Immunoadsorption in a dog with severe immune mediated hemolytic anemia

Immune mediated hemolytic anemia (IMHA) is a life‐threatening disease with severe, acute hemolysis as a result of an autoimmune response directed against erythrocyte surface antigens. In veterinary medicine, IMHA is usually treated with immunosuppressants and often multiple blood transfusions. In hu...

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Bibliographic Details
Published in:Journal of clinical apheresis 2021-08, Vol.36 (4), p.668-672
Main Authors: Richter, Petra, Fischer, Hendryk, Dörfelt, René
Format: Article
Language:English
Subjects:
Adsorption
Anemia
Anemia, Hemolytic, Autoimmune - immunology
Animals
Apheresis
autoantibodies
autoimmune hemolytic anemia
Blood transfusions
canine
Dogs
Erythrocytes
Female
Hematocrit
Hemolysis
Immunoglobulin G
immunoglobulin M
Immunoglobulins
Immunosuppression Therapy
Immunosuppressive Agents
Mycophenolic Acid - administration & dosage
plasma exchange
Prednisolone - administration & dosage
Veterinary medicine
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Summary:Immune mediated hemolytic anemia (IMHA) is a life‐threatening disease with severe, acute hemolysis as a result of an autoimmune response directed against erythrocyte surface antigens. In veterinary medicine, IMHA is usually treated with immunosuppressants and often multiple blood transfusions. In human medicine, immunoadsorption (IA) is an established therapy for antibody removal in immune‐mediated diseases. A female, spayed, five‐year‐old, 28 kg Entlebucher Mountain dog was presented with regenerative anemia and positive autoagglutination diagnosed as immune‐mediated hemolytic anemia to the veterinary emergency service. Conventional treatment consisting immunosuppression with prednisolone and mycophenolate failed to improve hemolysis. As hematocrit dropped daily, multiple blood transfusions of blood group DEA 1 negative were required. IA was initiated at day 3 with COM.TEC and ADAsorb platforms and a LIGASORBstaphylococcus antitoxin A column. IA with citrate anticoagulation was performed over the treatment time of 77 minutes with a blood flow of 50 mL/min. Total plasma volume of 1.6 L was processed. Complications consisted of vomitus and lid swelling, shivering, excessive clotting in the tubing after a calcium bolus and hypotension. After IA, hemolysis stopped immediately, plasma concentrations of immunoglobulin G, immunoglobulin M and bilirubin decreased, and hematocrit remained stable. The dog was discharged without further hemolysis 4 days after immunoadsorption with immunosuppressive therapy. IA is a promising adjunctive therapy in severe cases of canine IMHA, but it cannot be concluded to which degree IA or concurrent immunosuppression contributed to cessation of hemolysis in the present case.
ISSN:0733-2459
1098-1101
DOI:10.1002/jca.21913