Question submitted during the Underlying Disease Screening in Dogs with IMHA webinar:
What are factors that contribute to treatment failure or unsuccessful treatment of dogs with IMHA?
This is an extremely important question. The factors that contribute to unsuccessful therapy likely depend on whether trigger factors and underlying disease is identified, the genetic and immunologic milieu that is present that contributes to the severity of hemolysis and the magnitude of the proinflammatory and procoagulant state of the patient, over and under-treatment with immunosuppressive agents and monetary considerations. The steps in identifying factors that contribute to treatment failure will be to perform studies that definitively diagnose IMHA following established criteria, and screen for trigger factors in a systematic way, to determine mechanisms of different triggers as a cause for IMHA so we can determine which ones to always screen for, which ones to screen for in individual patients and which ones, if eliminated, do not require immunosuppression to treat the immune-mediated destruction and which ones do. There also need to be controlled clinical trials to determine the best immunosuppressive agents, the best thromboprophylaxis treatments, and the best transfusion practices. The upcoming ACVIM consensus guidelines for diagnosing and treating IMHA in the Journal of Veterinary Internal Medicine will be coming out soon (free online access) and they summarize and contain recommendations for what is currently known.
