Immune-mediated hemolytic anemia (IMHA) is a common autoimmune disorder in dogs. It affects both sexes but occurs more often in female, middle-aged animals. IMHA can be idiopathic (primary) or secondary to infectious, neoplastic and autoimmune disorders. There is an acute regenerative anemia with accompanying hypoxia. Destruction of erythrocytes can be intravascular (as a result of complement system activation) or extravascular (removal of antibody-coated red blood cells by the macrophages in the liver and spleen). Diagnosis is based on the presence of anemia, in vitro autoagglutination, positive direct antiglobulin test (Coomb`s test), detection of spherocytes. It is crucial to exclude possible secondary causes. The treatment protocol aims to cease cell destruction by high doses of corticosteroids, aggressive supportive care and long-term application of immunosuppressive drug combinations. Still lethality is high because of complications (pulmonary thromboembolism, DIC), medication resistance, relapses.
Al-Ghazlat S. (2009). Immunosuppressive Therapy for Canine Immune-Mediated Hemolytic Anemia. Compend Contin Educ Vet. 2009 Jan;31(1):33–41, 44; quiz 44.
Barcellini W. (2015). New Insights in the Pathogenesis of Autoimmune Hemolytic Anemia. Transfus Med Hemother. Sep; 42(5):287–93. doi: 10.1159/000439002. Epub 2015 Sep 7.
Barker R., Elson C. (1995). Red blood cell glycophorins as B and T-cell antigens in canine autoimmune haemolytic anaemia. Vet Immunol Immunopathol. Aug;47(3–4):225–38.
Barker R., Gruffydd-Jones T., Stokes C., Elson C. (1991). Identification of autoantigens in canine autoimmune hemolytic anemia. Clin Exp Immunol; 85:33–40
Burgess K., Moore A., Rand W., Cotter S. (2000). Treatment of Immune-Mediated Hemolytic Anemia in Dogs with Cyclophosphamide. J Vet Intern Med; 14:456–462
Carr A., Panciera D., Kidd L. (2002). Prognostic factors for mortality and thromboembolism in canine immune-mediated hemolytic anemia: a retrospective study of 72 dogs. J Vet Intern Med; 16:504–506
Day M. (1996). Serial monitoring of clinical, haematological and immunological parameters in canine autoimmune haemolytic anaemia. J Small Anim Pract. Nov; 37(11):523–34
Day M. (1999). Antigen specificity in canine autoimmune haemolytic anaemia. Vet Immunol Immunopathol. Aug 2;69(2–4):215–24.
Duval D., Giger U. (1996). Vaccine-associated immune mediated hemolytic anemia in the dog. J Vet Intern Med; 10:290–295.
Goggs R, Boag A, Chan D. (2008). Concurrent immune-mediated hemolytic anemia and severe thrombocytopenia in 21 dogs. Vet Rec; 163:323–327
Goggs R., Dennis S., Di Bella A., Humm K., McLauchlan G., Mooney C., Ridyard A., Tappin S., Walker D., Warman S., Whitley N., Brodbelt D., Chan D. (2015). Predicting Outcome in dogs with Primary Immune-Mediated Hemolytic Anemia: Results of a Multicenter Case Registry. J Vet Intern Med. Nov–Dec; 29(6):1603–10. doi: 10.1111/jvim.13642. Epub 2015 Oct 16
Grundy S., Barton C. (2001). Influence of drug treatment on survival of dogs with immune-mediated hemolytic anemia: 88 cases (1989–1999). J Am Vet Med Assoc. Feb 15; 218(4):543–6.
Horgan J., Roberts B., Schermerhorn T. (2009). Splenectomy as an adjunctive treatment for dogs with immune-mediated hemolytic anemia: ten cases (2003–2006). J Vet Emerg Crit Care (San Antonio). Jun; 19(3):254–61. doi: 10.1111/j.1476-4431.2009.00419.x
Houston D., Taylor J. (1991). Acute pancreatitis and bone marrow suppression in a dog given azathioprine. Can Vet J; 32(8):496–497.
Ishihara M, Fujino Y, Setoguchi A. (2010). Evaluation of prognostic factors and establishment of a prognostic scoring system for canine primary immune-mediated hemolytic anemia. J Vet Med Sci 72:465–470.
Jones D., Gruffydd-Jones T., Stokes C., Bourne F. (1992). Use of a direct enzyme-linked antiglobulin test for laboratory diagnosis of immune-mediated hemolytic anemia in dogs. Am J Vet Res. Apr;53(4):457–65
Kidd L., Mackman N. (2013). Prothrombotic mechanisms and anticoagulant therapy in dogs with immune-mediated hemolytic anemia. J Vet Emerg Crit Care (San Antonio). Jan–Feb;23(1):3–13. doi: 10.1111/j.1476-4431.2012.00824.xЛ.
Klein M., Dow S., Rosychuk R. (1989). Pulmonary thromboembolism associated with immune mediated hemolytic anemia in dogs: Ten cases. J Am Vet Med Assoc; 195:246–250
Klotins K., Martin S., Kruth S. (2003). Vaccination as a risk factor for immune mediated anemia in dogs: a multi-centre case-control study. Proceedings of the 3rd International Veterinary Vaccines and Diagnostics Conference. Guelph, Ontario (Canada), July 13–18.
Mackin, A. (2014). Immune-mediated hemolytic anemia: pathophysiology and diagnosis. DVAVM, 1–54
Mason N, Duval D, Shofer F. (2003). Cyclophosphamide exerts no beneficial effect over prednisone alone in the initial treatment of acute immune-mediated hemolytic anemia in dogs: a randomized controlled clinical trial. J Vet Intern Med; 17:206–212
Mason N., Duval D., Giger U. (1997). Evaluation of combined cyclophosphamide and prednisone versus prednisone alone in the treatment of canine immune mediated hemolytic anemia. J Vet Intern Med; 11:130.
McManus P, Craig L. (2001). Correlation between leukocytosis and necropsy findings in dogs with immune mediated hemolytic anemia: 34 cases (1994–1999). JAVMA 218(8):1308–1313
Mellett, A., Nakamura, R., Bianco, D. (2011). A prospective study of clopidogrel therapy in dogs with primary immune-mediated hemolytic anemia. J. Vet. Intern. Med. 25, 71–75
Orcutt E., Lee J., Bianco D. (2010). Immune-mediated hemolytic anemia and severe thrombocytopenia in dogs: 12 cases (2001–2008). J Vet Emerg Crit Care; 20:338–345
Piek C. (2012). Prognosis in canine idiopathic immune-mediated haemolytic anaemia. Veterinary Sciences Tomorrow, 1–8.
Piek C., Brinkhof B., Teske E., Rothuizen J., Dekker A., Penning, L.C. (2011a). High intravasscular tissue factor expression in dogs with idiopathic immune-mediated haemolytic anaemia. Vet.Immunopathol. Aug 22 [Epub ahead of print].
Piek C., Junius G., Dekker A., Schrauwen E., Slappendel R., Teske E.J. (2008). Idiopathic immunemediated hemolytic anemia: treatment outcome and prognostic factors in 149 dogs. Vet Intern Med. Mar–Apr; 22(2):366–73. doi: 10.1111/j.1939-1676.2008.0060.x. Epub 2008 Mar 10.
Piek C., van Spil W., Junius G., Dekker, A. (2011b). Lack of evidence for a beneficial effect of azathioprine in dogs treated with prednisolone for idiopathic immune-mediated haemolytic anaemia: a retrospective cohort study. BMC Veterinary Research. 7,15.
Piek, C. (2011). Canine idiopathic immune-mediated haemolytic anaemia: a review with recommendations for future research. Vet. Q. 31, 129–141
Rhen T, Cidlowski J. (2005). Anti-inflammatory action of glucocorticoids— new mechanisms for old drugs. N Engl J Med;353(16):1711–1723
Rochant H. (1980). Hemolytic anemias with a negative Coombs' test and a positive Coombs' test without hemolytic anemia. Ann Med Interne (Paris);131(7):452–66
Scott-Moncrieff J., Treadwell N., McCullough S., Brooks M. (2001). Hemostatic abnormalities in dogs with primary immune-mediated hemolytic anemia. J. Am. Anim. Hosp. Assoc. 37, 220–227.
Toll J., Aronsohn M. (2003). Prospective evaluation of medical therapy with or without early splenectomy for treatment of severe immunemediated hemolytic anemia in the dog (abstract). J Vet Intern Med; 17(3):383
Warman S., Murray J., Ridyard A., Eastwood J., Silva S., Day M. (2008). Pattern of Coombs' test reactivity has diagnostic significance in dogs with immune-mediated haemolytic anaemia. J Small Anim Pract. Oct; 49(10):525–30. doi: 10.1111/j.1748-5827.2008.00641.x
Weinkle T., Center S., Randolph J. (2005). Evaluation of prognostic factors, survival rates, and treatment protocols for immune-mediated hemolytic anemia in dogs: 151 cases (1993–2002). JAVMA; 226(11):1869–1880.