Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Matilda PRCA 6th Transfusion

Hello I am new here I have a dog who also has PRCA and I have been reading about PRCA on the Vet Net website. I have never posted on the site, I belong to another support group but I was wondering what the maximum amount of transfusions anyone here has known a dog to have. Matilda , my 3 and 1/2 year old, beautiful Jack Russell dachshund cross was diagnosed with this terrible disease 3 months ago. As you only know it is an absolute nightmare. She has been on everything and nothing is working....yet. I am in constant contact with Dr Dodds though having trouble with my “normal vets” to comply with my wishes though at the moment I do have her on the thyroxine ( since 11th May) and she is getting an anabolic steroid injection once a week. (she has had 3) I had to fight for it. The RVC wouldn’t entertain that at all and refused to give her anymore transfusions after her 3rd one. They had her on mycophenolate and the prednisolone but as she wasn’t responding after 6 weeks they said she never will . T They did refer me to my new specialists and they are looking after her now alongside my regular vet. She is still on prednisolone, but now taking lefludnomide and they are talking about trying her on lithium. I wasn’t happy about the leflunomide but unless I complied I was worried the new vets would turn me away too and not give me the transfusions I knew she was going to need. My regular vet is fantastic, is a big Jean Dodds fan but I need the bigger vets for the blood transfusions as they are so tricky at this stage. They are being very kind and supportive, i just hope they will stick with me to try and get Mattie better, I know she doesn't want to leave me . I have her on a multitude of Chinese remedies, homeopathic remedies. Iron supplements (all of which she has no problem taking) and she has acupuncture and healing too. I am giving her a greyhound supplement which helps to produce red blood cells. I also give her Floradix a liquid supplement for people pack with b vitamin and various other nutrients. Her coat is lovely and if you didn’t know you would never know she was sick. Even now with a pcv of 12 she has adapted very well. She eats like a horse and is alert, playful and follows me everywhere. She is currently being crossed matched and hopefully will have another transfusion on Wednesday I am feeding her on the Royal Canin sensitivity diet which Dr Dodds has said is fine. I am only giving her this because her gut became very ulcerated at one point and we nearly lost her.The RVC recommended this and it did the trick at the time. I think she would be fine to come off this now ( I would never feed her this usually....it’s organic all the way for me, maybe not home cooked but organic) and I am going to start cooking for her and include, chicken, rice, pumpkin, brocolli etc. I was considering the bioprep too but i can see from some posts that Dr Dodds isn't a big fan of it for dogs with this condition. I am angry at myself for not seeing some of posts earlier, I have trawled through loads but missed some really informative ones.....I am kicking myself. I am consumed by this...you know how it is. I am worried that at some point the vets will refuse to give her anymore transfusions and my time is running out. I feel that her immune suppressants aren’t working and it is the bone marrow that needs the attention. I hope I’m not too late, I am beating myself up. I look forward to hearing from you. It would be great to get some more opinions and advice. Thank you Lola Marlin

Lola Marlin London

Dear Lola -- I can't really respond to your post in an informed way, because I lost my dear beagle to IMHA five years ago, and she was transfused with oxyglobin, which I subsequently learned was not ideal. It sounds like you are being careful and learning about everything, and you have Dr. Jean Dodds working with you. Dr. Dodds has been such an incredible help to others on this forum. I just want you to know that my thoughts and prayers are with you and your sweet Matilda. Your girl is a cross between two very tough dog breeds, so that temperament will help her to fight as hard as she can. And, she's got you and Dr. Dodds fighting with her, as well as some of the other vets in London. I wish you all the best. In the meantime, I am sure that some of our forum members with in depth experiences will jump on here and help you out. Take care.

Brenda VA

Dear Lola, I don't know how much help I can be, I have no experience with PRCA. I know there are some people on this board that do though. I am sure some of the treatment is different than AIHA/IMHA/ITP, but certain things are the same. I am surprised Dr. Dodds approves of the Royal Canin food. As far as I know it is full of low quality fillers and not much meat. I think you are smart to start cooking your own food! Instead of rice (which is a grain) I would use potatoes, yellow or sweet. White fish (cod) would be a good choice too. I really can't tell if there is a limit on how many transfusions can be done. But I am pretty sure there are dogs that had more than 5-6. If you have not already gon to Joanne Dickson's Meisha's Hope website, please do. There is a lot of information there: http://www.cloudnet.com/~jdickson/index.html Also check out the success stories: http://www.cloudnet.com/~jdickson/successstories.htm I know there are some dogs there that survived PRCA, I am sorry I can't tell you exactly right now. I will do some surfing and get back to you. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Lola, I am so sorry to hear about Mattie and the very difficult time you have had in the past 3 months. This is a very complicated case and you seem to have done a lot to educate yourself and obtain any and all resources you can to help her. I have great faith in Jean Dodds, she saved my dog Chance's life in 2007. He had a similar condition, non-regenerative anemia and also neutropenia (also not making white blood cells). His bone marrow biopsy showed virtually no marrow cells what-so-ever and his prognosis was dim. There are many many things being prescribed and given to Matilda. It is tough to advise you one way or the other what to continue, what dosages to change or what to discontinue because of that. Dr. Dodds is your best source for that information and guidance and your local vet is a good resource for education and advice. I can help you understand some of the veterinary terminology that you don't understand well so that you can make a more informed decision. The major complication of giving multiple transfusions to a dog that is non-regenerative is that it can signal or mislead the bone marrow into believing that there are enough red blood cells (via a relatively high hemoglobin level) and there is no need to make more, thus they may think of this as "suppressing" reticulosis. Some of the medications used to treat this condition can also have this negative side effect of suppressing the bone marrow as well. I am curious why Jean Dodds has not suggested the use of cyclosporine for Matilda and would want to know her reasoning behind that. She was very quick to put Chance on this drug when we first talked and within days of my first contact with her, he was on it. Within less than 4 weeks he became regenerative again and within several months had a complete recovery. This drug is somewhat expensive, though in a dog Matilda's size, it would not be excessively so. There are relatively few side effects and any that do occur are generally not life threatening and will subside once the drug is removed. I am guessing that your vet specialists have done numerous diagnostic tests to determine if there are any conditions that are contributing to this? Do you know what they have done? Have they done a bone marrow biopsy, chest and abdominal x-rays, and possibly even an ultrasound? Do you have the results of your last two CBC complete blood counts? Could you post the out of normal range numbers here? Have they done at least one complete chemical screen in the last few weeks? Please post those out of range numbers here as well. I am specifically looking for liver and kidney function values. Let's try to tease through this information one piece at a time and see if we can figure this out together. Please stay here with us on this list for information and support. We understand what you are going through, as we have all been there at one time or another. It is a truly exhausting trial and I understand how frustrated and scared you are. You are not alone and we honor your courage and love for Mattie. my best patrice

Patrice NYS

My error, I used the wrong terminology: "thus they may think of this as "suppressing" reticulosis" This word should read: reticulocytosis. This is a condition where the kidneys signal the bone marrow to begin making more red blood cells. These are made from precursor cells and this process is a large increase in the "baby blood cell" production. They are sent out into main circulation early in an effort to begin carrying more oxygen to the body cells. Within about 3-5 days they drop their RNA inside the cell and mature into red blood cells. They are identified on a blood smear or by an automated blood analyzer by looking for this "bluish" RNA inclusion inside the cell and are labeled "reticulocytes" on the CBC. Any human or dog that has anemia (a HCT or PCV of less than about 37%) should have a minimum count of more than 1% or 60,000 absolute to be considered regnerative. In fact, at a PCV of 13%, the counts should be more like 5% and 600,000 absolute to be considered fully regenerative. This was the *very first number* I looked for on every CBC I had done. my best patrice

Patrice NYS

Lola, I can not offer you much in the way of advice, but there are many who are very knowledgeable and can (as you can read from the previous posts). I just wanted you to know that I am thinking of your sweet Mattie tonight. Don't be so rough on yourself. Sounds like you have been faced with quite the challenge of noncompliant vets, but you have stuck to your guns, you have done a great job being Mattie's voice. I have been exactly where you are. The fear, sadness, hope, dealing with less than compassionate vets. Questioning every decision you make, or don't make. Stick with your gut, and try to relax. Have a hot tub. :) Sending thoughts and prayers for you and Mattie. Jessi & Toqua

Jessi BC

Hi everyone, thank you for your posts, all very helpful and kind (made me cry!!!) I will be back later with some more info for you Patrice ,right now I am getting ready to take Matilda for her healing and acupuncture. I read the post from Kathleen regarding the Little Beagle Nollaig and she had had 5 transfusions so I am glad to see that she had so many bur made it through and I am going to take a copy of Nollaigs current meds with me to the vets and see what they say. Also the tick medicine could be interesting as the healer asked me if she had been bitten .On the cyclosporine though...it was one of the first things Matilda was given and she blew up like a balloon. Ut was then she went to the RCV for the first time and had her first transfusion and since then we didn't use it again. Maybe we left it off too soon. I'm sorry if last nights post seemed a little random and frantic, it was 2.30 am and I was beside myself, again . As I said I will be back with as much info as I can on Mattie's history, and meds thank you all again Lola

Lola Marlin Londn

Lola, I got your email and you didn't tell me where you lived but I see from above that you are in UK... therefore please give me your phone number and I will call you...there's a lot to talk about and I'm sure you will have lots of questions so if you would like me to call then email me your phone number privately...if not then I am more than happy to email. I know exactly the feeling of desperation that you're feeling as do many on this forum so no need to apologise for being frantic...it's that desperation to get Matilda well that will enable you to fight for what she needs.So glad you have Dr Dodds on board too,also if I hadn't found Karen and Darcy(another beagle with non regenerative anaemia who came through it) through this site then Nollaig might not be here today so I'm soooo glad you found this forum...keep posting on here as there are many people who genuinely care and will want Matilda to pull through this. I'm sure Karen(and Darcy) will help too if she sees this post. Take care Kathleen and Nollaig

Kathleen North Ayrshire

I am so sorry to read of Matilda's diagnosis, and you have found a great support forum. I was wondering if Matilda is on cyclosporine, I believe that is what turned things around for Ginger. If she is not on please ask your vet about this drug as cyclosporine takes a few weeks to begin working. Also you might want to get her on Pet-tinic which is a good vitamin supplement. How is Matilda feeling is she eating or showing an interest in things? Please keep us updated as we worry about all of our dogs on this site. Sending our hugs and prayers Cheryl & Ginger

Cheryl & Ginger Pineville PA

Lola, so sorry to hear you have to deal with this terrible disease. You found the right place to get help and support though! Like Patrice I was also wondering about the cyclosporine. I'm assuming that you already had a bone marrow biopsy/aspirate done? It might also be worthwhile checking out the thymus....I can't exactly remember what it was about the thymus I read about but I *think* it can be related somehow....I'll have to check it out when I get the time. I'm wondering the severity of the PRCA. Do you have copies of the first test *before* Matilda was put on the drugs? I'd be wanting to compare that first test to the following tests. Are there NO reticulocytes found or is the number low? All other values are normal? Is she normocytic and normochromic (normal red cell size average and normal hemoglobin concentrations)? If Matilda is doing well with the PCV where it is I'd hold off on ANY transfusions UNLESS needed. Like Patrice was saying this can ADD to the problem sometimes. HOWEVER....if they're needed they're needed! Feel free to post any and all results you might have. My thoughts and prayers will be with Matilda (& you). (((((HUGS))))) Johnny & Tessy

Johnny

Lola, I found one success story of a dog with PRCA, it is Chancey January 2008. Maybe you want to look it up for hope and inspiration. I know there are more dogs that have successfully battled PRCA. Everybody on this board has gone through the frustration and the roller coaster of this disease in one way or an other. Our experiences are all different and yet very similar. so come and vent anytime you have the need. There are certainly people on here that now way more about the disease than many veterinarians! (Patrice is incredible!!!) I am glad you have connected with Kathleen and Nollaig! This is a serious disease, but it can be beaten! Keep us posted, best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Lola, That is interesting about the cyclosporine. An allergic reaction is not beyond belief but it would be very rare. Usually the most bothersome side effects are gastrointestinal: diarrhea and vomiting. There are some rarer skin problems that may show up after prolonged use. This drug was developed in the 80's for human organ transplant patients who need long term suppression of the immune system to avoid organ rejection without the serious side effects that come with long term use of prednisone. In the last 5-8 years it has moved quite easily into veterinary use (as Atopica) for dogs with allergies. This use for severe autoimmune diseases is a recognized, but off label use. I wonder if this happened simultaneously with the administration of prednisone and it was confused with that drug's side effects? Prednisone will cause many side effects, some of which are fluid retention, swollen liver, loss of muscle tissue and shifting areas of fat. These side effects will change the way a dog looks very quickly and could be interpreted as swelling, esp. when the abdomen distends. Let us know what happens today. my best patrice

Patrice NYS

This is Matilda's last blood test results (her pcv has since dropped to 12....probably 11 today) Haematology Full Blood Count WBC.................... 8.1 x10^9/l 6.0 - 15.0 RBC.................... L 2.43 x10^12/l 5.00 - 8.50 Haemoglobin............ L 5.7 g/dl 12.0 - 18.0 PCV.................... L 16.7 % 37.0 - 55.0 MCV.................... 68.7 fl 60.0 - 80.0 MCH.................... H 23.5 pg 19.0 - 23.0 MCHC................... H 34.1 g/dl 31.0 - 34.0 Platelets.............. % Range x10^9/l Range Neutrophils 79 6.4 3.0 - 11.5 Bd Neutrophils 3 0.2 0.0 - 0.3 Lymphocytes 14 1.1 1.0 - 4.8 Monocytes 1 0.1 0.0 - 1.3 Eosinophils 3 0.2 0.1 - 1.25 Basophils 0 0.0 Film : Neutrophils show slight toxicity Scanty polychromatic cells seen Anisocytosis + Spherocytes + Platelet anisocytosis Platelet count appears normal in film

Lola Marlin London

These are the results from eean Dodds just under a month ago She has been on the soloxine but nobody told me to give it to her with pout food until last week:( ENRICHING PET LIFE THROUGH DIAGNOSTIC TESTING world-wide personal mail-in diagnostic lab for vets and pets Status: FINAL REPORT Notes: just started her on Soloxine 0 . 1 5 mg BID/on therapy for non-regenerative anemia Accession No. Doctor Owner Pet Name Received HML11985 PRENTIS MARLIN MATILDA 05/13/2010 Lola Species Breed Sex Pet Age Reported Canine JRT/Dach Mix FS 3Yrs 6mos 05/14/2010 6. 3 kg (13. 8 lbs) Test Requested Results Reference Range Units T4 Please note new Ranges T4 ↓ 1.00 0.80 – 3.80 μg/dL FREE T4 Free T4 ↓ 0.70 0.55 – 2.32 ng/dL T3 T3 ↓ ↓ 16 30 - 70 ng/dL verified by repeat analysis FREE T3 Free T3 1.7 1.6 – 3.5 pg/mL THYROGLOBULIN AUTOANTIBODIES Thyroglobulin Autoantibody 3 NEGATIVE % ------------TGAA CONFIRMATORY TEST INTERPRETATION ------------ < 10% = Negative; 10%-25% = Equivocal; > 25% = Positive Elevated TGAA levels confirm autoimmune thyroiditis. False positive results can occur if the dog has been vaccinated for rabies within 30 to 40 days. Thyroid hormone supplementation can decrease TGAA levels. Performed using the preferred Non-Specific Binding (NSB) Method. BLOOD CHEMISTRY Report sent separately May 14, 2010 Dear Andrew: Thyroid levels are too low here. TgAA is normal, so thyroiditis is not the reason for the hypothyroidism. Jean Adult Optimal Levels T4 1.40 – 3.50 μg/dL FT4 0.85 - 2.30 ng/dL T3 35 – 70 ng/dL FT3 1.6 - 3.5 pg/mL X Thyroid levels are below minimal expectations for a healthy performance adult (at least 1.4 µg/dL for T4 and 0.85 ng/dL for FT4). X As clinical signs support thyroid dysfunction, a 6-8 week trial of Soloxine® or equivalent product at 0.1mg per 12-15 lbs twice daily (e.g. 0. 125-0.15 mg BID), followed by retesting thyroid profile 4-6 hours post-pill to monitor response levels. X Optimal therapeutic response levels should be in the upper 1/3 to 25% above the upper limits of the resting optimal ranges at 4-6 hours post-BID thyroid medication. To ensure absorption, thyroxine is best given by mouth, at least 1 hour before or 3 hours after a meal. By Fax to 011-442-07-706-8392 ANTECH DIAGNOSTICS 17672-A Cowan Avenue Irvine CA 92614 Phone: 800-745-4725 Hemopet/Hemolife Client # 20073 11561 Salinaz Ave Chart # Garden Grove, CA 92843 Tel: 714-891-2022 on Rx for non-regenerative anemia Fax: 714-891-2123 Accession No. Doctor Owner Pet Name Received IRBD71019058 PRENTIS MARLIN MATILDA 05/13/2010 Lola Species Breed Sex Pet Age Reported Canine JRT/Dach Mix FS 3Yrs 7mos 05/13/2010 03:37 PM 6. 3 kg (13. 8 lbs) Test Requested Results Reference Range Units SUPERCHEM Total Protein 6.6 5.0-7.4 g/dL Albumin 4.1 2.7-4.4 g/dL Globulin 2.5 1.6-3.6 g/dL A/G Ratio 1.6 0.8-2.0 AST (SGOT) 13 (LOW) OK 15-66 IU/L ALT (SGPT) 14 12-118 IU/L Alkaline Phosphatase 79 5-131 IU/L GGT 8 1-12 IU/L Total Bilirubin 0.1 0.1-0.3 mg/dL BUN 12 6-31 mg/dL Creatinine 0.4 (LOW) OK 0.5-1.6 mg/dL BUN/Creatinine Ratio 30 (HIGH) OK 4-27 Phosphorus 4.7 2.5-6.0 mg/dL Glucose 106 70-138 mg/dL Calcium 9.9 8.9-11.4 mg/dL Magnesium 1.9 1.5-2.5 mEq/L. Sodium 146 139-154 mEq/L Potassium 5.0 3.6-5.5 mEq/L Na/K Ratio 29 27-38 Chloride 108 102-120 mEq/L Cholesterol 193 92-324 mg/dL Triglyceride 96 29-291 mg/dL Amylase 253 (LOW) OK 290-1125 IU/L Lipase 301 77-695 IU/L CPK 71 59-895 IU/L THYROID ANTIBODY PROFILE Report will be sent separately 14 May 2010 Dear Andrew: Chemistry results are all normal. Jean

Lola Marlin London

kathleen was so kind to me today...we stayed on the phone for ages. We have been living the same life over the last few months. I am going to call her know for some more pointers before it gets too late....I will be back later Thank you all for your kind wished...it gives me strength. best Lola

Llola Marlin London

Lola, Thank you for posting the results of the latest CBC. There are some important items missing from this report, platelets and reticulocytes (though there is a reference to the platelets and other items that are helpful which I will explain later). This might not be that unusual if you had this done at a smaller clinic. A complete "anemia panel" from a specialty clinic might be more complete. Before I say anything I would like for you to clear up any confusion I might have about the values for the white blood cells. In particular in this group I am pretty sure I have a good idea what should be the correct values but I am unsure what the first number you list in each group is: Neutrophils 79 6.4 3.0 - 11.5 Bd Neutrophils 3 0.2 0.0 - 0.3 Lymphocytes 14 1.1 1.0 - 4.8 Monocytes 1 0.1 0.0 - 1.3 Eosinophils 3 0.2 0.1 - 1.25 I am positive that the second number is the correct value in each group, but want to make sure. Under Neutrophils value = 79? Or is the value 6.4 with the range 3.0-11.5? Banded neutrophils: value = 3? or is the value 0.2? with range 0.0-0.3 Lymphocytes: value = 14? or is the value 1.1? with range 1.0-4.8 Monocytes: value = 1? or is the value 0.1? with range 0.0-1.3 Eosinophils: value = 3? or is the value 0.2? with range 0.1-1.25 my best patrice

Patrice NYS

This is the questionare I filled in when I first joined the K9 Immune Support Group. I have updated it too . we rescued Matilda 2 and a half years ago from the Mayhew Animal home in London. She had come over from Dublin with her sister just before they were gong to put them down. I have no idea about her history other than she was a stray ( though how they know it was her sister I don't know). She is a real scavenger and also has been partial to eating pooh in the past!!! She is quite nervous and jumps at anything, even now, so maybe this condition could be related to her stress levels as well as all the other possibilities. She is loving , affectionate and is really a Mummy's girl. We adore each other and she has been fighting this all the way with me. I can only hope I've been doing the right thing for her. Dogs Name: Matilda Breed: Dachshund / Jack Russell Cross Sex: Female Age: 3 and a half Weight (lbs or kgs): 6.75 Kilos If your dog is taking high doses of Prednisolone, is he/she also receiving a gastroprotectant ? Yes, now after the gastrointestinal bleeding. She wasn’t before. Which of the following symptoms do you see in your dog - yes/no - please provide details if positive: Lameness: No Bad Coat / Coat Loss: Her coat is amazing Aggression or Fearfulness: Always has been a little nervous Slow Heartbeat / Fast Heartbeat: Heart beat has been fast due to lack of oxygen but at the moment it is good ass is her breathing Temperature (high / low): as far as I know normal Mouth Ulcers: None Body Sores / Wheals: None Swellings: None Colour of Gums (pale / pink / normal): At the moment pale as her PCV is around 20. She is very bored of me constantly having my fingers in her mouth checking her gums!! Discharge (nose / eyes): No Unexplained Weight Gain / Weight Loss: before diagnosed had lost weight, but now she has gained weight , looks well but I am keeping my eye on her so she doesn't gain any more Lethargy: She is very very lively, very vocal and as naughty as she ever was. If you didn’t know you would not know she was ill. Diarrhoea: No Vomiting: No other (please describe): Has dog been spayed/neutered: Yes Has your dog been vaccinated (how often, when last?): She was vaccinated by The Mayhew Animal Home( from where I rescued her in Dec 2007) in 2007 and I vaccinated her again in 2008. Her last vaccine was in Nov 2009 and She had a rabies jab in May 2009 Regular use of chemical treatments? (worming/ fleas/ ticks): Have used Advocate in April 2009 Diet (BARF / home cooked / commercial dog food): Usually organic commercial food but at the moment on Royal Canin Sensitivity Wet food due to gastrointestinal bleeding caused by the prednisolone and the rantitidine originally perscribed at the RVC This seems to be fine for her and I add sometimes cooked liver, sh*take mushrooms, carrots etc. I emailed a copy of the foods ingredients to Jean Dodds and she said it looked fine. Your dog has been diagnosed with: Erythroid Hypoplasia / Myleolfibrosis When was your dog diagnosed ?:March 2010 Medication or Supplements (please note name, amount, frequency and history of dosage): when she was first taken to Hamilton Vet Clinic she was given the following – though I am taking the information from the invoices 26.04.2010 Dexadreson Injection 2mg Baytril 5% Prednisolone 5mg ( I think it was twice a day) Pro Kolin protexin ( only used that once) 27.04.10 Dexadreson Injection 2mg Baytril 5% Prednisilone 5mg ( I think it was twice a day) 28.04.2010 Dexadreson Injection 2mg Baytril 5% Prednisolone 5mg ( I think it was twice a day) 29.04.2010 Prednisilone 5mg 2.03.10 125mil Oxyglobin 1mls Antesepsin Suspension Zantac injection 2ml Predisolone 5mg Endoxana 50mg Buscopan inj 20mg At this time she was given all of the above we thought she had AIHA but she wasn’t responding to the treatment and after the Endoxana she became very bloated and I took her back to the vet at night as I was so worried about her. Over night the bloating went down and she went back to the vets.I don't really know if it was the cyclospren or the pred that caused the bloating but now I am scared to go back to the cyclospren. Her PCV had dropped to 5 and he was going to transfuse her with his own dog. It was at this point I decide to go to the RVC. She stayed in overnight had , had a transfusion her PVC went up to 25 and she was allowed to come home. She was given the following: Prednisolone 2mg twice a day Ranitidine 2mg twice a day She also had a bone marrow test which showed that she had Erythroid Hypoplasia and slight Myleofibrosis I kept going back to the RVC with her to check her PCV and over the course of a a couple of weeks it slowly dropped again . When she went in for her second transfusion it had dropped to 8. Overnight she became bloated again only this time it was with blood. The RVC fought to save her life and by the following evening she was fine and allowed to come home the next day. She was given some different drugs and I was told that if they were going to work they would do within 6 weeks. Prednisilolone 5mg tablet twice a day Mycophenolate 0.5 ml everyday Omeprazole 10mg cap once every other day Slowly the same happened and her pcv dropped ( and incase you are wondering with little or no exercise through out this whole thing). She had her 3rd transfusion on the 7th April.When she left the hospital her PCV was around 31 ( by now the man that discharged her wasn’t really interested and it it is not on her discharge notes) When I collected her from the RVC they told me they did not think she was going to get better. I decided then to go down some different routes and while she is still on the conventional meds she is also on homeopathic and Chinese remedies. Would you like me to list these too? Both sets of people know what the others are doing and I have also been in close contact with Jean Dodds who is also ware of everything Matilda has been through. Jean though, on top of everything else has recommended the thyroxine and the anabolic steroids. The 3rd transfusion lasted around 6 weeks. When I told the RVC that I wanted to try Jeans methods they were not very happy and in the end decided not to treat her anymore. They referred me to another vets. I also started to go to Andrew Prentis in London who is more than happy to go along with Jeans Suggestions. When her pvc dropped to 11(suddenly) she had another transfusion. She reacted to it about 2 thirds of the way through and came out with a pcv of 24 , this is when she started on the leflunomide. At this time she had only one anablolic injection which the vet asked me to stop while she was on the leflunomide but I carried on with the thyroxine. She dropped again and it was clear that she would need another transfusion which she had on the 27th May. I also started back on the anabolic steroid . Gradually she has dropped again and I am beginning to wonder, especially after speaking to Kathleen if she is going to respond to the immune suppressants at all. So far she has been n the leflunomide 3 weeks and it has had no adverse effects (yet) but l am wondering if that could be surpressing her bone marrow too. The vets say not as they say they can see from her white blood cells this is not the case. It is at this point I am going crazy. I can only understand so much !!!! At the moment I am waiting for a match for Mattie and hopefully that will come tomorrow, otherwise I will have to go myself to the actual Pet blood bank in Loughborough so they can check against all the blood instead of the six samples they are sending to the vets. This should have been done in the first place now I think about it clearly. She has never been teted for ticks (though her healer did ask me if she has been bitten) and now after speaking to Kathleen I am going to ask that she is put on Ronaxon. It can't hurt. I going to ask them to stop the leflunomide before it does any damage but to try her with the Lithium. I will carry on wit the pred She is on a gastric protector but I give her this with her steroid and I have been told that that is possibly not the right thing to do as it can interfere with the absorbtion of her drugs, Is this what others have found? Shoiuld she have a b12 injection too? The FLoradix formula she is on is good for iron as are the Chinese Meds and the Ironcyclen but jean says if Iam giving the ironcyclen I should leave off a couple of the other things . I hope this gives you a clearer picture. I am sorry if I have repeated myself from my last post but I thought it would be good to have it all down in one place. I will also post a list of all Mattie's meds seperately including her homeopathics etc. Best Lola Marlin

Lola Marlin London

Hi Patrice thanks for your responses.....you are right. In retrospect maybe it was the pred that caused her to bloat in the first place nad not the cyclopsporen but I am worried about trying it again. She had her bleeding episode without the cyclospren, when she was just on the pred. but the rvc change doses and she has not had that again, thankfully. ith regard to your questions about the bloods I just don't know. I'm finding it hard to eep up at this stage!! I have learned loads but not enough. I will get another blood test done next week all being well and I shall make sure it is ore extensive. I thought it did have the reticulocyte count on it though because my vet told me what it was (pretty non exisitant, some, but not enough) so I don't know how he would know that without it being on the test results. Maybe they did not send me the complete results. I am exhausted now and I may well have to go on the hunt for blood tomorrow so I am getting myself to bed a little earlier. I was here until 2.30 this morning and it showed today. I have also posted a question about the gastrosupressents and other drugs. Maybe you could take a look at that if you get the time thanks Lola xx

Lola Marlin London

The first numbers are the percentiles I'm assuming.

Johnny

Seeing the CellCept makes me wonder. It's been known to cause PRCA in some cases! If I were you I would be following everything Dr. Dodds recommends. She deals with more cases of these diseases than any other doctors!!! Have you ever sent away for a FULL tick panel? I'm also wondering if when you sent the blood to hemopet did you not get a CBC done with the thyroid panel and chem panel....I'm guessing you had the Profile 7200 done which WOULD include the CBC with retics and full analysis. I'm thinking you should explore the cyclosporine route again. I'd be making sure to get all the test results also. (if you haven't already). Thoughts and prayers are with you and Matilda. Johnny & Tessy

Johnny

Lola, Thank you for taking the time to put the complete reports up. This information is very helpful. I know you are overwhelmed right now. It is exhausting to try to understand all this and make decisions... when you aren't sure what exactly you are deciding about! You will not be able to understand all of this without significant study. I have a background in physical therapy so I was already trained to be able to read medical texts and understand the material quickly. Without a background like that it can take literally days to tease out the information on the internet that you need to have to make even one decision. But don't allow this to make you feel discouraged. At some point you have to count on the experts you have taxed to help you make these decisions. Having Dr. Dodds to do this along with your excellent local vet is a big plus for you. Some of us here on this list were mostly on our own and some of those dogs did not receive the best care that they could have. How many dogs here have died simply from blood clots in the early days of their diagnosis because their vets did not understand the importance of low dose aspirin therapy? We are here as a collective voice of experience in navigating the complexities of hematological canine diseases. There are many things you have posted that we could discuss but I thought perhaps the best place to start would be to look carefully at the diagnosis you have been given and help you to understand that. Here is the specific information: Your dog has been diagnosed with: Erythroid Hypoplasia / Myleolfibrosis When was your dog diagnosed ?:March 2010 What does this really mean? First: erythroid describes erythrocytes. These are the primitive cells in bone marrow which red blood cells develop from. Hypoplasia means underdevelopment or incomplete development. So these two words together mean that there is some level of underdevelopment or incomplete development of the cells in the marrow that turn into red blood cells. This is simply a description of what is seen, not a diagnosis of a cause. This would be referred to as a sign in medical terms. Myleolfibrosis. Myleo means marrow. Fibrosis means development of excess fibrous connective tissue. You might want to think of this similar to what happens when a scar gets overdeveloped and larger than the skin that used to occupy that area of your skin, it doesn't look like skin anymore. If this happened over a knuckle joint for instance, you might find it hard to bend your knuckle. Inside the bone marrow, the area that was once alive and contained lots of fat and precursor cells that were ready to become red blood cells, platelets and white blood cells has turned into fibrous bands of tissue. Again, this is a description of what has been seen by examining the marrow biopsy, or a sign. It is not a diagnosis of a cause. So the next step is to try to figure out the cause. There are many infectious agents, drugs, hazardous materials, and immune-mediated diseases that can cause hypoplastic or aplastic marrows. In addition, there are forms of leukemia, or a disease of white blood cells that can bring about this condition as well. Any one of these insults to one or more of the hematopoietic cell lines (cells that will become red, white cells or platelets) may result in an aplastic (means without cells) anemia where all cell lines are decreased, or a cytopenia (little/tiny number of cells) of only one or 2 of the different cell lines. Or in other words, are just the red cells affected? Is there also a decrease in white blood cells? How about the platelets? Loss of *just the red blood cells* results in Pure red cell aplasia, PRCA. Very unlucky dogs like mine also stop making white blood cells too (neutropenia) and can be in great danger of serious infections. The most unlucky dogs are those who are also not making enough platelets. They are at great risk of uncontrolled internal bleeding and have a very short time to recover before this condition is considered deadly. So your vets are attempting to determine what exactly is the cause and then determine what the best treatment to use in order to reverse the condition. By definition, pure red cell aplasia is considered most likely an autoimmune disease. Is this what Mattie has? If you were to read Dr. Dodd's work extensively you would see that she has a deep clinical understanding of what the current canine diseases are. This comes from her years of experience working directly with dogs. Researchers have somewhat limited clinical experience and rely on carefully prepared studies with small numbers of representative animals. Both of them have lots of information. Dr. Dodd's information is based on something called anecdotal information, researchers have empirical data. Dr. Dodd's information leads her to believe that most of these cases of hematological insult are autoimmune in nature. She bases this on years of information studying these dogs. Her work with autoimmune hypothyroiditis is known around the world. She has a full understanding of the effects that hormones, vaccinations, poor diet, environmental influences, and genetic inheritance play in these autoimmune diseases. When she looks at the lab workups of a new patient, she is evaluating those results based on the thousands of dogs that have come before. Does this mean she is absolutely right each time? No, but it does not mean she is wrong a lot of the time either. It simply means that these are extremely complex cases to treat. In Mattie's case she is looking at a lot of actual lab data and has come to the conclusion that she has a bone marrow deficit that is most likely autoimmune in nature and should be treated as such. Vets may sometimes question her decision making process because they like to see empirical data that shows a researcher determined the connection in a study. However in either case, when something is considered idiopathic, or the cause is really unknown, treating it as the disease you most likely believe it to be has to be the way to go. Otherwise, you can diddle away the time trying to nail down the cause and you may lose a life. So right now you are doing just that. Treating this as an autoimmune disease. Your goal is to suppress the immune system strongly enough that the destruction in the bone marrow will cease. In addition, you are also providing superior nutrition that assists the rebuilding of the bone marrow cells. Palliative care in the way of blood transfusions is also very important. In the meantime, your vets look over the data and try to find another possible cause. I know they are also thinking about some form of leukemia. The way I read your most recent results, there is no indication of that to me. They also asked you a lot of questions trying to figure out if there were any drugs, chemicals, heavy metals or poisons that may have contributed to this. You have done and are doing the very best you can right now. The most important contribution you can make now is to relax and be reassuring to Mattie. She understands when you are upset and this negatively impacts her mood and health. Go about your day as though all were normal, stay cheerful, get enough rest and set aside some time for yourself each day. That is what she loves, your attention and being part of your family. You will be able to do this. my best patrice

Patrice NYS

Dear Lola, I am so very sorry to hear about Mattie's diagnosis with PRCA. I am so glad you found this forum and that you are in touch with Patrice, Kathleen and Johnny. They are all fantastic with their knowledge, and helped me through my IMHA battle with my dog Millie. Please keep us updated on Mattie's progress. I can tell how much you love your girl, you have done so much for her already, and she sure sounds like a fighter! I have a Jack Russell cross also - he's so tough and resilient, I know that Mattie will fight this with you. All the very best, Sam & Millie.

Samantha Geelong

Just checking in to see how Matilda is doing today, did she have to have another transfusion? Sending our prayers Cheryl & Ginger

Cheryl & Ginger Pineville PA

Hi Cheryl Week she is still doing fine thank you.....she is playful and happy (even took a film in on my camera to the vet's today to show her playing nicely with her kong ( I don't let her go mad) just to prove how ok she is in case they think I'm exaggerating!!! Her PCV had dropped to 11 ( not bad seeing as it was around 12 on Monday so the dropped has slowed a little) and we have found a blood match ( well all six sample that were sent off matched her) and that is on hold for her at the vets. They want to wait as long as they can before the transfusion, treat the dog rather than the numbers....as we are thinking of the future and further possible transfusions the longer the gap she can have between them the better. She had a b 12 jab this morning and we have also started her on a course of doxyclynen incase she has an underlying parasitic infection,. This stuff helped Darcy and Noillag so fingers crossed it helps her. As she was a stray for a year before I we got her she could have had all kinds of problems or infestations. Anyway this won't hurt and it could help. i think we are leaving her on the leflunomide for one more week ( as about now is the time it should start working....though I don't hold out much hope ) and then re-access the situation, whilst carefully monitoring her white blood cells and liver. She will be checked again on Saturday morning when she goes in for her anabolic steroid injection, unless of course she takes a turn for the worse....I sleep with her every night, she is under the closest surveillance so don't worry people ....I'm on it xxxx

Lola Marlin London

Lola, are you ever on it!!! Good for you, you are Mathilda's advocate and you are doing a great job. All of us on this board are sad when we hear of a new diagnosis and worry. We are however always ready to celebrate the successes! So lets cross fingers and paws for Mathilda!!! Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Lola, Thinking of you and Matilda. Everyone here will guide you through everything that you need to know, but it sounds like you are doing a great job. Definitey keeping all fingers and paws crossed for you and Matilda. Hope you keep getting positive news, and always believe in your own feelings as to what is the best thing to do for Matilda. Julie

julie australia

This thread was discussed between 08/06/2010 and 11/06/2010

Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index

This thread is from the Vetnet archive. The live Vetnet forum is active now.