Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - LOLA: aplastic anemia

Hello again! So we just spoke with the internal medici.e doctor because she received the biopsy results... NO CANCER! I know this doesnt mean anything promising..but hey, its not cancer..they were wrong She also apologized because she had shot down my idea of aplastic anemia..and now they are diagnosong her with it. They are worried because her wbc are so low and her platelet count is so low that she probably couldnt form blood clots if she needed to. She also has a big bruise on her chest thats purpleish..not sure what its from it vets said it could be from trauma of surgery etc.....any ideas on this? Shes still on tick meds as well as uricin..she wants to start.her on prednisone nut.i want.to consult with dodds first incase she has any different opinions.. Were taking her home at 6iah..her pcv are still above thirty which im happy about. Let me know if you guys have any ideas or thoughts! Thanks for getting us through this. Christina, lola, mom and dad

Christina New jersey

Hi Christine, Lots of good news, but still a fight a head. I am pretty sure aplastic anemia involves shutting down the immune system along with stimulating production of new cells. Prednisone is the number one thing and fastest used for that. Check out Patrice's link on her thread on prednisone. There are other drugs like immunosuppressants that may be prescribed. Again, check out comments by Patrice on Hobbes' thread as she explains the drugs used there. I would accept the internal med specialist's apology and trust that she can at least start treatment. Dr. Dodd's would likely already specified what to use, but maybe she assumed Lola was on prednisone. I hope you get a response from Dr. Dodds soon, or Patrice, as I am sure she knows 100%. Prednisone will not cause serious harm short term, but make sure they give Famotidine with it (pepcid AC) and other stomach protectant if you suspect ulcers in any way (some do this either way, but I did not with Dylan and she was okay after 4 months on pred). I think she recommended Thyroxine too? Glad you are making progress. Richard

Richard Burnaby

SOOO glad to hear that Lola does not have cancer and can come home soon!!! Get some pet tinic when she gets home and yes I have heard of other dogs with bruising and I hope someone else will be able to chime in on this, I don't think that it is too uncommon. Tell Lola to keep up the good work,she is so lucky to have a wonderful and smart care giver like you. For a young person you are so responsible and knew enough to get all the information you could and not be afraid to be the voice of Loyla. Ginger sends a BIG golden hug!!! We could not see Lola's photo:(

Cheryl & Ginger Pinevile PA

YAY for no cancer!!! I'm glad you have an answer now, and can begin to make a plan. Saying prayers for you and Lola! Sally and Bentley

Sally Louisiana

My guess is that the purplish bruising is from the low platelet count. Check out this Web page on immune mediatead thrombocytopenia: http://www.marvistavet.com/html/immune-mediated_thrombocytopen.html part of which says and I quote: "Spontaneous bruising is the major clinical sign. The gums and oral surfaces or on the whites of the eyes are a obvious areas to check as is the hairless area of the belly. Small spots of bruising in large conglomerations called “petecchiae” (“pet-TEEK-ee-a”) are the hallmark sign. A large, purple expansive bruise might also be seen. This is called “ecchymosis.” You might want to read the rest of this page as well.

Joanne MN

This is part of Dr. Dodds protocol, highlighting the important parts for you. This is nearly the exact protocol I used for Chance but I didn't use Azathioprine and he didn't have thrombocytopenia (low platelets). The cyclosporine will start working in about 48 hours. It happens fast. You should see response in 3 weeks give or take? The purple is indeed petecchiae indicating very low platelets. There are instructions here about what to do for extremely low platelets. These vets need to move fast now. What were they thinking? Note Jean says right here that bone marrow failure is being reported in increasing frequency. Bone cancer in young dog is unlikely. I had best end this here.... my best patrice IMMUNE-MEDIATED HEMATOLOGIC DISEASE AND BONE MARROW FAILURE W. Jean Dodds, DVM HEMOPET Immune-mediated hematologic disease is being reported with increasing frequency in animals and humans. In the dog this syndrome is often associated with bone marrow failure. .....nonregenerative or poorly regenerative erythroid response; severe thrombocytopenia; profound leukopenia; other autoimmune diseases especially thyroiditis; active erythrogenesis, granulocytopoiesis or megakaryocytopoiesis with maturation arrest at the early stem cell level; and poor response to standard treatment protocols with corticosteroids and other immunosuppressive drugs. Our experiences with these cases indicate that: 1) Autoimmune thyroiditis/hypothyroidism is frequently present 2) Aggressive and more sustained treatment with corticosteroids is needed. Suggested doses are: Prednisone or prednisolone given at 2-3 mg/lb/day divided BID for 5-7 days, or dexamethasone equivalents at 0.25-0.35 mg/l b/day divided BID. 3) For severe cases, other immunosuppressive therapy is given. We prefer cyclosporine (Atopica, or Neoral, or Sandimmune, 100 mg/ml oral syrup) instead of cyclophosphamide (Cytoxan) and give it at 10 mg/kg for 5 days rest 2 days, then at 5mg/kg for another 5 days. The lower dose is repeated after a 2 day rest on a 5 days on, 2 days off cycle as long as is needed (usually 2-3 courses of 5 days). This drug induces rapid T-cell suppression within about 48 hours and has been safe, effective, and well-tolerated at these doses. In cases where sustained more potent immunosuppression is required for clinical stabilization, azathioprine (Imuran) should be instituted along with cyclosporine. Dose is 1 mg/lb/day for 7-10 days initially followed by a downward tapering over several weeks. Azathioprine may be needed every other day or less often, on a longterm basis. As azathioprine takes about 10 days to effectively suppress T-cells, clinical responsiveness will not occur immediately. Cyclosporine is therefore given concurrently in the early stages of the disease to provide rapid immunosuppression until the azathioprine takes hold. The goal of this immunosuppressive therapy is to stabilize the ongoing immune destructive process. The dosage guideline we use is adjusted to maintain the absolute lymphocyte count as about 1/3 of the normal range (750-1500/ul). 6) Hematinics containing iron, vitamin B12 and folic acid [e.g. Pet-Tinic] are helpful to provide the nutrients needed for hematopoiesis. 7) In poorly responsive immune thrombocytopenias (ITP), an initial dose of vincristine (Oncovin, 0.01 mg/lb IV) may be helpful to release remaining platelet stores, and danazol (Danacrine, 2.5-5 mg/lb BID initially and then tapered to SID) has been effective along with steroids and thyroid for longterm maintenance. 9) Cases with the best overall prognosis tend to be younger animals in which the underlying primary "trigger" of the immune-mediated disease was hypothyroidism, a drug which is withdrawn, or a recent vaccination/toxic exposure. Correction of the thyroid disease with serial monitoring of thyroid function to establish the appropriate maintenance dose of hormonal supplement is important.

Patrice NYS

Patrice, it is a damn good thing you are here :-) We are very lucky to all benefit from your constant effort. It is certainly too bad some vets have issue with change and other opinions that do not come from their usual channels. Christina, good luck. I hope the specialist is willing to take this and read it closely. Richard (sorry about the "Christine" earlier)

Richard Burnaby

Christina, Great news on no cancer. I am glad your vet felt that she should apologize. You might try to explain to her that you weren't second guessing her you were just reaching out to people who deal with this everyday. I hope that she is more open to Dr. Dodds protocol now? I am so happy you get to take her home. Penny

Penny Lytle Creek Calif

is anyone familiar with clavamox? lolas medicine for right now includes prednisone, cyclosporine, pet tinic, clavamox, doxycycline, pepcid, thyroxine.. the vet didn't have pet tinic so we are getting some tomorrow and the pepcid that lola would require is too small to cut (in pill version) so we have to get pediatric liquid. i'm not sure that i've read about clavamox yet

christina new jersey

I looked clavamox (brand name) up and it is a combination antibiotic with amoxycillin and another antibiotic amd inibitor to cover the amoxycillin resistant bacteria (the new world). I know amoxycillin is not one of the more toxic antibiotics, so the combination is safer than some of the new antibiotics they use. Happy to hear you are on the meds you need. Do make sure the cyclosporine is one of the brands mentioned by Patrice and not the no-name, or any other brand. They are not all equal apparently. Cheering for you guys and praying too :-) Richard

Richard Burnaby

good deal. clavamox and doxycycline are antibiotics, safe to use (although doxy can cause stomach upset and inappetance). the prednisone and cyclosporine are immunuosuppressants. Are they using Atopica? That drug is dosed according to canine body weight so it's good for Lola. pepcid is to reduce stomach acid to protect the esophagus and stomach linings from ulcers. Prednisone can cause ulcers at these high doses. thyroxine is thyroid supplementation. It is safe to use as long as the thyroid blood values are monitored regularly to make sure the dose is appropriate. Everything is here is appropriate and needed. I am not sure if they feel she is at risk for clots, so please ask if they should be using low dose aspirin therapy for her. They can call Cornell University if they are unsure about using this for this purpose. It was their study. p

Patrice NYS

we have atopica! i am about to give them to her now..but the vets were actually really worried about her little body not being able to make a clot if needed since she has so few platelets...aspirin is the last thing we would want right now (so they say) ..thank you patrice and richard..you are truly life savers! i wish the whole world were made up of people like you!

christina new jersey

This thread was discussed between 16/07/2011 and 17/07/2011

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