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

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

SUBMITTER: Swann JW

PROVIDER: S-EPMC6524099 | biostudies-literature |

REPOSITORIES: biostudies-literature

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ACVIM consensus statement on the diagnosis of immune-mediated hemolytic anemia in dogs and cats.

Project description: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.

| S-EPMC6430921 | biostudies-literature

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| S-EPMC6524396 | biostudies-literature

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| S-EPMC4913615 | biostudies-literature

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ACVIM consensus statement on pancreatitis in cats.

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| S-EPMC7995362 | biostudies-literature

Neutrophil Extracellular Traps in Plasma from Dogs with Immune-mediated Hemolytic Anemia.

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| S-EPMC5787156 | biostudies-literature

Cell-Free DNA and DNase Activity in Dogs with Immune-Mediated Hemolytic Anemia.

Project description:BackgroundImmune-mediated hemolytic anemia (IMHA) in dogs has a high risk of thrombosis and is associated with marked neutrophilia and necrosis. Cell death and release of neutrophil extracellular traps contribute to increased serum concentrations of cell-free DNA, and in human autoimmune disease reduced DNase activity further increases cell-free DNA. Free DNA in blood has prothrombotic properties and could contribute to hypercoagulability in IMHA.HypothesisCell-free DNA is elevated and DNase activity reduced in dogs with IMHA compared to healthy dogs.AnimalsDogs presenting to two referral hospitals with IMHA (n = 28) and healthy controls (n = 20).MethodsProspective observational study. Blood was collected and death and thrombotic events occurring in the first 14 days after hospitalization recorded. DNA was extracted from plasma with a commercial kit and quantified by PicoGreen fluorescence. DNase activity of serum was measured by radial diffusion assay.ResultsCell-free DNA was significantly higher in cases (median: 45 ng/mL, range: 10-2334 ng/mL) than controls (26 ng/mL, range 1-151 ng/mL, P = 0.0084). DNase activity was not different between cases and controls (P = 0.36). Four cases died and there were five suspected or confirmed thrombotic events. Cell-free DNA concentration was associated with death (odds ratio for upper quartile versus lower 3 quartiles: 15; 95% confidence interval 1.62-201; P = 0.03) but not thrombosis (P = 0.57).Conclusions and clinical importanceCell-free DNA is elevated in dogs with IMHA and likely reflects increased release rather than impaired degradation of DNA. Cell-free DNA concentration is potentially associated with death and might be a prognostic indicator, but this requires confirmation in a larger population.

| S-EPMC5598899 | biostudies-literature

Splenectomy in the management of primary immune-mediated hemolytic anemia and primary immune-mediated thrombocytopenia in dogs.

Project description:BackgroundCurrent 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.ObjectivesTo 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.AnimalsSeventeen 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.MethodsData 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.ResultsSix 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 importanceSplenectomy 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.

| S-EPMC9308443 | biostudies-literature

Systematic review of prognostic factors for mortality in dogs with immune-mediated hemolytic anemia.

Project description:BackgroundTreatment 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.ObjectivesThe 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.AnimalsThree hundred and eighty client-owned dogs with spontaneous primary idiopathic IMHA reported in 6 previous studies.MethodsA 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.ResultsFew 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 importanceThere are few pieces of high-quality evidence available to enable estimation of prognosis for dogs presenting with primary IMHA.

| S-EPMC4858088 | biostudies-literature

Predicting Outcome in dogs with Primary Immune-Mediated Hemolytic Anemia: Results of a Multicenter Case Registry.

Project description:BackgroundOutcome prediction in dogs with immune-mediated hemolytic anemia (IMHA) is challenging and few prognostic indicators have been consistently identified.ObjectivesAn 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.AnimalsData from 276 dogs with primary IMHA across 10 referral centers were collected between 2008 and 2012.MethodsOutcome 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.ResultsPurebreds 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 importanceMarkers 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.

| S-EPMC4864895 | biostudies-literature

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