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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - ? Drug Suppression
| Hi everyone from Johnny & Tessy. I was wondering if I could get some thoughts on drugs and their effects with regards to OVER suppressing the immune system or bone marrow to a degree that a pcv will stop rising and level out at a lower than normal level. I'm probably worrying too much but I was thinking that maybe this might be what is happening to Tessy. Her PCV seems to rise faster when lower but once she hits nearer the high 20's she seems to level out. I'm not saying that this is happening to her now cause she hasn't "leveled" since her relapse. I do fear that at her next appointment her pcv will be close to the same as it was last time in the high 20's. Currently she is taking 50mg pred/day, 37mg azath/day, and 200mg cyclosporine/day. I was wondering if the azathioprine might be suppressing her marrow too much or maybe even one of the other drugs. I guess my main question is "Will tapering a certain drug (lets say the azathioprine) jump start the marrow more? It costs an arm and a leg to send the blood off to find out a full rbc morphology, retic #'s & %'s, etc. Are there specific numbers I can keep an eye on to see if there is too much suppression....like the neutrophils or reticulocytes? I know that I am just overly worried but I figure it's good to learn of something before it becomes a problem. Just something I've been wondering about. Thanks for your time and patience again, Johnny & Tessy I can not seem to find anything specific in the archives (or maybe I did not look hard enough). |
| Jonathan |
| Hi Johnny, I can't give you real scientific info here, I'll leave that to the many people here who are much smarter than I...I can only tell you that all of these drugs most definitely suppress the marrow, especially AZA, Tiggs didn't really have that too bad, but it seemed like the more we weaned him from Pred and Aza, the better and better his PCVs, especially his hematocrit, became. It was almost counter intuitive, but I guess when they are regenerating, and in or nearing remission, they will produce many more on their own, when the drugs are lowered. Just our experiences. Hoping you get lots more information from others. This was just our experience. Our best to you and sweet Tessy! melissa and tiggs |
| melissa slc |
| Johnny, I have seen several cases of AIHA/IMHA in which azathioprine has over suppressed the immune system. The evidence of this happening is usually a lower then normal white blood cell count. Normal white blood cell count in a dog is in a range from 6-17. Once the Azatthioprine was lowered in these cases the blood counts including white did a slow rise. Just curious how long has Tessy been on Azathioprine. Some literature does indicate that after a few weeks this drug should be lowered to every other day. This site http://www.marvistavet.com/html/azathioprine.html says "Azathioprine is typically started once a day and then tapered to every other day use and is almost always started in conjunction with other immune suppressive agents." You might want to take a look at this entire page. Of all the drugs used in the treatment of AIHA/IMHA it seems, at least to me, that Azathioprine is the one most likely to cause bone marrow suppresssion. Once again, I am quoting from the web site I mentioned above: "One of the main issues with azathioprine is a problem with the bone marrow suppression." |
| Joanne MN |
| Hi all, a note about alternatives to vet blood testing - Dr. Dodds Nonprofit Hemopet does blood testing as well, at about half the cost of what my vet was charged by the blood company. My vet would pull and spin the blood, i would take it and ship overnite to hemopet with the form in the box and the icepack, and then we would get results, both me and my vet, in 3 - 5 days. It takes a little longer, but its a lot less expensive.My vet did not charge me for this, some will charge around ten dollars i heard to pull the blood and get the sample ready. Kent had more than 30 - i stopped counting - blood tests, because of the aiha, and also for the kidney disease he developed. we had to test for cushings at one point, and other things too. We only had our vet send out the blood in an emergency when we couldnt wait and needed more than inhouse done. Hope this helps someone financially...... Also, if a test is not on her form (hemopet.org) you can call and likely they do it, and they will tell you the price and what to write on the form and how much blood they need. |
| Christine FL |
| Charlie's PCV totally jumped 6 points after he had his first pred reduction after 2 weeks then went up 1 point after 4 more weeks. we are on week three of aza every other day i'm very interested to see where he will be when we check again after week 4. I think that reducing is key for their blood levels to rise. At least it sure seems that way in charlies case. I have tried to not get to wrapped up in the numbers, i really look at charlie and how he is behaving. Carol |
| Carol J Vancouver Wa |
| Carol, what drug was reduced first with Charlie? Was it the prednisone? Were any of his numbers abnormal? I'm just not sure which of the two (pred. or Azathioprine) I should reduce first. Tessy's doctor thinks we should start with the Aza. Her numbers remained the same this week as they have for the past 3 weeks so we'll see what happens next week and decide from there. Johnny & Tessy |
| Johnny |
This thread was discussed between 20/04/2009 and 23/04/2009
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