Treatment and predictors of outcome in dogs with immune-mediated thrombocytopenia

Abstract

Immune-mediated thrombocytopenia is a serious yet treatable disease, which may have a lower rate of recurrence than previously reported. The presence of melena or high BUN concentration in the study suggested a poor prognosis for affected dogs.

A Prospective Randomized Clinical Trial of Vincristine versus Human Intravenous Immunoglobulin for Acute Adjunctive Management of Presumptive Primary Immune‐Mediated Thrombocytopenia in Dogs

“…2 Because antiplatelet antibody assays are not widely available and have less than ideal sensitivity and specificity, a clinical diagnosis of presumptive primary ITP is made on the basis of exclusion of other identifiable causes of thrombocytopenia and response to treatment. [3][4][5] Clinical signs of ITP typically are those characteristic of a primary hemostatic disorder (eg, petechiae, ecchymosis, epistaxis, and gastrointestinal bleeding). Spontaneous hemorrhage usually does not occur until the platelet count decreases to <30,000-50,000 platelets/ lL 4,6 although there is poor correlation between the absolute platelet count and likelihood of serious hemorrhage.…”

“…To minimize the risk of serious hemorrhage, it is ideal for treatment to increase the platelet count to >30-50,000 platelets/lL as rapidly as possible. Most patients exhibit platelet count recovery within 1-15 days after initiating treatment with glucocorticoids, 3,4 but adjunctive treatment with VINC and hIVIG have been demonstrated to shorten platelet recovery time. 7,8 In a prospective study assessing platelet recovery time in dogs with severe ITP treated with prednisone alone versus prednisone and VINC, administration of VINC and prednisone together was associated with a more rapid increase in platelet numbers and shortened duration of hospitalization in dogs with ITP, compared with use of prednisone.…”

Evaluation of a DLA-79 allele associated with multiple immune-mediated diseases in dogs

“…For example, IMHA and ITP are both type II autoimmune diseases in which an antibody response is generated against the cell membranes of erythrocytes or platelets, respectively (McCullough 2003; O’Marra et al 2011). IMPA is a type III autoimmune disease in which antigen-antibody complexes accumulate in the joint space and lead to ongoing inflammation (Johnson and Mackin 2012).…”

“…Immune-mediated diseases such as immune-mediated hemolytic anemia (IMHA), immune-mediated thrombocytopenia (ITP), and type I diabetes (T1D) are common and life-threatening conditions in dogs with short-term mortality rates as high as 50% (Carr et al 2002; O’Marra et al 2011). Most immune-mediated diseases result from an aberrant immune system response in which normal defense mechanisms attack the body’s own cells, tissues, and organs (Temajo and Howard 2014).…”

Presumptive immune‐mediated thrombocytopenia secondary to massive Africanized bee envenomation in a dog

“…1 A consumptive coagulopathy appears less plausible because there was no evidence of secondary hemostatic dysfunction at the time the severe thrombocytopenia was identified, and consumptive coagulopathies typically are not associated with such a severe thrombocytopenia. 14,[16][17][18][19][20][21] In addition, while Africanized bee venom can cause thrombocytopenia, a study in 43 people that developed acute renal failure secondary to Africanized bee envenomation reported the mean platelet count for affected patients was 161 × 10 9 platelets/L (161 × 10 3 platelets/L) and the lowest reported platelet count was 31 × 10 9 platelets/L (31 × 10 3 platelets/L). 2 The median sting count per patient in this study was 900 stings per person suggesting that severe thrombocytopenia is not common sequela from even massive Africanized bee envenomation.…”