Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - dumb question

Ok I have looked at the protocol someone from here emailed me and I looked at Meisha's site but can not seem to find the info on reduction of meds....pred in particular. Anyone give me direction? I am taking Molly back within the next couple of days for blood count and if it remains stable and above 25 I will begin reducing pred but need to know by how much. She is on 20 a day. 10 in am and 10 in pm. And also, when I begin reduction should I test her blood how often? Thanks in advance, Molly's clinical signs seem really good. :) Amy

amy texas

Amy -- Others here are more knowledgeable than me about pred reduction -- my sweet Wiley never got that far -- but I think that the PCV needs to be above 30-35 and stay there for a while before the pred is reduced. Doing pred reduction too quickly can trigger a relapse. Glad to know Molly is doing well. Take care.

Brenda VA

it just really all depends on your dog and the situation, how there body is and what kind of side effects u experience while on it... id say a rule of thumb in normal scenario is cut it by 1/4 u dont necessarily have to be in that pcv range to reduce meds, although that would be nice...but just depends on your dog. my dog has had AIHA for a year and a half and has still never had a PCV over 28% med reduction can be done drastically if the dog becomes so weak that staying on them threatens there life, but under any other scenario i would suggest tappering off slowly im personally not a fan of these medications because of how its tore my dog up, but other people have had great success on them

Josh California

Amy, 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 Just an added note normal PCV in a dog is in a range from 37-55.

Joanne MN

My vet told us what to reduce to when she called with the blood test results. If I had to guess based on the doses you posted, I'd say you are probably going to go to 10mg in the AM and 5 mg in the PM and check in two weeks. I hope the tests come back that you can reduce!!!

Lori USA

I am new to this myself. But as far as meds and doctor visits go, I gave the meds as prescribed and schedule appointments as directed. However, as soon as I see any change in my dog I call my vet right away. My vet will take Lady that day and take a blood test if needed and we dicuss, again, the drug plan. Check your dogs gums for color, I check Lady's gums constantly for pinkness, if they are pale, watch your pet. Lady, as never made it to a scheduled appointment, as she crashes as soon as her pred is reduced, but she is still with us. But you said Molly is doing good, that is great.

Victoria Avon Indiana

Amy, There are no dumb questions. Each person that comes to this list for help dealing with this disease has to nearly become as knowledgeable as a veterinarian in order to help their dogs! Each new thing you learn helps you talk the lingo with your vet. That increases their respect for you and insures they will work harder to help your dog. It's a win win situation. Ask as many questions as you want to here. my best patrice

Patrice NYS

Thanks everyone! I want to be able to be an informed advocate for my dog. He told me last time to reduce after only like 13 days and cbc of highest 29. I was not comfortable and have kept her the same and am going Saturday to see cbc b4 I agree to a reduction. I am sure he will be upset with me but I did what I felt was best for my dog. THANKS so much for the answers! I will keep you posted....fingers crossed! Amy

amy texas

From Jean Dodds Protocol: Sending home: 1. Prednisone 2mg/kg PO divided BID for at least two weeks, taper very slowly every 10-14 days for another month until platelet count is above 100,000 or PCV is above 21 and stable. Then decrease dose, whenever the blood tests remain stable for two weeks. Eventually the steroids should be given every other day for maintenance. 2. Dogs usually require low dose prednisone every other day for a year or more. 3. Azathioprine 2mg/kg PO SID if needed, then reduce to 1 mg/kg SID, then to 1mg/kg every other day or three times per week. 4. Continue cyclosporine, if needed originally, at 2.5mg/kg SID 5. Continue thyroxin, if needed originally, at 0.1 mg /12-15 lbs. of optimum weight BID, given at least an hour before a meal to ensure absorption. 6. Pepsid-AC and Sucralfate PO while on high dose prednisone. 7. Recheck CBC weekly to start; CBC at 1 week, 3 weeks, and then q2 - 3 months while on Azathioprine 8. High protein (35%) ,low fat diet, no corn, wheat or soy. Split normal amount of food into four servings. 9. Consider Jean Dodd’s “Liver Cleansing Diet” if liver functions are high. 10. Milk Thistle and/or SAM-e for liver health. 11. Pet-Tinic added to food (for iron, B12, folic acid, copper, necessary to form new RBCs). 12. Have plenty of fresh water available for the dog at all times. 13. Watch dogs skin, especially elbows and blood draw sites, for formation of skin lesions.

Ron B San Mateo

This thread was discussed between 06/01/2009 and 08/01/2009

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