Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - HELP 4 Bailey

I want to thank you in advance for your response as I am really feeling discontent about this situation. My dog Bailey is a 3 year old Irish Terrier who somehow contracted a liver infection about a month ago (Liver enzymes slightly elevated). He was very sickly for two weeks with the infection. Symptoms such as lethargy, loss of appetite, weight loss (6pds), dark urine, vomiting, enlarged spleen. Bailey was taken to the vet several times for a check up within the last week. Liver enzymes have now returned to normal and we are now dealing with IMHA. Bailey now has an appetite, urine is yellow, a little more spunk, bodily functions working normally but pale gums, tired easily and heavy breathing (unknown if associated with predisone). I really trust our vet - would actually go to her myself if she would consider taking humans too (HAHA) but I feel like this process has taken so long. We believe the catalyst was the liver infection and then it spun into IMHA. We are fortunate to keep in contact with Bailey's breeder and a woman who owns Bailey's grandfather, Trucker. I reached out to them last week and I was told by Truckers vet that he has IMHA in which he had to have a splenectomy. I spoke to the vet last night and she said that she is a little puzzled because the reticulocytes are within the normal range but the red count was lower. At this point I feel like we are in the rare category. I have to take him back on Monday at 9:15 for another CBC. If this test shows evidence that the count has gone down again then we need to begin to speak about options. She suggested a possible bone marrow extraction to screen for cancer. Do you have any additional thoughts on this? In your expertise, are we moving in the right direction in terms of a plan? Should we be doing anything additionally? The spleen has gone down but not entirely. Interestingly enough if you extract the pale gums and rapid breathing (on/off), then I feel like we have our old boy back. A few weeks ago when he had the liver infection - I thought the worst and spent many nights on the floor with him. Now it's just so hard to tell where we are at. He still loves to go outside and for walks and is eating. I love him so much and just want him back to normal.

Kelly New York

I have seen bone marrow extracts suggested on this board in case of nonregenerative anemia. So long as he is still making reticulytes, I don't see why you would want to get this invasive procedure done. What meds/dosing is he on for it? And what was his last PCV/HCT value? Also, I know that it may seem like a good idea to let him do as much as he can movement wise, but in fact the best thing is to limit exercise until his PCV is in the 30s at least but then take it slow and don't overdo it.

Monet Sammamish

Kelly, If Bailey is anemic, his reticulocytes should be elevated in response to the lower RBCs. Many people on this board turn to Dr. Jean Dodds for advise as she is the preeminent leading researcher whose work is the basis for most treatment protocols adopted today. Jean can be reached by email: hemopet @hot mail . com (I broke up the address so that it will render, otherwise a filter will omit it).

RobertN Superior

Monet - I definitely do not want to get the bone marrow extraction!!! I want to avoid it if at all possible. Bailey is currently on Prednisone 20 mg in the morning and 10mg in the evening. He is also taking antibiotics Baytril and Ursodiol since the immune system is being suppressed. Bailey is also continuing to take Denamarin for liver support and soloxine which he took prior for a thyroid condition. We actually caught this in time - hematocrit 40 started at 43. May not seem bad now but he is weak. Robert - When I took Bailey Friday Bailey's blood was a different shade of red, only a little was extracted but the blood that was, was watery. The reason why we are perplexed is because the reticulocytes are not elevated and the RBC is lower. Your advice is so helpful and I will reach out to Jean. I will know by tomorrow afternoon and again we just caught this so he may seem normal but he is very far from it. I hope this will get better and not worse. Thank you both - it is comforting.

Kelly New York

Interesting. 40% is still within normal range of PCV (healthy is 37%-55%, but most dogs stay in the 40s) So this is likely the reason the reticulytes aren't elevated. At that point, I would say you guys sound pretty good off. The only med suggestions I have are to add Pepcid AC (give 10mg 30-60 minutes before prednisone) and if there is a decrease in PCV tonight, rather than go straight for the other tests, ask about adding other meds (cyclosporine, imuran)

Monet Sammamish

So I have an update now. The original values I gave you are off. We have had several cbc's over the last month. Hematocrit went from 43 to 42 to 30 to 19 (Friday) and now it has stablized at 19 (Today). All of the other values including the wbc are just about at normal so I am hoping that by Wednesday we'll have great news about the hematocrit. Bailey is showing to have more energy and is eating. Thanks again for your support!!!

Kelly New York

Maggie had a bone marrow biopsy perform on her and I will say that it removed any doubt that Maggie's condition was due to cancer. Ask Bailey's vet point blank what they want to measure from Bailey's marrow. Maggie certainly was sore the evening following the procedure but the next day it was as though nothing happened. Otherwise, the procedure, along with anesthesia, is expensive.

RobertN Superior

Okay, that makes much more sense. The fact that it is stable today is a really good sign because the destruction has stopped. I would recommend still asking your vet about adding cyclosporine since his count hasn't increased. Additionally, the pepcid that I mentioned is definitely worth it. What this does is protects the stomach lining from the prednisone by reducing the acid. If you don't use it, he'll develop stomach ulcers (ouch)

Monet Sammamish

Dr. Dodds suggestion to me was that I probably could have gone without the bone marrow biopsy for Chance. Since many cases of bone marrow failure -in dogs- are autoimmune it can be beneficial to proceed with a treatment protocol. If there are some signs of improvement after starting treatment, then the success of the treatment likely indicates an autoimmune condition. If there are no signs of improvement in a week or two then an owner could proceed with further testing such as a bone marrow biopsy. Chance's bone marrow biopsy report only indicated that he had no cells in his bone marrow (after several aspirations at different locations) and this did not get us any closer to a diagnosis or treatment protocol. Once the test results came back I was told there was very little hope. However, he survived and lived another three years. There is always a need to have bone marrow biopsies available for other reasons. I still believe in good diagnostics. But sometimes a cost effective approach (like trying a treatment) is a good diagnostic tool by itself. I offer my experience as a suggestion, but you must go with your own decision. my best patrice

Patrice NYS

Kelly- I had a bone marrow done on Chloe but didn't have the information on this board at the time and wouldn't do it again. You can actually screen for cancer in any dog with the new RECAF test done in a lab in BC. It is 90% accurate for any type of cancer and very inexpensive (under $100). The bone marrow is very expensive plus anesthesia. Chloe is alive and still on cyclosporine and tiny dose of prednisone. Although not quite the same dog she was 19 months ago, I am very happy that she is a survivor thanks to Dr. Dodds. Cheri and Chloe

Cheri Maryland

Thank you all for your experience - I am so exhausted and stressed because I just want him to be okay and I won't be okay until he is. Since the count has stabilized at 19, our plan (vet and I) is to touch base daily to see if he is still feeling okay and recheck Friday if he is. If not, then we need to go up to the animal hospital uptown where they have a larger facility and blood should Bailey need it. No bone marrow or additional testing at this time although I am so very grateful for your thoughts. I am so confused because yesterday we got great news! Hematocrit stabilized and all of the other values that were concerning us including the white count have come down. Everything is virtually normal with the exception of the hematocrit. There is regeneration and Bailey was feeling better. Today is not a good day. Spent all night back and forth to the bathroom and this morning he vomited. I don't think either one of us have slept. I just hope he has not taken a turn again.

Kelly New York

This thread was discussed between 27/11/2011 and 29/11/2011

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