Imha and imtp

RE: Imha and imtp

Anthony Dennison — Mon, 20 Jan 2020 11:59:42 GMT

I'm in agreement with Andy - last two cases I had didn't respond to preds alone. First one I delayed adding additional immunosuppressants, second I was quicker on.

1mg/kg pred q12hrs, ciclosporine at dose in formulary. We've been going for a transfusion quicker than we sometimes do as well using pRBCs as it just improves recovery times (saying that second case mentioned the PCV dropped right back down after initial transfusion and owners didn't want to go for a second so PTS. 9 month old labrador :( )

RE: Imha and imtp

Andrew Kent — Sat, 18 Jan 2020 13:35:56 GMT

There is little evidence for these things so comes down to a matter of personal preference - be interesting to see more details about the case as likely a difference between ITP cases that become anaemic and true Evans patients.

These can be tricky patients so I am often aggressive with immunosuppressants. That also depends on finances, size of dog etc.

Likely I would consider a combination of pred + ciclosporin or mycophenolate. There may also be a role for vincristine.

I don't use anti-thrombotics whist the platelet count is very low (use in that instance is controversial) but would add later on.

Happy to discuss further if you want to give more info about a specific case?

Andy

RE: Imha and imtp

Sara Ramsey — Fri, 17 Jan 2020 19:05:35 GMT

I think my approach changes with each case depending on severity but I found the ACVIM consensus statements on treatment and diagnosis of IMHA useful for bringing the information together.

Tend to be considering careful nursing and monitoring, clopidogrel, ciclosporin, blood transfusions if showing signs of hypoxia due to low red cell numbers.

I think there was a useful podcast at this year's Congress to (James Swann...sorry if I have name wrong)

RE: Imha and imtp

Beats — Fri, 17 Jan 2020 19:04:24 GMT

I'm old school and principally use prednisolone at 1mg/kg q12hrs (or equivalent steroid) to start with. more in a very severe case.

On occasions I add mycophenolate and try to reduce the pred dose quicker than I might otherwise have done.

I haven't personally used azathioprine for number of years, but would consider it for dogs.

I haven't personally used low-dose aspirin for a number of years.

I try to avoid iv cannulas.

I probably only see 2 or 3 cases personally a year.

Interested to hear what others do as I may be way out of date - thanks for posting the question!