Prognostic factors and efficacy of human intravenous immunoglobulin G in dogs with idiopathic immune-mediated hemolytic anemia: a retrospective study

Park, So Young; Kim, Hakhyun; Kang, Byeong Taek; Kang, Ji Houn; Yang, Mhan Pyo

doi:10.14405/kjvr.2016.56.3.139

Cited by 5 publications

(6 citation statements)

References 37 publications

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“…The dosage range for prednisone or prednisolone is based on review of published literature and clinical experience, with some panel members (2/8) recommending that the initial dosage of prednisone or prednisolone not exceed 2 mg/kg/day, or 40 mg/m 2 /day for dogs >25 kg, owing to the risk of more severe adverse effects with higher dosages. Review of published literature, including a study population treated with prednisolone alone, indicated an initial response rate of approximately 80%, but did not find any evidence to suggest that IV dexamethasone is superior to PO prednisone or prednisolone . Studies supporting previous statements that prednisolone may be more effective or less irritating to the gastrointestinal tract if given twice daily currently are lacking.…”

Section: Results and Recommendationsmentioning

confidence: 81%

“…Rationale Administration of IVIG may appear to be an attractive prospect because it is suggested to act quickly, but several studies showed no effect of this treatment on survival when compared to other immunosuppressive regimens in dogs with IMHA (Table 4). 18,[21][22][23][24][25]59 The design and risk of bias varied among these studies, but all supported the same conclusion ( Figure 5). Studies have indicated that administration of IVIG may be associated with more rapid recovery of a normal PCV, 22,60 or a lesser requirement for transfusions, 61 but 2 of these studies did not include a control group, 60,61 and the other contained a number of statistical anomalies 22 ( Figure 5).…”

Section: Strength Of Recommendation: Strongmentioning

confidence: 75%

“…Administration of IVIG may appear to be an attractive prospect because it is suggested to act quickly, but several studies showed no effect of this treatment on survival when compared to other immunosuppressive regimens in dogs with IMHA (Table ) . The design and risk of bias varied among these studies, but all supported the same conclusion (Figure ).…”

Section: Results and Recommendationsmentioning

confidence: 91%

“…Review of published literature, including a study population treated with prednisolone alone, indicated an initial response rate of approximately 80%, but did not find any evidence to suggest that IV dexamethasone is superior to PO prednisone or prednisolone. 2,5,[18][19][20][21]24,25,[44][45][46] Studies supporting previous statements that prednisolone may be more effective 47 or less irritating to the gastrointestinal tract 48 if given twice daily currently are lacking. Human medical literature suggests that once daily administration may be associated with fewer adverse mineralocorticoid effects.…”

Section: Rationalementioning

confidence: 99%

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

Swann

Garden

Fellman

et al. 2019

Veterinary Internal Medicne

187

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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.

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Section: Results and Recommendationsmentioning

confidence: 81%

Section: Strength Of Recommendation: Strongmentioning

confidence: 75%

Section: Results and Recommendationsmentioning

confidence: 91%

Section: Rationalementioning

confidence: 99%

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

Swann

Garden

Fellman

et al. 2019

Veterinary Internal Medicne

187

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“… 7 Use of hIVIG in human medicine also has been reported to prevent hemolysis associated with sickle cell disease, and for blood transfusion in patients with lymphoma. 1 Similarly, in veterinary medicine hIVIG has been used for several diseases, 2 , 8 including immune‐mediated hemolytic anemia (IMHA), 9 , 10 , 11 , 12 , 13 immune‐mediated thrombocytopenia, 14 , 15 , 16 cutaneous drug reactions, 17 , 18 and myasthenia gravis. 19 …”

Section: Introductionmentioning

confidence: 99%

The use of high‐dose immunoglobulin M‐enriched human immunoglobulin in dogs with immune‐mediated hemolytic anemia

Bestwick

Sharman

Whitley³

et al. 2021

Veterinary Internal Medicne

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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.

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Immune‐Mediated Anemia in the Dog

Haines¹,

Mackin²,

Day³

2022

Schalm's Veterinary Hematology

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Prognostic factors and efficacy of human intravenous immunoglobulin G in dogs with idiopathic immune-mediated hemolytic anemia: a retrospective study

Cited by 5 publications

References 37 publications

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

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

The use of high‐dose immunoglobulin M‐enriched human immunoglobulin in dogs with immune‐mediated hemolytic anemia

Immune‐Mediated Anemia in the Dog

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