Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Mitch - prognosis not so good

Firstly thank you all so much for your support shown on my last thread, I did read all your messages. Mitch's PCV has remained a stable 28 and his platelets have risen to 41 from 28 since he went back to the Dick vet (He has been 44 and 50 previously - they fluctuate greatly). Before todays bloods the plan had been to try vincristine but the results now show that his WBC count is now dropping low as well. I dont know the figures. Apparantly he may have myelofibrosis. Immune mediated in any way? - noone seems to know. Tomorrow they are trying couple of different drugs but he has been given a guarded prognosis at best. I can't even begin to explain how I feel. Kath

Kath Scotland

Hi Kath, sorry to hear they are giving you a poor prognosis. Tessy's HCT was stable at around 28% also for the longest time. it was only within the last couple of months that it stated to climb. Her WBC's also fluctuate. Sometimes they're low and sometimes they're high. Are you still giving the cyclo just once a day? Talk with Dr. Dodds or you other doctors about switching this to twice daily. I think most dogs take it twice a day. By upping this you might be able to lower one of the other marrow suppressing drugs? I'ld also consider switching the stomach protectant maybe. I think i remember you saying he's taking sucralfate? Tessy was on this at first and it messed with the absorption of the cyclo. I switched it to omeprazole and the results were much better. If I were you I'ld sit down, make a list of everything (causes, drugs, tests done, etc) and start crossing things off that were done. For example if you had his thyroid levels checked, cross that off. If you had him checked for tick diseases, cross that off. etc. etc. The last thing we need is to be missing something and with all the stress that this terrible disease brings it can be very easy to forget something. Might make things easier. I'll be hoping and praying for Mitch. Hang in there, be strong, and know you have the support and help of everybody here if you need it. Johnny & Tessy

Johnny

Hi Kath I am sorry Mitch is not doing as well as we all hoped. I personally think holding steady with a PCV of 28 is that bad and like Tessy my dog Ginger's also stayed in the 20's for awhile. I think the important things are how is he acting and how is eating? If he is acting okay and eating try not to be so concerned with the numbers. If you can please let us know the names of the drugs and the dosage they are trying. Also what is the dosage of the cylco he is on and how much does he weigh and have they done the trough test to make sure Mitch is on the correct dosage? It is so important that he is on the correct dosage of the cyclo and if not it won't help him. Sending extra, extra hugs your way. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Kath - Did they recently add cyclo on top of other immuno-supressant meds? If so, Johnny's right, they may need to adjust the doses of the other meds now that he's on cyclo. My dog, Murray, became "too supressed" and his white count dropped b/c the internist treating him at the time had the doses too high. His white count came back to healthy levels once the meds were stopped. I've read posts from other owners who were also able to get back to healthy white counts once the doses were adjusted. I hope it's nothing more serious than that - that's great that his platelets are moving in the right direction! Take good care, Bonnie

Bonnie Chicago

Kath, As said on here so often, there are ups and downs with AIHA. Mitch is stable, that's most important. There are times that medications have to be change or increased/decreased, in order to achieve good results. There is no set medication protocol, each and every dog responds differently. I agree with Johnny; make a list. If Mitch is not responding well to a medication, then try another. Or perhaps change the dosage. Of course all this under the watchful eye of your Vet. My Ren was given that guarded prognosis a couple of times. Keep hope and keep fighting. Tessy and Ginger and Ren are just a few examples of survivors of this disease. Sue & Ren

Susie delaware

I agree with everyone else. It may not be as bad as you are feeling it is right now. Olivers PCV had been in the teens for a month until he had his transfusion last week which brought it up to 22.3. 28 is pretty darn good. Hang in there. You and Mitch are also in my thoughts and prayers.

Mardi Northern Cali

Kath, I am sorry Mitch's numbers are not going so well. Hopefully it will be just an adjustment to the drugs. Try to hang onto some positive thoughts until you have something more concrete to go on. I know that sounds like it is just too impossible to do but remember you have a lot of people here to lean on, Penny

Penny Lytle Creek

Hi Thanks for your messages of hope. I will discuss things further with my vet tonight. I think the main thing I got from my vet is that this may well not be an immune issue at least not primarily. The body is likely not destroying his blood factors at all and the myleofibrosis is completely unrelated which would make sense of the lack of spherocytes and the negative coombs etc. There may be neoplasia somewhere that has been missed. It had been indicated to me previously that this may be a production issue and not an immune issue at all which would give a much poorer prognosis. All the things you have mentioned make a lot of sense if this is an immune issue but the fact is that is very much in question. Just feeling back to square 1 again and have likely been going down the wrong road for 4 weeks. Kath

Kath Scotland

Kath Did they see evidence of myelofibrosis on the bone marrow biopsies especially as Mitch has had 2?, as they would have seen some scar/ fibrous tissue, as I know they had looked for that in Nollaig's bone marrow biopsy but they found no evidence of it. If you give me your email address I would like to send you some info that you might be interested in to help Mitch as I don't want to put links on here as I know it can block me from the site then.My email link is above. Take care and praying for Mitch as always. Kathleen and Nollaig

Kathleen North Ayrshire

Thanks Kathleen I will send you my email address. The first bone marrow biopsy just showed nothing much of note except a normal number of megakaryocytes (was expected to be higher with ITP). No sign of cancer. No signs of RBC regeneration although this has clearly occured since then. The second attempt only an aspirate was taken as they could not get a biopsy, apparantly common in small dogs. The second aspirate showed high numbers of red cell precursers but that megakaryocytes were lower than previously. I do wonder why something wasn't seen on the bone marrow - will ask later. I do know that Marg Chandler is supervising Mitch's case this week. Kath

Kath Scotland

Kath I can only reiterate the words of other responses to your post - I'm terribly sorry that you aren't getting the news you so want to hear about Mitch's health. But, stay positive, this doesn't mean that his condition will not turn around. My pooch also had a negative coombs test - indeed, if I'd known they were going to do one, I would not have given my permission because in AIHA and PRCA dogs, the result often returns negative. Hoping you hear some positive news soon. Best wishes, Claire

Claire Cumbria

Every day brings a different story. Having spoke with the vet tonight I have clarified a few things. She must of been very overtired last night because she meant he had hypoplasia not myelofibrosis!Although she stands by her guarded prognosis all the same. It may or may not be immune mediated. Having read a lot of texts now from which I summise the following - Immune mediated stem cell injury may be reversible or irreversible and may progress to myelofibrosis. (irreversible). (Myelofibrosis was not found on mitch's b/m biopsy.)IM stem cell injury may take several weeks to respond to immunosuppresive therapy. Mitch (weighs 4.8kg) is curently on prednisolone 7.5mg twice a day (for 4 wks now) atopica 50mg once a day (for 3 weeks now) antepsin 0.5g three times day zantac syrup 0,6ml twice a day donaxon 50mg once a day I am happy with mitchs PCV as it is stable at 28 now and it is regenerating which it wasnt before. (Lowest was 10).Platelets are fluctuating all over the place highest 50 lowest 7. Latest was at 44. Platelets in general seem to have improved. White blood cells have just this last few days dropped severely. I questioned the meds but although it was agreed they could cause low WBC apparantly not so dramatic as he has. I have little control over his care, food, meds etc as he remains in hospital where he has been for nearly 4 weeks except for 1 day. I cannot make sense of an anemia that seemed to resolve quite quickly after transfusion and prednisolone with a thrombocytopenia which is fluctuating all over the place and now a severe drop in wbc at this stage. It doesnt fit with any of the text I can find. I worry that if he does have an immune mediated disease against the stem cells the length of time it could take to turn this around may be longer than his wee body can cope with all the meds. Thanks again for all your support. It keeps me going in the early hours when sleep doesn't come. Kath

Kath Scotland

Kath Does the vet say if Mitch is eating and acting okay and if so do they say he maybe able to come home soon? When you go to visit how does he seem. If all they are doing right now is giving him the meds do you think you could do that at home and take him to a local vet to have his blood work done? We are hoping Mitch can turn this all around and come home soon. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Boy, you guys have really been through the ringer. I am so very sorry. It sounds like they aren't sure yet, what exactly is going on. Poor Mitch. Poor you. It is very good PCV stable at 28 and regenerating. Yippee. I know nothing about hypoplasia. I can only offer words of support and let you know I'm thinking of you. 4 weeks is a very long time to be away from Mitch. I couldn't imagine how much you must miss him and he miss you. Take care and keep us aware of how Mitch is doing and yourself, of course.

Mardi Northern Cali

Hi Hypoplasisa just means he is not making any of his blood components ( I think practically same as pancytopenia or aplastic anaemia - Patrice please put me right on that one if I'm wrong!). Mitchs problem may be immune mediated and the problem is occurring early in the production of the blood cells. It is unlikely we will ever know why this has occured.All they can do now is stop his immune system and he is now on some meds to try and kickstart his blood cell production particularly WBC. Mitch first got taken into our local vets when more bruising started appearing on his belly (he was home for the first few days of his illness) 4 days later he then got transfered to the Dick vet hospital when his PCV dropped to 10 and he needed a blood transfusion.The problem is he is so at risk of bleeding because his platelets drop low within a very short space of time. He can drop from 50 to 28 within a day. He was allowed home when his platelets were 50 last weekend but he came down with a stomach upset and was back in 24 hours later to find his platelets had dropped to 28 already. Now the additional problem is the WBC as he is so at risk of infection. He is just not stable enough to come home even without the new WBC problem. When I saw him last week he was physically and mentally tired but his spirit is still very strong. Also at the hopsital his bloods can be taken in the morning and results back in the afternoon but at our own vet (except for Pcv counts which aren't a big problem for us) the results take from the morning of taking the bloods to the next evening by which time he could be in severe trouble. I don't visit him - I have his intertests at heart, he needs to stay quiet, calm and not see his mum keep walking out without him, plus he has the very real chance of overwhelming infection right now. Time is unfortunately also a constraint with 2 other dogs, 3 ponies and not forgetting the 2 kids and a job which I have to return to on Monday after the summer off. Kath

Kath Scotland

Kath What is donaxon for? Sure it's not ronaxan which is basically doxcycline and is used in case there's any tick disease/parasitic infection causing Mitch's problems.I got the vet to start Nollaig on ronaxan weeks ago just in case that's at the root of her trouble.So that's good if he's on this as it will cover that basis. Pure red cell aplasia what Nollaig has, is basically immune mediated stem cell(or pre cursor cell) injury directed at the red cells.Rory her internal medicine specialist vet says they use an average time frame of 100 days as sometimes it can take this long to turn things around(he had a dog 130 days before it turned things around)However he said 'some dogs respond to immunosuppressive drugs and some don't and we don't know why this is' but he also said with some dogs their marrow can just spontaneously right itself.Hence why I told you I was putting Nollaig on the bioprep, to aid Nollaig's own natural ability to heal. Nollaig's white cells dropped to a dramatically low level there just a few weeks ago think they were 0.1 or less and it was purely down to the drug(leflunomide) which she was on, so drugs can and do dramatically affect white cells,she then caught a vomiting/diarrhoea bug which developed into sepsis and was put into isolation ward on iv antibiotics but she did recover.If she'd been on antibiotics she probably wouldn't have caught infection but because she was at home and it just dropped suddenly we didn't know white cells were so low. A few months ago azathioprine did exactly the same thing (after being on it for 6 weeks then the white cells just dropped dramatically) and she was put on antibiotics to prevent infection but I remember at the time a vet saying we don't know if it's progression of the disease in the marrow but he said it would be very unusual for the red cell line to be affected and then the white cells it would normally be white cells first.So is that not the case in Mitch too his red cells were affected first? As it turned out, on both occasions, as soon as these drugs were stopped, her white cells returned to normal.Many dogs can be on azathioprine and leflunomide and it doesn't affect their white cell line so are the vets absolutely certain that in Mitch's case it's not the atopica or another drug that's affecting his white cells? I pray for Mitch,same as I do for Nollaig, that they will just have a dramatic turnaround and that their own bodies will heal them cos then we can get them off all these nasty drugs. Take care Kathleen

Kathleen North Ayrshire

Hi Kathleen Good to hear from you. Yes it is ronaxon he is on -oops. I do have my concerns re the drop in WBC and the medication. I will push my concerns again. However is this likely to happen with prednisolone ot atopica to such a degree? I know these are different drugs to what Nollaig had a bad response too. Maybe I should ask Dr Dodds for her opinion? It does seem odd that his WBC suddenly drop now. I will have a change of vet no doubt this weekend and next week and maybe a different viewpoint from them. I guess there is still time for him to turn this around but unfortunately we are not going to have the finances to keep going like this for so long. It has cost nearly £4000 in a month and we only have another £2000 left. Our only hope being that he gets strong enough to come home soon. Kath

Kath Scotland

A further thought - If they take him off the meds in case they are affecting his WBC then what will still stop his immune system taking over again? kath

Kath Scotland

Contacting Dr. Dodds for an opinion sounds like a very good idea to me. I know that she would probably adjust the med dosages until there is an absolute lymphocyte count of around 1/3 of the normal range (750 - 1500 / ul). Do you know what Mitch's Lymph counts are? If you contact her you should also ask about switching the cyclo to twice a day....every 12 hours. What are Hid WBC counts as of late? Prayers and best wishes for you and Mitch. Johnny & Tessy

Johnny

Kath, Hypoplasia is: hypo meaning low or none, plasia meaning growth, formation, development. So put together: low levels (or no levels) of development or growth. Pancytopenia is: pan meaning global or "panoramic", cyto meaning cell, penia meaning lacking or simply "little". So a global loss of all cell types. Aplastic anemia is: a meaning "not" and plasia meaning "to form." Anemia generally means reduced hemoglobin of the red blood cells. But combined with aplastic generally means a loss in all three cell lines of the marrow. These terms do not have a cause or diagnosis associated with them. They are simply a description of the condition. So they are more or less interchangeable. What is variable is the cause, and there can be many. What is common to all three cell types are the precursor cells in the marrow. These three cell types all form from the same precursor cells. What may be different in how these cells are affected is the mechanism of the immune signaling devices that "attach" to each cell type. And further, is there a primary autoimmune cause or is there a secondary cause like tick disease, infection or some form of malignancy? If, after significant diagnostics, a secondary cause cannot be identified, then it might be assumed that this of a primary autoimmune nature. Dr. Dodds would say that this is an often seen cause of canine pancytopenia, bicytopenia or cytopenia. In each case she would follow a protocol that she has determined, from clinical experience, has worked in many dogs to reverse the destruction. There is no documented "one size fits all" treatment for canine autoimmune anemia. Chance had bicytopenia meaning loss of two cell lines. He was deficient in the red and white cells, but luckily not in the platelet line. His cause was autoimmune destruction of the precursor cells. Sufficient immunosuppression by prednisone and cyclosporine was a successful treatment. It was a lengthy and dangerous treatment, requiring constant antibiotic treatment (and many other drugs). He was open to all kinds of opportunistic infections. Think of the "bubble boy," I had to monitor his temperature continually throughout the day and night for several months. I talked it over with my vets early on and decided that most of his treatment could be done locally. Keeping him at home was the best thing I did for him. I was able to monitor him all the time. My vets were eager to work with Dr. Dodds and they did everything they could in terms of treatments to help me. So when I was treating Chance, I found that I simply had to put aside the "why" this was happening and move forward with the treatment. The more I focused on the cause, the more upset I became. Chance's condition took many many months to change. He was very sick from May until Sept. 2007. By October he was showing signs of significant recovery and by December was so improved that it was amazing. Perhaps that is one reason that Joanne developed this forum and allows such free discussion among members? How we react to this disease and what our actions are is as important as the actual treatments themselves. I personally had to dig deep into my own faith to get through this. Not everyone that comes here will be successful. But I think the important thing is that each person should have faith that they might be successful. And if they are not, they will still feel that they did everything they could. Be optimistic. Have faith. my best patrice

Patrice NYS

Thanks all, - wow what a post Patrice! It was my understanding that the three terms were pretty interchangeable which it seems they are. I appreciate there is no diagnosis merely a description of the symptoms. I certainly felt that when the WBC dropped as well on Wednesday that we were coming to the end. However on a brighter note today Mitchs PCV has gone to 32/33 which is the very highest it has been - it has been pretty stable at 28 for a couple of weeks previous. His platelets are remaining at 41 - although a very low number they have been pretty stable for a week. Best of all after being given Granolocyte colony Stimulating Factor his WBC has risen from 2.2 to 7.3. His vet is very pleased with how well he has responded - he will have another dose tomorrow. I had a long conservation with the vet overseeing Mitch tonight and we discussed lots of things. No secondary cause has been found and they have not stopped looking. A second test for ehrlichia, lyme and others? all came back negative... and so for now it is likely a Primary immune mediated attack against the stem cells. We discussed meds and possible link with his sudden wbc drop and she is going to look into this further and discuss with others although her feeling is that it is not the cause. She is very open and encouraging that I put forward any thoughts,ideas or suggestions I have. She also took Mitch for a little wander herself today and said he seemed rather brighter and what a wonderful, sweet little dog he is.

Kath Scotland

Patrice - just wanted to say a big thankyou for your detailed post but more partcularly the last two paragraphs. I have been so sure I was going to lose Mitch this week that I have found myself practically greiving before he has even gone. I will try to follow your advice and believe we will be successful. Maybe I could take a lesson from Mitch as well - he certainly isn't giving up without a fight. Thankyou all so much, you really have kept me afloat. Kath

Kath Scotland

Kath, When my Ren first had AIHA, I thought that she would surely succumb to the disease. There were trying days and it took every ounce of strength within me to remain hopeful. Ren eventually did recover only to have a relapse one year later. The relapse was twice as bad as her initial bout with the disease. For weeks I concentrated on the blood work numbers. Some days looked promising and then she would have a bad report and I'd fall apart again. I finally came to a point where I routinely gave her medication; I showed love to her constantly and tried not to grieve in her presence. I prayed without ceasing. But most of all, I never gave up! When my Vet said there was no hope, I sought out another Vet. When that Vet gave Ren a guarded prognosis, I pleaded with her to all we could. I was willing to try any medication or treatment available. I am happy to report that Ren is stable and doing well. However, it took many months until she was stable. I know how you feel. We have all be there. There is hope, and I pray that Mitch will fully recover. This disease is not for the dog owner that is faint of heart. We have to be some of the strongest people in the world to take care of these precious souls. Sue & Ren

Susie delaware

Kath: Just wanted you to know that we are thinking of you and Mitch and praying that things will get better soon. Rita, Mike and Sheba

Rita IA

What is the news on Mitch?

Mardi Northern Calif.

Kath I know it is really hard to be apart from Mitch, but just look at Phoebe and be positive - he is in the right place and with Marg Chandler looking after him - well you could not wish for any better!! I think Patrice is right, dig deep, find the faith to carry on fighting for Mitch. I know you have a fairly hectic family life and the pressure must really be on, but try to stay positive for Mitch and know that everyone is awaiting news about him. I am a great believer in the power of prayer, so with everyone praying for Mitch let's hope that his situation can be turned around, it takes a very very long time, but it can be done!! Here's hoping for good news!! Gill & Phoebe xx

gill uk

Hi Kath Just wondering whether you've had any news on Mitch? Best wishes, Claire

Claire Cumbria

Thanks for asking - I started a new post.This one was getting a bit long!

Kath Scotland

This thread was discussed between 26/08/2009 and 01/09/2009

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