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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Archie
| Archie is presenting most of the time as a healthy lively puppy, however his blood tests are a little puzzling. His pcv over the last 3 weekly tests have read 38, 36, 34. He will be tested again on Tuesday but no idea why its less each week albeit slight. Is this just normal fluctuation or should we be worried? Our vet is waiting for advice from a specialist regarding his meds she hasn't reduced them for a couple of weeks. Considering it is only a couple of months since his pcv was 10 we're not unduly concerned (ish). Current medication is prednisilone 10mg daily, azathioprine 12.5mg every other day and the milk thistle. He isn't showing any side effects and his weight is now as it should be for his age and size. 7.5kg. Appreciate your thoughts. Sue |
| Sue Cambs UK |
| Hi Sue, Just for my benefit, could you look at your CBC complete blood count report for something called reticulocytes? It could be listed as retic. If there is an absolute retic and a percentage could you please post those here? Also look to see if there are any white blood cell values. This is often included with a CBC, but not always. Post those as well. Let's see what these show before I comment. my best patrice |
| Patrice NYS |
| Hi Patrice, Here are Archie's last cbc results which was done 3 weeks ago. The vet may do another this month if his pcv has dropped again Tuesday. You did look at these results a couple of weeks ago and said that the only reading in the high zone is the liver and that isn't unusual at this stage. Our vet suggested that he wore a muzzle in the garden to stop him picking things up? What do you think about that as it is really hot here for us at the moment and he hates it! We do hav chickens although they are usually penned in, they occasionally jump over. Sue ALB 40 ALP 573 ALT 409 AMY 212 TBIL 9 BUN 4 CA++ 3.00 PHOS 2.21 CRE 34 GLU 5.8 NA+ 144 K+ 5.1 TP 69 GLOB 29 QC OK HEM 0 LIP 3+ ICT 0 |
| Sue Cambs UK |
| Sue, These are the results of your chemical screen, looking at things like calcium, phosphorus, sodium, potassium, liver and kidney function. What I need to see are the results of the CBC: RBC, HGB, PLT, HCT, and most esp reticulocytes (retic?) These things count the numbers of the red elements in the blood. He's a puppy, right? So he's probably picking up lots of stuff to chew on. If you have any pesticides or other dangerous chemicals outside, then either monitor him outside so he won't do this or give him something that he will like to chew on that is safe. When both Cassie and Chance were little and were chewing a lot, I would put them in their crate with a towel and a fresh marrow bone (soup bone?) that I had frozen. Or I would put them in the yard with one and watch them. An alternative is a Nylabone. I don't know if you have those available in the UK. Puppies like to chew and it's good for their teeth and jaw muscles. It also relieves stress. Avoid things like rawhide, they are not particularly safe for animals. Cassie even likes carrots! my best patrice |
| Patrice NYS |
| Hi Patrice, Archie's pcv was 38% today, I asked the vet about the retic count and she said it wasn't necessary as the results are great she no longer does the slides. They did it when his results were in the anaemic range. She also spoke to the specialist who said to stop the azanthrioprine, keep the current dosage of steroid this week and we will look at reducing the prednisilone next week if he maintains 38%. Can you advise if I should challenge this? She does seem to know what she is doing and luckily for Archie she had dealt with a case of imha before he was treated so dealt with it correctly from the beginning. Thanks, Sue |
| Sue Cambs UK |
| Sue, I wanted to know about the reticulocytes because you were describing Archie's last three pcv results as "38, 36, 34." This could have possibly indicated a condition called non regenerative anemia. This is similar to autoimmune hemolytic anemia, but the cause is generally autoimmune destruction of red blood cell precursor cells in the bone marrow. The symptoms of this are not the sudden and massive destruction of red blood cells in circulation (and the sudden drop in pcv) that you see with AIHA but rather a slow steady drop in the number of circulating blood cells as the body stops making news ones to replace the old ones that are aging out. So thus you would see the pcv drop a little each week. My dog Chance had this non regenerative state. He was diagnosed around a pcv of 32% but it eventually dropped to 17%. It is the far more deadly version of AIHA because the body has stopped making red blood cells. The end point comes later than the sudden destruction of AIHA, but it is many times more difficult to treat. Reticulocytes are the baby blood cells that are made in the bone marrow. Without them, there will be no mature red blood cells. The normal number seen in a dog or human that does not have anemia is about 60,000 or 1%. Combining anemia (pcv below 37%) and a number of reticulocytes lower than this is in indication of a non regenerative anemia. Since Archie's PCV was 38% this time, there doesn't seem to be a decline that was indicated by the previous 3 numbers. If I were you, I would only monitor the PCV about every 2-3 weeks for a few months to ensure that this number remains here or gradually increases. Yes, gradual decreases in the prednisone are definitely in order if this number maintains or increases. Follow the vet's instructions carefully while doing this. Good luck! patrice |
| Patrice NYS |
| Hi Patrice, Thank you for your help. It has been so useful to be able to ask the questions that are thought often after we have seen the vet. Your answers convince me more because I know you know what we have been going through. Thanks again, Sue |
| Sue Cambs UK |
| I'd be happy with a PCV of 38%. Perhaps this area could be the new norm for Archie. If this were me I'd be wanting a CBC instead of a PCV done at least every second test. Just knowing certain numbers can tell one lots on how the body is doing and responding. Could just be an issue of what time of day the testing was done or how much water he was drinking that day prior to the testing. If a dog is dehydrated then the PCV would be higher than it normally would be. Any chance this might be the reason? This all kinda reminds me of the same thing Tessy was going through. The numbers were fluctuating a couple points for the longest time (between 30% & 34%) before stabilizing and rising slowly. For her it was called "microcytic anemia (slight)" and I simply cured this problem by adding Pet Tinic back to the med schedule again! Again, knowing the numbers from the CBC could tell us things like this (for me it was the average size of the blood cells circulating). ALSO, just because a vet has treated a dog before for this disease does not mean they know all they should....not knocking your vet....just saying to keep asking questions and do your OWN homework....just in case! I wouldn't doubt most vets aren't even up to date on current protocols for treating this disease! ANYWHO...mini rant over! LOL It may also be wise to have them at least check the liver enzynes and perhaps the creatinine just to see where they are now....must be almost a month now since they were last checked. Have you been using milk thistle or anything else? Sorry...I just can't remember. Keep us posted on how he's doing AND give him LOTS of belly rubs and scritches for me! Johnny & Tessy |
| Johnny |
This thread was discussed between 23/05/2010 and 26/05/2010
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