Evaluation of membrane‐based therapeutic plasma exchange as adjunctive treatment for immune‐mediated hematologic disorders in dogs

摘要

Background Therapeutic plasma exchange (TPE) has been used increasingly to treat immunological diseases in dogs, although data concerning its efficacy are lacking. Hypothesis/Objectives To describe the clinic and the outcome of dogs with immune‐mediated hematological disorders (IMHD) treated with membrane filtration TPE. Animals One hundred forty‐six dogs diagnosed with IMHD, including 17 dogs treated with and 129 control dogs treated without TPE. Methods Retrospective study of cases selected with a search of all medical records for dogs diagnosed with IMHD (2010‐2019). Primary outcomes included the assessment of safety and efficacy of adjunctive TPE compared to medical treatment alone. Results The TPE group included 7 dogs with immune‐mediated hemolytic anemia (IMHA), 5 dogs with immune‐mediated thrombocytopenia (IMT), and 5 dogs with combined IMHA‐IMT; the control group included 63 dogs with IMHA, 47 dogs with IMT, and 19 dogs with IMHA‐IMT. Dogs treated with TPE were more often refractory to initial immunosuppression (71%) than controls (43%; P = .04). Complications were observed in 15/43 TPE treatments (35%). The response rate of dogs treated with TPE was 83% in IMHA (controls, 65%; P = .5) and 80% in IMT (controls, 70%; P = .71). Overall, 12/17 dogs (71%) treated with TPE reached complete remission, 2/17 (12%) partial remission, and 3/17 (18%) died or were euthanized. Eighty‐two percent of the dogs treated with TPE survived to discharge (controls, 69%; P = .4). Conclusions and Clinical Importance Despite a bias toward dogs refractory to initial immunosuppression, dogs treated with adjunctive TPE had a similar outcome as dogs treated medically.