Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Cooper's Challenge with IMHA

Four weeks ago a good friend of mine directed me to your great AIHA/IMHA site. I have read almost every post since and gained a vast amount of knowledge on how to handle all the challenges ahead with one of our furkids. It has now been almost 2 1/2 months since Cooper's IMHA challenge began for him and for our entire family with all the nasty's that come with this dreaded disease that all of us are so familiar with. In one day he went from robust 2 year old Airedale to a listless out of energy guy that refused to even eat. The vet clinic diagnosed almost imediately IMHA. His PCV was 28 and xrays showed an enlarged spleen. He was put on Pred. 30mgx2 for the next 5 days. The next PCV showed 24 and the vets got very aggressive with Pred. 50mgx2. Nine days later PCV was 39 and the vets went to Pred. 40mgx2 and added 50mg AZT. Over the next 3 weeks they slowly lowered the Pred. down to 15mgx2 and AZT to 25mg. The vets took PCV tests twice each week with counts lowering slightly to 34 range and have stayed there for the last four weeks. In a further attempt to get in the "normal" range he had us start giving all 30mg Pred. at the same time. A week has now passed and no net change in PCV, so starting today we incresed the AZT back to 50mg per day to see if we get a spike in the numbers. I guess my question is how do we get "normal range" and stay there? Are we trying to move to fast? Any observations, or recomendations would be greatly appreciated.

Ron Lakeland

Hi Ron, It's nice to meet you, welcome to our forum, though we're sorry you have had to join us here. Cooper's progress actually sounds very good. A PCV of 34, even though it's lower than the 39 he had, is still very good. Is he maintaining at that 34? Tiggs, and many dogs here, took months to get to that level, and some never rise into the 30's for some time. Also, it's not uncommon for the PCV to level for a while, you just don't want downward *trends*. Things happen slow and steady, and that is good. Also, AZA and Pred do cause some marrow suppression where cells are produced. Once stable and meds are slowly tapered, you might see the PCV slowly rise again. As long as you have a good vet and take things slow, it sounds like Cooper's prognosis is good. Just watch for any signs of infection, or elevated white cell counts. Tiggs had a few setbacks like that, where the PCV dropped and he had an underlying infection. Also, machines can read PCV's a little different week to week. So, four points could just be a slight variance, hence, looking for those trends as opposed to +/- a few points. A rule of thumb on med reduction: no more than 25-35% every two to three weeks of stable disease (PCV holding and at or near remission range). Good luck, keep us posted, and never hesitate to ask anything here or to even consider a second opinion from another vet or internal med specialist. Dr. Dodds also has helped many here on this board and can be reached via her email or website at Hemopet. thinking of you, melissa and tiggs

melissa slc

Hi Ron, I am glad you found this board and at the same time sad you had the need to. Be assured, you are in good company! I have learned so much here and am grateful for all the advice and support that I was given. We are also still in the beginning of this journey. I think patience is one of the hardest things I had to learn with this disease. Kahlu was diagnosed January 24. and he still has not gotten over a PCV of 36. Slow progress is good, not decreasing is ok. We all wish there would be a magic pill that would make our dogs healthy quickly. Unfortunately that pill is not available. It seems every dog reacts different and needs a different combination of medications. My vet got insecure at one point and needed some guidance. I asked her to contact Dr. Dodds, which she gladly did. We got good advice for supplements from her. My vet also contacted an internal medicine specialist, just to get more information and insight. I think all this helped to make the (hopefully) right decisions for Kahlu's medications and especially the reduction of them. Please keep us posted on how things are going. Best wishes, Brigitte & Kahlu

Brigitte BC Canada

Ron, I almost forgot to mention Joanne's website. http://www.cloudnet.com/~jdickson/successstories.htm All the success stories are such an inspiration. I have learned so much from them and most of all have received hope and encouragement. I can't thank Joanne enough for her work! Brigitte & Kahlu

Brigitte BC Canada

Ron, I am so sorry to hear your Cooper has been diagnosed with IMHA. If you have not read my Web site on AIHA/IMHA as yet, please do so when you can: http://www.cloudnet.com/~jdickson/ Be sure to follow the links on the first page to other sites on AIHA/IMHA that will be helpful to you and do read the Success Stories pagees. They will show you what has worked for other dogs in terms of treatment options as well as give you a lot of HOPE. It sounds like the prednsione reduction is too much too soon. 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

Joanne MN

Has your vet ever mentioned Cyclosporine or Atopica, my dogs PCV was in the low to mid 20's for a few long weeks and about four weeks after beginning the Cyclosporine it rose into the 30's. It has been almost two years since her initial diagnosis and her PCV has never gone over 40 and for the most part it is in the upper 30's and she has been just fine. She has to stay on a maintenance dose of medication for the rest of her life and we have her blood work done every six months and so far everything has been good. Be careful if your vet wants to start reducing the med's to soon and if you can read Dr Dodd's protocol for treating AHIA. If you feel anything is not right regarding her treatment don't be afraid to speak up. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Ron, I am so sorry to hear about your Airdale, Cooper. My Dad loved Airdales and had a beautiful girl named Thistle, so I have a fondness for these strong willed clowns. You have had a lot of good advice here. I just want to make sure that your vet has tested carefully for tick diseases. You live in an area of the country where they are very active year round and do carry disease. A number of tick diseases can initiate an anemic condition as they insert themselves into the red blood cells. There is an in-house test called Snap 4-DX that can test for 3 tick diseases and heartworm. This test has a simple yes or no result. In addition there are more sophisticated tests that look for other tick diseases and can measure the titer or amount of tick disease in the blood. These tests generally are sent to specialty labs. my best patrice

Patrice NYS

Patrice you are so right. The advice given here is outstanding. We have not tested for ticks at this point but will take your advice Thursday at the clinic and have it done. Melissa, he does have a slight infection in his front paw and it isn't helping us get his PCV higher. Clindamyacin hasn't been effective, the vet just switched to Baytril 68mgx2. to clear it up. And ofcourse the white blood cells are elevated at 24 because of the infection and the continuing use of Prednizone. Cheryl and Ginger-- Cyclosporine has been mentioned as a possibility if Pred and AZT doesn't get the up to normal. Brigitte-- I have followed your story with Kahlu very closely as there are many similarities. In fact I pieced together and printed all of your posts since you came on board. I continue to wish you the very best in your quest to get beyond 36 in your PCV tests. A special thanks to Joanne for welcoming Cooper and I to the group. The many years of unbievable service to all of our fury friends must have you oh so close to Sainthood. The compassion, wisdom, and guidance expressed by this board is truly remarkable.

Ron Lakeland

Hi Ron. Sorry to hear about Coopers diagnosis. You are at probably the best place for help and information. 34 is a good PCV number. Tessy has yet to climb over 30 so I kinda envy you. Cooper must be a tough dog. It is a good thing that it was caught early...this most likely prevented you from having to have a transfusion. It sounds as though he is highly regenerative also. That is a great thing. Hopefully you find some more answers out regarding the tick tests. He seemed to be doing much better on the higher doses of pred so I would question the doctors reasoning for reducing so quickly. Slow and steady is the answer. Cooper is responding positively so keep up the fight and be strong for him. Remember that we are here to help and offer advise if you need it. Feel free to ask away...there's no such thing as a stupid question. I'll send a prayer out for Cooper. Johnny & Tessy

Johnny

Johnny, Thanks for your support. We think that we have been put through a lot with this nasty disease at our house so far, but nothing compared to you and Tessy. I have read many of your posts and I take my hat off to both of you. And I might add a mighty fine looking gal she is in the photos that you posted most recently. The very nasty side effects of 100mg Pred and 50mg AZT perday helped sway our vets into lowering the dosage perhaps to quickly. Others here have indicated it is easy to get stuck at a number before moving forward. Hopefully the increase back to 50mg of AZT will have a positive effect. I wish you and Tess the very best in your quest to win this war. Ron & Cooper

Ron Lakeland

This thread was discussed between 28/04/2009 and 30/04/2009

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