Equine IMHA Clinical Dashboard

Equine IMHA Acute Dose Calculator

Configured strictly to Equine-Specific Clinical Guidelines

Equine Standard Active
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Weight Parameters
Patient Weight Entry

1. Immunosuppressive Plan

Dexamethasone IV (Acute Stage)
0.1 - 0.2 mg/kg
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Primary choice for acute stabilization; horses cannot efficiently process oral prednisone.
Prednisolone Oral (Maintenance)
1.0 - 2.0 mg/kg
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Transition path once stable and eating. Given PO once daily (q24h).
⚠️ CRITICAL SAFETY WATCH: High-dose corticosteroids carry a documented risk of triggering Laminitis (Founder) in horses. Assess digital pulses and hoof temperatures every 12 hours. Cryotherapy should be ready.

📋 Equine Single vs. Dual Therapy Advisor

Check presenting clinical signs to evaluate if concurrent dual protocol is indicated immediately:

Clinical Protocol Suggestion: Select presenting signs above to receive point-of-care recommendations.

2. Mandatory Thromboprophylaxis

Critical Priority
Unfractionated Heparin (UFH)
40 - 100 U/kg SC
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Traditional therapy. Given SC every 8 to 12 hours. Target parameters should be monitored using real-time aPTT labs where available.
LMWH (Dalteparin)
50 U/kg SC
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Standard dosage: 50 U/kg subcutaneously once daily (q24h). Offers more predictable antithrombotic response profile.
Aspirin Maintenance
4 - 10 mg/kg PO
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Alternate-day maintenance protocol targeting platelet COX-1 inhibition. Given PO every 48 hours.
⚠️ Prescribing Rule (Heparin Monotherapy Standard) Veterinarians should prescribe **EITHER** Unfractionated Heparin (UFH) **OR** LMWH (Dalteparin) alone. Do not combine heparin classes. Use caution when adding oral antiplatelet therapy like Aspirin due to bleeding/ulceration risks in stressed or steroid-treated horses.
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Thrombosis is a Primary Cause of Mortality. Equine IMHA patients enter a severely hypercoagulable state quickly. Antithrombotic therapies should be initiated concurrently with the first corticosteroid dose to optimize survival chances.

📋 Equine Diagnostic & Clinical Guidelines

🔍 True Auto-Agglutination vs. Rouleaux

Equine blood naturally forms prominent **Rouleaux** (stacked coins aggregation), easily mimicking auto-agglutination. You **must** perform a Saline Dilution Test using 1 part blood to 4 or 10 parts saline. Normal rouleaux stacks dissolve instantly, whereas true diagnostic auto-agglutination persists.

🐴 Neonatal Isoerythrolysis (NI) Checks

In newborn foals presenting with acute hemolytic icterus in the first 24-36 hours postpartum, suspect NI. Instantly deny access to maternal colostrum. Support with alternative colostrum or washed maternal RBCs if blood count drops dangerously.

📚 Clinical Decision Guide: Single vs. Dual Protocols ▼

The Equine Corticosteroid Standard: Dexamethasone (IV) is the standard first-line choice during the acute stage, as horses cannot convert oral prednisone efficiently in the liver. Once stable and eating, they can be transitioned to oral Prednisolone.

When to use Dual Therapy (from Day 1): Initiate dual protocols (such as adding supportive low-dose heparin alongside IV dexamethasone) immediately if the horse shows active intravascular hemolysis, severe hypoxia, or sudden catastrophic drops in PCV.

When to use Sequential Therapy: If the patient presents with stable extravascular IMHA, starting with standard corticosteroid monotherapy is highly acceptable. Perform continuous digital pulse assessments and maintain laminitis monitoring.

Mathematical Formulas (Proof)
Dexamethasone IV (Acute Stage): Weight (kg) × 0.1 mg to 0.2 mg/kg once daily (IV q24h)
Prednisolone Oral (Maintenance): Weight (kg) × 1.0 mg to 2.0 mg/kg once daily (PO q24h)
Unfractionated Heparin (UFH): Weight (kg) × 40 U to 100 U/kg subcutaneously (SC q8-12h)
LMWH (Dalteparin) Protocol: Weight (kg) × 50 U/kg subcutaneously once daily (SC q24h)
Aspirin Maintenance: Weight (kg) × 4 mg to 10 mg/kg orally every 48 hours (PO q48h)
Source: ACVIM Consensus Statements & Large Animal Medicine Guidelines. MATH ALGORITHM VERIFIED FOR ACCURACY