Systematic Review of Prognostic Factors for Mortality in Dogs with Immune-mediated Hemolytic Anemia

Background: Treatment of dogs with primary immune-mediated hemolytic anemia (IMHA) is difficult and frequently unrewarding. Prognostic factors have been evaluated in a number of previous studies, and identification of such factors would be beneficial to enable selection of appropriate therapeutic regimens and supportive care. Objectives: The aim of the current study was to undertake a critical appraisal of the risk of bias in evidence relating to prognostic indicators for mortality in dogs with IMHA. Animals: Three hundred and eighty client-owned dogs with spontaneous primary idiopathic IMHA reported in 6 previous studies. Methods: A systematic review was conducted to evaluate evidence relating to prognostic factors for mortality in dogs with primary IMHA. Search tools were employed to identify articles and a validated appraisal tool was used to assess the quality of individual studies by considering inclusion and exclusion criteria, measurement of prognostic, outcome and confounding variables, and statistical methods. Results: Few studies evaluated prognostic indicators for IMHA in dogs, and all of these suffered from methodologic flaws in at least 1 major area. Fifteen different variables were identified as prognostic indicators, with 2 variables identified by > 1 study. Conclusions and Clinical Importance: There are few pieces of high-quality evidence available to enable estimation of prognosis for dogs presenting with primary IMHA.