Therapeutic Strategies for Treatment of Immune-Mediated Hemolytic Anemia

Vet Clin North Am Small Anim Pract. 2020 Nov;50(6):1327-1349. doi: 10.1016/j.cvsm.2020.07.010. Epub 2020 Aug 16.


Immune-mediated hemolytic anemia is a common hematologic disorder in dogs. Disease management involves immunosuppression using glucocorticoids, potentially in combination with other medications such as azathioprine, cyclosporine, or mycophenolate mofetil. Therapeutic drug monitoring may enhance the utility and maximize the safety of cyclosporine and mycophenolate mofetil. The disease is proinflammatory and prothrombotic. Antithrombotic drug administration is therefore essential, and anticoagulant therapy should be initiated at the time of diagnosis. Additional therapies include red blood cell transfusion to support blood oxygen content. Future therapies may include therapeutic plasma exchange, anti-CD20 monoclonal antibodies, and complement inhibitors.

Keywords: Antithrombotics; Blood transfusion; C1-INH; Dogs; Glucocorticoids; Mycophenolate mofetil; Therapeutic plasma exchange; Thrombosis.

Publication types

  • Review

MeSH terms

  • Anemia, Hemolytic, Autoimmune / drug therapy
  • Anemia, Hemolytic, Autoimmune / veterinary*
  • Animals
  • Cyclosporine / administration & dosage
  • Cyclosporine / therapeutic use
  • Dog Diseases / drug therapy*
  • Dogs
  • Enzyme Inhibitors / administration & dosage
  • Enzyme Inhibitors / therapeutic use
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use*
  • Mycophenolic Acid / administration & dosage
  • Mycophenolic Acid / therapeutic use
  • Plasma Exchange / veterinary*


  • Enzyme Inhibitors
  • Immunosuppressive Agents
  • Cyclosporine
  • Mycophenolic Acid