Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - PRCA and transfusion -low pcv result

Hi Shaunna my Saluki/Whippet, had a blood transfusion today after her pcv dropped to 9 - it had previously been 12. We were hoping that her pcv would rise to at least 20 with the transfusion, but unfortunately, it only reached 15. This is devastating and I feel as though it buys us so little time for the drugs to kick in. She's only been on the high doses of prednisolone for 5 days and the atopica for 3 days. I assume, at this rate she will need transfusing again very soon, like in a week or so, and that's obviously going to be problematic. Can anyone offer any advice on what else we can do - or for that matter what to expect? Also has anyone had a transfusion, which was so low? I've been trying to be so optimistic and then this happens ! Thanks Claire

Claire Cumbria

Claire I'm very sorry to hear about the transfusion but I do have concerns as to why there was only an increase of 6%.Nollaig's transfusions have put her from 1st transfusion:8%pcv to 22%pcv, 2nd transfusion: 10%pcv to 32%pcv, 3rd transfusion:12%pcv to 38%pcv 4th transfusion: 16%pcv to 42%pcv 5th transfusion: 10%pcv to 34%pcv. I'm wondering if the vet gave Shaunna a whole unit of blood which is what Nollaig gets and Nollaig weighs 16kg. You need a donor dog of over 25kg for it to be safe to take that amount of blood from.If they for example had a dog of say 18kg they cant take the same amount of blood from it. Also the packed red blood cells are only viable on the shelf for 28 days and then the vets have to discard that blood, so you ideally want the blood to be as fresh as possible and not one about to be binned, as red cells die off in time. It's not an immediate problem as at least it's put her up a bit but you have to buy more time than 1 week with a transfusion esp for prca as it takes time to respond to treatment. I really urge you to see a specialist as it will save you money in the long run,I believe that you would have seen a much bigger increase in Shaunna's pcv as Rory would have given her a full unit of blood esp as I would imagine Shaunna weighs more than Nollaig and therefore needs a full unit? Did the vet give you a reason for the poor increase? Kathleen

Kathleen North Ayrshire

Hi Kathleen The figures you suggest are the ones I had hoped for. She did receive one unit and it came from a blood bank - so what does that mean? The blood was of poor quality? Claire

Claire Cumbria

Claire Wanted to let you know that on the 2nd and 3rd transfusion they got a match for Nollaig still fairly easily(as these hospitals have bags from the Pet blood bank in stock) but there can be more chances of reaction than with the 1st transfusion, that's why you would want her in a specialist hosp if that is indeed required as they have much more experience and an intensive care unit where they check the dog every 5 minutes and Nollaig has had 5 now which have all gone very smoothly.So don't panic Claire, Shaunna has many options open to her at this stage and many more drugs that can be tried to get her well. Hopefully your vet will get you referred soon,honestly just one consultation will then give you access to an expert. Kathleen

Kathleen North Ayrshire

Claire If indeed the blood came from the Pet Blood Bank UK, then I would expect it to be of good quality. I am clearly not a clinician so am not able to comment as to why then you did not get a bigger increase but what I would say is because you have not got a high pcv then the sooner you see an expert in this disease the better,it could save you money in the long run. My regular vets is a large 2 site practice with at least 14 vets and one of them told me that in the 10 years she had been there that between 4 vets they had seen only 5/6 cases in that time and that was of AIHA not even PRCA which is even more rare.When I talk to them about the drugs that Nollaig is on they have never used them and some they have never even heard of. Because this is a rare disease you need an expert,it will give you great peace of mind. Kathleen

Kathleen North Ayrshire

When Scruffy had his transfusion it only went to 17 from a low of 8. I wondered too how much they gave him. It dropped to 13 within about 4 days then very slowly dropped over a month until it got to 8 again. The Imuran and Pred stopped the immune destruction slowly but his problem was his bone marrow would not regenerate. I did not have a specialist and paid the price for bad advice.

Julie Australia

Claire, Have you tried contacting Dr. Dodds? She is a specialist in blood and tranfusions and is very quick to respond and is very very giving of her time and expertise. Keeping you and Shaunna in ny thoughts and prayers Penny

Penny Lytle Creek Calif

Calypso had 2 blood transfusions. With her second one her HCT barely increased, it is not that uncommon for them to lysis the transfusion...we see this alot in pediatric patients. Is her retic count good and is she acting better clinically?

Wendi Ohio

Thanks for all your replies... Wendy I've never come across this term before - this whole area is so new to me - what does 'lysis the transfusion' mean? Thanks, Claire

Claire Cumbria

Hi Claire So sorry you are in this awful situation. Lysis I believe means that your dogs immune system quickly also attacks the transfused blood. How long after the transfusion was the blood test taken. I would definately contact Edinburgh or Glasgow vet school and get some idea of how much it would cost for at least some initial treatment. Mitch is at Edinburgh and they are fantastic he is in serious danger but I feel calm knowing he is in such good hands and so closely observed. He went in for a blood transfusion and bone marrow biopsy, blood tests etc, meds and quite a few days stay. We were quoted 1000 to 2000 although I'm sure we will be at the top end of that now. Ask your vet for referral the first thing they will do is give a quote. We never even asked for one but it was provided for us before we even left our own vet even though it was an evening emergency appt. Kath

Kath Scotland

Claire If indeed it is pure red cell aplasia Shaunna has, which is what you have been told I believe, the destruction of the red cells happens in the bone marrow and not in the peripheral circulation as is the case in auto immune hemolytic anaemia,therefore I dont believe that is what has happened in Shaunna's case. That is why in AIHA the pcv tends to drop very quickly e.g 10 or more percent overnight as opposed to in PRCA which tends to be a gradual drop.Nollaig's pcv drops about 4.25% average a week as the red cells just die off naturally out of the circulation but the problem is new red cells from the marrow are not replacing these in order to keep the pcv steady. What is the vet saying who performed this transfusion regarding this low increase in pcv? Kathleen and Nollaig

Kathleen North Ayrshire

I was just wondering how Shaunna is acting and is she eating? Please know that we continue to keep your Shauuna in our prayers and hope for a speedy turn around. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Hi Claire, I check this board regulary, but don't post much. My dog Ollie had PRCA, I've been following your battle. I dont have much to offer, as everyone here is a bit more versed than myself, except to second Kathleen's post about transfusions with PRCA can be expected to last longer. My vet had said it can last from 2-5 weeks in fact, so that is one of the "bright spots" of PRCA. I lost my boy to a blood clot about 10 days after his transfusion, but I can say that at the the time he didnt lose any benefits of the transfusion at the 10 day mark, he was holding at a pcv of 20-22, but we had started at 13 vs. 9 so I'd say 15 isn't too bad. Hang in there, your doing all the right things. I'll be thinking of you both, Mj

mj ny

Hi Claire. Sorry, I did not see in your title that you are dealing with PRCA. The lysis I spoke of has to do with IMHA...I do not know if it occurs with PRCA. While in many cases of IMHA, you need immediate blood to save their life but on the flip side animals with IMHA destroy their own red cells, as well as transfused cells as well. That is why if they look okay clinically, it is best to wait until the IMHA has stablized a bit before giving a transfusion. Often with IMHA transfused cells may be destroyed even faster than the animals own cells would which further complicates IMHA. Other things come into play like autoagglutination. A retic count is key because if it is elevated that is a better sign initially (it checks their regenerative response) It is a fine line because you need them to survive long enough in for the meds to start kicking in. I am a pediatric ICU nurse and we often try not to transfuse kids unless we have no other choice because of lysis and so that we do not expose them to anymore blood products than we have to. When Calypso went in her HCT was 10 and she was not doing well clinically, so she got a blood transfusion. Within 24 hours she got her second one. Finally at 48 hours her HCT dropped again to 12, but she was clinically better (eating baby food, wagging tail, interactive; she was not ready to go outside and play but stable). Her retic count was good so we decided it would be best for her not to get blood a third time and slowly her HCT came up on it's own.

Wendi Ohio

Hi Thanks everyone for your posts. I have absolutely no idea why the transfusion didn't produce higher results - I'm hoping the blood had been compromised as opposed to 'something' more sinister lurching in Shaunna's immune system. What I do know is that the result is devastating. I was hoping this would buy her more weeks and not just days. Julie, Kath & Kathleen After the terrible transfusion result, I asked to be referred to Royal Dick and the appointment is on Monday. No idea of what to expect and I presume my little one will be admitted. The thing I have grasped thus far with prca is trust your gut instincts. I had a bad feeling about the transfusion yesterday and I went ahead with it anyway rather than ask for a referral. Penny Yes, I've contacted Dr Dodds, though couldn't supply all the test results, but she nevertheless offered advice, which I am incredibly grateful for. Mj I'm so sorry to hear about your boy. I was warned only today that blood clots is/are a complication of prca and transfusions. It just seems like another hurdle to jump. Cheryl & Ginger Shaunna is depressed and lethargic, but she is eating a little bit more so I haven't syringe fed her today. She is also showing an interest in the outdoors. Wendi Shaunna's retic count is non existent. I'm eagerly awaiting for these cells to appear. Claire

Claire Cumbria

So glad you have an appt. on Monday at the Royal Dick. How long a journey is it for you? If you think Shaunna is getting worse over the weekend I would contact the hospital directly and get an emergency appt. sooner rather than later, technically she has been referred now so there shouldn't be a problem. Best wishes for Monday - you won't regret making this decision, it has given me such peace of mind knowing the care Mitch is receiving there. Thinking of you and Shaunna Kath

Kath Scotland

Hi Kath The journey to Royal Dick is just under 3 hours so it's quite a hike and fingers crossed she is stable over the weekend. If not, I shan't hesitate with an emergency appointment. It's good to know that many on this board recommend the place. I shall keep you posted. Take care and hugs to Mitch. Claire

Claire Cumbria

Claire, have you considered an anabolic steroid like nandrolone decanoate or Deca Durabolin (2-5 mg/kg given once a week or 4-6 doses). These steroids will help to stimulate the bone marrow, which is what we want to happen. You could also explore the thyroxine route. Dr. Dodds has recommended using thyroxine (0.1 mg/10lb given twice daily) to stimulate hematopoiesis and bone marrow. You'll have to remember though that not all vets agree with this method and will quickly shoot it down. The way I see it is it can't hurt to try....right. You should also make sure you have the proper amounts of iron, B12, folic acid, and copper added to the diet. These nutrients are necessary in the formation new RBCs. Many people use Pet Tinic to get the right mixtures of each. Don't get discouraged from low PCV results post transfusion. All dogs are different and have different results. Being depressed and lethargic are common but the fact that she is starting to eat is great. That shows the meds are starting to work. The main thing is to stop the destruction. I'll keep Shaunna in my thoughts and prayers. Johnny & Tessy

Johnny

Johnny, Thanks for your post. I say a previous post where you mention the anabolic steroids, such as nandrolone decanoate or Deca Durabolin, but I don't know if they are prescribed in the UK. I shall certainly ask about them - though I don't know if they have severe side effects? I shall also ask about the thyroid panel and insist that one is completed - I assume it's a simple blood test? How long does it normally take for results? Best wishes, Claire

Claire Cumbria

Hi Claire Firstly, hows Shaunna doing? I cannot tell you of the relief I felt when you said you were taking her to RD on Monday, it was a 3 hour trip for us too - don't be too upset if they ask you to keep Shaunna in to do test etc and ask you to go home (the very worst part), but be assured Claire - she will be in ther very best of care - the best in Europe!! When Phoebe had her first transfusion there she rejected it - found out after tests she was Rh Negative and the blood had been RH positive - step backward. She had a bad reaction - no increase in PCV. She was then given Oxyglobin a substitute blood transfusion - her PCV hardly increased at all and we thought we were going to lose her (the best thing is that they will ring you everyday with a detailed update of all procedures). They will also probably want to do a bone marrow biopsy. Phoebe had two as the first one did not give the results expected, the second result was that the problem was in her bone marrow, she was not regenerating - another step backward. She was given another transfusion with Oxyglobin - and there still was no dramatic change in PCV. They then started her on preds and azathioprine and after 3 weeks she was allowed home. She was thin, tired and lethargic - not my Phoebe at all. Then slowly, very very slowly, the PCV started to rise (try to go back and read my initial posts - you will see how worried and desperate I was). The Azathioprine did not seem to be working and her PCV was not increasing at all. Then came the time to stop Aza and give her Atopica (I call this the miracle drug). It too, takes time to take effect. - You cannot be in a hurry with this disease - and she is slowly climbing (read my Horray post of PCV 32). I know to a lot of people this is not a eureka moment but when your loved one has been as low as Phoebe and Shaunna - anything is a bonus. So hang on in there Claire - I am speaking to Alistair/Marg tomorrow regarding Phoebe's skin bump - so even this far down the the line I am still in contact with them. You will lose sleep over the next few days/weeks but Shaunna is in the best place - I will say a special prayer for her and Mitch as they will be companions at Royal Dick. Take care - will you please post tomorrow night to let us know how you've got on - don't worry if the news is grim when you receive it - when you are at rock bottom the only way for you and Shaunna is up!! Our very best wishes for you both tomorrow Gill & Phoebe

gill uk

Hi Claire, I just wanted to say good luck for tomorrow. I think you will find they will almost certainly want to keep Shaunna in a few days whilst they carry out tests etc. Although I thought I would be upset at leaving Mitch I actually felt relief as I knew the high level of care he would receive. They are great at keeping in touch with you and keeping you updated. Blood test results are also back the same day which is a big improvement and saves hours and hours of worrying! Mitch remains at the Dick Vet. His PCV remains the same (around 27) but he actually has no anaemia issues that are known of (we just squat on this board now)! He has a low platelet (thrombocytopenia) issue believed to be immune mediated. I spoke to Alisdair at the hospital not long ago and there may now be a question mark over this as he has been on prednisolone for 11 days and cyclosporine for 4 days with no sign of his platelets rising above 7. He was at 42 after the transfusion but have been around 7 since. He may have an issue with producing platelets or producing the cells that produce the platelets which may not be immune mediated due to lack of response. This could be a far worse prognosis however I will speak with Shasta tomorrow and hopefully discuss this further. Good luck Claire and I will be thinking of you. Kath

Kath Scotland

Claire Good luck for tomorrow and leet us know how you get on. You asked about the thyroid test,yes it is a simple blood test and make sure they test the following: T4, TSH, free T4, TgAA, Anti T4 Antibodies and anti T3 antibodies. Be warned they might say that Shaunna is not displaying any clinical signs of hypothyroidism, as they did with Nollaig.But I asked Rory if he would do it for me, and he agreed, and as I mentioned her free T4, her active thyroxine, has been shown to be low so she will now go on soloxine(thyroxine).I'm not saying it will cure her prca but it will help to stimulate the marrow to produce red blood cells as that is one of the things thyroxine does.I got the T4 and TSH levels back next morning as they were done in lab at Glasgow Vet School but the other T cell tests had to be sent to a lab down in England so they take 3 to 5 working days to get back so you are as well asking to get these done tomorrow. Gill mentions having to get oxyglobin administered and that it didn't increase Phoebe's pcv(oxyglobin wont increase the pcv, that was explained to us when Nollaig was given it,in fact it can sometimes put pcv down by a couple %.It will increase haemoglobin levels and therefore oxygenate the body for a very short time),Nollaig was given this too when they couldn't find a match there for her 5th transfusion but at Shaunna's stage where this would only be her 2nd transfusion,if indeed she does require it,they should be able to find her packed red cells because she won't have built up the same antigens to other bloods yet. Oxyglobin costs the same as blood transfusion, and because you're not insured like us too Claire, you want your money to go on something that will last longer so that the drugs get chance to work. I'm sure the Royal Dick can order in bags of red blood cells from pet blood bank UK, which arrive next day by courier from Loughborough same as Glasgow Vet School does.In fact in Nollaig's case there,we sent Nollaig's blood down to Pet blood bank for them to cross match all their blood rather than sending up bags of blood that were no use to Nollaig,and they sent up 2 bags that matched her next day.But as I said that was because it was now Nollaig's 5th transfusion and it was difficult to get her a match but that should not be the case for Shaunna at this stage it being only her second. They might decide anyway, if still at 15%, not to rush in and transfuse her,if clinically she is ok. Sorry Claire, did you say that Shaunna had a bone marrow biopsy already to prove PRCA? Gill,thank you for all the details about forceval etc...very grateful.This forum is just brilliant for what would otherwise be a disease that you wouldn't meet any owners that you could talk to for advice etc due to its rarity. Anyway Claire make sure you ask as mmay questions as you need to tomorrow (write them down, otherwise with so much to take in you'll forget,I know I've done it!)because the more you understand about the disease/transfusions/drugs the better able you are to make the right decisions for Shaunna. Be praying for Shaunna. Kathleen and Nollaig xx

Kathleen North Ayrshire

Hi Gill Shaunna has had a restful day - not so good in the night with her breathing - panting a lot - which I believe can be a side effect of the prednisolone. She's eating so much better - all home cooked food. Today, she had brown rice, chicken, tiny bit of chicken's liver, coley fish, broccoli and peas. And not to mention the obligatory Scottish short bread biscuit. Should she be admitted, I can't imagine for one moment that she will eat their food. But I guess we'll jump that hurdle when we come to it. I know each instance of PRCA is an individual case, but it gives great hope knowing that Pheobe is responding so well to the treatment and that both you and Kath speak highly of Royal Dick. Shaunna was only on the Azathioprine for one day and then under the recommendation of Marg Chandler (my vet spoke to her by phone) we changed her to Atopica, which was last Tuesday (6 days). She has already had a bone marrow biopsy and hopefully they won't have to do a second. Kath Thanks also for your message and your good wishes, which I return in full for Mitch. I'm so pleased that you are staying on the board because you have offered lots of insightful information and hopefully we can continue to offer support. Kathleen Thanks for the additional info on thyroid panels - I shall request the test tomorrow. I asked my local vet about whether Shaunna could have a problem with her thyroid and she said she wasn't symptomatic and I agreed earlier in the week. Little did I realise at that point (several days ago) that there was such a thing as a thyroid panel test, which is obviously more comprehensive than the more bog standard test for thyroid problems. Well, I better make a move, but I shall let you all know how things go. Fingers and toes crossed. Takes care, Claire

Claire Cumbria

I'm sure they will find something to tempt Shaunna to eat at the dick vet. Mitch is being hand fed chicken, ham and tuna! I think he is dragging out his recovery just so he can say at that hotel! I sent you an email as well Claire. Take Care Kath

Kath Scotland

Claire Please know that we are thinking about you and Shaunna tomorrow and we are sending our prayers. The pred and AIHA will case panting. We are very happy to hear she is eating better, to me that is a very good sign. Please keep us udated on how she is doing. Cheryl & Ginger

Cheryl & Ginger Pineville PA

This thread was discussed between 06/08/2009 and 09/08/2009

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