Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Prednisone Dosage

What would be considered a good agressive(formula) dosage for prednisone in the early stages of treatment for AIHA.Maybe i'm asking for max dosage... Courious because my local vets do differ on this..... Timmy is a 11 pounder.. Terry and Timmy

Terry pa

Hi Terry I was always told to worked on 2 to 4mg per kg daily divided into 2 doses for pred and 1 to 2mg per kg for azathroprine with a tummy protector. There are more knowledgable members than me who may have a better idea. Love to Timmy. Steph

Steph Gloucestershire UK

Terry, The least amount of prednsione that an AIHA/IMHA dog should be on at the onset of the disease is 1 mg per pound of the dogs weight per day divided into 2 doses one dose to be given in the AM and one dose in the PM. Some vets will give an even higher dose at the onset. I have seen some dogs on 2 or 3 mg per pound of the the dog's weight per day, but it usually not wise to stay on that high doseage for too long

Joanne MN

Hi Terry, I think both Steph and Joanne have answered this, but Tiggs was on 120 mgs/day at 64 lbs. This was the max recommended for his size. It made him very ill and he had pretty terrible side effects, but nontheless, I do think it was effective. He got 60 mg in the am, and 60 mg in the pm. Along with Aza, and a very low dose baby aspirin and Pepcid. Hoping things are looking up for you and Timmy. melissa and tiggs

melissa slc

Terry, at 60lbs Kahlu had 75 mg prednisone (spit in two doses every 12 hrs) for 3 weeks, we then lowered it to 70mg until he started to stabilize and we could do further reductions. He was also on 50mg aza once a day. Best wishes Brigitte & Kahlu

Brigitte BC Canada

Hi Terry I do have to say that Billy was on 40mg per day at 10kg for a very long time and as Melissa says the side effects were horrendous - in fact it was the side effects that contributed significantly in his death. You have to make sure that your dosages are reduced gradually once recovery has started. My vet was of the opinion that if the drugs were bringing his levels up then that was the dosage he should stay on. Best wishes to you both Steph

Steph Gloucestershire UK

Ren was about 10-11 pounds when she first started out on Pred. Her dosage was 10 mg. daily divided AM/PM. After two years she still takes 2.5 mg daily. Hopefully to be reduced by half this next vet visit. Sue & Ren

Susan delaware

Dear Terry, how's Timmy doing today? I hope and pray things start getting better for him. Prednisone dosage eh....I remember wondering this question way back when Tessy was starting her drugs. Check out this site... http://www.hemopet.org/files/Immune%20mediated%20hematologic%20disease.pdf This is by Dr. Dodds and she really knows her info. Might help you to answer some questions. Hope it helps. I also found this in the archives and it may also be of assistance to you.... Protocol for treating IMHA: (Immune-Mediated Hemolytic Anemia) History: 1. Any history exposure to ticks, any travel to tick infested areas? Other infectious diseases such as leptospirosis, bacterial or fungal or parasitic diseases. Test to rule out Babesia, Ehrlichia, Bartonella, & Rocky Mtn. Spotted Fever, Lyme, as causes. 2. On any current meds that could cause anemia, thrombocytopenia? For example, Sulfatrimethoprim. Estrogens, non steroidal anti-inflammatory drugs? 3 Has there been any exposure to rat poison? Zinc exposure (in the form of coins; seen on X-ray) 4. Were there any recent vaccines (w/in last 3- 45 days? 3. Any concurrent health problems? Neoplasia : Hemagiosarcoma, Sertoli cell tumor, lymphoma. Other conditions: Hypothyroidism, especially autoimmune thyroiditis; Cushing’s disease; Addison’s disease; diabetes; any other recent illness or surgery or stress event including sudden change in temperature? Diagnostics: Minimum data base 1. CBC including platelet count and platelet size (immune-mediated platelets usually have predominantly small platelets). 2. Check Purple Top Tube for auto agglutination, check slide for auto agglutination, look for spherocytes, or stomatocytes on the peripheral blood smear 3. Manual differential, cell morphology (regenerative anemia? (at least 30% of IMHA cases are not regenerative) 4. Spherocytes (near the feather edge don't count) 5. Platelet estimate consistent with low count or due to clumping? 6. Chemistry panel ( Low albumin may indicate hemorrhage) 7. Chest rads & abdominal rads to rule out cancer, pneumonia. 8. Abdominal rads to r/o zinc toxicity (metal coins), cancer, pyometra,etc. 9. Abdominal Ultra Sound to check for Neoplasia(i.e. dog >7yrs) 10. Babesia titer or other infectious diseases if greyhound or if there’s travel history, Ehrlichia, RMSF, Lyme leptospirosis, titer if also thrombocytopenic. 11. UA - look for hemoglobinuria 12. Coagulation panel if evidence of exposure to rodentacides. Or suspected Neoplasia. 13. As the underlying cause can be autoimmune thyroiditis, and thyroxin is needed for normal hematopoiesis, check full thyroid antibody profile. Treatment: (D/C any current meds!) 1. Prednisone 2mg/kg PO BID divided; start at same time as Dex SP is given 2. +/- Azathioprine (Imuran) 2mg/kg PO SID if dog is not responding to the prednisolone. 3. +/- Cyclosporine (Atopica) starting at 10mg/kg SID for the first week, then 5mg/kg thereafter, if patient is refractory to the above drugs. 4. Pepsid–AC to prevent gastric ulcers from the prednisolone. 5. Doxycycline 5 mg/lb bid just in case it is Ehrlichia *Do not use Cytoxin, Oxyglobin - studies show a decreased survival rate with these drugs. 6. Thyroxine (0.1 mg / 12-15 lbs. of optimum weight BID), to stimulate hematopoiesis, or if patient is hypothyroid Transfusions: a. Better to transfuse sooner than later. b. Transfuse if PCV<15% or ( >12% if reduction in PCV is not peracute). c. Use Packed Red Blood Cells (best) or Fresh Whole Blood. d. True universal donor (DEA 4) is best as you usually can't type or cross-match due to auto agglutination. Monitoring: 1. CBC q12hrs, initially, then every few days depending upon the patient affect. 2. Monitor electrolytes q24hrs if on IV fluids 3. Monitor the slide for agglutination q12 - 24hrs 4. Blood smear every few days to look for regeneration, platelets (platelet half-life is 3-5 days; platelet count may not go up because the new platelets go first into the inter endothelial cell spaces to “plug the holes” as seen by fading of bruises or pinpoint hemorrhages and no more new ones; then the next batch circulates and raises the blood count.) Sending home: 1. Prednisone 2mg/kg PO divided BID for at least two weeks, taper very slowly every 10-14 days for another month until platelet count is above 100,000 or PCV is above 21 and stable. Then decrease dose, whenever the blood tests remain stable for two weeks. Eventually the steroids should be given every other day for maintenance. 2. Dogs usually require low dose prednisone every other day for a year or more. 3. Azathioprine 2mg/kg PO SID if needed, then reduce to 1 mg/kg SID, then to 1mg/kg every other day or three times per week. 4. Continue cyclosporine, if needed originally, at 2.5mg/kg SID 5. Continue thyroxin, if needed originally, at 0.1 mg /12-15 lbs. of optimum weight BID, given at least an hour before a meal to ensure absorption. 6. Pepsid-AC PO while on high dose prednisone. 7. Recheck CBC weekly to start; CBC at 1 week, 3 weeks, and then q2 - 3 months while on Azathioprine 8. High protein (35%),low fat diet, no corn, wheat or soy. Split normal amount of food into four servings. 9. Consider Jean Dodd’s “Liver Cleansing Diet” if liver functions are high. 10. Milk Thistle and/or SAM-e for liver health. 11. Pet-Tinic added to food (for iron, B12, folic acid, copper, necessary to form new RBCs). 12. Have plenty of fresh water available for the dog at all times. * Note this was reviewed and edited by Jean Dodds, DVM. Some vets think the thyroid portion is controversial. Whatever route you choose remember that he is also on Atopica cyclosporine. I would think that if Timmy is indeed taking a total of 20mg/day (is this right?) of prednisone that this is a high dose for such a small dog. Just make sure he does not stay on this drug for too long. Once he starts to improve then discuss with the doctor reducing this med to a more acceptable level. Just keep an eye out for spherocytes...this will tell you whether there's still destruction going on in the body. We want construction (high retics)...not destruction (spherocyte presence). I'ld highly recommend getting Timmy on milk thistle to help protect his liver. The cyclosporine should soon be kicking in so that will help tonns. A PCV of 23 is alright, just not where we'ld like to be. Hopefully once the meds take hold this number will begin to rise. Keep a good eye on the autoagglutination. Have they done anything for htis yet? Aspirin/heparin? Looking forward to hearing from you soon. I'll be keeping Timmy in my thoughts and prayers. Johnny & Tessy

Johnny

Hello Everyone. Timmy's pcv is now 22 so were not sure if he is leveling or what right now since the decrease in pcv has really slowed down after the higher dose of pred.. and the addition of the thyroid supplement.I did get a supply of milk thistle gels.I need to find the dosage for timmy.I think the gels i got are 400mg.I added pet tinic to his diet to support his system some.I do have him on compounded low dose asprin as a safeguard dispite reluctance from one of the main vets.Their is so much good research and statictics to support its benefit.I ran the higher dose of pred. by dr.dobbs and she thought this was ok at this point.The only other option it seems is imuran as a possibility at some point.He is eating really well and drinking and outside duties are ok... He appears to be a little less wobbly and has more interest in things so i hope this clinical improvement means something.I try to take a deep breath every morning and forge ahead to do everything within my means to help this little guy.I just hope it is enough. I would like to thank everyone here for your continuing love,prayers and support. Terry and timmy

Terry Pa

Terry, This is positive, Timmy seems to be holding steady. As for Aza/Imuran, keep in mind, this drug has one of the longer response times, up to six weeks, so if you decide to go that route, you might discuss it now. The advantage of adding it is that it tends to has less side effects (liver and bone marrow suppression being the main side effects), so when Timmy reaches more stability, you could slowly lower the Pred and the Aza would likely stay put for a while. Just a thought you might ask your vet. Also, clinical improvement can speak volumes, try to keep that in mind when looking at numbers- which can drive you crazy! Our best, keep us posted and hugs to you guys. melissa and tiggs

melissa slc

also, Johnny, thanks for posting that very comprehensive and informative protocol- I hadn't seen that before. It's interesting the sidebar about the thyroid panel being 'controversial'. I can't see how a simple blood test could be controversial if it could help the patient. You all know Tiggs' story- we think he became hypothyroid during the course of his IMHA, and it was an incredible change in his skin, coat, and energy when we added the thyroid meds into the regime.

melissa slc

Thanks everyone for hanging in there with me as my nerves are frazzeled often when i am scrambling to find answers and advise i have found through all of you that has become like family to me.Timmy would not have made it this far if it were not by changes made by being informed by all the great knowlege gained here. Dr. dobbs has been gracious enough to talk by phone a few times and gave me some great input as well.Timmy has held his own for 5 days now with a pcv of 23,26,22,22 that has bounced back and fourth.The pred was doubled from 5mg to 10 mg bid and thyroid supplement was added a day before these last pcv readings.We are 2 weeks total on the pred with the double dose started 4 days ago and 8 days out on the atopica.So i don't know if were just out long enough on the meds or jacking the pred and adding the tyroid supp. that is working.He is eating well and seems to improve clinicly.He just seems to act more himself.He is still pretty weak and bloated from his spleen and liver.I thank God every day that Timmy is still with me. It has been suggested if he remains stable in through the middle of next week to run a CBC and blood smear to check cell generation and just what what is going on now that we are seeing some stabilization.Thanks for being here and my thoughts and prayers are with all of you and your babies... Terry snd timmy

Terry Pa

This thread was discussed between 29/07/2009 and 31/07/2009

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