Immune-mediated hemolytic anemia (IMHA) is an important cause of morbidity and mortality in dogs. IMHA also occurs in cats, although less commonly. IMHA is considered secondary when it can be attributed to an underlying disease, and as primary (idiopathic) if no cause is found. Eliminating diseases that cause IMHA may attenuate or stop immune-mediated erythrocyte destruction, and adverse consequences of long-term immunosuppressive treatment can be avoided. Infections, cancer, drugs, vaccines, and inflammatory processes may be underlying causes of IMHA. Evidence for these comorbidities has not been systematically evaluated, rendering evidence-based decisions difficult. We identified and extracted data from studies published in the veterinary literature and developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria for IMHA, comorbidities, and causality. Succinct evidence summary statements were written, along with screening recommendations. Statements were refined by conducting 3 iterations of Delphi review with panel and task force members. Commentary was solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted. The resulting document is intended to provide clinical guidelines for diagnosis of, and underlying disease screening for, IMHA in dogs and cats. These should be implemented with consideration of animal, owner, and geographical factors.
Bibliographical noteFunding Information:
The authors thank Sandy LaMonaca, Peggy Alfarano, and Victoria Cramer for their invaluable administrative assistance. The authors are also very grateful to the members of the various specialty listservs who kindly offered their expert feedback on the draft manuscript, thus improving the quality of the finished product. Finally, the authors extend their sincere thanks to Ivy Leventhal of ACVIM, who managed the submission process to the various listservs and the final manuscript to Journal of Veterinary Internal Medicine. The consensus statement was presented at the 2018 ACVIM Forum in Seattle, Washington.
© 2019 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
- Delphi survey
- direct antiglobulin test
- flow cytometry
- iceberg model
- veterinary and comparative clinical immunology society