Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Jennie Update

Jennie's PCV was 29 today. Since she was diagnosed on 2-5-08,and her PCV was 20, she has been slowly climbing. The prednisone must really do a job on them because she doesn't really look good yet. The Dr. is taking her down just a bit on the Pred because she thinks her lack of mobility in her back legs could be caused by the high dosages of Prednisone -- only a slight decrease though because her blood still isn't where the Dr. wants it to be. It feels like it's been six months instead of three weeks. I am thankful though that I have the means to take care of her. I feel so sad for all those animals that aren't loved and well cared for. That's it for today -- had to share this with someone!

Gail SD

I would be really careful of reducing the Presnisone already, it can make her have a relapse. My puppy has been on Prednisone since Christmas Eve day, 100mg at first, then JUST four weeks ago down to 50mg daily, now it will be 25mg daily for another three weeks, then 25 mg every other day for awhile. I hated some of the side effects, but my vet kept cautioning me on reducing the Pred too soon. I was not going to let her have a relapse, which is very common when Pred is reduced too soon. Please, be very careful...

Joanne Wyoming

Gail, I am glad to hear that Jennie's pcv has risen up to 29! That is considered moderate anemia now, rather than severe. That is a good thing! The mobility thing in the back legs does seem to be a side effect of the prednisone. Chance had some very bad tremors in his back legs during that time. The tremors are less now that we are on very low doses of prednisone, but they have not disappeared. He is able to go for 3 hours walks so I am not worried about it. My advice to you would be to work on getting her pcv higher and stable now rather than worrying about this side effect on the rear legs. I know Joanne's golden Angelo continues to have some rear end weakness a long time after his recovery but it doesn't seem to be bothersome to him either. You may see hair loss, high liver values, hear groaning, panting and see Jennie have trouble walking or standing. Take a deep breath and focus on getting that pcv number up and stable. Once that happens, you can lower the dose safely. All this other stuff will begin to disappear. I promise. My best to you, Patrice

Patrice NYS

Oh geez, I'm going to post this before going to the vet so I hope I can get some feedback first. Jennie has been on 120 mg (60 in the a.m. and 60 in the p.m.) since the 5th of February. Her pcv has risen (quite slowly) to 29.5 (yesterday.) I have been freaked out with the effects from the Prednisone and the Dr. yesterday decided to lower to 80 mg (40 i the a.m. and 40 in the p.m.) From the above responses and if others would respond, do you really think the decrease in dosage is too quick and too much???? I hate this!

Gail SD

Gail, What is Jennie's weight?

Joanne MN

Hi Joanne, We're (kind of) neighbors! Jennie is a big dog - 84 pounds. Gail

Gail SD

Gail, The usual dosage of prednisone at the onset of AIHA/IMHA is one mg per pound of the dog’s weight per day divided into two dosages, one dose to be given in the AM and one dose to be given in the PM. Some vets will give an even higher dosage at the onset. I have seen some dogs on as high as 3 mg per pound per day, but that is usually only when the PCV is very low. 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: “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 If Jennie was started on only one mg of prednisone per pound of her weight per day at the onset of her illness then a reduction of the magnitude your vet has suggested is way too much. However if she was started on a higher dosage of pred at the onset, say 2 or 3 mg per pound such a reduction may be warranted. It is interesting you said that Jennie has had a slow recovery in that she has only had an increase of 9 points in her PCV in the last 2 weeks, but actually an increase in PCV of 9 points in a little over 2 weeks is really great progress. Most times a dog who has AIHA/IMHA sees their PCV decrease for a week or so after the AIHA/IMHA diagnosis so Jennie has really made great process. So to answer your question, it really depends on Jennie’s weigh as to whether the pred should be lowered this much or not. Gail, I wrote the above post in word offline before I read your last post. So if Jennie is 84 pounds and were my dog, I personally would be fine with a dosage of 80 mg of prednsione per day with a PCV of 29, but this is just my non vet opinion. Normal PCV in a dog is in a range from 37-55 so you are getting close to that normal range. Huge doses of pred do have lots of side effects so I do understand why your vet made this reduction.

Joanne MN

Joanne, thanks so much. I really do trust this Dr. - she has an excellent reputation in our area and I was a bit uncomfortable questioning her lowering the dosage. Especially since I have been a bit of a patient myself (I could use some tranquilizers!!!) So, to summarize - Jennie has been on 1.5 mg per weight since the 5th of February and her pcv has risen from 20 to 29.5 (yesterday's reading.) She is now going to be taking 1 mg per weight (half in the a.m. and half in the p.m.) Thank you also for the feedback that you think Jennie has been responding well - the Dr. is happy with it as well. Really - Jennie actually responded immediately to the medication so I should relax a bit, I guess. She just makes me feel so sad for her since the effects of the Prednisone are so awful. She just looks so befuddled all the time. Thanks again. I am so glad I found this site.

Gail SD

Gail, Chance is 100lbs and was on 80mg of pred for quite a while as he was non regenerative and he also had neutropenia (no production of white blood cells). It is actually a lowish dose for a dog his size with such severe anemia and we could have gone higher. The addition of cyclosporine at 225mg per day is what worked for him and saved his life. Patrice

Patrice New York State

Hope Jennie's numbers keep climbing.

leslie ca

Patrice, Thanks for your feedback. I'm feeling better now that she is going to be okay on the 80 mg. I don't expect to see that dosage decrease for a while. How do you know when their white blood cells are not producing? Gail

Gail SD

Gail, The complete blood count cbc will show values not only for red blood cells but also white blood cells. In general, an automated analyzer profile will have some kind of graph or way to indicate values that are out of norm. Or they may just list a reference range and you figure out from that if your values fall within that normal range. You generally will see some kind of heading like complete white count and then a breakdown into neutrophils, lymphocytes etc. The majority of wbc are the neuts, one type of lymph, t, are the type of wbc we are trying to suppress as they are in general the lymphs that do the destruction of rbc. So that number will actually decrease throughout treatments. However, we also had a bone marrow biopsy done, they actually use a tap to drill into the front shoulder to sample the core. The specialist drilled 5 taps and all of them were devoid of cells, indicating complete non regenerative anemia of both red and white lines. We were lucky that he was still producing platelets or he would surely be dead by now. Patrice

Patrice New York State

What kind of dog is Chance and how long have you been fighting this? It sounds like Chance was one sick puppy. I hope he's doing better?

Gail SD

Hi Gail, My Golden Retriever was diagnosed (at age 10) and was around 70lbs and on the same amount of Pred as your dog. (He was also on Azathioprine) His first deduction was the same as yours after his PCV popped up to 36. He did however remain on the meds for well over a year. He is currently in remission and will be celebrating his 13th Birthday in April! The medications do cause some awful side effects. Sometimes I'm sure it's hard to decide what to do. Angelo had many side effects such as: severe muscle loss, sores on his mouth, staph infections and hair loss to name a few. Thankfully he is fully recovered with the exception that he did not regain all of his muscle in his hind legs, but he is a senior remember. (We are going to a Canine Aqua Therapy Facility tomorrow to see if he will like the underwater treadmill.) My reason for this message is to tell you and everyone that most of the side effects DO go away with time. You have to be patient, it is a long road with good days and bad days but WELL worth the wait. I have an online photo album that will show you how my dog had progressed. I added 2 new photos today as we have snow :-) http://www.photosbyjeanne.com/gallery/2584058_vfr56 As always, my thoughts and prayers to those dogs and their people who are still fighting. Jeanne in NJ Goldens, Angelo & Archie

Jeanne New Jersey

To anyone who is interested you can read Angelo's AIHA Success Story at the following URL: http://www.cloudnet.com/~jdickson/archives19.htm Angelo is the September 2007 Success Story at the Meisha's Hope Web site. Angelo not only had AIHA but also immune mediated thrombotopenia (ITP) at the same time. ITP is a disease of the platelets while AIHA/IMHA is a disease of the red blood cells. Having both diseases at the same time results in a condition known as Evans Syndrome. Angelo (like so many other AIHA/IMHA Survivors) are such an inspirtation to so many. They prove that not only can dogs survive the disease, they can go on to live happy healthy lives. The great photos in Jeanne's albums are indeed proof of that.

Joanne MN

Jeanne in NJ, You can't beat a Golden, can you! What beautiful dogs they are. Thanks for sharing these photos. It really shows there is hope. Thanks! Gail

Gail SD

Jeanne, Of course, I identified your name incorrectly, please excuse my poor memory. I was thinking of Angelo and that you had said he had retained some rear end weakness. I often remind myself of that when I see Chance's back leg tremor sometimes. It doesn't affect his ability to walk or run in the least, but never-the-less is something that could be alarming to look at. Gail, Chance is my "heart dog" and is a 10 yr old Giant Schnauzer. We have two Giants, Cassie is 3. How Chance developed this and the struggle we have been through is quite a lengthy topic. In short it started last year in March with a mass on his spleen. It was very large, 7 lbs, and when it (and the spleen) was removed the pathology report showed it to be nothing more than a benign hematoma. He recovered quite nicely from that surgery but in about 1.5 months, he began to have a couple of sudden collapses when he was exercising vigorously. It was determined that he was developing anemia, that it was non regenerative and that it was going to become very severe. The specialist I saw held little hope for him. I have a medical background and began studying veterinary hematology, trying to find an answer to what was wrong and what I could do to help. With that information, assistance from Dr. Dodds for treatment protocols, and my local vet's constant devotion to help him he began to recover by late August and was back to pretty much himself by December. If you saw him now, you would not know that he had been near death. Matter of fact, he can be quite annoying sometimes in his zest for life! He finds great fun in charging out barking to the bird feeder to protect it from squirrels. Chance is also a therapy dog and I am very eager to get him back to the nursing home in a short while. I can tell you that the side effects of the meds were horrible. My husband had a much harder time watching than I because I understood that they would go away when we reduced the prednisone. If you would like to research this on your own you can type into google: "cushing's disease iatrogenic canine." This is a fancy word for flooding the adrenal glands with too much cortisol (from the prednisone). That causes the body to have a number of undesirable side effects. In a sense, owners whose dogs have the *reversible* type of Cushing's disease are in a much better position than those owners whose dogs have the "real" Cushing's disease due to disease of the adrenal glands. If you would like to see pictures of Chance at his best and his worse, you can see them at: http://www.flickr.com/photos/patricel/ My best, Patrice

Patrice NYS

Patrice, I've never seen a Giant Schnauzer before. What awesome dogs! Wow - the photo from mid summer 2007 to late summer 2007 is really something. He looks like a different dog altogether! These photos are great for those of us who are in the beginning stages of this disease because it really shows there is hope and when they start to look bad because of the medications, we need to just keep going on. Thank you for sharing!

Gail SD

Gail...I don't have your e-mail so I will include this protocol from Jean Dodds in my reply. Good luck Ron Protocol for treating IMHA: (Immune-Mediated Hemolytic Anemia) History: 1. Any history exposure to ticks, any travel to tick infested areas? Other infectious diseases such as leptospirosis, bacterial or fungal or parasitic diseases. Test to rule out Babesia, Ehrlichia, Bartonella, & Rocky Mtn. Spotted Fever, Lyme, as causes. 2. On any current meds that could cause anemia, thrombocytopenia? For example, Sulfatrimethoprim. Estrogens, non steroidal anti-inflammatory drugs? 3 Has there been any exposure to rat poison? Zinc exposure (in the form of coins; seen on X-ray) 4. Were there any recent vaccines (w/in last 3- 45 days? 3. Any concurrent health problems? Neoplasia : Hemagiosarcoma, Sertoli cell tumor, lymphoma. Other conditions: Hypothyroidism, especially autoimmune thyroiditis; Cushing’s disease; Addison’s disease; diabetes; any other recent illness or surgery or stress event including sudden change in temperature? Diagnostics: Minimum data base 1. CBC including platelet count and platelet size (immune-mediated platelets usually have predominantly small platelets). 2. Check Purple Top Tube for auto agglutination, check slide for auto agglutination, look for spherocytes, or stomatocytes on the peripheral blood smear 3. Manual differential, cell morphology (regenerative anemia? (at least 30% of IMHA cases are not regenerative) 4. Spherocytes (near the feather edge don't count) 5. Platelet estimate consistent with low count or due to clumping? 6. Chemistry panel ( Low albumin may indicate hemorrhage) 7. Chest rads & abdominal rads to rule out cancer, pneumonia. 8. Abdominal rads to r/o zinc toxicity (metal coins), cancer, pyometra,etc. 9. Abdominal Ultra Sound to check for Neoplasia(i.e. dog >7yrs) 10. Babesia titer or other infectious diseases if greyhound or if there’s travel history, Ehrlichia, RMSF, Lyme leptospirosis, titer if also thrombocytopenic. 11. UA - look for hemoglobinuria 12. Coagulation panel if evidence of exposure to rodentacides. Or suspected Neoplasia. 13. As the underlying cause can be autoimmune thyroiditis, and thyroxin is needed for normal hematopoiesis, check full thyroid antibody profile. Treatment: (D/C any current meds!) 1. Prednisone 2mg/kg PO BID divided; start at same time as Dex SP is given 2. +/- Azathioprine (Imuran) 2mg/kg PO SID if dog is not responding to the prednisolone. 3. +/- Cyclosporine (Atopica) starting at 10mg/kg SID for the first week, then 5mg/kg thereafter, if patient is refractory to the above drugs. 4. Pepsid–AC to prevent gastric ulcers from the prednisolone. 5. Doxycycline 5 mg/lb bid just in case it is Ehrlichia *Do not use Cytoxin, Oxyglobin - studies show a decreased survival rate with these drugs. 6. Thyroxine (0.1 mg / 12-15 lbs. of optimum weight BID), to stimulate hematopoiesis, or if patient is hypothyroid Transfusions: a. Better to transfuse sooner than later. b. Transfuse if PCV<15% or ( >12% if reduction in PCV is not peracute). c. Use Packed Red Blood Cells (best) or Fresh Whole Blood. d. True universal donor (DEA 4) is best as you usually can't type or cross-match due to auto agglutination. Monitoring: 1. CBC q12hrs, initially, then every few days depending upon the patient affect. 2. Monitor electrolytes q24hrs if on IV fluids 3. Monitor the slide for agglutination q12 - 24hrs 4. Blood smear every few days to look for regeneration, platelets (platelet half-life is 3-5 days; platelet count may not go up because the new platelets go first into the inter endothelial cell spaces to “plug the holes” as seen by fading of bruises or pinpoint hemorrhages and no more new ones; then the next batch circulates and raises the blood count.) 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 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. * Note this was reviewed and edited by Jean Dodds, DVM. Some vets think the thyroid portion is controversial.

Ron B San Mateo

Hi, My Calamity was admitted to the hospital Monday morning with a PCV of only 9, I don't know how she was still standing. She also has ear and bladder infections. I went to visit this morning and they told me her PCV was on the rise, it's up to 17 and she finally ate something. I'm going out of my mind with worry. Nobody can figure out why this happy, healthy, normally active 4 year old got so sick, so fast. She was fine last Thursday, Friday she didn't eat... and it was down hill from there. This site is the first that I have read that has given me some hope.

Allie Virginia

Patrice, How fortunate that your Chance has had such a successful recovery. Gail, be patient - make sure you are confident with your doctor and read all you can possible read about the disease. Unfortunately, my Molson (11 year 4 month old cocker spaniel) had to be put down as a result of liver disease associated with his diagnosis of IMHA in December of 07. Work with a good hematologist who can watch liver counts and is able to distinguish what is related to drugs and what is the result of liver disease. It is heart breaking to lose such attentive, affectionate and faithful companions. Thanks to all who share their stories for others to learn. It is so important, because many Vets have never come across IMHA. AM

AM FL

This thread was discussed between 21/02/2008 and 26/03/2008

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