Questions submitted during the Underlying Disease Screening in Dogs with IMHA webinar related to treatment of IMHA:
Can dogs test Negative for IMHA when they are on Prednisolone? If so, what should I do if the dog is on prednisolone at the time I'm considering doing the test?
How long after diagnosis does a canine need to stay on cyclosporine?
Regarding: Can dogs test Negative for IMHA when they are on Prednisolone? If so, what should I do if the dog is on prednisolone at the time I'm considering doing the test?
Dogs can test negative on Coomb’s tests after prednisolone, its not immediate, but its unfortunately not possible to predict when or if it will occur in a given patient. The sensitivity of the Coombs test is 61-82% (so not 100%) for dogs even when they are not on prednisone. Looking for spherocytes on a blood smear, and testing for autoagglutination and Coombs testing are all important tests to determine if the red cell destruction is immune-mediated. An algorithm to diagnose IMHA and the confidence with which the diagnosis can be made is included in the diagnostic algorithm in the upcoming consensus guidelines for diagnosing IMHA from the ACVIM mentioned above and in the lecture and should be helpful. If immunosuppressive therapy is on board it will be difficult to determine if a test is negative because therapy is working or if they didn’t have IMHA to begin with. But a positive test would support it. Testing prior to immunosuppressive therapy is optimal.
Regarding: How long after diagnosis does a canine need to stay on cyclosporine?
Whether a dog needs additional (more than prednisone) immunosuppressive therapy and guidelines for pharmacodynamic monitoring and tapering recommendations for cyclosporine are provided in the Treatment of IMHA ACVIM Consensus Statement that is about to be published. Generally speaking monitoring the response to therapy, the magnitude and tolerability of side effects of prednisone/prednisolone and pharmacodynamic monitoring help determine how rapidly cyclosporine can be tapered in an individual patient.
