The Association of Immunomodulatory and Immunosuppressive Drugs in the Treatment of Immune-Mediated Hemolytic Anemia in Dogs: A Case Report
A.S. Ferraz; J.M. Didiano; T.T. Hato; M.A.B. Moreira; P.A. Lopes; C.A.R. Sultanum
The immune-mediated hemolytic anemia (IMHA) is a disorder triggered by the destruction of the erythrocytes mediated by the presence of immunoglobulins or the complement system. It can be classified as primary, secondary and by the presence of alloantibodies. The laboratory finding frequently observed is the moderate anemia with characteristics of regeneration (macrocytosis, reticulocytosis and polychromasia). The therapeutic protocol is mainly based on the immunosuppression. A two-year old poodle dog has been seen, showing apathy and pale mucous .In the full blood exam it was observed a regenerative anemia with reticulocytosis and the presence of spherocytosis, indicating the IMHA diagnosis. The biochemical tests of liver and renal profile showed results within normality. The serologic test for detection of antibodies against Ehrlichia canis turned out to be negative. Discarding the main causes of secondary IMHA, the diagnosis of IMHA was awarded. The therapeutic protocol adopted was the transfusion of concentrated red blood cells, associated with the immunosuppressant prednisone (2mg/kg/BID) and enrofloxacin (5mg/kg/BID). After one week of treatment no improvements have been found. It was opted for the association of immunomodulatory drugs such as cyclosporine (10mg/kg/BID), mycophenolate sodium (10mg/kg/BID) and a new transfusion. After 20 days of treatment with the new association, it was observed stabilization of hematocrit with later increase returning to the values of normality. Thus, it appears that the combination of immunomodulatory and immunosuppressive can help in cases of IMHA that do not respond to the therapy with corticosteroids only.