From the Research
For dogs with primary immune-mediated hemolytic anemia (IMHA) not fully responding to prednisone and mycophenolate, cyclosporine is often the next agent added, typically at 5-10 mg/kg orally once daily, with blood level monitoring recommended to maintain therapeutic concentrations between 400-600 ng/mL, as suggested by the most recent and highest quality study 1.
Key Considerations
- The goal of adding these agents is to enhance immunosuppression through different mechanisms, ultimately reducing antibody-mediated destruction of red blood cells while allowing reduction of prednisone dosage to minimize long-term steroid complications.
- Alternative options include adding azathioprine at 2 mg/kg orally once daily for 7-14 days, then every other day, which can be effective, though regular CBC monitoring is essential due to potential myelosuppression 2.
- In severe or refractory cases, human intravenous immunoglobulin (IVIG) at 0.5-1.5 g/kg IV over 6-12 hours may provide rapid but temporary improvement.
- Splenectomy represents a surgical option for dogs failing medical management, eliminating a major site of red blood cell destruction.
Supportive Care
- Blood transfusions for severe anemia (PCV <15%) are crucial.
- Thromboprophylaxis with low-dose aspirin (0.5 mg/kg/day) is recommended.
- Careful monitoring of side effects remains essential throughout treatment.
Evidence-Based Recommendations
- The ACVIM consensus statement on the treatment of immune-mediated hemolytic anemia in dogs provides evidence-based guidelines for treatment, including the use of immunosuppressive and antithrombotic drugs 3.
- The most recent study on therapeutic strategies for treatment of immune-mediated hemolytic anemia highlights the importance of immunosuppression and antithrombotic therapy in managing the disease 1.