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Immune Mediated Haemolytic Anaemia (view source)
Revision as of 12:32, 16 August 2010
, 12:32, 16 August 2010no edit summary
{| cellpadding="10" cellspacing="0" border="1"
{| cellpadding="10" cellspacing="0" border="1"
| Also known as:
| Also known as:
| IMHA<br>
| '''IMHA'''<br>
Autoimmune haemolytic anaemia (AIHA)
'''Autoimmune haemolytic anaemia (AIHA)'''
|}
|}
==Treatment==
==Treatment==
Affected animals often present acutely and may require intensive care. The ultimate aim of long-term treatment for IMHA is to control the autoimmune response.
Affected animals often present acutely and may require intensive care. The ultimate aim of long-term treatment for IMHA is to control the autoimmune response.
===Stabilisation===
===Stabilisation===
In animals that have lost a large percentage of their PCV acutely, it is likely that a blood transfusion will be required. Since animals with IMHA are not usually hypovolaemic, packed red blood cells are often transfused to replace erythrocytes without significantly expanding the plasma volume. In emergency situations, whole blood or synthetic haemoglobin molcules (such as Oxyglobin [tm]) may be used to support the oxygen carrying capacity of the patient. Oxygen may be provided to tachypnoeic and dyspnoeic patients by facemask, nasal catheter or flow-by.
===Immunosuppressive Therapy===
===Immunosuppressive Therapy===
Whatever supportive measures are taken, the autoimmune response must be controlled to prevent the continuing lysis of red blood cells. The following types of drug are typically used to achieve this goal:
*'''Corticosteroids''' such as prednisolone and dexamethasone are used universally as a first-line treatment for IMHA as they are frequently effective and they are available in a variety of preparations. Traditionally, very high doses of corticosteroids have been used to try to control the autoimmune response and dose rates beyond 2-3 mg/kg may be associated with significant adverse effects. More recently, there has been a move to add further immunosuppressive agents (see below) in a polypharmaceutical approach which allows the clinician to keep the corticosteroid dose rate at a reasonable level.
*'''Azathioprine''' is frequently used in the management of IMHA and it has effects on both cell- and antibody-mediated immune responses. It may take 3-4 weeks of treatment before patient experiences the maximal effects of the drug. Azathioprine is a cytotoxic drug and gloves should be worn to administer tablets. Owners or keepers should be made aware that the active drug or its metabolites may be present in the saliva and other secretions of animals receiving the drug.
*'''Ciclosporin A''' is a fungal metabolite that inhibits a signaling molecule (ciclophilin) involved in T cell activation. Since B cells require T cell help to become activated, differentiate into plasma cells and produce antibodies, there is a rationale for the use of ciclosporin in cases of IMHA.
*Other less commonly-used drugs include danazol, mycophenolate mofetil and cyclophosphamide.
===Adjunctive Therapy===
===Adjunctive Therapy===
==Prognosis==
==Prognosis==