Influence of immunosuppressive treatment on Clinico-Pathological features in 33 cases of Canine primary IMHA.

Background: Primary immune-mediated hemolytic anemia (pIMHA) is the most common immune-hematological disease in dogs. It represents a diagnostic and therapeutic challenge, and only a limited number of prognostic indicators are accepted consistently. Objective: The aims of the study were to investigate the influence of immunosuppressive treatment on clinico-pathological features at time of presentation to the referral center (“M. Modenato” Veterinary Teaching Hospital) and to suggest some clinico-pathological prognostic factors. Methods: Thirty-three cases of pIMHA collected between February 2010-2016 were included. Data regarding history, blood laboratory tests, immunosuppressive treatments and patient outcome was collected. Patients were divided into two groups (16 patients previously treated with immunosuppressive, group A, and 17 untreated, group B) and statistically compared (Mann-Whitney test). Results: Significant differences between the two groups were found. In group A platelet count (P=0.002) and serum concentrations of alkaline phosphatase (P=0.010) were significantly higher than group B. In group B serum concentrations of total protein (P=0.025), globulins (P=0.002), C-reactive protein (P=0.003), and lactate dehydrogenase (P=0.028), and urinary parameters as pigmenturia (P=0.0003) and bilirubinuria (P=0.041) were significantly higher than group A. Thrombocytopenia, hyperbilirubinemia (>1.5 mg/dL), urea concentration (>55 mg/dL), and number of nucleated RBCs (≥30 per 100 WBCs) were statistically related with un-favorable outcome. Conclusion: Immunosuppressive treatments may mask some clinico-pathological features of pIMHA, making case history essential for the prognostic assessment. Number of circulating NRBCs, thrombocytopenia, hyperbilirubinemia and blood urea concentration can be useful indicators for predicting disease outcome.