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Evaluation of membrane-based therapeutic plasma exchange as adjunctive treatment for immune-mediated hematologic
Thierry Francey1, Mathieu Etter1,2, Ariane Schweighauser1
1Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland.
Background:
Therapeutic plasma exchange (TPE) has been used increasingly to treat immunological diseases in dogs, although data concerning its efficacy are lacking.
Hypothesis/Objectives:
To describe the clinic and the outcome of dogs with immune-mediated hematological disorders (IMHD) treated with membrane filtration TPE.
Animals:
One hundred forty-six dogs diagnosed with IMHD, including 17 dogs treated with and 129 control dogs treated without TPE.
Methods:
Retrospective study of cases selected with a search of all medical records for dogs diagnosed with IMHD (2010-2019). Primary outcomes included the assessment of safety and efficacy of adjunctive TPE compared to medical treatment alone.
Results:
The TPE group included 7 dogs with immune-mediated hemolytic anemia (IMHA), 5 dogs with immune-mediated thrombocytopenia (IMT), and 5 dogs with combined IMHA-IMT; the control group included 63 dogs with IMHA, 47 dogs with IMT, and 19 dogs with IMHA-IMT. Dogs treated with TPE were more often refractory to initial immunosuppression (71%) than controls (43%; P = .04). Complications were observed in 15/43 TPE treatments (35%). The response rate of dogs treated with TPE was 83% in IMHA (controls, 65%; P = .5) and 80% in IMT (controls, 70%; P = .71). Overall, 12/17 dogs (71%) treated with TPE reached complete remission, 2/17 (12%) partial remission, and 3/17 (18%) died or were euthanized. Eighty-two percent of the dogs treated with TPE survived to discharge (controls, 69%; P = .4).
Conclusions And Clinical Importance:
Despite a bias toward dogs refractory to initial immunosuppression, dogs treated with adjunctive TPE had a similar outcome as dogs treated medically.
