Immunosuppressive Therapy and Hypercoagulability

摘要

Immune-mediated hemolytic anemia (IMHA) results from the antibody-mediated destruction of circulating red blood cells.1 In dogs, IMHA is the most frequent cause of hemolytic anemia, and the most common form of immune-mediated disease. Unfortunately, despite our best efforts, mortality rates for canine IMHA remain high, ranging from 50 to 70%.2 One of the most common cause of death in dogs with IMHA is thromboembolic disease, particularly pulmonary thromboembolism (PTE). The incidence of PTE in IMHA patients is reported to be over 50%, and may even be as high as 80%.3 Glucocorticoids are the most commonly used immunosuppressive agents for the treatment of IMHA in dogs. However, glucocorticoids are commonly associated with side effects that are undesirable to the patient and owner. Although glucocorticoids are the cornerstone of IMHA therapy, additional immunosuppressive agents such as cyclosporine, azathioprine, mycophenolate mofetil and leflunomide are often concurrently utilized to reduce the undesirable side effects of glucocorticoid and further suppress the immune system.