Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Bentley's Latest Crisis

Hi, all.... I wanted to catch up a bit....Bentley's lab work 10 days ago looked better....no spherocytes, HCT still around 26.3, and retics at 110,000, and his WBCs down to 16.0. Then he had a week or so with lots of tummy issues...vomiting and diarrhea. We got that under control, and had a chem panel done. His ALB last Friday was 2.0, and WBCs had climbed to 19.1, so the vets put him on Clavamox for a week. Fast forward to yesterday/today..... HCT 27.6, RBC 3.93, HGB 8.8, Platelets 931, Abs.Retics 223.8 (Highest yet!!) , and no spherocytes...good news there ALB is 2.8 (a little better, but still low) NOT GOOD NEWS: Total WBCs 38.5, NEU 29.5, Bands 1.9, LYM 2.3, MON 4.4, EOS 0.4 MORE NOT GOOD NEWS: The specialist did a urinalysis....Specific Gravity 1.012, Excess protein 4+, and Protein/Creatinine Ratio of 10.....so DEFINITE trouble with his kidneys. The doc doesn't think it is an infection, but thinks it is damage from the IMHA....But the final results of the culture & sensitivity won't be ready until Monday or Tuesday. The plan right now is to stop the Sucralfate short-term in case it is inhibiting absorption of the meds, and to increase the one med we have room to tweak, the mycophenolate. Hoping this makes some difference. Tues we are planning a trough test for the Cyclo. Any ideas would be much appreciated....I am really worried that this kidney damage is a big problem. Thanks so much, Sally and Bentley

Sally Louisiana

It sounds like Mr. B and Cookie are having similar problems as she too is having tummy issues (no vomitting but some very foul diarrhea). I may end up getting a fecal done to rule out parasites. We are still waiting on the urinalysis (very mad at the clinic we got it done at, they said we'd hear yesterday and I called twice to see what's up, they said they faxed the results over to our regular vet but our regular vet didn't have it)

Monet Sammamish

Sally, Found this about the use of Mycophenolate in canines. http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=569903&sk=&date=&pageID=6 "Mycophenolate mofetil (10 to 20 mg/kg orally or intravenously twice daily), similar to azathioprine, targets B and T lymphocytes by inhibiting an enzyme necessary for de novo purine biosynthesis. This drug was developed to help prevent allograft rejection in people and has been used in dogs to treat myasthenia gravis and glomerulonephritis. At therapeutic doses, mycophenolate is minimally myelosuppressive, but gastrointestinal side effects can be substantial in dogs (gastrointestinal hemorrhage, anorexia, and diarrhea). To minimize these side effects, the dose can be lowered to well-tolerated levels when used in conjunction with other myelosuppressive drugs.31 Few reports have been published on the use of this drug for IMHA." I am only guessing when I say that Mycophenolate may be part of the trigger now for the current tummy issues. Would increasing the dosage make it worse? Wanting to avoid blocking absorption of drugs is a good idea, but Sucralfate can be moved to a different time of the day to accomplish this. I used it on an overnight fast. Especially when using prednisone, this would be even more important. Are you still using anything like pepcid? Kidney issues are complex. There is an excellent group on yahoo that you probably should join and ask questions about this. The moderators have a number of years doing this under their belt and they can give you very valuable advice. Do this sooner rather than later, time is important when it comes to the kidneys. http://pets.groups.yahoo.com/group/K9KIDNEYS/ my best patrice

Patrice NYS

Sally: I'm not sure what dosage or how long Bentley has been on cyclo, but I do know that one of the less common side effects of taking this drug can be an increase in both a dog's creatinine and BUN levels. We saw this in Sheba when she was on Atopica. After she was weaned from it her levels did drop. Check your package insert for the full info. Rita, Mike, Greta and (Angel) Sheba

Rita IA

Thanks to all for your comments! Monet, I'm sorry Cookie is having tummy troubles! And yes, I know how hard it is to wait on vet phone calls! Hoping for the best for you!! Patrice, Mr. B was put on Mycophenolate as our specialist at the time had experienced good results with it on IMHA cases....I suspect current specialist will give it a week or so to see if numbers improve, then decide if we will continue it or not.... I was giving Mr. B the Sucralfate first thing in the morning, and then at about 5 pm, at least 4 hrs after his lunch, and 2 hrs before his evening meal. But the specialist is still concerned about absorption issues. Yes, Mr. B is on Pepcid A/C....he has been the whole time. He feels the Pepcid will be fine right now, and we can add back the Sucralfate if needed. Rita, I will read the package insert....I wouldn't be surprised if the meds caused some of the problems. He's been on the cyclo for nearly two months now... Will update when I know more....Thanks, everyone! Sally and Bentley

Sally louisiana

Cyclosporine for two months? Has the dosage been decreased at all??? What dosage is the prednisone? My dog had the most severe case of non-regenerative anemia my specialist had ever seen, but he still responded to the cylosporine within 3 weeks. My feeling is that if in two months there has been very little progress then something other than autoimmune is triggering this. Have they discussed this possibility with you? The kidney's are directly involved in the process of making blood. If they don't produce the proper stimulating hormone, the bone marrow will not make blood. In humans with kidney disease they will use Epogen shots to help anemia. Dogs can sometimes respond similarly, but getting this drug for canines is difficult. I know I have read a lot of information about this kidney connection with anemia on the k9kidney forum. I am no expert, but they are. my best patrice

Patrice NYS

Patrice, He had all the typical tests run at the beginning of all this in June, including xrays, scans, and bone marrow aspiration....the diagnosis was IMHA. To date, no other possibility has been mentioned. Bentley has been on Cyclo for nearly two months....he started on 25 mg 2x day, for about four weeks, then was increased to 50 mg 2x day three weeks ago....at that time, we actually began to see improvement with the RBC morphology (No spherocytes) He has been on Prednisone 10 mg 2x day since July 1....Pred alone did nothing for him. As of now, the specialist believes the trouble with the kidneys will be due to the IMHA...as I said, still waiting on final culture & sensitivity. It would really be better news if a positive test for infection showed up, and could be treated with antibiotics...that's what we're hoping for at this point. He is regenerating strongly at this point (just as of this last week), but this is also when the WBCs spiked and we found the urine protein issue....so very hard to know just what is going on. I'll be sure to check out the other group quickly. Thanks again, Sally and Bentley

Sally Louisiana

Sally, Has Bentley been tested for Lyme disease? There is a condition called Lyme Nephritis that sounds suspiciously like these symptoms. I have known of many dogs diagnosed with this on the tick list I belong to. Read more here: http://sites.google.com/site/blackgsd/lymedisease Look for this on the right side of the page: Early Detection of Nephritis: Advice from IDEXX "Lyme nephritis is a devastating glomerular-tubular disease that carries a guarded long-term prognosis. Early diagnosis is critical. All dogs in endemic areas should be screened for Lyme with the SNAP 4Dx Test. Every positive dog should be screened for proteinuria. Additionally, in endemic areas, every time proteinuria is detected in a dog, it should be screened for Lyme. (Proteinuria: too much protein in the urine, which may be a sign of kidney damage.) This is the key to early recognition of this disease, which will lead to earlier treatment and a better prognosis." read more...

Patrice NYS

Patrice, They didn't test him, but did put him on doxycycline for a two week period in the event there was tick disease....I went to the link you provided, and it is very similar to what Mr. B presents. I'll be asking about that tomorrow, for sure. I'll let you know what the vets tell me.... Thanks so much, Sally

Sally louisiana

Sally, If they did not specifically test for Lyme and only treated for two weeks with doxy then there is a possibility that the dosage was not high enough or given long enough to effectively eliminate the Lyme spirochetes from the body. If I have seen this once, I have seen it hundreds of times when owners come to Tick-L to ask questions about their very sick dog. We have several experts on Tick-L and many knowledgeable owners. If you wish to join Tick-L you can do so by going to this link: http://saluqi.home.netcom.com/ticklinks.htm and then click on this: Managing your TICK-L subscription options, etc. Subscribe, sign off, change options, or search the list archives from the TICK-L home page Once you have done this you have access to many years of posts and you can search it all. That would be an excellent start. my best patrice

Patrice NYS

Patrice, After doing lots of reading last night, I found info that supports exactly what you mention....that two weeks of doxy isn't enough to solve a tick disease....If that is Mr. B's problem, it appears to still be active. I submitted the request to be added to the Kidney group....I'll go to the Tick group as well. I'm now making a list of questions to ask the vets in the a.m.!! I'm just soooo very worried about his kidney function. Thanks so much, Suzanne

Sally Louisiana

Sally, Please try not to worry right yet. There are a lot of people on Tick-L who know this condition like the back of their hand. The folks on the kidney group may not be as familiar with this condition, but they can help you with understanding the test results and make suggestions. Knowing what you are dealing with takes some of the stress out of making decisions. I wish I was able to give you a big hug right now and let you know that I have faith that you will do whatever you can to help Bentley. my best patrice

Patrice NYS

Patrice, You have been more help and support than you can ever imagine, and I could never thank you enough!! I'm putting questions to paper today for the vets....if you can think of any specific ones I should ask, please note them for me. I want to make good decisions for Bentley. Right now, he is happy, eating well, wagging his tail....yes, sleeping more than normal, but otherwise looks pretty good. So I'm not giving up yet!! I just want to be sure I'm not missing anything.... Again, thank you so much for everything! Sally and Bentley

Sally Louisiana

Sally, I saw that Bentley is scheduled for a trough test on Tuesday. The cheapest place seems to be Cornell and all the paperwork is online. It was hundreds of dollars less than other places. Chloe only had the test twice and neither time did it show she was at a therapeutic level. Chloe has now been on cyclosporine for 16 months! Dr. Dodds can tell though by the lymphocyte count I think. Stay strong and wishing you the best for Bentley. Cheri and Chloe

Cheri Maryland

I never had the trough test done, as per Jean Dodds. Chance was so responsive to the treatment that it was apparent it was working. p

Patrice NYS

OK, another update...... today we did a quick CBC at our regular vet. Their values always vary a bit from the specialists. His HCT was still around 27, and WBCs were about 34.0, so down only a little bit. Based on this, I decided to go ahead with the Cyclo trough test. I also talked with my regular vet, and we decided to do the Tick Panel. I have to at least attempt to see if all Bentley's problems are from tick disease.....I'll keep you all updated as I get results. Sally

Sally louisiana

We got partial results from the tick panel today.... Heartworm: Negative Ehrlichia Canis: Negative Lyme: Negative Nanplasma Phagocytophilum: Negative We also got final results from the urinalysis culture & sensitivity: negative for infection (although he was still taking Clavamox so that could be skewed?) Specialist believes kidney issues are from the IMHA....I'm in the process of going on the Kidney Forum, but am a bit behind as my father-in-law had surgery, and we've been up at the hospital alot this week A CBC at our regular vet showed his ALB back within normal values, and his total WBCs down from 38. to about 34. So somewhat better.... Will post more later! Thanks for any thoughts or ideas....I am still worried sick. Sally and Bentley

Sally Louisiana

They make kidney supplements for dogs, if you're interested: http://www.amazon.com/gp/product/B00076NTBE/ref=pd_lpo_k2_dp_sr_2?pf_rd_p=486539851&pf_rd_s=lpo-top-stripe-1&pf_rd_t=201&pf_rd_i=B0017TY89W&pf_rd_m=ATVPDKIKX0DER&pf_rd_r=1NCCXX96J78ZWWM44C5G

Monet Sammamish

Monet, Thanks so much!! I will definitely look into that, and check with the vet! I hope Cookie is feeling better....Mr. B sends her big puppy hugs and kisses! Sally

Sally Louisiana

Sally I want to let you know I am hoping and praying that you Bentley will get better soon. Connie

Connie Washington

Sally, How is Bentley doing today? I am finding so much useful information here. I will ask the vets.if Lucky has ever been checked for Lyme disease. We will be there tomorrow spending 15 minutes for blood work and an hour for all the questions that I am writing down as I read all of the posts. Poor Lucky has been on Predisone and Atopica for a little over 9 mos. When they've started to ween her, Her cells drop. She can't even reach a 20 now. She was up to a 26 last month and they switched her meds. on us. It turns out that those new meds were what they normally give to cats. Since then, her Red blood cells remain low. Good Luck Bentley, and you too Sally.

Kathy Crestline

Well, another update! The rest of the tick panel came in, except for one test......everything negative, including Babesia, which is the one I was most worried about. So Bentley has no tick disease it seems.... Connie, thank you so much for your kind words....he is fighting hard. Kathy, Mr. B is doing well today. He is turning circles (his way of asking for something), barking, and wagging his tail! His appetite is good, and we have been able to transition back to mostly home cooked food for him. I would DEFINITELY ask about Lyme or other tick disease....it can cause many of these symptoms. Bentley was bitten by two ticks not long before this started, so it was a real concern for us. So far, we haven't been able to get Mr. B into full remission....his Reticulocytes are better, and there are no longer Spherocytes in his RBC morphology, but his HCT hasn't gone up yet....probably because his WBCs are still high due to inflammation from the IMHA. Have you tried the PetTinic? It is a supplement that helps with iron...Mr. B has stayed at HCT of about 27, and I think it may have helped him. This site is FANTASTIC for info and learning about this illness....I would have been lost without the advice of all the wonderful folks here!! Good luck at the vet tomorrow, and keep us up to date on what you find out. Sally and Bentley

Sally Louisiana

Hi Sally and Bentley. This site is great. I am so happy that I discovered it. I have written down so much and have so many questions for the Vet. tomorrow. They will be doing a complete blood panel and we did ask about PetTinic. The vet. gave us Hi-Vite Drops and said that it is the same as PetTinic. We started Lucky on it tonight with her other 8 pills. We are asking about Lyme and Tick disease, as she was a Stray when the animal Shelter caught her. I know that she had been dumped in the Mountains with nothing around. We don't know her history but know that a tick bite could have been possible. The sweet little/big girl has a strong will to live and we have a strong will to see her do just that. I think with Lucky's case our small town vets. are learning a lot. They have been getting more cases of Autoimmune disease. I worry that it could be altitude as we live in the mountains. We are only at the 4,500 ft. level, but it still makes me wonder. It Looks like Bentley has a strong will too. I hope he continues to improve. I wish you and him a long, happy life together. Take care and have a good night....

Kathy Crestline

This thread was discussed between 27/08/2011 and 03/09/2011

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