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.
Background
The IV use of human immunoglobulin (hIVIG) in dogs with primary immune‐mediated hemolytic anemia (IMHA) has been described previously, but herein we describe the use of high‐dose IgM‐enriched hIVIG (Pentaglobin).
Hypothesis/Objectives
Dogs treated with high‐dose Pentaglobin will experience shorter time to remission and hospital discharge and have decreased transfusion requirements compared to dogs receiving standard treatment alone.
Animals
Fourteen client‐owned dogs diagnosed with primary IMHA at specialist referral hospitals in the United Kingdom.
Methods
All prospectively enrolled dogs received prednisolone, dexamethasone or both along with clopidogrel. Patients were randomized to receive Pentaglobin at 1 g/kg on up to 2 occasions, or to serve as controls. No additional immunosuppressive drugs were allowed within the first 7 days of treatment. Remission was defined as stable PCV for 24 hours followed by an increase in PCV.
Results
Ten of 11 dogs from the treatment group and 2 of 3 dogs from the control group achieved remission and survived until hospital discharge. Survival and time to remission were not significantly different between groups. The volume of packed red blood cells transfused, normalized for body weight, was not significantly different between groups. Potential adverse reactions to Pentaglobin occurred in 2 dogs, but their clinical signs may have been related to the underlying disease.
Conclusions and Clinical Importance
Treatment with high‐dose Pentaglobin was well tolerated by dogs with primary IMHA but no significant advantage was found in this small study. Additional studies examining larger groups and subpopulations of dogs with primary IMHA associated with a poorer prognosis are warranted.
An 11-year-old, female, spayed Shetland sheepdog was referred for a 48-hour onset of lethargy, inappetence, pigmenturia and intra-abdominal mass of unknown origin. Laboratory sampling identified regenerative anaemia, hyperbilirubinemia, hypercholesterolemia and elevated alanine transaminase and alkaline phosphatase. Bilirubinuria and haematuria were noted on urinalysis. Thoracic radiographs were unremarkable. Ultrasonographic examination identified free abdominal fluid and a heterogeneous mass associated with a medial liver lobe. Haemoabdomen was confirmed, and partial hepatectomy was performed. Histopathology identified neoplastic cells arranged in nests and rosettes. On immunohistochemistry, neoplastic cells were positive for neuron-specific enolase and synaptophysin and negative for S100, chromogranin A and cytokeratin. Transmission electron microscopy revealed small round electrodense granules consistent with neuroendocrine granules. A final diagnosis of hepatic carcinoid was made. The dog received no adjuvant treatment. Re-staging with conventional imaging was performed every 3 months. No local recurrence or metastatic disease was identified within a 21-month follow-up period.
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