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ACVIM consensus statement on the diagnosis of immune thrombocytopenia in dogs and cats

LeVine, DN; Kidd, L; Garden, OA; Brooks, MB; Goggs, R; Kohn, B; Mackin, AJ; Eldermire, ERB; Chang, YM; Allen, J; Christopherson, PW; Glanemann, B; Maruyama, H; Naskou, MC; Nielsen, LN; Shropshire, S; Viall, AK; Birkenheuer, AJ; Forman, MA; Hanzlicek, AS; Langner, KF; Lashnits, E; Lunn, KF; Makielski, KM; Roura, X; Spada, E

Authors

DN LeVine

L Kidd

OA Garden

MB Brooks

R Goggs

B Kohn

AJ Mackin

ERB Eldermire

YM Chang

J Allen

PW Christopherson

B Glanemann

H Maruyama

MC Naskou

LN Nielsen

S Shropshire

AK Viall

AJ Birkenheuer

MA Forman

AS Hanzlicek

KF Langner

E Lashnits

KF Lunn

KM Makielski

X Roura

E Spada



Abstract

Immune thrombocytopenia (ITP) is the most common acquired primary hemostatic disorder in dogs. Immune thrombocytopenia less commonly affects cats but is an important cause of mortality and treatment-associated morbidity in both species. Immune thrombocytopenia remains a diagnosis of exclusion for which diagnostic guidelines are lacking. Primary, or non-associative, ITP refers to autoimmune platelet destruction. Secondary, or associative, ITP arises in response to an underlying disease trigger. However, evidence for which comorbidities serve as ITP triggers has not been systematically evaluated. To identify key diagnostic steps for ITP and important comorbidities associated with secondary ITP, we developed 12 Population Evaluation/Exposure Comparison Outcome (PECO) format questions. These questions were addressed by evidence evaluators utilizing a literature pool of 287 articles identified by the panelists using a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations that then were integrated by diagnosis and comorbidity domain chairs. The revised PECO responses underwent a Delphi survey process to reach consensus on final guidelines. A combination of panel expertise and PECO responses were employed to develop algorithms for diagnosis of ITP in dogs and cats, which also underwent 4 iterations of Delphi review. Comorbidity evidence evaluators employed an integrated measure of evidence (IME) tool to determine evidence quality for each comorbidity; IME values combined with evidence summaries for each comorbidity were integrated to develop ITP screening recommendations, which also were subjected to Delphi review. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The final consensus statement provides clinical guidelines for the diagnosis of, and underlying disease screening for, ITP in dogs and cats. The systematic consensus process identified numerous knowledge gaps that should guide future studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Treatment of Immune Thrombocytopenia.

Citation

LeVine, D., Kidd, L., Garden, O., Brooks, M., Goggs, R., Kohn, B., Mackin, A., Eldermire, E., Chang, Y., Allen, J., Christopherson, P., Glanemann, B., Maruyama, H., Naskou, M., Nielsen, L., Shropshire, S., Viall, A., Birkenheuer, A., Forman, M., Hanzlicek, A., …Spada, E. (2024). ACVIM consensus statement on the diagnosis of immune thrombocytopenia in dogs and cats. Journal of Veterinary Internal Medicine, https://doi.org/10.1111/jvim.16996

Journal Article Type Article
Acceptance Date Jan 16, 2024
Online Publication Date May 16, 2024
Publication Date 2024
Deposit Date Jun 3, 2024
Publicly Available Date Jun 3, 2024
Print ISSN 0891-6640
Electronic ISSN 1939-1676
Publisher Wiley Open Access
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1111/jvim.16996
Keywords autoimmune; hemostasis; immune-mediated; platelet; thrombopoietin; MEDIATED HEMOLYTIC-ANEMIA; FLOW-CYTOMETRIC ASSAY; PLATELET-ASSOCIATED IMMUNOGLOBULIN; ANGIOSTRONGYLUS-VASORUM INFECTION; EXPERIMENTAL CANINE EHRLICHIOSIS; ORANGE-POSITIVE PLATELETS; BONE-M

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