Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - New member - Maggie diagnosed last week

Hi all, new poster. I have been reading through many stories and my heart goes out to all of you and your furry friends. Maggie, my 7 year old yellow Lab was diagnosed Thursday last week, 20-October, following declining CBCs (down to 24% last week), an ultra-sound and a bone marrow biopsy. Apparently her immune system is cutting of the flow of RBCs in her bone marrow. Fortunately, we found out about her condition by accident and early as a result of treatment for another condition, "Limber tail" which is a strain in the muscle around the base of the tail akin to a lower back strain for us. She had been showing very few symptoms, if any, of being anemic. We started her on Oct. 21st with 80 milligrams/day of Prednisone and 50 milligrams every other day of Azathioprine. She immediately showed some side-effects of the prednisone, including thirst, frequent urination and heat intolerance. In addition, her energy level dropped after a day of taking the pred. But yesterday, Monday Oct. 24, she showed a spike in energy, more energetic wagging and more enthusiasm and perkiness including some bunny chases on her morning walk. Today, Tuesday, she is less active. But she is stable and her gums are nice and pink. She just isn't as perky as yesterday. From reading other posts, because their bodies are constantly adjusting, I take it that is not unusual for dog to have increases in energy followed by low energy days? Diet-wise, I feed her a very good (expensive all natural) dry food, mixing it with pumpkin for dogs in the morning, chicken, bison or liver rotated in the evening, and broccoli and carrots. Her appetite is very good. She gets Dasuquin (a chondrotin and glusomin supplement) along with Derma 3 (a omega3 supplement) every day. She is also on Phenypropanolamine (PPA) for urinary incontinence. Here is where it gets weird. She had pretty sever anemia 2.5 years ago (down to 18 on her CBC) and recovered on her own, just before we had a chance to do a bone marrow biopsy. My vet in consultation with her internal medicine specialist, says there is definitely an external trigger to this. This seems like a very supportive community and I am grateful for any comments. Maggie is doing well for the most part, I just hate seeing her less than her usual self. Thanks, Robert/Maggie.

RobertN Superior

One issue, Maggie, during her last visit, weighed 87.9 LBs yet she was given a 80 milligram dosage. Wondering why the vet did not elect to give her 90 milligrams. Could it be because she presented healthy? The decayed RBCs are not in her bloodstream as her immune system is attacking them in the marrow. So she only started to really show low energy after taking the Prednisone. Her gums are still nice and pink though. Still curious as to why she would seem almost back to normal on Monday, then want to sleep all day on Tuesday. Maybe I over-walked her. Trying not to overdo it, and my instructions to my dog-walker are to just let her out to do her business. Yesterday, she was very perky, enthusiastic when greeting the walker, today she was fast asleep.

RobertN Superior

Hi Robert, Welcome to the group, but sorry you have need of it. It is fortunate that you found this early in your girl Maggie. HCT of 24 is high enough to not need transfusion, and hopefully the pred and aza will kick in quickly and her RBC destruction will stop. IMHA is very much a roller coaster....some days they seem better, and other days worse. From all I've read and been advised, it is best to greatly restrict their exercise during this initial crisis. Keeping them quiet and resting is better for their recovery. HCT of 24 is low enough to cause the sleepiness you are seeing. Her diet sounds pretty good!! Lots of us also give PetTinic and Milk Thistle, two supplements that help protect the organs from med side effects and produce more RBCs. Interesting about the external trigger possibility....if that trigger were removed, she could make a good recovery. Does the vet have any ideas on figuring it out?? Again, welcome....everyone here has been a Godsend to us! Sally and Bentley

Sally Louisiana

Hello Robert, I am sorry you had to join us but glad you found us so soon. For more information and also hope, please go to the Meisha's Hope website: http://www.cloudnet.com/~jdickson/index.html make sure to visit the success stories, they will give you lots of information and most of all hope that Maggie can recover from this. Here are some of my thoughts. The prednisone is definitely on the low side and so is the azathioprene. I have actually never heard of anybody dosing it eod in the initial phase. My 60 lbs dog was on 50 mg daily. Maybe ask the vet why? The prednisone will take effect pretty quick, the azathioprene will take a couple of weeks. With these high doses of pred it is crucial to protect the stomach! I urge you to get a prescription for sucralfate or carafate. If you don't do this it is very likely that Maggie will get bleeding stomach ulcers. These stomach protectants have to be given away from all other medications so they don't interfere with absorption. Milkthistle and SamE would be good supplements to protect and support the liver that is taking a beating from the prednisone. Maggie's body has been through a lot. Her oxygen supply is still not great, that is the reason why she is tired. Please let her rest as much as possible. Big dogs are also prone to ligament injuries during this phase because they loose lots of their muscle. Playing with other dogs is not a good idea. Has Maggie been tested for blood borne tick diseases? This would definitely be something I would check. Your description made me think this could be the culprit. This would be an easy blood test and would have to be treated with antibiotics. While you are doing this, also have the thyroid checked. Most likely it will be low and a supplement could make a difference in Maggie's recovery. Please don't hesitate to post all the results from the blood tests so far. There are some incredibly knowledgeable people checking in here that can give you insight. Best wishes to you and Maggie, Brigitte

Brigitte BC

Robert, I am so sorry to hear about Maggie. My dog Chance had very serious bone marrow failure also and it was very tricky to diagnose and treat. I am pleased to say that he did survive after several months of intensive treatment. Do not give up hope. I will be here to help you. Unfortunately, there can be several very different causes for bone marrow failure and some of them evade diagnosis or require extreme testing with a specialist. And, as with my dog, after failing to diagnose any cause, we just tried a treatment and when it worked we had a good idea what the cause was (autoimmune). I know this doesn't make sense but nothing about bone marrow failure is straightforward. If you were to read the textbooks I have, you would also see how convoluted the body systems can get sometimes. This is a very different condition than autoimmune hemolytic anemia. Instead of rapid and sudden destruction of many red blood cells, the red blood cells in circulation age out and are removed (as they normally are at about 120 days). So they are not removed all at once. We make red blood cells everyday and so the ages of the RBC's are variable. So you see a gradual decline in the numbers on tests. Brigitte has made some excellent suggestions for testing, things I always recommend. In addition you have had some excellent testing done already. Right now I would recommend that you ask for two more blood tests. I am suspicious, by your description of her past history, that she may have a serious nutritional deficit that may be contributing to this. Ask your vet if they would please do a blood tests for levels of B12 (Cobalamin) and Folate (this is one test) and also test for iron (ferritin). They can draw a small amount of blood for these two tests and it will have to go out to a specialty lab. These tests are kind of like bread crumbs that lead us to a possible cause and treatment may not necessarily be adding more of these nutrients to the diet directly. So please don't run out and buy iron supplements. I am work today and a little short on time so I won't go into detail about how these nutrients may be involved right now but this can be very important. Please collect all your lab results. Ask for all past copies of paperwork. The CBC's are a goldmine of information and I can help you learn to interpret the information on them in a way that makes sense. I would especially like to see the results of the last two CBC's complete blood count and the chemical screen (sometimes called chem screen or superchem). There is great hope to be successful treating Maggie. my best patrice

Patrice NYS

Robert, If you are eager to read something about this, I am going to post a link to a chapter in the textbook Schalm's Veterinary Hematology so that you can read it in google books. Use this link to get there and then just scroll back to the beginning of chapter 147 (page 965)and read the opening introduction. This is a very hard read, so just skim it. Don't get frustrated, ask me questions. my best patrice http://books.google.com/books?id=HKCDyJH41IcC&lpg=PA967&ots=E3Wlrm_I3Q&dq=canine%20cobalamin%20and%20bone%20marrow%20failure&pg=PA963#v=onepage&q=canine%20cobalamin%20and%20bone%20marrow%20failure&f=false

Patrice NYS

Sally/Brigitte, I have been following both of your stories, so I really appreciate your feedback. Maggie was definitely tested for thyroid function but I am not sure for ticks. I do remember her being negative 2.5 years ago. I also wonder about the pesticides the town I live in sprays in the summer to control the bug population in our open space which is adjacent to our home. Maggie is also on an antibiotic, Cephalexin, as she had a lump removed (turns out to be benign) from under her skin during the bone marrow biopsy extraction. I am wondering whether - if there is an underlying undetected infection - the antibiotic may help her recovery. She does seem strong, although its only been a week. I will definitely talk to my vet about the additional prescriptions for her stomach and the supplements for her liver. Best news is she seems stable and today after work, even jumped up to greet me. Despite her only making it halfway, it's something she hasn't attempted since weeks prior to her diagnosis! I take solace in her sleepiness in that all her rest is helping her get better. Finally, her appetite is good, but she hasn't pooped for a full day now. The cold rain does not help! Tomorrow it turns to snow, which is usually a cause for great celebration as she typically loves the white stuff. A true Colorado dog! I will be working from home tomorrow, so hopefully she can be productive at some point. More pumpkin tonight, needless to say. Thanks, Robert and Maggie

RobertN Superior

Hi Patrice, Thanks for sharing your insight. I will absolutely forward your suggestions to my vet. She is very thorough, and it may be that she has already tested, but reading up on the B12/Folate deficiencies, I do see some interesting parallels. With Maggie having a past record of recovery and a diligent and open-minded vet, I am positive that we will get to the bottom of this and have a strong and happy resolution. I just need to be prepared for a marathon rather than expect a sprint! Thanks again. Robert and Maggie

RobertN Superior

Robert, My thoughts and Prayers heading your way for you and Maggie. I wish you the very best. Kathy

Kathy Calif.

This thread was discussed between 25/10/2011 and 26/10/2011

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