Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands.
Vet Q. 2011 Sep;31(3):129-41. doi: 10.1080/01652176.2011.604979. Epub 2011 Aug 2.
Idiopathic immune-mediated haemolytic anaemia (IMHA) is one of the most common immune-mediated diseases of dogs. The aim of this article is to review current knowledge of canine IMHA, its etiology, clinical presentation, diagnosis, complications, and treatment, in an attempt to establish why its outcome is still so poor. Clinical signs of anaemia develop within 3 days and dogs present with a median haematocrit of 13%, leucocytosis, a left shift, and reticulocytosis. Coagulation test results support the presence of disseminated intravascular coagulation. About 50% of dogs die in the first 2 weeks after presentation, and analysis of risk factors suggests that mortality is associated with hypercoagulability, inflammatory response, and liver and kidney failure. A positive direct agglutination test, spherocytosis, and true autoagglutination are widely accepted tests to demonstrate anti-erythrocyte antibodies, but are not yet standardized. To date, there is no evidence to support the efficacy of immunomodulators in addition to corticosteroids in the treatment of IMHA. Despite numerous investigations, the prognosis of IMHA remains dismal. There is an urgent need to validate and standardize diagnostic tests and criteria, and clinical trials might benefit from stratifying dogs by mortality risk. Analysis of samples from well-defined cases of canine IMHA might provide insight into the aetiology and pathophysiology of IMHA.
特发性免疫介导性溶血性贫血（IMHA）是犬最常见的免疫介导性疾病之一。本文旨在回顾犬 IMHA 的病因、临床症状、诊断、并发症和治疗的最新知识，试图阐明其预后仍然如此差的原因。贫血的临床症状在 3 天内出现，犬的平均血细胞比容为 13%，白细胞增多，左移，网织红细胞增多。凝血试验结果支持弥散性血管内凝血的存在。大约 50%的犬在出现症状后的前 2 周内死亡，对危险因素的分析表明，死亡率与高凝状态、炎症反应以及肝肾功能衰竭有关。直接凝集试验阳性、球形红细胞和真性自身凝集被广泛认为是检测抗红细胞抗体的有效方法，但尚未标准化。迄今为止，除了皮质类固醇外，免疫调节剂在治疗 IMHA 中的疗效尚无证据支持。尽管进行了大量研究，但 IMHA 的预后仍然不容乐观。迫切需要验证和标准化诊断试验和标准，临床试验可能受益于根据死亡率风险对犬进行分层。对明确的犬特发性免疫介导性溶血性贫血病例样本的分析可能有助于了解 IMHA 的病因和病理生理学。
