From the Research
For dogs with immune-mediated hemolytic anemia (IMHA), I recommend starting with immunosuppressive therapy using prednisone at 2-4 mg/kg/day divided twice daily, along with cyclosporine (5-10 mg/kg twice daily) or mycophenolate mofetil (10-20 mg/kg twice daily) as adjunctive therapy, as supported by the most recent and highest quality study 1. When managing canine IMHA, it is essential to consider the use of monoclonal canine anti-erythrocyte antibodies (mCAB) as a valuable diagnostic tool.
- Blood transfusions may be necessary for severely anemic dogs (PCV <15%).
- Thromboprophylaxis with low-dose aspirin (0.5-1 mg/kg once daily) or clopidogrel (1-3 mg/kg once daily) is important as thromboembolism is a significant complication, as highlighted in the study 2. Regular monitoring of complete blood counts is essential, initially every 1-3 days, then weekly until stable.
- Immunosuppressive medications should be gradually tapered over 3-6 months once the PCV stabilizes above 30% for at least 2 weeks. The mCAB test helps distinguish primary IMHA from other causes of anemia by detecting antibodies bound to red blood cells, though a positive result must be interpreted alongside clinical signs and other laboratory findings, as noted in the study 3. Treatment success varies, with approximately 70-80% of dogs responding to therapy, though relapses can occur and require lifelong management in some cases. It is crucial to consider the guidelines for diagnosis and treatment of IMHA in dogs, as outlined in the ACVIM consensus statement 1, to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.