Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - For Courtney

Courtney, The vet's diagnosis is non-regenerative anemia. She is treating it as immune system related. When I questioned her about using the Azapriothine versus the Cyclosporine, she said the Cyclosporine entered the system quicker. She didn't go into any details and seemed to think the Azapriothine was a good choice at this time. I know there are possible side effects (aren't there always!) with the Azapriothine, but she said there were also some with Cyclosporine. If I note any problems with the Azapriothine, I'm to give her a call. I gave Darcy today's dose of Azapriothine at five o'clock and am watching for any problems. She's sleeping by my feet right now and breathing a little heavy. She gets her Prednisone later this evening. The vet did caution me to use gloves when cutting the Azapriothine (they would cut them in half for a $10 fee). She said that Azapriothine is a chemo-like drug, which really scares me. I questioned the pharmist at the Harris Teeter where I purchased the pill cutter and he said that wearing gloves was not necessary unless I had an immune problem; he said just to wash my hands afterwards. Why did your internist take Lola off of the Azapriothine? Did she have adverse side effects or was it just not helping? What other drugs is Lola taking besides the Cyclosporine and has she had any transfusions. I'd just like to know Lola's history/progress so that we can compare notes, if you don't mind sharing. I'm fairly new to this board, so I apologize if I've missed your postings. Thanks!

Karen NC

Courney & Karen, When we started with Holly 17 months ago with IMHA she was started on Prednisone and Cyclosporin,(I think Cyclosporin becasue it works faster) after about 6 months she was switched over to Azathioprine because the cyclosporin was not being absorbed into her body enough to jusity the $$'s. When she first started on Aziathioprine her numbers did drop because it can take several weeks to start working, but they she started climbing on her PCV. She still takes aziathioprine to date as well as prednisone and the only problem that we have had with the aziathioprine is her White BLood Count is always low, but they monitor it very closely and some on here say if it goes to low can switch to every other day to bring it back up. Holly has no other symptoms from it other then her WBC. Hope this helps. Linda

Linda Sapphire

Linda, I'm curious what dosage your dog is on for both prednisone and Azathioprine after 17 months. What kind of dog is Holly? How expensive is cyclosporine?

Jane MN

Linda, Thanks so much for the info about Holly and her experience with the Prednisone and Azathioporine. The vet told me that the side effects with Azathioporine could be feeling bad; liver toxicity; bone marrow suppression (white cells). She said that Darcy will have to be checked periodically while on Azathioporine for the liver and white cells. I'm glad you told me about the every other day dosage if the white cell count goes low. How much does Holly weigh and how many mgs. of the drugs is she on? Have you seen weight gain because of the Prednisone? How low have her PVC levels been and has she had transfusions? I'm just wondering what I can expect with this condition. The vet never mentioned IMHA. She just keeps talking about non-regenerative anemia. Jane, My vet told me if I purchased the Cyclosporine from her it would be $120/month (50mg./day). I called Walmart and can get it there for $87.68. I haven't checked with Costco yet, as Courtney suggested. She said it's around $64 there. I don't know if you have to be a Costco member in order to get prescriptions filled there.

Karen NC

Karen, Darcy's situation sounds similar to our's. Murray was diagnosed with non-regenerative anemia at the level of the marrow after a biopsy. The pathologist didn't note actual destruction of the precursor cells taking place but ruled out cancer, etc. so the internist we were seeing at the time felt comfortable with the diagnosis. I got a second opinion from another internist who wasn't as sure of the diagnosis and suspected bone marrow failure but, in her opinion, you would follow IMHA protocols to see if you could get a response since there is no treatment for bone marrow failure (subsequently, Dr. Dodds agreed with this). Murray went months with a low PCV and no signs of regeneration. And, after a long time, things slowly started to improve. What makes this illness even harder is that there isn't a "one size fits all" for every dog. I just wanted to share Murray's story to, hopefully, give you a bit of hope. And, I'll be hoping Darcy has a good outcome. Take care- Bonnie

Bonnie Chicago

Jane & Karen, Holly is a mini dachshund. She was diagnosed March 26, 2007 when she entered the hospital her PCV was 8 and she had been having seizures over the weekend prior to being hospitalized. At that time she weighed 10 lbs. They did a bone marrow aspirate and core biopsy at that time and found the bone marrow to be abnormal. They said the biopsy revealed erythroid hypoplasia and called it IMHA stating that her body was destroying her own red blood cells. She was given one blood transfusion at that time and started on cyclosporin and prednisone. She did begin vomiting alot but they suspected because they had to remove foreign matters from her stomach from all the licking she had done over the previous 3 months, plant like material and blanket fibers, and they thought the vomiting from the anesthetic procedure. She was started with 10mg of prednisone and liquid cyclosporin (100mg/ml) given 0.14ml by mouth 3 times a day and also 20 mg pepcid. When we ran out of the liquid cyclosporin provided by the hospital because of the expense we went to a local pharmacy where they compounded the pills for us according to her size/weight limit and they cost $84 a month for 0.14mg 3 times a day. August of 2007 is when we switched over to Aziathioprine because they did a trough test and discovered that Holly's body was not absorbing the cyclosporin to warrant the cost of it. Once we had her PCV in the high 30's we began to decrease prednisone like 2.5mg a day, but each time we did that her reticulocyte count started to rise and her Internist say this was not good so we would have to up the prednisone again. Currently Holly is on 1mg of prednisone 1/2mg in am and 1/2mg in pm, and she still takes 1/4 pill of the aziathioprine which is labeled 50mg. She also gets 1/2 tablet of sucralfate of 1gm in the am at least an hour before any meds, and gets 1/2 of 10mg pepcid in the evening. She also gets a 1/2 teaspoon of raw milk thistle seeds ground up into powder in her lunch and at dinner, this is to protect her liver. She currently weighs 15lbs, so yes she has gained weight and is always starving. Her last bloodwork her PCV was 52.1 highest it has even been, but again becuase of the last reduction on the prednisone her reticulcyte count has gone up to 1.6, so we were not able to do any reduction on the pred this month. For the last 6 months we have only been reducing the prednisone 1mg a month and the internist says that Holly will most likely be one of the dogs that has to remain on meds for the rest of her life, being 3 years old, we were very sad to hear this. About 7 months ago, Holly had a set back of which we were never able to figure out what from, maybe a virus and she became very ill and her numbers went off the charts and we basically had to start all over with the higher dosage of prednsione. Tommorrow we go in for a full thyroid panel test which has never been done because she just dones not have the energy she should have for a 3 year old, plus the hair on her belly is almost all gong and her glands feel slightly enlarged to us. I sorry to go on so long and hopefully have answered your questions. And yes, this can be a very long and expensive disease, always waiting and wondering how blood work is going to turn out. I feel for every one on here, especially all the new ones coming aboard, but please know we are all here to help each other. Without everyone on this board, we would have never gotten through this with Holly. Thanks, Linda

Linda Sapphire

Courtney, Just read about the Azath. and that really does scare me. I just washed my hands really good after I cut the pills in half. I'm not planning on any pregnancies, but I'll be more careful. Guess you have to wear gloves every time you touch those pills. Darcy has never had a bone marrow test. I didn't want to put her through that because I thought it might not tell us anything. At the time her PVC was 13%, the vet said she could have a bone marrow test afterwards. It would have been too risky when her level was down. I'm still uncertain about doing the bone marrow test. Did I understand correctly that you're giving Lola three meds --- Prednisone, Azath., and Cycl.?

Karen NC

Karen, You can pick up a cheap plastic pill cutter so you don't have to touch the pills at all. They did a bone marrow test on Holly when her PCV was down to 8, they had to do to find out exactly what was going on. Linda

Linda Sapphire

Well, the bone marrow test is great for potentially finding out a lot. It can rule out cancers,and tell you what kind of production is happening. Our regular lab tests looked ok, but there were more questiosn than answers, like why did she seem to feel okay, but have lousy numbers. Well, the bone marrow told us the answer, she's about to respond..and it ruled out any cancers. Just another piece to the puzzzle really. Lola is a min longhair dachshund, 12 lbs, 6 yrs.

Courtney SLO

This thread was discussed between 27/08/2008 and 29/08/2008

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