Assenmacher Tara D, Jutkowitz L Ari, Koenigshof Amy M, de A Lucidi Cynthia, Scott Michael A
J Am Vet Med Assoc. 2019 Aug 1;255(3):366-376. doi: 10.2460/javma.255.3.366.
To characterize the clinical features of dogs with precursor-targeted immune-mediated anemia (PIMA).
66 dogs with PIMA.
Electronic record databases of a teaching hospital were searched to identify dogs with a diagnosis of nonregenerative anemia between 2004 and 2013. Inclusion criteria included persistent nonregenerative anemia (Hct ≤ 30% and reticulocyte count < 76,000 reticulocytes/μL), cytologic findings supportive of ineffective bone marrow erythropoiesis, and absence of underlying disease. Information regarding clinical signs, clinicopathologic findings, treatment, and outcome was extracted from records of eligible dogs. A regenerative response was defined as a reticulocyte count > 76,000 reticulocytes/μL or sustained increase in Hct of > 5%. Remission was defined as a stable Hct ≥ 35%.
The median Hct was 13%, and reticulocyte count was 17,900 reticulocytes/μL. Rubriphagocytosis was identified in bone marrow aspirate samples from 61 of 66 dogs. Collagen myelofibrosis was detected in bone marrow biopsy specimens obtained from 31 of 63 dogs. Immune-mediated targeting of mature erythrocytes was uncommon. All dogs received immunosuppressive therapy. Fifty-five dogs developed a regenerative response at a median of 29 days, and 40 of those dogs went into remission at a median of 59 days after PIMA diagnosis. Thromboembolic events were confirmed for 9 dogs and were associated with a decreased survival time. Median survival time was 913 days for all dogs.
Results indicated that most dogs with PIMA responded to prolonged immunosuppressive therapy. Studies to determine optimal immunosuppressive and thromboprophylactic protocols for dogs with PIMA are warranted.
描述前驱靶向免疫介导性贫血（PIMA）犬的临床特征。
66只患有PIMA的犬。
检索一家教学医院的电子记录数据库，以识别2004年至2013年间诊断为非再生性贫血的犬。纳入标准包括持续性非再生性贫血（血细胞比容≤30%且网织红细胞计数<76,000个网织红细胞/μL）、支持无效骨髓红细胞生成的细胞学检查结果以及无潜在疾病。从符合条件的犬的记录中提取有关临床症状、临床病理检查结果、治疗和结局的信息。再生反应定义为网织红细胞计数>76,000个网织红细胞/μL或血细胞比容持续增加>5%。缓解定义为稳定的血细胞比容≥35%。
血细胞比容中位数为13%，网织红细胞计数为17,900个网织红细胞/μL。66只犬中有61只的骨髓穿刺样本中发现有红细胞吞噬现象。63只犬中有31只的骨髓活检标本中检测到胶原性骨髓纤维化。成熟红细胞的免疫介导靶向并不常见。所有犬均接受免疫抑制治疗。55只犬在中位数29天时出现再生反应，其中40只犬在PIMA诊断后中位数59天时进入缓解期。9只犬确诊有血栓栓塞事件，且与生存时间缩短有关。所有犬的中位生存时间为913天。
结果表明，大多数患有PIMA的犬对延长的免疫抑制治疗有反应。有必要开展研究以确定PIMA犬的最佳免疫抑制和血栓预防方案。
