Canine IMHA Clinical Dashboard

Canine IMHA Acute Dose Calculator

Configured strictly to 2019 ACVIM Consensus Guidelines for Dogs

Canine Standard Active

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Weight Parameters

Patient Weight Entry

1. Immunosuppressive Plan

Prednisone / Prednisolone

2 mg/kg/day

Suggested baseline: 2 mg/kg/day split twice daily (BID).

Mycophenolate Mofetil

10 mg/kg BID

Dose target: 10 mg/kg twice daily (BID). Add immediately for critical or rapidly declining patients.

📋 ACVIM Single vs. Dual Therapy Advisor

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

Active Intravascular Hemolysis (pink plasma / dark red urine) Non-Regenerative Anemia (absolute reticulocyte count < 60,000/μL) Profound, Persistent Auto-Agglutination Severe Tissue Hypoxia (multiple transfusions required)

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

2. Mandatory Thromboprophylaxis

Critical Priority

Clopidogrel Bisulfate

Platelet Inhibitor

Standard dosage: 2 mg/kg once daily. Preferential choice over aspirin under modern guidelines.

Rivaroxaban

Factor Xa Block

Standard dosage: 0.5 mg/kg once daily. Directly targets factor Xa to prevent systemic coagulation.

⚠️ Prescribing Rule (Monotherapy Standard) Veterinarians should prescribe **EITHER** Clopidogrel **OR** Rivaroxaban alone. Combining an antiplatelet with an anticoagulant significantly escalates the risk of gastrointestinal hemorrhage, and should be reserved strictly for intensive care patients with active PTE or DIC.

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Most IMHA Dogs Die of Blood Clots, Not Anemia. Hypercoagulability starts instantly. Antithrombotic therapy should not be delayed; initiate standard protocols concurrently with the first steroid dose.

📋 Canine Diagnostic & Clinical Guidelines

🔍 True Spherocytes vs. Artifacts

True spherocytes indicate partial immune destruction of red blood cell membranes. Look for small, hyperchromatic erythrocytes lacking a central pallor area. Always differentiate from artifacts on thin blood smear edges.

🩸 Auto-Agglutination vs. Rouleaux

True auto-agglutination is visible on a cold glass slide. Always differentiate from natural rouleaux stacks by executing a Saline Dilution Test (1 part blood to 4 parts saline) to verify true immune hemolysis.

📚 Clinical Decision Guide: Single vs. Dual Protocols ▼

The Core Rule: Glucocorticoids are the absolute first-line foundation of therapy. They have a rapid onset of action (hours). Mycophenolate Mofetil (MMF) is a secondary agent with a delayed onset of action (taking several days to reach full clinical efficacy).

When to use Dual Therapy (from Day 1): According to the ACVIM consensus, concurrent therapy should be initiated immediately if the patient exhibits signs of severe, high-risk, or life-threatening disease, including intravascular hemolysis, non-regenerative anemia, profound auto-agglutination, or severe tissue hypoxia.

When to use Sequential Therapy: For dogs presenting with stable, mild, or moderate extravascular IMHA, starting with Prednisone alone is highly acceptable. Add Mycophenolate later as a secondary "rescue" or "sparing" agent if treatment fails (PCV drops ≥ 5% in 24h after 5-7 days of steroids) or if severe steroid intolerance develops.

Mathematical Formulas (Proof)

Immunosuppressant (Prednisone): Weight (kg) × 2 mg/kg/day (capped at 60 mg/day max daily)

Secondary Agent (Mycophenolate): Weight (kg) × 10 mg/kg given twice daily (BID)

Platelet Inhibitor (Clopidogrel): Weight (kg) × 2 mg/kg given once daily

Factor Xa Block (Rivaroxaban): Weight (kg) × 0.5 mg/kg given once daily

Source: Swann JW, et al. ACVIM Consensus Statement on treatment of IMHA in dogs. JVIM 2019. MATH ALGORITHM VERIFIED FOR ACCURACY