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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Advice Regarding Pred Dosages
| Please bear with me regarding the length of this piece. In early March my mother-in-law's 4 year old Italian greyhound named Vivian had a bout with diarrhea which caused her to stop eating, drinking. She also was very fatigued. On March 4 my sister-in-law took Vivian to the Vet. where she was found to be dehydrated. Blood tests and X-rays were taken. The X-rays revealed no problems but the blood test revealed anemia - her count was 21. The Vet. first suspected some sort of internal blood loss. Vivian was rehydrated and sent home to be put on a strict chicken and rice diet. The Vet. also requested a stool sample be brought in the week after to check for blood or parasites. On March 10 my sister-in-law took her back where the test revealed nothing in the stool, but her blood count was now at 20. A blood marrow test was taken which showed no trace of cancer. At this time the Vet. still suspected a parasite infection, either tick or flea. At this time they also were able to rule out a thyroid and diet deficiency problems. Unfortunately the bone marrow sample was not good enough to determine any other causes, so another marrow test was scheduled on the Wednesday the 18th. On that day, another blood test showed her count now at 19. The day that test was done the Vet. decided to start Vivian on meds. When the results of the second test came back, nothing showed - parasites were definitely ruled out. So as process of elimination AIHA was suspected. There was a follow up last Thursday, the 25th, after the meds were prescribed. (incidentally, at this time she wighed 9 lbs.)Here is a rundown of the Meds and the dosages. Wed 03-18 2 Prednisolone (each tablet 5 mg, 10mg total) 1 Doxycycline Thurs and Fri 4 Pred (2 separate doses, 20 mg total) 1 Doxy Sat through Tues 2 Pred, 10 mg total) 1 Doxy Wed Nothing Thurs 03-26 Pred (10 mg total), 1 Doxy The followup on Thursday the 25th showed she had gained 2 lbs (because of the Preds?), her heart rate had slowed down and a slight hint of pink showed on her gums. She also was given another blood test. We were encouraged, but then on Sat. the 26th. the blood test results showed a drop to 16. Needless to say, my sister-in-law was devastated. The Vet.told her the immune system was shutting down. I then told my sister-in-law that I was suspicious of how the Pred. was being administered to Vivain due to the fact that since this all began I have visited numerous websites -including yours - to learn all I could about AIHA, which led me to point out to her that I suspected the reason the count may have dropped came about becuase the loading dose was cut back so drastically after a few days, thus causing a relapse. The Vet. has now outlined a different dosing package: The coming 1st week (7 days) Pred. 5 mg per tablet (4 doses, 2 tablets each, 40 mg total) Cyclosporine 25 mg tablet (1 dose) 2nd week (7 days) Pred. (2 doses, 2 tablets each, 20 mg total) 50% reduction! Cyclo. (1 dose) 3rd and 4th weeks (14 days) EVERY OTHER DAY Pred. (2 doses, 2 tablets each, 2O mg total) Cyclo. (1 dose) This dosing schedule troubles me. The Vet. told my sister-in-law the teatment will take time. Given the fact that the reduction in the meds. is recommended so quickley, should we find another Vet? And if anyone living in the LA/LB area is reading this, could you recommend a good AIHA Specialist? We need help. I also wanted to say that I think Vivian can beat this. She's not as active as she once was, but she still responds well to outside stimulus very well. The Vet. made the the comment that this was an unusual case. Gives one confidence, doesn't it? Thanks. Denny, Long Beach CA. |
| Denny Long Beach |
| Denny, Please get Vivian to an internal medicine vet ASAP, as in tonight or tomorrow morning. Vivian needs to be treated very aggressively if she is to survive this crisis, and at a PCV (hematocrit/red cell count) of as low as 16, she should probably have a blood transfusion. Under really no circumstances should the dose be lowered until she has reached a STABLE PCV in the remission range (about the mid 30's and holding). At that time, Pred should really only be reduced by 25% once that stability is acheieved. In some respects the vet was on the right track by testing for tick borne/parasitic causes, but it troubles me as well that they waited to begin steroid therapy. If she truly has IMHA, then time is of the essence. Dosing should be around 1 to 4 mg/kg/day, divided into two doses, most vets will go to the high side initially, as Pred takes about a week to take effect. It's good she's on the Cyclo and the Doxy, many vets will also prescribe Azathiaprine in conjunction with Pred. Also, of the utmost importance is discussing the possibility of adding a very low dose of Aspirin to prevent clots- many recent studies are showing that this is critical during this initial crisis to prevent clotting, which can be one of the leading causes of death in an IMHA dog. Please visit Joanne's Meisha's Hope website as soon as possible, and urge your family members to obtain a second opinion as soon as humanly possible! All our best, and please keep us updated. Melissa and tiggs |
| melissa slc |
| Denny, If Vivan were my dog I would be taking her to a veterinary internal medicine specialist ASAP. I do have some information that might be helpful to you in regard to the prednisone reduction. This information is from a Magazine called “Veterinary Medicine” subtitled clinical solutions for practicing veterinarians. This is the June 1999 issue. In the article called “Managing immune-mediated hemolytic anemia in dogs” by Stephanie J, Lifton, DVM, Dipl. ACVIM which was peer reviewed before publication we find the following information and I am quoting here: “The level of medication should be kept constant until the PCV is normal for at least three to four weeks. If the dog is having severe side effects from the prednisone (e.g. polyuria or polydipsia, panting, exercise intolerance) the dose can be lowered slightly after two weeks or another medication such as Azathioprine can be added to the treatment regimen. Remember this medication needs to be given two to three weeks to take effect before the dose of prednisone can be decreased.” “Once the disease is in remission, the dose of prednisone can be lowered by 25% to 35% every three to four weeks until the lowest dose that keeps the disease under control is reached. This can be accomplished by either decreasing the dose or the frequency of administration (e.g. twice a day to once a day then every other day then every three days and so on.) If the dog is receiving more then one immunosuppressive drug, change the dosage or frequency of only one drug at a time.” End of quote. Even though this is a from a source that is several years old, this is the prednisone reduction schedule that many of the veterinary teaching hospitals follow in regard to AIHA/IMHA If you have not read my Web site on AIHA/IMHA as yet, you might want to do so when you can. The URL is: http://www.cloudnet.com/~jdickson/ Be sure to follow the links on the first page to many other sites on AIHA/IMHA that will be very helpful to you and do read the SUCCESS STORIES pages. They will show you what has worked for other dogs in terms of treatment options as well as give you a lot of Hope. Dogs CAN and DO surive AIHA/IMHA and go on to live happy heathly lives but to do so they need to be treated promptly and aggressivley by a vet who is very knowledgalbe about the disease. It does not sound like Vivan has such a vet so I do urge you to seek another opinion from a veterinary internal medicine specialist or a veterinary teaching hospital. Be assured you and and your family are in my thoughts and prayers during these very most difficult days. |
| Joanne MN |
| Denny, Unfortunately it sounds like your Vet does not have a clue about treating AIHA. You also might want to contact Dr. Dodds at Hemopet in Garden Grove. She will respond very quickly to emails. She also rescues Greyhounds. www.hemopet.org She also has her protocol for treatment posted at her site. You might also try Advanced Critical Care and Internal Medicine in Tustin. 949-654-8950 They are expensive but they worked miracles for one dog on this board named Lola. You can go back in the archives and read her story. Keep us posted Penny |
| Penny Lytle Creek Calif |
| It sounds to me like your current vet does not have experience in dealing with this horrible disease. That sounds like a very abnormal medication cycle. PLEASE have it checked out for Vivians sake. I would get the advise of a specialist ASAP (today). Like Penny said....maybe you could contact Dr. Dodds at hemopet. You came to the right place for help. This site is so great and the people here are sooooo understanding and willing to give advise. This forum has helped me more than I could ever explain. I wish you the best and Vivian will be in my thoughts and prayers. Johnny & Tessy |
| Jonathan |
This thread was discussed on 30/03/2009
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