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.
An 11‐year‐old cat presented for a 1‐week history of dyspnoea. The cat had a history of allergies that were being managed on cyclosporine. Physical examination revealed an increased respiratory rate and effort, and the cat was oxygen dependent. Thoracic radiographs revealed a severe diffuse nodular pulmonary pattern, suggestive of metastatic neoplasia. An abdominal ultrasound was performed to evaluate for a primary mass or evidence of disseminated disease. A 4.3 × 2.2 cm ileocolic mass was noted. Fine‐needle aspirates of the intestinal mass were poorly exfoliative. Toxoplasma gondii titres were performed (IgM <1:20 and IgG >1:20,480). Fine‐needle aspirates of the pulmonary nodules revealed neutrophilic and macrophagic inflammation with large numbers of 2–4 µm, crescent‐shaped organisms, consistent with Toxoplasma gondii. Cyclosporine was discontinued and clindamycin was prescribed. The cat was discharged 3 days later. Repeat imaging revealed resolution of the pulmonary and intestinal lesions. Clinical cure was achieved.
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