To describe the technique of centrifugal therapeutic plasma exchange (cTPE) in dogs diagnosed with immune-mediated hemolytic anemia (IMHA) and summarize the outcome of the procedure.
Retrospective review of cTPE performed at North Carolina State University from 2016 to 2018, through a search of the institutional database for cTPE and IMHA.
University teaching hospital.
Seven dogs with confirmed IMHA were presented to a university teaching hospital ICU for cTPE. Six dogs were not responsive to standard medical management with immunosuppressive agents, while 1 dog presented before immunosuppressive agents were begun.
All dogs underwent multiple cTPE procedures using 1 of 2 commercially available apheresis systems.
Measurements and Main Results
At presentation, the median HCT was 0.15 L/L (15.7%) (range, 0.10–0.19 L/L [10.3%–19%]) and the median total serum bilirubin was 32.5 mmol/L (1.9 mg/dl) (range, 15.4–597 mmol/L [0.9–34.9 mg/dl]). The median number of transfusions before cTPE was 1 (range, 1–4), with a median total of infused RBCs of 12.9 ml/kg (range, 8.8–37 ml/kg). cTPE with an exchange of ≥4 times total plasma volumes was used to decrease the level of circulating autoreactive antibodies. The median total plasma volumes exchanged was 4.5 times (range, 2.5–6.5 times) over 2–4 procedures. Anticoagulation was performed using a combination of systemic heparinization and regional citrate in all dogs. Six of 7 dogs (85.7%) were discharged from the hospital and were alive 90 days after discharge. One dog (14%) did not respond to cTPE (∼6.5 times total plasma volume exchanged) and was euthanized.
cTPE is a feasible and relatively safe bridging treatment option for the management of canine IMHA.
Journal of Veterinary Emergency and Critical Care, EarlyView.Wiley: Journal of Veterinary Emergency and Critical Care: Table of Contents