Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Mo - 10 year old cocker diagnosed with AIHA on Sat

I wonder if anyone could give me the benefit of their experience with AIHA. Our amazing girl, Mo (aren't they all amazing?) developed rapid onset AIHA and was hospitalized on Sat with a red cell count of 9. Following a transfusion and steroids since then, she is now at 18 but her count hasn't increased in two days. We are praying that she will recover, and I guess I am searching for hope that there is a chance she will make it. Can she survive with a count of 18? The threads I have read show dogs who have had AIHA for months/a year or more and got through it with a lower count. Any hope/positive stories would help right now - Steve (my husband) and I are devastated at the thought of losing her. Thanks ever so.

Diane Wehrle Milton Keynes

my dog was down to 9 then had the transfusion.. and is still going well a year and half later. its a llooooooong process. your just at the beginning. hope she continues to grow in numbers. it normally takes a couple of weeks to see the numbers change. hang in there.. Pam and Rosie

Pam il

Hi Pam Thanks soooo much for your positive words - we are searching for hope right now. Mo has always been so healthy and is amazingly fit for a 10 year old. The thought of losing her devastates us so to know that there is a chance that she will survive is an amazing boost at a very low point for us. Give Rosie a pat from us. Take care Diane

Diane Milton Keynes

Diane, I am so sorry to hear about your girl Mo (how old is she?)coming down with AIHA. I am glad you found us though. Please don't give up hope! It is a serious disease, but many dogs have survived and lead a happy and healthy life. Please go to Joanne's website, you will find lots of information there. Go to the success stories, they will give you lots of hope! http://www.cloudnet.com/~jdickson/index.html A PCV of 18 is of course serious, but just as Pam mentioned, there have been many dogs that have recovered after being in the single digits. Is Mo still at the vet or were you able to take her home? It is crucial that you have a vet with experience in this disease. Your average vet knows the basics, but you might want to see a specialist (internal medicine). Maybe some one from the UK will post where they went. Please ask away! Post all the medications your dog is on and the other values from the blood test. You should ask for all the copies of the tests. Best wishes, Brigitte 7 the poodle boys

Brigitte BC Canada

(((Diane))) Is Mo home now? Tell us the drugs she's on, the dosages, and her weight. And like Brigitte said...get copies of ALL the bloodwork done thus far. Can you tell us everything they've done so far regarding tests? X-rays? Ultrasounds? Tick panels? Thyroid? ...anything you can htink of! Keep the hope and faith going. Lots of dogs survive this disease to go on and live normal healthy lives. My thoughts and prayers are with Mo. Johnny & Tessy

Johnny

Hi Rosie and Johnny, Many many thanks for your kind - and valuable - comments. We had a downturn today which has been very upsetting - Mo's blood level has fallen from 18 to 15 although she is eating which is a good sign I hope. They are transfusing her tomorrow, but first giving her a haemoglobin transfusion which apparently acts as an "umbrella" to protect the red blood cells. She is still in the hospital - unfortunately she got sick while we were travelling to Switzerland from the UK and so is in the hospital in Bern, Switzerland. She will be released on Tues so that we can take her home on Tues and she will continue treatment in the UK. Is it known blood levels to fall at the beginning? I would welcome all of your experiences. They have performed lots of test - ultrasound (no tumours), liver (a slight change but they think more to do with the fact that she is an older dog), and her bone marrow is making red blood cells which is positive but they are being destroyed at the moment. I understand that Mo is on Prednisone, but also a human immune suppressant called Cellcept - the vet worked in the USA and used it there with good results. The vet in Switzerland said that she would write a report and so I will get exact dosages when we see that. I will definitely take your advice with regard to finding a specialist - we are taking Mo to the vet first thing on Wed and we will ask to be referred immediately. Thanks once again for your comments - they really really help and give us hope where previously we had none. Diane

Diane Wehrle Milton Keynes

Diane, it's normal for the hematocrit to drop some after a transfusion. All a transfusion does is buys the dog more time for the drugs to start working. It can take upwards of a week for drugs to start working and properly suppress the immune system. There's not a whole lot one can suggest when the dog is in hospital but if it were me I'd ask about maybe adding cyclosporine to the mix. This drug works very effectively for treating this disease. You could also ask what they are doing to help with the liver damage. SAM-e or denamarin might be a good idea ....but they may just be waiting for Mo to stabilize some. With regards to finding a specialist...the absolute BEST choice would be Dr. Dodds in California. Lots of us here have used her services just because she's the best at what she does. She'll do phone consults for very cheap ($45 I think???). Some of the best money I ever spent when treating TEssy! She's usually pretty quick at responding to emails also if you were to chose to email her! Just an option for you. She's likely much more cheaper also than any other specialist you'll find! Any news yet today? I'll be keeping Mo in my thoughts and prayers. Johnny & Tessy

Johnny

Hi Johnny (and Tessy!) Thanks so much for your suggestions - I have made a note of them to discuss with the vet in the UK. It is so comforting to hear that the drop is normal and that it can take a while for her to improve. The impression we were getting from the vet in Switzerland was that Mo's blood levels should be improving immediately and, as they are not, makes us so so concerned. Today, Mo's blood level rose to 17 after the haemoglobin transfusion yesterday, and so they are holding off transfusing blood as she is above 15. Fingers crossed that she stablises enough to make the journey back from Switzerland to the UK. Thanks once again for your help and good wishes - it really does help so much. Diane (and Mo!)

Diane Wehrle Milton Keynes

Sending my prayers for Mo and hoping she can come home soon. I was happy to read she didn't have to have the second transfusion and hope she is beginning to turn things around. It often takes a few weeks for the medicines to kick in so give her some time and watch for very small improvements at first. Please keep us updated. Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Hi Diane, I hope things are going as well as can be expected. We were lucky as our vet had dealt with this before and treated Archie from the start before waiting for the coombes test. Only later did we find out that she had qualified only 3 years earlier. I did ask for Archie to be referred to the university hospital in Cambridge but was talked out of this by both my partner and our vet who felt confident she knew how to treat him. Of course for us this worked out well, what I did do though by discussions with Johnny was ensure that the blood tests were done at the time as we did have a few false readings and it turned out they were done by nurses and not straight away. I'm sure we drove the surgery potty with my long list of questions each time I visited and insisting on sitting and waiting for results. Keep on in there and good luck with the journey home. Archie did spend a few days in the vet hospital and it was scary when he first came home but he was happier here with us running round after him and manages to still have us doing this! I wish Mo well Sue

Sue and Archie Cambs UK

Hi Diane, I am hoping you haven't updated on here because you're too busy or still on your way home. Thinking of you and Mo and hoping things are okay? Sue

Sue and Archie Cambs UK

Hi Sue Thanks so much for your post - I haven't managed to post until now as we have been through the mill since Mo got home since late Tuesday. Initially was doing well and we went to the vet on Wed first thing and her blood level had gone up to 34. The local vet had made an appointment for her with a specialist who we also visited on Wed as a failsafe. He gave Mo a thorough examination and advised on a test for her potential risk of blood clots - apparently this is a real risk for some dogs in the initial weeks of treatment for AIHA who show "markers" in their blood. Apparently there is a 35% risk of a dog with AIHA getting a blood clot, and they can do little about it if it occurs - it is usually fatal. Anyway that night Mo got terrible diarrhoea which the vet was fearing, as Mo is on a potent cocktail of five drugs and one is very rough on the stomach (mycophenolate - see below). Mo also showed for a high risk of blood clots and so now is in hospital being treated for the diarrhoea and having a transfusion of Heparin to offset the risk of blood clots. They suspended the mycophenolate to ease the diarrhoea - which it did - and the good news is that Steve (my husband) saw her this evening and her diarrhoea was virtually gone. She is also really bright - like the old Mo back. She is in hospital over the weekend as they are changing her drug regime to twice daily rather than once daily to protect her stomach, and she will have the mycophenolate every other day. They tested her liver and whilst there are spots it is not cancer which is a big relief. They also did another ultra-sound and all was clear. Her pcv level has dropped a little, but the vet said that he is not too worried about this as it likely to be a result of the diarrhoea. The positive thing that the vet also said was that he didn't think it was an AIHA relapse but side-effects of the drugs. Her drugs are below - excuse the spelling as it might be Swiss: prednisolone - 2mg a day cyclosporine - 8mg a day mycophenolate (Cell Cept) - 20 mg a day aspirin - 0.5-1mg a day omeprazole - 10mg a day (for this week) We are going to visit Mo on Sunday and so I will update you afterwards on how she is. Thanks sooo much for your interest - it makes a massive difference. Diane, Steve and Mo

Diane Milton Keynes

Diane, Are you sure it is 2mg of prednisone, not 20mg? 2mg would not be enough to suppress the immune system. Same with the cyclosporin 80mg would be more appropriate, not 8mg. Mo should also be on a stomach protectant, check Patrice's post on that subject a couple of days ago. It an other thread you ask about titers to test for immunity. This is a blood test where it can be determined if your dog is still immune for rabies, parvo or distemper. If she is a vaccination would be unnecessary. It is so good to hear that the ultrasound came back with good results and the diarrhea has cleared up! Best wishes, Brigitte

Brigitte BC Canada

Good to hear they took Mo off the cellcept! Not a big fan of the drug myself. the pred/cyclo is a much better combo! I'm with Brigitte in that the drug amounts don't make sense. How much does Mo weigh? My thoguhts and prayers are with Mo. Johnny & Tessy

Johnny

Hi Diane, I guess you weren't able to travel home, I hope you have friends or family to support you there? I hope things settle down for Mo. The pcv sounds good at 34.The medication I will leave to those that know to comment on. Fingers crossed for you all. Sue

Sue and Archie Cambs UK

Hi Johnny/Brigitte/Sue I will definitely check the amounts - the prescription was in Swiss German so I might be reading it wrong. A few days ago Mo weighed 13kg (she has dropped from 14.5kg since she fell ill). Johnny, as far as I know they are planning on putting her back on Cellcept, although once every two days to be easier on her stomach. I will definitely ask the vet about a stomach protectant (as per Patrice's post) on Monday when we talk to him again. Mo's blood is now 27 and holding steady, but it's not high enough we know. The vet said that he wasn't too worried about the drop because the reading of 34 we were given might be on the high side as it was done by our local vet (apparently there are two ways of measuring the pcv, and local vets do it the easy/quick way which can read higher). I guess it will take a while to climb? I hope this is normal - can anyone advise? Sue, we did manage to travel back to the UK - I flew back on Sun and Steve my husband followed with Mo on Tuesday. He picked her up from the hospital and drove 13 hours straight to get home late Tuesday night. She spent two nights at home and has been in hospital since. We miss her! But the good news is that if the diarrohea is over then she might be home Mon/Tues. Fingers crossed! We are visiting her tomorrow afternoon in the hospital and so I will let you all know how she is doing. Take care and lots of love to you all. Diane

Diane Milton Keynes

Diane, I am Swiss and in Swiss German 2mg are 2mg :) I am really worried about that small amount. Mo should be on at least 20 if not 30 mg per day. If I were you I would make sure this is a mistake and you got the dose wrong. I am a bit baffled that you were not able to take Mo home. With a PCV of 27 there is really no immediate danger. Unless there is something else going on that I am not aware of, she should be home with you. You are right, it sometimes takes a while, weeks or even months for the PCV to climb back to the normal range. You have to be patient. Fluctuations are normal. It depends on so many things. Is the dog dehydrated, the time of the day, was the dog stressed when the draw was done etc. You are also correct, that it depends on the lab, the machine or who is looking at the sample. At the vets they can spin the blood for a fairly accurate reading of the PCV. this should also very cheap and you should have the result very quick. (15-20 minutes) If the blood is sent out to a lab it takes up to 24 hrs but they look at more things than just the RBC. There is also a pathologist looking at the sample and giving a report. That is why it is more expensive but you also find out more. How is Mo acting? Is she eating? I really think you should push on getting her home, she would be happier and you could feed her better food than she is probably getting at the vets. Best wishes, Brigitte

Brigitte BC Canada

Hi Brigitte I have just checked Mo's paperwork and I made what we call an "operator error". Her daily osages should have been multiplied by her weight as most were xxmg/kg which I understand is per kg?. So as she is at 13kg at the moment so they would be: prednisolone - 26mg cyclosporine - 104mg mycophenolate (Cell Cept)- 260mg aspirin - 6.5-13mg omeprazole - 10mg Mo is in the UK - Steve collected her from the hospital in Bern and drove her straight home last Tues. She was at home for just two nights but had to go into hospital as she had terrible diarrohea on Wed night - a side effect of the drugs we understand. We dearly hope that she can come home on Mon/Tues - we miss her! I am definitely going to look at stomach protectants and ask the vet about it on Monday. Thanks so much for the care. Diane

Diane Milton Keynes

Hi Diane, I am glad you got back to the uk and I hope Mo gets back to the house soon. I looked back on Archie's data and at the point where Mo is his pcv was 15% so don't lose hope and at least if she is in the hospital they can monitor it. Archie was reluctant to eat when he was staying at the vet and althougn I was worried sick things did improve albeit slower than I would have liked once he was home. Thank goodness for pet insurance, we certainly had our monies worth. Thinking of you all. Sue and Archie

Sue Cambs UK

Hi: Your dog appears to be on a stomach acid reducer already ... Omeprazole is the medicine name ... prevacid is a brand name for the medicine.

elaine ottawa

Yep, omeprazole IS a stomach protectant. IMO it's one of the better choices....kinda like the gold standard! If I were you I'd get some carafate/sucralfate just to have on hand in case you need it. The pred, cyclo, aspirin and omep dosages all seem right! Are you splitting the doses to give twice daily? The aspirin only gets given ONCE daily! Having a stable crit is super good for now! It may be possible that the higher PCV of 34% may have been taken when he was dehydrated some AND might be a difference between a PCV (simple spun test...usually higher) and a hematocrit/hct (usually lower by only a few points). If you can manage to try to take him for tests at the same time during the day and always amake sure he gets lots of water beforehand. Are they keeping him to give fluid via IV??? If not I'd be wanting to bring him home also. No need of keeping him ina stressed state away from home! Continued thoughts and prayers. Johnny & Tessy

Johnny

HI guys Thanks so much for the really valuable feedback - it fills in so many knowledge gaps and makes us feel so much better. We visited Mo today at the hospital and she was the old Mo that we know and love - we took her for a little wander around the grounds and she was pulling on the lead and sniffing like mad. She has also put on a bit of weight which is great - the nurse said that she loves her food so she is clearly not stressing which is great - and her ears were up for the first time in two weeks. She doesn't have much energy and gets tired easily but I guess that goes hand in hand with a pcv of 27. Her gums were slightly pink now, not yellow/white as they were on Wed/Thurs. The vet said that he has changed over her dosages to twice daily apart from the aspirin which is once a day, and the Cell Cept will be given every other day from now on. The vet is seeing her tomorrow morning and then we are hoping she will come home. Sue, you are so right about the virtue of pet insurance, not that we wouldn't have done exactly the same thing even if we weren't insured. The wonderful thing about dogs is what Cesar Milan says - they live for the moment. All Mo knows now is that she feels good, and the fact that she was poorly this week doesn't occur to her. Humans can learn a lot from dogs!!! I will let you know how everything goes - love to everyone (human and furry). Diane

Diane MIlton Keynes

Hi, a quick update and some worries that I hope you will be able help with. Mo came home from the hospital this evening with a pcv of 29. Her drug regime is rigorous - below. Is this usual? Good? or are we missing something? After such terrible diarrhoea I am very nervous about her getting enough stomach protectant - the thought of Mo having to go through another episode is so worrying. Prednisolone (Prednidale) 25 mg tablet Half a tablet twice daily Amoxycillin Clavulanate (Synulox) 50 mg tablet 3 tablets twice daily Mofetili Mycophenolas (Cell Cept) 250 mg tablet 1 tablet every other day Aspirin eighth of a tablet a day Sucralfate (Antepsin) 5ml twice a day Metronidazole 200mg tablet Half a tablet twice daily Ranitidine (Zantac) 1.6ml twice daily 30 mins before food Daltiparin sodium (Fragmin) 0.07 ml injection every 8 hours Atopica (cyclosporine A) 50 mg tablet 1 capsule twice daily wearing gloves Any advice would be really appreciated. I feel like we are on a tightrope with this, and I now know that it could be a long and slow process. On the plus side, it is wonderful having her home! She is tired but I would be too if I had been through what she has. Thanks ever so for any advice anyone can give. Diane

Diane UK

At what times do you give everything? I'd try my best to keep everything separated if possible. Let us know the timing and we'll see what can be changed...if anything. the dosages look about right for now....we'll have to watch the CBC's to determine if the dosages are suppressing the immune system sufficiently enough. Good to hear she's home now! LOTS and LOTS of rest and fresh clean water is a must! Avoid all stress also. Give Mo some luvins for me. Johnny & Tessy

Johnny

Cell Cept has well known side effect of very bad diarrhea. It is worse than the cyclosporine in this aspect. Decreasing it is really going to help that. I am not sure I am a big fan of this drug, but it looks like your vet is thinking similarly. It really only has an effective window of time of about 8 hours per dose. Research has shown, that sometimes after that, the body tries to make up for the immune suppression by increasing its efforts 3-fold to make more T and B cells. Make sure the sucralfate is given with lots of time on either side of food and meds. It is best given on an overnight fast if you can swing this. It coats and heals tissue so 8 hours is a good amount of time. Metrondiazole is great for diarrhea, but also use a diet that helps. You don't have to do what I do, but I use well cooked sushi or basmati rice with a spoonful of plain canned pumpkin with scrambled eggs (or plain cooked chicken, anything really bland) and a little yogurt to help firm up the stool. There are a lot of drugs here, but they all have a job to do. Be persistent in asking when is the earliest that some of them could be removed. For instance the aspirin and heparin (fragmin) could be removed once they feel that the risk of serious inappropriate clotting is over. Keep track of how long you are using the clavamox and check to make sure they feel it is doing what it is supposed to. Antibiotics need to be given for a minimum of 7-10 days. If they have been successful, then there is no reason to continue them after 14 days. The prednisone should be decreased slowly as the PCV increases. Cyclosporine continues until there is near complete recovery but at lower doses. Stomach protection continues until you aren't giving aspirin, cell cept or prednisone anymore. Please let us take some of the worrying on for you so you have more time to cuddle Mo. I will take the first shift tonight. Take a break. my best patrice

Patrice NYS

Hi Patrice and Johnny Thanks so much for your really great advice on the meds. Steve, my husband, spoke to the vet today and apparently we only have one more dose of the Sucralfate (Antepsin) which was this morning but the Zantac continues - is this right? Patrice you mentioned that the Sucralfate coats and heals tissue - is just the Zantac enough to prevent a recurrence of the diarrhoea or should I be asking the vet to continue with the Sucralfate? I am so worried about Mo having to go through any more discomfort - as you advise Johnny we are working very hard at giving her lots of rest and no stress. Being back into her normal routine will be good for her, but I think it will take a little while to see the benefit. As you advise, we are giving her lots of cuddles and she responds when she is not too tired with lots of licks! Thanks SOOOO much for your advice and support - it makes the AIHA world a lot less lonely. Take care Diane

Diane Milton Keynes

Sucralfate/carafate is relatively inexpensive and is always good to have on hand regardless! This doesn't prevent diarrhea but will help protect the stomoch from ulcers. It's usually more used for treating ulcers while the antiacids are used to prevent. Zantac/pepcid/omeprazole would all work to help prevent ulcers. If you are not comfortable with discontinueing the sucralfate then by all means ask for more and continue with it. It can only help matters if given at the right timing. Give Mo some hugs for me! Johnny & Tessy

Johnny

Hi Diane, You must be absolutely shattered, I remember just going through the motions at work when Archie was ill as we had exhausted our annual leave within the first month and would have rather been at home so took it in turns to check in at home a couple of times each day. Mo has done well to get over the initial crisis and I do hope she continues to steadily improve. I can still remember this time last year so clearly as you will and somehow you will get the strength to get through this. Sue

Sue Cambs UK

Johnny, thanks so much for the information - really helpful. We are taking Mo to the vet on Thursday and so I will ask about Sulcralfate then. I will definitely give Mo lots of hugs from you - despite being much more tired and slower than she ever was she still looks forward to her walk (even though she can't really go very far and is on the lead). Sue, thanks for letting me know that I'm not the only one who is absolutely exhausted by this process. We are constantly looking for any sign that Mo is struggling so we are never relaxed and are shattered by the evening. Take care everyone - human and furry. Diane

Diane Milton Keynes

Hi Dianne, I am just about to go on holiday but checked in to see how Mo is doing. I hope you're just too busy to post and that things are steadily improving. Take care, Sue

Sue and Archie Cambs UK

Hi Sue Thanks for getting in touch - its lovely to know that she is in your thoughts. Mo is stable - the hospital sorted all of her stomach issues by altering her meds routine, but her pcv hasn't increased and is still at 29/30. Also some aspects of her behaviour have changed since she has been ill, and we are not sure if it is the disease or the meds. She has so much less energy, and generally doesn't want to climb stairs, but on the plus side she is wagging her tail and is hungry (that is probably the meds!). This morning she wanted to come home and so Steve cut her walk short, and her gums are paler (I check them religiously now!). She has an appointment with the vet tomorrow for another blood test so we should know more then. Have a great holiday and love to you and Archie!

Diane Milton Keynes

Diane, Love the wagging tail and the appetite. Remember it is still early days. I know to you it seems Mo has been sick for a long time, but for this disease you are just barely past the start line. Having a PCV of 29/30 after 3 weeks is pretty good. Just be patient and you will see that number go up slowly. Good call on taking Mo home when she is giving you the message that it is too much. I know it is hard, but don't over do it with the exercise. She needs lots of rest to heal. Don't get freaked out right away when the gums are a bit paler for a while. The color can fluctuate, depending on the time of day and exercise. Try and push at the gums and see how fast the color comes back. The faster the better. Keep us posted and best wishes! Brigitte & the poodle boys

Brigitte BC Canada

Hi Brigitte, and the boys! Thanks so much for your comforting words - I get paranoid over any slight change in Mo and this feels like the longest three weeks of my life. It is really helpful to know that she is doing well for the stage she's at - we are structuring our life around her so that she has a familiar routine with lots of rest and no stress. I will let you know what the blood test comes back with after Thursday. Take care, Di, Mo and her very chubby sister Powder.

Diane Milton Keynes

Hi dianne, glad to read that mo is improving, usually the blood starts to rise when the meds are being decreased, that seem to be the way with this disease as the meds are cooling down the immune response, thats the way they work, it is a slow process so just be patient. like Bridget said, take care

Bev canada

Just a quick update on Mo following her latest visit to the vet today. Her pcv level has dropped a little again (to 28), but the vet said that he isn't too worried as apparently it can dip a little - is this normal? Also she has some bleeding in her stomach (ulcers) and so the vet recommends we give her Sulcrafate which we will now do twice daily. The good news is that her risk of blood clots is now back to normal, but we are continuing with the heparin. Does anyone know how long we should expect her pcv level to stay at around 28? Love to all and to our buddies. Diane

Diane Milton Keynes

This thread was discussed between 10/03/2011 and 31/03/2011

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