina State University, Raleigh, NC, 27695, USA
| | - Lhoucine Chdid
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, 27607, USA
| | - Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, 27607, USA
| | - Julien Guillaumin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Theresa O'Toole
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, 01536, USA
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
| | - Lorna J Kennedy
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK, M13 9PT
| | - Robert B Rose
- Department of Molecular and Structural Biochemistry, North Carolina State University, Raleigh, NC, 27695, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, 27607, USA
| | - Kathryn M Meurs
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, 27607, USA
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19
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Warland J, Skelly B, Knudsen C, Herrtage M. Apparent resolution of canine primary hypoparathyroidism with immunosuppressive treatment. J Vet Intern Med 2015; 29:400-4. [PMID: 25619526 PMCID: PMC4858098 DOI: 10.1111/jvim.12535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/22/2014] [Accepted: 12/02/2014] [Indexed: 01/01/2023] Open
Affiliation(s)
- J Warland
- Department of Veterinary Medicine, Queen's Veterinary School Hospital, University of Cambridge, Cambridge, UK
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20
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Bachman DE, Forman MA, Hostutler RA, Corn S, Lin J, Kociba GJ. Prospective diagnostic accuracy evaluation and clinical utilization of a modified assay for platelet-associated immunoglobulin in thrombocytopenic and nonthrombocytopenic dogs. Vet Clin Pathol 2015; 44:355-68. [PMID: 26302235 DOI: 10.1111/vcp.12281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND No diagnostic tests reliably distinguish primary immune-mediated thrombocytopenia (pIMT) from other causes of thrombocytopenia. OBJECTIVES The purpose of the study was to evaluate diagnostic sensitivity and specificity using modified direct and indirect platelet-associated immunoglobulin (PAIg) assays and reticulated platelets (RP) by flow cytometry for the classification of thrombocytopenic dogs and differentiating pIMT. METHODS Platelets were isolated from plasma samples of thrombocytopenic dogs and nonthrombocytopenic healthy and ill dogs. For direct PAIg, they were analyzed by flow cytometry after incubation with anti-human amylase fluorescein isothiocyanate (FITC, negative control), anti-canine IgG-FITC, anti-canine IgM-FITC, and anti-human CD61-conjugated fluorochrome (AF647). For indirect PAIg, platelets from normothrombocytic dogs were incubated with thrombocytopenic dog plasma and analyzed similar to direct PAIg. RP percentages were determined based on forward light scatter vs thiazole orange fluorescence. RESULTS Seventy-five thrombocytopenic dogs, 16 nonthrombocytopenic ill dogs, and 24 healthy dogs were evaluated. Diagnostic sensitivity and specificity utilizing direct IgG was 29.4% and 75.9%, respectively; when combining direct/indirect assays (IgG/IgM), it was 76.5% and 65.5%, respectively, for distinguishing pIMT. For RP, no significant difference between pIMT and sIMT was noted. RP > 8% with positive PAIg had a sensitivity of 94% and specificity of 27.6% for distinguishing pIMT. There was a significant difference in platelet concentration and CD61% staining between control and pIMT. CONCLUSIONS The combined modified assays resulted in fair diagnostic sensitivity and specificity for the diagnosis of pIMT. The modification of the immunoglobulin assays improved diagnostic accuracy; however, a single panel to accurately classify thrombocytopenia remains elusive.
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Affiliation(s)
- Dawn E Bachman
- MedVet, Medical and Cancer Center for Pets, Worthington, OH, USA
| | - Marnin A Forman
- MedVet, Medical and Cancer Center for Pets, Worthington, OH, USA
| | | | | | | | - Gary J Kociba
- IDEXX Reference Laboratories Inc., Worthington, OH, USA
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21
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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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22
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Nakamura RK, Fenty RK, Bianco D. Presumptive immune-mediated thrombocytopenia secondary to massive Africanized bee envenomation in a dog. J Vet Emerg Crit Care (San Antonio) 2013; 23:652-6. [DOI: 10.1111/vec.12120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 10/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Reid K. Nakamura
- Advanced Veterinary Care Center; 15926 Hawthorne Blvd Lawndale CA 90260
| | - Renee K. Fenty
- Internal Medicine Department; Veterinary Specialists of the Valley; Woodland Hills, 22123 Ventura Boulevard CA 91364
| | - Domenico Bianco
- Internal Medicine Department; Veterinary Specialists of the Valley; Woodland Hills, 22123 Ventura Boulevard CA 91364
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23
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Balog K, Huang AA, Sum SO, Moore GE, Thompson C, Scott-Moncrieff JC. A prospective randomized clinical trial of vincristine versus human intravenous immunoglobulin for acute adjunctive management of presumptive primary immune-mediated thrombocytopenia in dogs. J Vet Intern Med 2013; 27:536-41. [PMID: 23527952 DOI: 10.1111/jvim.12066] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 11/29/2012] [Accepted: 02/04/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dogs with immune-mediated thrombocytopenia (ITP) are at risk of hemorrhage when platelet count is <50,000/μL. Treatment with vincristine (VINC) or human intravenous immunoglobulin (hIVIG) decreases platelet recovery time compared with treatment with corticosteroids alone. OBJECTIVES To compare the effect of hIVIG versus VINC on platelet recovery in dogs with ITP. METHODS Prospective, randomized study. Twenty dogs with idiopathic ITP (platelet count <16,000/μL) were enrolled. All dogs were treated with corticosteroids. Dogs were randomly assigned to receive a single dose of hIVIG (0.5 g/kg) or VINC (0.02 mg/kg). Outcome measures were platelet recovery time, duration of hospitalization, and survival to discharge. RESULTS There was no significant difference in age, sex, weight, or initial platelet count between dogs treated with hIVIG (n = 10) and dogs treated with VINC (n = 10). Median platelet recovery time for both groups was 2.5 days (P = .51). Median hospitalization time for all dogs that survived to discharge was 4 days and not different between groups (P = .29). Seven of 10 dogs in the hIVIG group and 10 of 10 in the VINC group survived to discharge. Survival analysis did not identify any significant difference between the groups at discharge, 6 months, and 1 year after entry into the study. No adverse effects were reported in either group. CONCLUSIONS AND CLINICAL IMPORTANCE Vincristine should be the first-line adjunctive treatment for the acute management of canine ITP because of lower cost and ease of administration compared with human intravenous immunoglobulin (hIVIG).
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Affiliation(s)
- K Balog
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
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