Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - 7 Months and still not doing well

My little one, Winston was diagnosed in June with IAHA and underwent his fourth transfusion yesterday. He started at 5.5lbs and has put on 2 lbs from the pred. He's now taking predisone/azathioprine/atopica - I added f3+ bioprep and 5mg folic acid. His red blood cell count has been as low as 8% and has high as 33% but his doctor hasn't been able to get him stabilized. I don't know what to do. I just don't think I can put him through another tranfusion. This last one was too hard on him. Are there any remedies out there that anyone can suggest that I've not tried? Please help.

Lisa TX

Lisa, I am sorry you are still having so much difficulty with stabilizing Winston. An interesting and annoying side effect of frequent transfusions is that it can slow down the necessary stimulation of the bone marrow to make more blood properly. Determining what an appropriate "transfusion trigger" is can be tricky and varies from dog to dog and person to person. The viewpoint on this has changed a bit over the years. For instance transfusions used to be more common in humans at much higher PCV's and more readily done until it was discovered that sometimes the transfused blood carried an unwanted disease. Caution ruled for a period of time. The American Red Cross has had to make significant changes to how they collect, store and process donated blood to accommodate these needs. So what constitutes a transfusion trigger? Not just a low PCV, which might be anywhere from as low as 6 to as high as 30. But what is the clinical reaction by the dog to that low of a PCV (anemia)? Is the dog really affected poorly or does it seem to be handling the lower PCV well enough? That can vary widely. It is the clinical experience of your vets that guides them in this decision. So if Winston continues to show poor clinical response to a low PCV: heavy breathing, racing heart, thin and beady pulse, pale mucous membranes, collapses, anorexia etc, then that might be considered (combined with a low PCV) an indication that a transfusion is required. If this happens at a PCV of 22, then so be it. But if a dog seems to be feeling somewhat ok at 22, then perhaps it would be best to hold off. Dr. Dodds does indicate that transfusing a dog that is not showing clinical signs like this might in fact slow down the regenerative process in the bone marrow. If this were me I would focus on excellent at home nursing care after this most recent transfusion. Quiet recovery with good food, clean water, moderate exercise and very little stress may be what is needed. Frequent vet visits can have the unwanted side effect of keeping the dog uneasy and this increases the stress hormones in the body. If you are not able to stabilize Winston from this point on it might be appropriate to see a specialist who may want to do a workup that includes a bone marrow biopsy. They might also have excellent input into the type and dosage of your current immunosuppressive drug. my best patrice

Patrice NYS

Hi Lisa I am so sorry to hear about Winston - I am new to this illness myself with my Riley and have received a lot of help here. As Patrice has indicated, perhaps a view from a specialist? I have recently done this as Riley did not seem to be going anywhere, but at a plateau, and I took a trip to the teaching hospital and they have adjusted the Atopica - well increased it from one dose of 25mg to two doses. Im honestly not sure yet whats going on, as my vet did some tampering with the pred, which I think has got in the way of things, so we have to wait a bit longer to see whats going on. Riley is on the same medication as Winston - he has been as high as 34%, then back to 29% - differences between the in-house PCV and the external lab. I wish you success with Winston, and that he improves very soon - I know how much these numbers mean. What is Winston's PCV at the present time? Silka

Silka Melbourne Australia

Hello Lisa, That's tough news about Winston. I am pretty new to this so I can't offer much other than my thoughts and prayers which are with you both. Good luck in this new year and remember to keep your hopes up. Kelly

Kelly Redding

Thanks for your thoughts - Patrice - your comment about the frequency of transfusions makes sense - It's hard though when you're desperate to do something - when a transfusion is being recommended, you grab at it. His first transfusion was at 8% and the others, including the most recent were when he dipped to 19%. I'll take him back in 10 days to be have bloodwork done. It seems his lapses are further apart each time but I just don't know how much his little body can take. Since Winston has put on weight from the pred, he's up to 7.5 mg/day of prednisone. But he's taking 25mg Atopica twice a day now - that's the most recent change she made. That's the same amount as your Riley, Silka. What does Riley weigh? The Azathioprine is only a qtr of a tablet every other day.... she tapered that off from a qtr tablet every day about 3 wks ago. I've made notes of what other medications have been suggested on other threads and I'm going to ask about the cytoxan and cyclosporin. I also saw something about danazol and winstrol?

Lisa TX

Please know that Winston is in our thoughts and prayers and we hope he turns this around soon. The Bioprep along with the other drugs did really seem to help my dog. Ginger's PCV went up 10 points in a months time after starting the Bioprep. How long has Winston been taking it? Please keep us up dated on how Winston is doing. You might want to email Dr Dodds and ask her for her advice, here is her email address. hemopet@hotmail.com Sending hugs your way, Cheryl & Ginger

Cheryl & Ginger Pineville PA

Hi Ginger - Winston has been taking the Bioprep for more than 2 months. He takes 1 cap 2x/day. I did not notice any significant improvement in the red blood cell count after starting the Bioprep but I'm not willing to stop it either. I checked w/ Winston's doctor. She had no issue with giving it to him. I'll take your suggestion on contacting Dr Dodds. Thank you !

Lisa TX

Hi again Lisa Riley is a maltese shihtzu X - he is 6 and a half years young - I have found out that shihtzu breed is predisposed to this illness - not sure what may have triggered it, but I had given him a spot on flea treatment the same week, but a few weeks before, both my dogs were playing and we found a spot of blood on the floor which I now suspect may have been from Riley's nose. I think that Riley is now about 6.5 kg, which is about 14.3 lbs, with the weight he has put on from the pred. Atopica IS cyclosporine - he started in September of 25mg of pred - 2.5 tablets (12.5mg) twice a day - I am never quite sure what whether the tablet dosages are the same over there as in Oz, but I suspect so. Half a 25mg of azathioprine every day, and one cyclosporine (Atopica) capsule was added a few weeks later to try to get the reductions started. A few weeks later they cut the pred down to 2.5 once a day and when Riley got a case of pancreatitis which put him into hospital, on specialist advice they wanted to reduce one of the meds, either the pred of azathioprine as they felt it was not helping - so it was agreed to give half an azathioprine every other day. A few weeks ago, after Riley's numbers never seemed to change, I took him to the training hospital, and she added another cyclosporine (Atopica) to make it the same dosage as yours. I would really like to know if there is any difference in giving them twice a day or once a day - I was told to give them both together. Riley was also give a trough test to see whether the cyclosporine was working the way it should. Apparently it should be 200-400 but his test came back as only 136! After the dose was doubled, the test was done again and came back at 435. The specialist was ok with that, in that it does fluctuate during the day. Riley's PCV had gone up to 34 the week before the pancreatitis, so they dropped the pred by half a tablet, then the PCV dropped, so up we went again. I think I had some differences with my local vet and the specialist who wanted to wait until Riley got into the reference range (37-55) to make any reductions, and at the moment she is away, so I havent had a response from her, but I made the decision to go up again. Same thing just recently, PCV came in at 34 (this was done in-house) so we dropped a half, and the external hematocrit came back at 28, so up we went again. Lisa are you saying Winston's most recent PCV was 18? What type of dog is Winston and what does he weigh? Riley was 5.5lbs when all this started - 3 September. Sounds like our doggies are kind of on the same path here, and the same size perhaps? Good luck with the next blood count - read as much as you can - check the archives here as well as the Meisha's Hope site and write everything down. Patrice is a fantastic help and is always right on with her advice. I also emailed Dr Dodds who was very helpful - you may be able to send her a blood sample for testing, given you are in the US. Good luck and stay in touch. Silka

Silka Melbourne Australia

Hi Silka - Winston is a Maltese - started out at 5.5 lbs. I don't know the kg's. His last PVC was 19%. He's only been above 30% after each of his prior transfusions and hasnt been able to maintain that level beyond afew weeks. It sounds as though you've been catching the dips quickly and making changes before Riley gets too low. Did you receive any recommendations from Dr Dodds message that was contradictory to Riley's doctor and specialist? What did they think was the reason for the pancreatitis? What have you been feeding Riley? I've been giving Winston and his sister Royal Cannan Duck and Potato - but I also give them baked chicken in the evening with all his medications. I've read several people are removing all processed foods - cooking their own hormone free meats. Is there some finding that the foods could have caused or aggrevated this condition? It's quite scary when you look around your home at all the chemicals we use in our every day life. I want to know what it was that caused this but I don't guess I'll ever know. It seems strange that Winston got sick and his sister did not.

LIsa TX

Has your vet every suggested a trough test to make sure Winston is on the correct dosage of Atopica. Here is an explanation of why a trough test maybe needed taken for the Meisha's Hope website It is very important to measure blood cyclosporine levels when the drug is being used.The therapeutic range for cyclosporine is from 300-500 ng/ml (nanogram/milliliter). One reason that frequent blood testing is necessary with cyclosporine is that there can be a great deal of variability in its absorption. One dog may absorb a larger percentage of the prescribed dosage then another. Cyclosporine concentration blood tests called trough tests are not able to be done "in-house" at veterinary clinics nor do most outside labs run cyclosporine levels. Trough tests are usually sent to veterinary teaching hospitals, to be run. The blood for the trough test must be drawn at the exact time a dosage of cyclosporine is scheduled to be given. This allows the lowest amount of cyclosporine in the body to be measured on the trough test. Since cyclosporine saturates the tissue, the dosage may need to be adjusted from time to time, another reason trough testing is so important. Because cyclosporine interacts with a variety of other drugs it should be used with caution with other medications. To get the full benefit from cyclosporine the dog must be on a very strict feeding and dosing schedule. The diet must be consistent without any deviations in amount, type of food or feeding time. Because cyclosporine has a half life of only 19 hours it must be given every 12 hours. Cyclosporine is sold under many brand names including Neoral, Gengraf and Atopica. Danazol is a drug primarily used as an adjunctive therapy with corticosteroids.

Cheryl & Ginger Pinevile pa

Hi Cheryl - Apparently Winston has never received this type of testing as I've never been asked to hold off on his dose until I get to the office for his bloodwork. This sounds quite serious.. Could he be receiving TOO MUCH Cyclosporine? I've also never been given any kind of guidence on diet and feeding times. Winston has always been permitted to eat whenever he was hungry since I work different hours. I know the dosage has not exceeded 19 hours between each pill though. The office is closed over the holiday weekend so I'll call on Monday to see if this is something I can have scheduled as soon as possible. She has sent off bloodwork before but all the most recent testing has been done locally.

Lisa TX

Lisa, Veterinary Drug Handbook also says about Cyclosporine and I quote: "Give on an empty stomach, (one hour before or two hours after meals)Importance of regular dosing must be stressed." The Veterinary Drug Handbook also says about cyclosporine and I quote: "Therapeutic drug monitoring: ideally 24-48 hours after starting therapy and then every two to four weeks: target trough level (12 hours after last dose) have been suggested at 100-500 ng/ml in dogs for immuosuppression. Because different methodologies may yield different results contact the labortory for recommendations on the evaluation of the levels." End of quote

Joanne MN

Lisa, don't take a transfusion just cause it's available. It should be a LAST RESORT so to speak. Just like what Patrice was saying above. Is Winston regenerative? What are his retic numbers? Is there any blood loss internally? I'ld consider lowering the pred some if you added the cyclo. You should get in contact with Dr. Dodds and have her take a look at the blood. She worked wonder for so many dogs here and especially for my Tessy. Tessy wasn't showing good improvements for almost 5 months till we contacted Dr. Dodds and she made several recommendations. The best money BY FAR I've spent on this disease. Have you considered adding Pet Tinic to Winstons food? This has helped us considerably! I also know that Dr. Dodds DOES NOT recommend Bioprep. It has helped others on this site but I always say "why take any unnecesary chances" right. Best of luck figuringhtis out. I know how frustrating htis can be. I'll keep Winston in my thoughts and prayers. Strong healing vibes coming your way buddy. Johnny & Tessy

Johnny

You have both given me so much information to process. I will change the method of medication delivery ASAP - Although I do have to wrap the pill in food to get him to take it... And I will call the doctor about the trough test as I know that has never been given. I sent an email off to Dr Dodds. Haven't heard anything yet. I plan to take the paperwork from the website to the doctors office for sending off a blood sample. It sounds like Tessy is on the road to recovery. I'm eager to hear back from her office. Winston is regenerative. He does not have internal bleeding that has been identified. And I don't know what a retic number is.... Isn't the pred suppose to be 1 mg for each pound of body weight? If that's correct, Winston is right at the dosage for his weight given the gain he's experienced. He's been on Atopica for several months - gradual increases all along the way. My gosh - You've given me so much to discuss with his doctor. I feel empowered to do something!

Lisa TX

Johnny, is Dr. Dodds against Biopreparation or does she just think it is unnecessary? I have given it to Kahlu for about 3 months now. Of course I can't say with certainty that it does any good or not. I would love to hear your insight. Brigitte

Brigitte BC Canada

Hi again Lisa Here is a response from the specialist, via email, in regard to the high result of cyclosporine in Riley's system after it was increased: "I think that the result is a good improvement and I am not concerned that we are a little higher than the therapeutic range for a one off sample. The drug concentration is likely to fluctuate a little during the day and may be lower than this later in the afternoon/evening." I also have to wrap the cyclosporine in food for Riley to take it - there has been times Ive found it under my chair, or in a corner, but I now wait to make sure he has taken it. I cook Riley's food now, also for Bonnie, my border collie, who has lost weight on it and looks quite good. With the help of internet searching, as guided by Patrice, I boil chicken breasts (no skin) and cut them up - I steam/mash a few vegies i.e. broccoli, cauliflower, carrot, sweet potato, spinach, pumpkin, zucchini, squash - also overcooked rice for easier digestibility. I then put these together, and stir in a teaspoon of low fat probiotic yoghurt and and a teaspoon of low fat cottage cheese, and a teaspoon of an Aussie brand health booster supplement with milk thistle and lots of other stuff. I believe Riley's pancreatitis was a combination of roast chicken - to try to help him eat - and the medication. I will send you the emails I received from Dr Dodds so you can see what has been said, but Im sure you will hear soon. Golly, its hard to try and guess what the triggers are and why some get this and some dont - drives you nuts. At the end of the day we just have to deal with it. I wish you well. Lets know how you go Silka

Silka Melbourne Australia

Brigitte, I asked Dr. Dodds if it would be alright to put Tessy on the Bioprep way back when we were all discussing it and she seemed to know what it was and she said she didn't think it was safe or wise due to the live micro-algae in it. I think her exact words were "Not entirely safe for a dog on immunosuppressive therapy". I'm going to have to take her word on this...and frankly most everything she recommends. She's helped us so much and has been right about everything else so far. She's the best in this field so if anybody would know she would. Not trying to dissuade people from using this product...it's just not for me or Tessy. Too many risks involved for me. My best, Johnny & Tessy

Johnny

Thanks Johnny! Brigitte & Kahlu

Brigitte BC Canada

This thread was discussed between 01/01/2010 and 03/01/2010

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