Use of Technique of Plasmapheresis in Dog with Immune-Mediated Hemolytic Anemia
World Small Animal Veterinary Association World Congress Proceedings, 2009
V.M. Guyoti1; M.A.B. Moreira1; P.A. Lopes1; C.A.R. Sultanum1; M.P. Sanchez1; S.S. Souza1; T.M. Macedo2; T.C. Crema2
1Anhembi Morumbi Veterinary Hospital; 2Rebouças Veterinary Hospital, São Paulo, Brazil

The immune-mediated hemolytic anemia (IMHA), a common hematologic disorder in dogs, is a disease in which autoantibodies mediate erythrocytes destruction. In cases where immune-mediated diseases do not respond satisfactorily to standard treatment, adjuvant therapies, such as plasmapheresis, can be performed. The method consists of plasma removal in conjunction with hemocomponent replacement from the patient. The primary objective is removing the undesirable plasma components which are responsible for the serious consequences in IMHA. A 7 month old, male, 19kg, Burmese mountain dog was served in the Anhembi Morumbi Veterinary Hospital, weakened, apathetic, with the presence of ticks and myiasis. On physical examination an enlargement of the lymph nodes, pale mucosa, abdominal sensitivity and cachexia were observed. Laboratory tests were requested indicating leukocytosis, severe anemia, presence of spherocytes in blood smear, autoagglutination and moderate hemolysis. Through the association of the patient's clinical history and findings of physical and laboratory examination, the diagnosis of IMHA was established. The chosen treatment was based on the immunosuppressive and immunomodulatory therapy with prednisone (2mg/kg BID), azathioprine (2mg/kg SID) and cyclosporine A (10mg/kg SID) in addition to several blood transfusions. However, after 50 days, due to the unsatisfactory response therapy and unfavorable evolution of the anemia, the plasmapheresis technique was performed. During the procedure 2.05ml of the patient's blood were removed and centrifuged for the separation of erythrocyte and plasma concentrate. The total discarded amount of plasma was 1.704ml. To replace these volume extracted, 1.866ml of fresh frozen plasma, from donors from the Anhembi Morumbi veterinary blood bank, were infused. Concomitantly, a whole erythrocyte concentrate removed from the animal was then replaced and others 435ml of erythrocyte concentrate was transfused due to the severe anemia. During plasmapheresis the animal was carefully monitored: blood pressure, length of capillary filling, heart and breathing rates, clotting time, hematocrit and diuresis were measured. With plasmapheresis the dog was clinically stable by 30th days and the disease process was controlled. However, a new exchange plasmapheresis was not performed again and after this period there was a significant decrease of patient's packed cell volume. Due to the procedure's cost and the lack of appropriate equipment it was not possible to continue the therapy and the patient died on 40th day. With the automation process and an increased number of researches to prove the plasmapheresis effectiveness in IMHA, this procedure can be established in the hospital routine for the treatment of severe cases.

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V.M. Guyoti
Anhembi Morumbi Veterinary Hospital
São Paulo, Brazil