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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Medication side effects, cost, and effectiveness
| While on vacation last week, my beloved 12 year old Shih Tzu Toby was provisionally diagnosed with AIHA. The diagnosis is still uncertain, as he ingested onion and garlic during the time period in question. He collapsed 4 days after developing dark urine; his crit had dropped from 41 to 20, and when it continued to drop, he was transfused. He's on prednisone---post transfusion went up to 31, then drifted down to 27 in the 2 days post transfusion, but now, 4 days later is up to 31 again. Frontline may also be implicated; he has never had fleas, as he's a city dog, but at the beach house picked up a major infestation, and was given Capstar and Frontline (and ate the bad meal) the day before he developed the dark urine. As we may be facing medication decisions, I would deeply appreciate feedback on medications used for this condition---effectiveness, cost and side effects. A further complication is that the ultrasound looking for stones to explain the dark urine (it had blood as well as bilirubin initially) also disclosed adrenal hyperplasia, and in retrospect he has exhibited symptoms of Cushing's Disease for a few months. (Which makes me wonder---if he is endogenously producing excess corticosteroids already, it would seem odd to develop an autoimmune disorder...) Sorry to be so wordy, but as you all know, this condition really hits you over the head with the need to learn a lot, quickly. I am a pediatrician, so the medical stuff is a little familiar, but of course, I don't know the ins and outs of canine medicine. Thanks in advance; this website is very helpful. |
| Ann Connecticut |
| Ann, I am so very sorry to hear of your most beloved Toby's possible AIHA diganosis. If you have not read my Web site on Canine AIHA/IMHA as yet, you might want to do so when you can. The URL is http://www.cloudnet.com/~jdickson/ Be sure to follow the links on the first page to many other sites on AIHA/IMHA that will be very helpful to you and do read the Success Stories pages as well. They will show you what has worked for other dogs in terms of treatment options as well as give you a lot of HOPE. The treatment page at my Web site contains info on the most commonly used medications for the treatment of Canine AIHA/IMHA as well as links to other sites that have more info on these medications. I truly do know how hard this is so be assured that you and your dear Toby are in my thoughts and prayers during these most very difficult days. I am sure others will share their thoughts and experiences with you as well. |
| Joanne MN |
| Hi Ann, I'm sorry to hear about the potential diagnosis of your Toby. It does seem that shih-tzu's are a commonly affected breed with IMHA. As far as meds go, most vets will start on a high dose of Prednisone along with Azathiaprine, which you might recognize from the human medical world as an immuno suppressive used in organ transplantation. Aza takes many more weeks to reach it's efficacy, so they are usually started at the same time, but Pred can work within a week. The main side effects of Aza are increased ALT numbers in the liver, which may or may not effect your dog. Pred however, has many side effects as you may know- muscle wasting, poly uria, extreme hunger and thirst, depression, etc. It's important if it's IMHA to treat it aggressively an this onset. What's interesting though, is that if Toby already has Cushings, they may need to look at another med besides Pred. Many here use Cyclosporine/Atopica, which is more expensive and requires more accurate dosing and testing. A very low dose of baby aspirin can provide protection against clotting, which is a very serious threat to IMHA dogs. You would think this is contraindicated with Pred, but in fact, many new vet studies prove this is effective and life saving for a good number of dogs. My dog Tiggs was able to be successfully treated with Pred and Aza alone. Be sure he is on a stomach protectant, and you may need to also add an anti nauseal if he is having trouble with vomiting. Gentle foods such as steamed white rice and boiled chicken can help with the appetite. It's good you have a medical backgroung- it's a lot to absorb. Dogs can and do survive, as Joanne has said. My dog Tiggs will celebrate his 1 year anniversary with IMHA on Thursday. He is doing awesome! Please keep us posted, our best to you and little Toby. melissa and tiggs |
| melissa slc |
| Ann, I am so sorry to read about Toby's serious condition. This must be very frightening to you. I wish I could give you a hug of reassurance. I can tell you that I don't often see this, but his condition is called Heinz Body Anemia. This is a direct result of ingestion of the onions and garlic. While humans have few problems eating these foods, in some animals it causes a very sudden and serious hemolytic anemia. There are other things that can also cause this type of anemia and one in particular is ingestion of sweet tasting antifreeze. Cats are particularly susceptible to Heinz Body Anemia and some dogs have a more difficult time with it as well. Diagnostically, the lab technician takes a blood smear and observes under a microscope these particular types of red blood cells that have features that identify them as having this type of anemia. Here is a link to a google reader of the textbook description by Schalms' Veterinary Hematology. http://tiny.cc/iGQM6 Start with page 178 to read the chapter. Some pages might be missing, as this is a freebie look, but you will get the general idea. Hospital treatment is essential to get through this crisis and I have no doubt that your vets are very prepared to treat this emergency. Whether or not there is an autoimmune element to this I can't say for sure. The drugs that are used for treatment do cause their own problems, as you are discovering. But in general, once you remove the suspect cause, onions, and administer emergency treatment, the body should begin to replace the damaged red blood cells with new ones and recovery would be gradual. my best patrice |
| Patrice NYS |
| Thanks for kind wishes and comments. I was hoping that everyone whose dog is on meds for this disorder would let me know what drug had been prescribed, how much it cost, whether it worked, and what side effects you have seen. Toby seems to be stable, though rather subdued. He is due for another checkup tomorrow. If his counts continue to rise, we can wean him off of prednisone. If he doesn't improve, a second drug will be needed. This is why I want input from others about their experiences. Has anyone's dog been put on cytoxan? My vet has mentioned this as a fall back option. |
| Ann CT |
This thread was discussed between 14/07/2009 and 16/07/2009
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