Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - newly diagnosed with AIHA

Claire, Cumbria, UK, chickpeadip@yahoo.co.uk Can anyone offer any advice? I am desperately worried about my 5 year old lurcher girl who is seriously ill. She was diagnosed with non-regenerative anemia (AIHA) yesterday and is having her bone marrow tested today and we should have the results in about 1 wk. Her blood tests last week showed that her pcv is 18, her white blood count is slightly on the low side, protein - slightly low, and calcium slightly raised. It would seem that the condition came on gradually, which I believe is slightly better than sudden onset. And I feel hellishly guilty for not recognising the symptoms sooner. Rather than await the bone marrow results the vet thinks it's best to start her on steroids tomorrow to give her the best possible chance of surviving. He mentioned the name prednisolone and could any one confirm whether this is the best line of treatment because I'm completely ignorant? I see in an earlier post that Royal Dick in Edinburgh has a good reputation for treating the condition - is this correct? because I'm prepared to travel if necessary. Please help. Many thanks, Claire

Claire Cumbria UK

Claire, I am so sorry that your girl ha been diagnosed. If you haven't found your way to Joanne's website be sure to take a look. Don't beat yourself up too much for not recognizing things sooner. We all have been there. There are a number of posters from the U.K. that I am sure will check in and give suggestions of who they feel knows best how to treat this in your area. Take heart in the knowledge that you have found a place where people truly understand what you are going through. Penny

Penny Lytle Creek Calif

Clarie, I am so very sorry to hear that your most beloved gal has recently been diagnosed with AIHA. If you have not read my Web site on AIHA/IMHA as yet, you might want to do so. 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. 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 main Success Stories page is on vacation for the summer but there are 22 archives for you to look through. prednisolone or prednisone is the cornerstone of treatment for AIHA/IMHA but many times other medications such as Cyclosporine or Azathioprine will need to be added to the treatment regimine. You can read about most of the medications used for the treatment of canine AIHA/IMHA on the Treatment page of my Web site. Guilt will do neither you or your gal any good so please let go of it and work at learning all you can about the disease so you can have a dialogue with your vet in regard to treatment options. I truly do know how hard this is so please be assured you and your most beloved canine companion are in my thoughts and prayers.

Joanne MN

Clare, If your dog's AIHA appears to be non regenerative, does you vet think it could be PRCA (pure red cell aplaisa) which is thought by many to be the most difficult form of AIHA to deal with. I posted about PRCA to someone else a while back ago so went back and found that post and am copying and pasting part of it here: Please check out these links: http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/60205.htm http://www.ncbi.nlm.nih.gov/pubmed/12420831?dopt=AbstractPlus Also you might want to read these two Success Stories at my Web site. Both of these dogs had PRCA and did recover. http://www.cloudnet.com/~jdickson/archives16.htm scroll down to the May story http://www.cloudnet.com/~jdickson/archives17.htm scrpll down to the October story

Joanne MN

I will be thinking of you and praying that things work out and a recovery for your pup is on the horizon.

Josh California

I'd like to thank you all for your responses and I have now had a good look through Joanne's website, which is packed full of positive information. We collected our dog yesterday after her bone marrow test/biopsy and she has been prescribed prednicare - we are just awaiting the results from the tests. She was also prescribed antibiotics. She's eating and drinking, but clearly in discomfort from the surgery. As yet, I don't know if it's PRCA The question I have is this - is the spleen usually implicated in IAHA? And should I therefore request a scan? Many thanks, Claire

Claire Cumbria

Claire Nollaig has pure red cell aplasia and has been treated for the past 5 and a bit months now at the University of Glasgow small animal hospital by a Rory Bell who is an internal medicine specialist and a very knowledgeable and experienced guy when it comes to this disease,I would highly recommend him particularly and Glasgow University vet school has an exceptional reputation. Maybe you would consider that option even though it's a bit of a trek for you? Their telephone number is 0141 330 5848 and website www.gla.ac.uk/faculties/vet/smallanimalhospital/ Take care Kathleen

Kathleen North Ayrshire

Kathleen thanks for your mail. Do I have to be registered with the University of Glasgow small animal hospital or could I just contact Rory Belto over the telephone for advice??? Thanks, Claire

Claire Cumbria

Claire I was referred to the Glasgow Vet hospital by my vet that day and was sent up as an emergency case and seen that day.Nollaig's pcv was 8% and she had to have an immediate blood transfusion.Nollaig's pcv drops slowly and therefore we just noticed that for a day or two she was very slightly lethargic.They then kept her in for 4/5 days to do tests/scans etc to rule out cancer/drug toxins/tick disease/poisons etc etc and then did a bone marrow biopsy but she was started immediately on 3mg/kg prednisolone twice a day also azathioprine as it takes around 6 weeks to start working(if it's going to) so the sooner it's started the better. If I were you Claire I wouldn't waste any time get referred to Glasgow Vet hospital and ask for Rory Bell( I do hope you are insured though as it has cost us approx £8000 so far in the last 5 and a half months as unfortunately none of the treatments have worked so far on Nollaig and we refuse to give up as prca is the hardest form to treat in that it can take time for a positive result but sometimes dogs do not respond to treatment but in a lot of case they do so you need to give your girl every chance possible. I am collecting Nollaig today from the hospital as she has been in for her 5th transfusion and she took a life threatening infection which she thank God has overcome.She has been in for 2 weeks now so am desperate to see her again. I will ask Rory Bell today what the procedure would be for someone like you in Cumbria and post up later. Kathleen

Kathleen North Ayrshire

Claire Here is advice from one of the top vets in the UK (as told to me by other vets in Scotland) and highly experienced in dealing with this disease and will be very thorough and won't miss a thing! 'The person from Cumbria is entirely within her rights to request that her dog is referred, and she can specify the place that she would like to be referred to. It would be highly unusual for a vet to even consider turning down such a request, but she’s well within her rights to insist on referral if need be' Cheers rory Rory Bell MVB DSAM DECVIM-CA MRCVS FHEA European Veterinary Specialist (internal medicine) Senior Lecturer (Small Animal Internal Medicine) Division of Companion Animal Sciences University of Glasgow Veterinary School Bearsden Road Glasgow G61 1QH Phone: 01413305848 Fax: 01413303663 e-mail: r.bell@vet.gla.ac.uk

Kathleen North Ayrshire

Kathleen Many thanks for the information re: Royal Dick and Rory Bell. Unfortunately, we don't have pet insurance and after receiving quotes for pricing, it is out of our league. All we could afford is the consultation, and approx £2000 of treatment. No idea where that would get us. After changing vets yesterday, our poor Saluki/Whippet was diagnosed with pure red cell aplasia today - we are absolutely devastated. Her pcv was 12 yesterday and a blood transfusion is being held off as her body seems to be coping (just) and moreover, she can only have one transfusion through the practice. She been on pred since Tuesday (28th July), initially 2mg twice daily and then yesterday we upped it to 2.5mg. We start her on 4mg of prednisolone this evening (twice daily - she weighs 20kg) and then 25mg of azathrioprine (twice daily) tomorrow. I'm very anxious about upping the dose of pred and starting the second drug, but I don't know what other options we have. I feel as though we are running out of time. Claire

Claire Cumbria

Claire, I am so sorry your girl got diagnosed with this awful disease. At least now you know what you are fighting against. I think to increase the prednisone was a good decision, from what I have been reading it should be much more though. For a 45lbs (20 kg) dog it can be 90mg per day max. and at least 45mg min. it is a drug that gives the dogs horrible side effects at these high doses, but it can also safe their lives. I would certainly contact your vet as soon as possible and question this low dose. Azathioprene is a good drug for this disease but it can take some weeks for it to kick in. You do not have the luxury of time, this is why I think your dog needs a much higher dose of prednisone. I am sure some other people on this board can tell you the same. I will be thinking of you and your girl. Brigitte & Kahlu

Brigitte BC Canada

Claire, I completely concur with Brigitte with the dosage of Prednizone for our dog at this point. Dosage should be administered equally twice daily. Even with this amount of dosage it will take a few days for it to kick in. At A PCV of 12 time is of the essence and the transfusion will buy you the necessary time you need for the meds to kick in. Ron & Cooper

Ron Florida

Claire Please read the protocol below. The minimum dosage of prednisone given at the onset of AIHA is 1 mg per pound of the dog's weight per day divided into two dosages. Some clinicians will prescribe an even higher dosage for dogs with a very low PCV. Ginger weighs 75 pounds and was on 80mg in the beginning of her treatment. You must be the voice for your dog and recommend that the dosage be corrected to reflect your dogs weight. Cheryl & Ginger

Cheryl & Ginger Pineville PA

I agree with what everyone is saying. Here the standard of treatment with Prednisone to start at 2mg/kg divided up into 2 doses per day and can go up to as much as 4mg/kg. They would only consider using a lower does meaning 1mg/kg if it was caught way early. So in your case your dog weighs 20kg so she should be on a minimum of 40mg a day (so 20mg in the am and 20mk in the pm). The 4mg doses you are giving her is not going to get you a response. Wendi and Calypso

Wendi Ohio

Claire, While full treatment may be out of reach at Royal Dick perhaps the consult would be a good idea just so you can get the meds right for your girl?

Penny Lytle Creek Creek

I don't know enough to comment on what you should do, but I wanted you to know I'm thinking of you and will pray that everything will turn out ok. Try to take a breath, tray to calm yourself a bit and listen to everything everyone above is telling you. These people know what they are talking about and are very helpful. Be brave. God bless and keep us posted. Your in our thoughts.

Mardi Northern California

Hi So sorry you are going through this with your girl. I can only echo what others are saying re. dosage. My little guy started his treatment this week- no response as yet. He weighs about 4.8kg and he is on 5mg pred twice a day. Please bring this up with your vet. I know the treatment my dog is on has been checked with the Royal Dick via my vet. I know it can be difficult but if you say you have read of other dogs being on much higher doses they may at least check it out. Best of Luck Kath

Kath Scotland

Thanks for everyone's responses. My dog started yesterday on 4mg x 2 for her body weight which is 20kg. We are giving this dose a.m and p.m so that's 8mg in total - is this dose still not high enough? Thanks, Claire

Claire Cumbria

Claire I understand your predicament with the money situation but if you indeed do have the money for a consultation and approx £2000 of treatment please please please get referred to Rory Bell at the Glasgow Vet Hospital not the Royal Dick details above because sometimes this illness can be fixed quickly and with drugs that do not cost a lot of money and so you would possibly not need to spend anywhere near that to get her well. Plus once you have consulted with Rory he would work along with your vet down in Cumbria(who I have to say is way out on his dosage of prednisolone Nollaig weighs 15kg and is currently on 30mg prednisolone a day and she has prca so I know you have to be aggressive with this drug)and that way you wouldn't have to keep travelling up here.Also Rory is very understanding about the money side of things, because we are the same as you not insured, so if you told him that, he would only do the things he felt your dog really needed to give her the best chance. Please Claire give your little girl the best chance possible you dont have time to waste,a blood transfusion will cost about £300 at the Glasgow Vet Hospital and if she goes any lower which is quite likely she will need that soon.This will give her time to see if the drugs will work but Rory will get her on the right dose. I am begging you Claire to reconsider because I wouldn't want you to have any regrets!I hope you don't think I'm interfering I just dont want you to be like Julie who contacted me recently about losing her wee 9 month old dog Scruffy and she had an inexperienced vet who didn't send her to a specialist and now she always thinks what if? E-mail me with any questions or advice etc... Take care Kathleen

Kathleen North Ayrshire

Clarie This dosage is WAY WAY too low. Here is what the veterninry drug handbook say in regard to prednisone usasge for AIHA/IMHA. I am quoting here: For autoimmune hemolytic anemia: 1-4 mg/kg PO (by mouth) daily divided BID (twice a day). End of quote. The figure I have always heard is 1 mg per pound of the dogs weight per day divided in to 2 doses So the least amount you should be giving per day is close to 50 mg divided into 2 doses, one dose to be given in the AM and one dose to given in the PM. I arrived at this figure since 20 kg = 44pounds. At one mg per pound one would be giving 44 mg but many times it is fine to round up. Please please get another opinion ASAP!!

Joanne MN

Hi again Claire, Yes the pred is way too low. My dog is on 5mg twice a day and he weighs less than a quarter of your dog at only 4.8kg. Kath

Kath Scotland

Are you sure it isn't 40mg twice daily. I find it hard to comprehend how a doctor would prescribe such a low dosage for this case. Perhaps you should be seeking out another doctor for your lurcher girl. They obviously don't know what they're doing. 2-3mg/kg starting out is a good aggressive approach for a case like this. Talk to your vet ASAP about this. Unfortunately, time is of the essence when dealing with this disease. You need to get the meds right so they can start to do their job. Contact Dr. Dodds if you know of no other specialists. She's great and will be able to advise you on the correct dosages of drugs. Reach her at hemopet.com....please get another opinion. All the best, Johnny & Tessy

Johnny

Hi Surely, we are all singing from the same song book - my dog is on the maximum recommended dose, which is between 2 - 4 mg per kg of body weight. Thus she is on 40mg twice daily, which is a total of 80mg. Claire

Claire Cumbria

Just read your post Johnny, it would seem that we express things differently around these parts which is very confusing. Thus while I have been expressing the figure 8mg - 80mg is the absolute value. Kathleen, a big thanks for the additional info on Rory Bell. I shall be pursuing that avenue again tomorrow with the view to arranging a consultation. I pursued it last week and abandoned when I was emailed the prices, which raised treatment options beyond our scope. We are doing everything we can at present - changed vets this week after receiving absolutely terrible treatment and our new vet has been very good thus far. Though I would have thought that transfusing sooner as opposed to later was a better option. We started my Saulki/Whippet cross on the azathioprine a few hours ago and I believe it can take weeks to kick in. My dog will also be having her pcv checked tomorrow and the day can't arrive soon enough. Her gums still appear very pale so I can only assume that means the prednisolone isn't working yet? Claire

Claire Cumbria

Claire, I am so glad we cleared up the miss understanding of your girl's prednisone dose! that means i can relax now:) Don't expect a huge change right away. it will take a bit of time. One thing I learned with this disease is patience. Just relax and give your girl lots of tlc. Best wishes, Brigitte & Kahlu

Brigitte BC Canada

Phew, thanks Brigitte, I've been on panic stations here over the dosage. It took a discussion with my husband and a phone call to my brother to make me realise the error - the vets where we live have been expressing the pred figures differently and I followed. My Saluki/Whippet has only been on the higher dose since last night and it's hard not to panic - I just wish my original vet had got the dosage right last Tuesday, it might have made such a difference. Research, speed, effective communication and access to darn good treatment seem key to a successful outcome in PRCA. Claire

Claire Cumbria

Good to hear she's on the proper dosage Claire...although it at the high end. 80mg total per day is quite a large amount of pred to be giving a dog who only weighs 20kg. That's 4mg/kg! Once she becomes stable I would recommend talking with the doctor regarding reducing this amount. Especially now that you have added azathioprine to the mix. It usually takes about 10 days for azathioprine to effectively suppress the T-cells. May take a bit longer to notice any changes though (month or more). You could also explore the cyclosporine avenue. This drug induces rapid T-cell suppression within about 48 hours and has been safe, effective, and well-tolerated at the recommended doses. The price is usually what gets most people though. VERY EXPENSIVE! I've been away for a few days and may be missing info so sorry if you already covered this. Is she on a stomach protectant? You should also consider giving her a product to help her protect her liver (milk thistle/SameE). Hematinics that contain iron, vitamin B-12 and folic acid (pettinic maybe) are helpful to provide the nutrients needed for hematopoiesis (blood building). I'm not overly informed on the ins and outs of Non-regenerative anemia so take what I say only as advise and always consult the doctor before changing or adding anything to her diet. Do you have her reticulocyte numbers handy? If not you should ask the doctors what these numbers are. These will usually help determine the degree or severity of the non-reg AIHA. I'll be keeping you and her in my thoughts and prayers. Give her some hugs from Tessy & I. Johnny & Tessy

Johnny

Johnny You're right, 40mg twice daily is a high dose for my dog as she only weighs 20kg, but it was the dose suggested by Dr Dodds by email and my own vet then agreed. I'm so ignorant and naive about this condition as I have only been coming to grips with it since last week. Dr Dodds suggested that the original dose prescribed 20mg twice daily was too low. Hence the change. Does anyone else think this dose is too high?? I'd Greatly appreciate any comments. There's so little research or literature on PRCA. Thnks, Claire

Claire Cumbria

Claire....it's not that I think the dose is too large for now....just for the long term. If Dr. Dodds recommended this dose to you then it is most likely a good thing. Maybe she wanted to use this dosage due to the non-regenerative matter of this case. In either case she will most likely lower this dosage once lurcher stabilizes. Did she also recommend the azathioprine? You've got an excellent doctor on board in Dr. Dodds. I trust her with all her recommendations she gives me for Tessy. Is it in fact PRCA she has or is this what they think it is? Prayers and best wishes, Johnny & Tessy

Johnny

Claire, If it comes from Dr. Dodds, i would not doubt or question it for a minute. She knows her stuff. Not all vets are on the same boat with her and she is considered a bit of a rebel in some circles. I am very happy that my vet admires her and was more than happy to work with her. don't forget to go through the success stories on Joanne's website. I know there are some stories of dogs that also had PRCA. Make sure your Lurcher (what is her name?) gets enough water, quality food and is on a stomach protectant. this high dose will be hard on her body, but it has to be that high to save her life. I will also repost something Sheila wrote a while ago and i like a lot (I hope she doers not mind!): Sheila, VA, sheila@rileynet.com *We spend so much time and energy focusing on our beloved canines with AIHA, I thought I would throw out some survival tips for their human family* AIHA is a marathon, not a sprint, so pace yourself physically -- eat properly, exercise, try to get enough sleep. AIHA is an emotional rollercoaster complete with hopeful highs and crushing lows -- seek support, acknowledge and talk about your feelings. AIHA is random and unfair, it can test your spirit and faith -- now is the time to lean on your beliefs, to find strength and peace in them. AIHA is life altering, but it is only one part of your dogs life -- it doesn't take away 'who' your dog was/is or erase the 'before' time and memories, try to call on thoses positives and allow that joy to bolster and fill your heart. AIHA requires us to be an advocate for our dogs, with almost no warning or prior training we must become a doctor, scientist, researcher, financier, counselor, and cheerleader. Even the most confident person can begin to question past choices and actions, and that can shake your confidence badly. Do not give into fear and doubt, separate facts from feelings and try to stay focused on the future. ~*~*~*~*~ Bless each of you for being such a wonderful friend to your dog, it takes such a loving strong person to fight this disease. We each talk about how special our furbabies are, and they are, but I think their 'owners' are just as special. I believe that our dogs know just what we are giving and doing, and I think that that means more to them than whatever the outcome of this evil disease may be. Your dog thinks you are the greatest, so please take care of YOU today!! ~Sheila, lucky mom to Dakota, Nuggett, Harley and Radar (my current gang)

Brigitte BC Canada

Claire No 80mg is the right dose of pred to start with to treat prca as its one of the hardest forms of IMHA to deal with as it occurs in the bone marrow and not in the circulation and so the vet needs to be aggressive with the treatment to see if it will work. If it works then the vet will gradually reduce this dosage.The vet should be protecting the dogs gastro intestinal tract with something like sucralfate to avoid pred causing ulcers. Basically in prca the red cells are being destroyed in the marrow at the precursor stage of development i.e very early on, therefore a non regenerative anaemia. I was told by Rory you diagnose PRCA by basically ruling everything else out i.e cancer,drug toxins,tick disease,poisons and by the result of the bone marrow biopsy.I presume you have had results of bone marrow biopsy? PRCA normally happens gradually i.e the pcv reduces gradually hence why the dog has time to adjust to the situation and can cope with it better than a dog whose pcv drops overnight a dramatic amount and the dog collapses. Honestly Claire you wont regret getting seen by Rory as on the whole I have been very impressed by his knowledge of this disease and the treatments offered. Azathioprine does indeed take about 6 weeks to work if it's going to and please make sure that they check the dogs white cell count as well as Nollaig had to be taken off this drug 6 weeks into it by Rory as her white cell decreased to a dangerously low level where she could have caught a life threatening infection and not been able to fight it.Taking her off the azathioprinne though reversed his and her white cell went back to normal.This is why you need an experienced vet on hand who has experience of these drugs even as I said to you if you consulted with Rory once and then he advised your vet in Cumbria by phone on what checks to do and drugs to try etc... Please note that azathioprine does not reduce white cell count in all dogs because plenty of people on this forum this drug has worked for them. You will learn Claire, after reading this forum for a while, that every dog has a different experience/results with this disease but on the whole you can pick up really good ideas and advice from this site. When I brought Nollaig to Rory she had a pcv of 8% and was given a blood transfusion that day.ANy questions ask away as there are very many knowledgeable people on this site ready to help. Kathleen

Kathleen North Ayrshire

Hello, I am sorry to hear about your furbaby getting this dreadful disease.You have come to the right place where help comes from the hearts of people who have been through this battle and what you learn here can make the difference.I am a little over two weeks out my own journey with my furbaby Timmy's AIHA and i just wanted to chime in on the prednisone.Timmy weighs 11 lbs and was on 5mg twice a day after consulting with a local vet after a week we doubled to 10mg twice daily.I also consulted with dr. dobbs on the higher dose and and she agreed this was ok for short term.Timmy is on other supportive meds.But i think it has made a difference overall clinically and his pcv is starting to stable. Dexamethasone which is a much stronger drug than prednisone is often times given in the early stages via IV along with prednisone to help surpress the immune system.I am sure someone here can can comment further on this You are in my thoughts and prayers. Terry and TImmy

Terry Pa

Claire -- everyone here is much more knowledgeable than I am on treatment, since we lost our dear beagle within a week of her IMHA diagnosis. But I just wanted to wish you and your girl all the best in your fight. Glad to know you're talking to Dr. Dodds and some good vets, as well as the wonderful people here. Please take care.

Brenda VA

This thread was discussed between 28/07/2009 and 03/08/2009

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