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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Ehrlichosis AIHA treatment protocol
| Hi All, Very grateful to have found this site, just started my battle with IMHA on Dec 22 when my 3-year old Shih Tzu, Taz was diagnosed. I have two main questions, anybody have any experience being switched from oral Prednisone to DMSO? And my second question is reading other sites, including Meishas hope website; there seems to be a better survivial rate for dogs that are treated with Azathioprine and prednisone, especially if they are also suffering from Ehrlichiosis? My vet currently has him on Cyclosporine rather than Azathiprine (Im assuming because Cyclosporine does not suppress bone marrow, but I am concerned about the statistical evidence showing better survival rate for Echrilichiosis dogs that are treated with Azathiprine). I would be gratefull for any insight. I summarized Tazs history with this disease below. As unbelievable as it was to me at diagnosis, apparently his case presented very "normally" for this disease. The night before, we went on our usual 2-3 mile hike (no signs AT ALL of anything wrong), next day down and out, at first I thought he was just tired until I saw his gums (white) rushed to my local vet who diagnosed immediately and sent me to Internist that night. His PCV at admission was 10%, they did immediate blood transfusion. Subsequent testing showed responsive anemia triggered by Lyme and Ehrlichia infections. He spent a week in the vet hospital and ended up needing 2 blood transfusions. At the end of the week, my vet suggested I take him home (he was not eating at all) and did not feel he responded very well to the therapy. His PCV was 9, I asked him if he could give him one more transfusion to bolster him before I brought him home to, well basically die. He did the transfusion, and that night his PCV was 27, the next morning he dropped to 18, but my vet said that is totally to be expected and was actually quite pleased because his pee was yellow, so he said that he had a positive response to that transfusion. At release on December 28 his PCV was 18; yesterday I took him back to the clinic to get his PCV checked, it was 17. The vet was actually thrilled (he told me at release that he still had a shot but it realistically did not look good since he was not able to be stabalized within a week, which in his experience was the time when most cases that would survive stabalized). He said he felt that the steriods are starting to work, he said his one concern is that his PCV did not rise, so he switched him from Pred to DMSO to see if he could suppress immune system more. Taz is currently on Cyclosporine, Leflunomide, Cell Cept, Doxycycline, Baytril and pepcid AC. Any insight would be much appreciated, this little dog was tossed out of a car in front of my eyes, and was covered with filth when I caught him, we bonded very closely from the get go. I feel so badly for the little guy it's a horrible, helpless feeling to watch this happening to him. |
| Donna Reading |
| Donna, I am so sorry to hear about Taz. I am glad that you have a good clinic where he is being cared for properly. It is very important to understand that the tick disease ehrlichiosis is the cause of the anemia. There are three different organisms that cause this disease and they each have a slightly different effect on the body. In your case, the organism Ehrlichia, is setting up the body to damage the red blood cells. It is splitting hairs, but this means that this is not AIHA autoimmune hemolytic anemia, but rather IMHA immune mediated hemolytic anemia. There is an foreign invader that causes the immune system to destroy the red blood cells. It finds the organism in the red blood cells and it attacks them to get rid of them. It's a bit more complicated than I have explained but close enough to understand. Anemia is not a disease by itself, it is a symptom of some condition. In this case the condition is infection with tick disease. So treating the condition should begin to resolve the anemia. But it's not quite so simple as that. The immune system is now on high alert and needs to be checked while the doxycycline fights the tick disease. It is really a careful balancing act. I am on a tick forum where we help owners with tick diseases. There are a number of experts on this list, including a vet. One member has built a very nice website that has material that has been gathered over the years from Tick-L. I am including a link to her website and a snip of information for you to read. I suggest you spend some time today reading this page/website and becoming familiar with the information here. You will also benefit from joining Tick-L, if you wish, the links to do that are on every page of this website at the very bottom of the page. my best, patrice http://sites.google.com/site/blackgsd/ehrlichiosis "Changes in the blood may show up as nonregenerative anemia, thrombocytopenia (an abnormal decrease in platelets) or leukopenia (an abnormally low number of white blood cells). In the severe chronic stage, secondary immune-mediated hemolytic anemia (IMHA) may cause a dog to have a hemolytic crisis in which destruction of the red blood cells is so rapid that the body just can't make replacements fast enough. Or the dog may develop pancytopenia. When the immune system turns on itself, as it does in an auto-immune disorder, sometimes the only recourse is to use a corticosteroid such as prednisone or prednisolone to suppress it. Since the immune system is already under attack by E. canis, the vet has a fine line to walk in determining how much prednisone will be enough and not too much. Prednisone, given to a dog that has undiagnosed ehrlichiosis, can be dangerous but in the right hands, if the disease has been recognized and is being treated, this drug can be life saving." |
| Patrice NYS |
| Thanks a bunch Patrice, I will check out the link. |
| Donna Reading |
This thread was discussed on 01/01/2011
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