Prognosis

Mortality seems to be correlated to the severity and rapidity of hemolysis, as well as to the ability to handle steroid therapy and other therapeutic side effects.

While the prognosis for all cases of AIHA should be considered guarded, certain factors seem to classify cases as favorable or unfavorable.

Cases that are generally considered favorable exhibit

• a slowly developing anemia
• regeneration of red blood cells
• an absence of autoagglutination.

Cases that are generally considered unfavorable exhibit

• a peracute, fulminating onset
• intravascular hemolysis
• persistent autoagglutination
• nonregeneration of red blood cells
• hyperbilirubinemia
• evidence of hemoglobin in blood and urine
• presence of liver and kidney problems
• thromboembolic disease.

It is crucial to take whatever precautions available to avoid secondary complications that can be fatal. These secondary complications include

• pulmonary and multiorgan thromboembolism
• portal vein thrombosis
• Disseminated Intravascular Coagulation
• heart murmur
• damage to the kidneys and liver due to lack of oxygen flow.

One study found that 32% of the deaths of AIHA dogs were due to pulmonary thromboembolism, which can be caused by endothelial damage by circulating immune complexes, prednisone therapy and the release of thromboplastic substances secondary to hemolysis. Pulmonary thromboembolism seems to be associated with high bilirubin levels, intravenous catheters and transfusions.

A recent retrospective analysis indicates that females are at a higher risk for AIHA and autoagglutination at diagnosis isn't necessarily associated with an increased risk of mortality , but that an increased risk in mortality may be associated with hemoglobin-based oxygen carriers and cyclophosphamide. It should be noted that this study has questionable significance since only 88 dogs were included. See abstract #214 & 215.

When the hemolysis is chronic or associated with other immunologically mediated diseases, the possibility of multisystem immune mediated disease, more in the realm of true autoimmunity, should be considered.

Remission

Remission is achieved after there is no longer evidence of red blood cell destruction and the PCV has stabilized within the normal range of 37-55%. Please note that this can takes months and even up to a year. It is only once that remission is achieved that complete weaning of medication should even be considered. Many dogs need medication for life to avoid a relapse.

Cure

Some dogs have only one bout with AIHA, achieve remission, are weaned off all drugs and never have another episode. Others relapse while or after being weaned off all medications. Since there is no way to know which dogs will sustain remission and which will relapse, AIHA is never thought of as cured, only managed successfully.

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