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What are the differentials for a 7-year-old Golden Retriever with elevated ALP and normal ALT?
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What are the current treatment guidelines for canine immune-mediated hemolytic anemia (IMHA)?

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Immunosuppressive therapy remains the cornerstone of IMHA treatment. The ACVIM consensus panel recommends initiating with prednisone (2 mg/kg/day PO) as first-line therapy, with gradual tapering over 3-6 months based on clinical response and reticulocyte counts.

For severe or refractory cases, a second immunosuppressive agent is recommended. Mycophenolate mofetil (MMF) at 10 mg/kg PO BID has largely replaced azathioprine as the preferred adjunctive agent due to faster onset of action and a more favorable side-effect profile.

Thromboprophylaxis is critical — IMHA carries a 30-80% incidence of thromboembolic events. Low-dose aspirin (0.5 mg/kg PO q24h) or clopidogrel (2 mg/kg PO q24h) is recommended for all patients. In hospitalized patients, unfractionated heparin or low-molecular-weight heparin should be considered.

ACVIM Consensus 2024 JVIM 2023 Review JAVMA 2022

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