Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Bilirubin levels

Ruger is very yellow and his bilirubin is up to a 39. Any suggestions to get this under control? Any other dogs have bilirubin this high? I am so worried about him and don't know what to do. Add more drugs, wait it out. He is stable and slowly climbing but at 19 and climbing this slow I am worried about the bilirubin.

Jaime Parker

Jaimie, there are people on this board that know way more about chemistry than me. I understand that the liver has to work overtime with this disease, because of all the meds and the disease itself. Kahlu was on a milk thistle tonic and sam-e (Zentonil in Canada) until a few days ago, because his liver values were skyrocketing. It would be a good idea to give Ruger something to support his liver. We have not seen the high bilirubin, that might indicate something else all together. Maybe somebody else knows. Best wishes, Brigitte & Kahlu

Brigitte BC Canada

Jaime, I am sorry I cant be of help but wanted to say I have been these boards for 1 year half since my dogs diagnosis and have seen little with high bilirubin. If Patrice doesnt answer, maybe you can pop her an email. She has a medical background and understands most of these numbers more than any of us. I did some searching and AIHA can cause juandice,along with bile duct blockage in the liver. BUT also it can be a side effect from azithyropene, this might be the first place to start by going to cyclo instead. I would discuss all of these with your vet. Laurie

Laurie CA

Higher than normal Bilirubin levels is very often seen in AIHA/AMHA cases. These higher levels is what's causing the yellowness you are seeing (jaundice). Usually it's a sign of severe liver problems but in this case it's fair to say the hemolysis of hte blood is causing this. Too much is being produced and the liver can not keep up with it....thus Jaundice. I'm not that good at explaining it but this will subside once the blood destruction gets under control. Azathioprine is a known drug to increase bilirubin counts as well as antibiotics....is Ruger on antibiotics? Doxy? If I were you I would feed Ruger a liver cleansing diet. Here's a great place to start.... http://www.canine-epilepsy-guardian-angels.com/liver_diet.htm Also, like mentioned above, Milk Thistle can be used ot help preotect the liver. It won't "fix" the liver but it will help to prevent any further destruction. Hopefully our resident expert Patrice will chime in on this one for you. Good luck. It's good tohear that the PCV went up a point to 19. Any climb at this point is really good. Prayers and best wishes. Johnny & Tessy

Johnny

Johnny has a good suggestion for the liver diet, here is a great article on why you should feed a liver cleansing diet http://www.b-naturals.com/newsletter/liver/

Laurie CA

Hi Jaime, My Kents bilirubin levels were increasing, and he was put on Ursodial, per Dr. Dodds suggestion. I think though there is a point in the levels where they cannot take this drug - i am not sure. It sounds like the liver is being hit hard, and i would not personally use the drug discussed earlier what it was called rheumatism etc drug. Can you consult with a specialist? Maybe even with Dr. Dodds at Hemopet? Once the AIHA is under control, you can start to give supplements for the liver such as milk thistle and sAme which really work very well. Re the high cost of drugs - go on google and look for 'free drug card' or free rx card - there is a site with two cards, very patriotic looking site, but the cards are taken almost anywhere and can help with savings, plus costco has the least expensive drugs too, and when combined with the free drug cards make some expensive drugs more affodable. Ursodial was something like $70 plus dollars a month, but i got it for around 28$ with the card at costco, and you do not have to be a member to use the pharmacy. always compare the prices with walmart, and online too. I am thinking of you, and hoping for the best, Christine

Christine Florida

I have been giving my Lucy Denosyl (liver supplement) ever since she's been on Azathioprine, which she has to take the rest of her life; and she is an AIHA survivor for over 3 years now.

Susan OK

Jaime, Bilirubin is a byproduct of red blood cells being broken apart. Our red blood cells live about 120 days, get old and then are broken apart by the spleen and the parts are scavenged. This is a normal, everyday, process. But not all of our RBC are broken apart each day! It is a gradual process of making a small number of new cells each day so they don't all age out the same time. Bilirubin is the coloring, so to speak, of hemoglobin which is inside the red blood cell. It carries the oxygen to the body cells. In a normal human or dog, this coloring from the old red blood cells is processed by the liver and it goes on to leave the body in your wastes (bile), like feces. Thus the brown and yellow coloring. When a dog or human is in hemolysis, or destroying red blood cells at an uncontrolled rate, the blood becomes filled with way more "stuff" from these broken RBC than normal. The liver has a rough time trying to process all of this "stuff" and thus, the bilirubin can't be flushed from the body fast enough. This indicates the liver is overwhelmed with its job. The solution to this is to, most importantly, stop the red blood cell destruction. Once that slows down, the liver has the time and resources to remove it from the blood. One of the most important nutrients to help the body is water. This will ensure that there is enough fluid to maintain the proper amount of fluid content in the blood. Also, when there is active hemolysis during AIHA, it may be wise to talk to the vet about using low dose aspirin to prevent improper clotting. my best patrice

Patrice NYS

Again thanks for the input. We got Ruger home adn his PCV had climbed another point to 20 before we left. e is on the urisodol so I think if I can just get him to start eating more that will help to flush more of the bilirubin out. We did not start the other drugs, cyclosporine , we decided to give him until Monday and see how his counts look. I am confident they will be in the high 20s and he will be on his road to recovery. : )

jaime Parker

Patrice, perhaps you can answer this question. I am fairly knowledgeable about AIHA as I am a medical lab technologist and have worked in the Chemistry dept of a hospital lab for 33 years. Our little schnauzer was just diagnosed on yesterday. His PCV is 23. Ten days earlier it was 43. Our first schnauzer died of this disease (I can't believe this is happening again). I suspected this is what he had as I am familiar with the symptoms and also as I noticed that his urine was quite yellow. I happened to have urine dipsticks at home, so I dipped it and it showed mod to large bilirubin in his urine. Now, I certainly understand why his bilirubin would be high as he is lyzing his RBC's fairly quickly but his SERUM bilirubin is normal. I can't figure out how this could be. Unfortunately, I am on disability leave from work and am unable to ask our chemistry pathologist (who is also away sick). Any comments?

Christine BC

Christine, that is so hard. Ruger's case is the first I have heard of this horrible disease and I am barely getting by because I am so stressed, worried, etc. He is home! They sent us home with him on heparin shots we have to give 3 times a day. Then we will slowly reduce to aspirin as he stops agglutinating so fast. I am happy to say his color looks much better tonight. I hope this is a good sign. His breathing is rapid and a bit heavier than I noticed on my visits in the hospital but I am hoping this is just because his PCV is so low??? Does anyone know what to look for if they throw a clot? THe dr. said labored breathing but I do not know what exactly this means. THanks

jaime Parker

This thread was discussed between 18/12/2009 and 19/12/2009

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