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Canine Immune-mediated Hemolytic Anemia:
I. Evaluation of the Prognostic Factors
II. The Therapeutic Efficacy of Human Intravenous Immunoglobulin
Immune-mediated hemolytic anemia,human intravenous immunoglobulin,autoagglutination,prognostic factors,intravascular hemolysis,
|Publication Year :||2013|
|Abstract:||犬免疫性溶血性貧血(Immune-mediated hemolytic anemia；IMHA)為犬隻常見的貧血疾病之一。在臨床醫療上，由於患犬常在免疫抑制藥物發生作用前，便因病情迅速惡化導致死亡，因此找尋一個能快速穩定動物病情的治療方式，便顯得非常重要。本研究的目的為針對較嚴重的病例，分析其基本資料、臨床表現與治療期間一系列血液學檢查，找出影響預後的因子及評估治療中加入靜脈注射人類免疫球蛋白(human intravenous immunoglobulin; hIVIG)的效果，做為未來臨床治療上的參考。
31隻IMHA患犬中，有19隻於治療過程中給予hIVIG(Group 1)，而12隻則未給予hIVIG(Group 2)。經過治療後，Group 1之存活率(63%)顯著高於Group2之存活率(25%)(p=0.04)。其次，group1中就診時出現血管內溶血現象之患犬，有7隻(group 1a)，而未出現的則有12隻(group1b)，而group2中就診時出現血管內溶血現象之患犬，有8隻(group 2a)，而未出現的則有4隻(group 2b)。經治療後Group 1b有10隻存活，存活率為83% (10/12)，而Group 2b僅1隻存活，存活率則為25% (1/4)，此存活率於兩組間有顯著差異(p=0.03)。
Immune-mediated hemolytic anemia (IMHA) is one of the most common anemic disease in dogs. Clinically, dogs with severe IMHA were often dead before the conventional immunosuppressive drugs become effective. Therefore, finding a therapy to immediately control immune response is important. The aims of our study were to find prognostic factors and evaluate the therapeutic efficacy of human intravenous immunoglobulin (hIVIG) in dogs with autoagglutination.
31 dogs diagnosed as canine IMHA by anemia and true autoagglutination at NTUVH during the period between April 2006 and April 2013 were collected in this study. The result suggest that, the mortality of dogs older than 8 years old was significantly higher (p =0.03). These 31 cases were divided into two groups, survival group (n=15) and non-survival group (n=16). The number of platelet count of survival group was significantly higher than non-survival and the probability of intravascular hemolysis, total bilirubin, BUN levels of survival group were significantly lower than the non-survival group at admission. After treatment for 48 hours, the number of platelet increased, the BUN and total bilirubin decreased and the intravascular hemolysis disappear in survival group. In contrast, the number of platelets decreased, the BUN and total bilirubin increased and the intravascular hemolysis was persistent in non-survival group. Based on these resuslt, the plate counts, BUN, total bilirubin and intravascular hemolysis were useful in the assessment of the treatment efficacy.
The dogs in the group 1 (n=19) were treated with the combination of human intravenous immunoglobulin (hIVIG) and other immunosuppressive drugs. While dogs in group 2 (n=12) were only treated with immunosuppressive drugs. In group 1, 7 dogs were presented with intravascular hemolysis (group1a) and 12 dogs were not (group 1b). In group 2, 8 dogs had been detected intravascular hemolysis (group 2a) and 4 dogs had not (group 2b). The survival rates were 63 % (12/19) and 25% (3/12) for group 1 and group 2, and 83% (10/12) and 25% (1/4) for group1b and group 2b, respectively. There were significant differences in survival rate between group 1 and group 2, group 1b and 2b (p=0.04, p=0.03).
In conclusion, the prognostic factors of dogs with IMHA included age, platelet counts, intravascular hemolysis, BUN and total bilirubin. The increase of platelet count, decreases of BUN and total bilirubin level and the remission of intravascular hemolysis after 48 hours of treatment suggest better prognosis. This study also proved that combined treatment with hIVIG have a better efficacy based on the better long-term survival rate.
|Appears in Collections:||臨床動物醫學研究所|
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