Journal watch25 June 2019
Author(s): J.W. Swann, O.A. Garden, C.L. Fellman, B. Glanemann, R. Goggs, D.N. LeVine, A.J. Mackin and N.T. Whitley
Published in: Journal of Veterinary Internal Medicine
Date: May/June 2019
DOI: https://doi.org/10.1111/jvim.15463
Type of access: Open access
(click for full article)
Our summary
Swann, J.W. et al. (2019) ACVIM consensus statement on the treatment of immune‐mediated hemolytic anemia in dogs. Journal of Veterinary Internal Medicine, 33 (3), pp. 1141-1172.
The aim of this consensus statement was to give recommendations for the treatment of immune‐mediated haemolytic anemia (IMHA) in dogs. The statement was developed by a panel of experts following a systematic review of the literature. The papers were reviewed using a quality assessment tool with four domains, which looked at study design, diagnostic criteria for IMHA, explanation of treatment protocols and validity of statistical methods. An additional domain was applied to randomised controlled trials assessing randomisation, blinding and intention-to-treat analysis.
The initial recommendations were refined through four rounds of Delphi review and then presented and discussed at the American College of Veterinary Internal Medicine Forum in 2018. The final recommendations were classified as either ‘weak’ or ‘strong’. Strong recommendations are where five or more panel members agreed with the decision – all other recommendations were considered ‘weak’. Strong recommendations start with ‘we recommend’ and weak ones with ‘we suggest’.
There are 46 recommendations under 12 areas:
- Timing of treatment
- Blood typing and cross-matching
- Blood transfusion and blood products
- Immunosuppressive treatment
- Monitoring for adverse effects associated with immunosuppressive treatment
- Management of drug-associated myelosuppression
- Management of infections in dogs receiving immunosuppressive drugs (including therapeutic drug monitoring)
- Approach to relapse
- Emerging immunomodulatory treatments for dogs with IMHA
- Antithrombotic treatment
- Supportive care and antimicrobial treatment
- Monitoring dogs in remission from IMHA
There is also a final section focusing on recommendations for future research.
Take home
This consensus statement provides practitioners with a valuable overview of the treatment of IMHA, based on the published literature and expert opinion. The weighting of the recommendations as ‘strong’ and ‘weak’ and the use of tables and algorithms makes the information contained in the statement easy to follow. They will provide a good basis on which to produce local practice guidelines.
A consensus statement on the diagnosis of IMHA is also available see:
Garden, O.A. (2019) ACVIM consensus statement on the diagnosis of immune-mediated hemolytic anemia in dogs and cats. Journal of Veterinary Internal Medicine, 33 (2), pp. 313-334
Also of interest is the American College of Veterinary Emergency and Critical Care (ACVECC), Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines. See our intheSPOTLIGHT feature.
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