Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Prednisone side effects

Maggie, my yellow Lab and I are not enjoying the side effects of Prednisone. She was not really showing many if any symptoms of her anemia before her diagnosis, so its hard to see the medicine take its toll. She never suffered a true "crisis" as we started her on the prednisone while her CBCs, while low at 24, were not dehabilitative. Her bone marrow is making plenty of RBCs, its just that her immune system has been preventing them from being released. So her liver is not straining to clean out dead RBCs and the symptoms weren't noticeable. She has really good days or parts of the day, then struggles through with the panting and heavy breathing (not anemic related) and bloated stomach. She slept in the kitchen today so as to cool down on the tile even though I did not have the heat on. But when she woke, her breathing had slowed and she came over, tail wagging for affection and enthusiastically gobbled her dinner. Yesterday (Friday 28 Oct), a week into her meds, she had her best day since taking the Prednisone. It was if none of this were happening, she was frolicking, chasing bunnies, vigorously wagging her tail, acting her old silly self. In fact she even jumped up to me, something she hadn't done in months, even prior to taking the prednisone. We had a rough start today, but she seems to feel better now, picked up her beef marrow bone and tossed it in the air then pouncing on it. Plus, just after 7 days, and she has already lost some of her muscle definition. Next Thursday, two weeks into her meds, we will do a blood draw and get her CBCs. At what point does a vet typically consider lowering the prednisone dosage? My vet says something triggered this. Two suspects include pesticides sprayed in my home to get rid of earwigs or me giving her the Interceptor heart worm medication within 3 weeks as opposed to a month apart. I'm more inclined to suspects the chemicals used in the pesticides, or lawn fertilizer, etc. I also have read somewhere that combo boosters are prime suspects for an unbalanced immune system. I am going to discuss with my vet Maggie's vaccine history. I know that this is a marathon, not a sprint. Just venting I guess. I have faith though, that she is on track for a full and happy recovery. Then I need to really watch out for chemicals that have caused her immune system to flair up. Blessings to all two and four legged warriors. Robert and Maggie

RobertN Superior

They started reducing Cookie when she was stable in the 30's. We reduced either every week or every other week because she never dropped lower than 34% again and they wanted to so long as she stayed above 30% and they wouldn't decrease if it dropped at all. Then she went a month until they decided to reduce again since it is a pretty drastic reduction (from 5mg daily to 5mg every other day) But, it depends on the doctor as to the speed. I think Dr. Dodds recommends every 3 weeks? With Cookie that wasn't an option because of her liver enzyme levels.

Monet Sammamish

Robert, To understand the side effects of prednisone read this very excellent webpage about Cushing's Disease. Read the section titled Iatrogentic Cushings, which is Hyperadrenocorticism caused by the administration of excess corticosteroids (prednisone). http://www.kateconnick.com/library/cushingsdisease.html To better understand how outside factors influence the canine immune system read this short and understandable paper by Dr. Jean Dodds: The Canine Immune System and Disease Resistance http://www.canine-epilepsy-guardian-angels.com/ImmuneSystem.htm The Merck Veterinary Manual is a wealth of information that is very readable. Keep an online medical dictionary open to look up words you do not understand. http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/10208.htm&word=bone%2cmarrow%2cfailure my best patrice

Patrice NYS

Practical Application of Bone Marrow Aspiration and Its Interpretation http://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00044.htm Vaccine Damage In Dogs http://www.dogsnaturallymagazine.com/vaccine-damage-in-dogs-2/

Patrice NYS

Thanks Patrice. The articles, particularly the first one, shed a lot of light on Maggie's symptoms. I need to stop looking at her gums under different light... sometimes they look nice and pink, sometimes pale. Then I realize, we are standing under florescent lights or its too bright or its dark. I just need to trust the process and realize that while the Prednisone as unappealing side effects, observing those effects show that its in her system and has a chance to work. Today she woke up looking and acting more herself, but I will resist the urge to take her on a longer walk. I want to really take some time to learn about Maggie's exposure to potential triggers. I plan on printing out the articles and really taking the time to compare to potential environmental exposures, including vaccines.

RobertN Superior

Robert, Gums can look variable during the day and night. Refill is the more important criteria. Simply press a thumb into the gum, then release and watch to see how rapidly the gum refills where the thumb print was. If you have a healthy dog available to compare this will help you evaluate. Dogs have a particularly responsive spleen. The spleen provides several functions. One is to store blood, another is to routinely remove aging red blood cells and it is also a very active participant in the immune system. Dogs, in particular, have the ability to store large quantities of blood in the spleen (esp when sleeping). This may be referred to as nocturnal anemia as the amount of circulating blood may be very low. When startled from sleep by some perceived danger such as the door bell ringing <VBG> strong muscles around the spleen squeeze and helps the spleen instantly put this blood back into circulation. Fight or flight reaction. So, at rest a dog's gums might be paler than when they are excited or hot. I also used to view the area under the eye by pulling down the lower lid. This is a great quick check. I got so good I could just look at his ears and tell if they were pink or gray. The spleen is the organ that provides immune system protection against a very serious tick disease called babesiosis (in both humans and dogs). This disease behaves similarly to malaria and is known around the world. Humans and dogs without a spleen are virtually unable to properly fight this. In the womb, the spleen provides the service of making blood until bone marrow is formed. It can sometimes aberrantly begin to perform this function later in life and this can be connected with bone marrow failure. This is called extramedullary hematopoiesis. In the first months of Chance's illness I did search furtively for a cause. I have medical training and I was able to read veterinary texts. My research showed me that, while environment can sometimes be the sole trigger for autoimmune problems, our genetic inheritance is a very important factor in the expression of disease. Once I was able to talk with Dr. Dodds and read more of her published material I understood that environmental influences are often triggers to an immune system that is primed by inheritance to be over-alert. Chance was one such dog. He had very bad allergies beginning at a young age and I treated him for years with allergy shots. I suspect that his pedigree had a great deal to do with this. But, regardless of cause, Jean was right on when she had me treat him with an aggressive immunosupppressive treatment. Prednisone was not enough to stop the destruction in the bone marrow. This is where some vets fail in their treatment protocol for serious bone marrow failure. Looking for a cause is sometimes an exercise in futility. If a treatment begins to work, then you have the answer. If I had followed the specialist's advise, he would have died. Certain breeds, esp those that have significant line breeding in their ancestry, are more prone to autoimmune conditions. If you were a geneticist and could research these lines you probably could have an possible indication of how certain diseases are passed generation to generation. A perfect example is the heavy misrepresentation of Cocker Spaniels that develop serious autoimmune hemolytic anemia. Another similar line breeding problem is the German Shepard Dog's propensity to develop hemangiosarcoma of the spleen. Since this is a cancer, one would think that it could not be autoimmune, but remember that the spleen does provide an immune system function. Is there a connection? As Jean's paper on immunity points out, there can be multiple triggers to the immune system that cause disease. For instance leaving dogs unneutered or unspayed allows hormones to influence immunity. Wide swings in hormones flooding the body can be a significant trigger. Add in a routine booster vaccination, seasonal allergic symptoms or simply a bee sting and you have the recipe for serious autoimmune disease. Blaming yourself for using tick or flea protection as the sole cause for autoimmune disease is more of a function of self guilt than it is a reliable trigger for disease. I continued to protect Chance against heartworm and ticks, with Jean's blessings, even when he was very ill because I know how serious tick disease and heartworm disease are. It is natural for loving dog owners to want to know what they did wrong to cause their dog to become ill. But, even with humans, illness often occurs without our direct input. My husband once noted to me that dogs just seem to be more fragile. I believe it is partly true, they have shorter life span and their systems can be on "fast forward" all the time. If there is a problem with health, it too can be accelerated. For instance, in many cases, cancer can be a function of aging body cells that begin to lose their proper instructions. So, thus, you see humans begin to develop some cancers later in life. But for a dog, later in life can be 8 or 9 years old! So dogs can develop cancers that parallel the types of cancers associated with aging in humans at a relatively young age. my best patrice

Patrice NYS

Patrice, Thanks for your valued input. Maggie was acting perky so we just went for a 20 minute walk and her gums were very pink. I tried the "refill" test and the spot filled back right away. I understand what you are relaying regarding responsibility for a dog's illness. I believe that my focus on a trigger comes from the fact that Maggie has, in the past, recovered from anemia on her own. My vet and her consults at Colorado State U. Animal Hospital believe that she had encountered something that 'triggered' her anemia and that once it passed through her system, her anemia resolved itself. My vet also called this recovery - without intervention - 'a miracle'. Granted, Maggie is a pedigree yellow Lab and therefore, based on Dr. Dodds' article and what you are saying, her breeding mostly likely plays a part in her being prone to triggers. I will continue Maggie's heart worm prevention. My vet does not see the Interceptor as being a trigger as she has been on it all her adult life. Thanks again Patrice. Your insight and knowledge is priceless. Robert and Maggie

RobertN Superior

Hi Robert, Sorry to hear about Maggie. My Dog Dylan (diagnosed with AIHA March 19, 2011) was very reactive to prednisone and experienced an acute attack of AIHA. She reacted to prednisone within 4 days and after bottoming with a PCV below a value of 10, 4 days after diagnosis, she improved to 39 less than 2 weeks later. Because of her immediate PCV recovery and the fact hat she was suffering symptoms of Iatrogenic Cushings disease immediately, we started reducing prednisone fairly quickly. After 4 days I knew prednisone was working. After 2 weeks she had virtually no sign of anemia, but started to become paralyzed. In 4 weeks of prednisone, even with some reductions, she could not lift her head. Because of other signs as well, mainly aggression and drive for food, we had decided her initial dose was too high and cut it a little 2 days after she started and before she started recovering. Then again in 10 days, she went from her original 2 mg/lb/day to 1 mg/lb/day. Then we cut 10 mg per day out each week until the prednisone symptoms stopped worsening and for awhile after. Each time I reduced, she got better 4 - 6 days later and stabilized, never showing sines of anemia. The AIHA never returned and we continued to reduce until she was off prednisone in early July. She was unable to stand from about April 10 to May 21 when she stood for the first time again. She was a fairly unique case and cases with the disease in the bone marrow like Maggie are very different than Dylan's. Dylan's symptoms came on quickly and were from destruction of circulating mature RBC's only, Then just like it arrived, it left, so acute poisoning of some sort seems to have been her issue. This is not like Maggie's case, but the reactivity to prednisone does seem to be similar. I would want to keep a close eye on symptoms. Anemia is very different from prednisone side effects, but the disease hsa to be stopped and for Maggie, RBC's need to be released so PCV can rise. If the disease is being stopped, then reducing prednisone earlier just to get to a better level for Maggie might be in order. If Dylan relapses I suspect we will start her on half the dose she started on last time due to her reactivity. Each dog responds to levels of prednisone a bit uniquely and if I had left Dylan on the predefined schedule for 3 weeks at a time, I believe she would certainly be dead or permanently debilitated from prednisone. My vets fully agree that my pushing to get Dylan off prednisone fast saved her. But like I said, her disease was different and prednisone alone clearly stopped it. Good luck with Maggie, Richard and Dog Dylan,

Richard Burnaby

Robert, What you say is very interesting. I am curious, did they ever do any tick panels either in the past or currently? I spoke above of babesiosis and how the spleen can successfully rid the body of that tick disease. I have had lengthy conversations with a few of the Tick-L list members about this recently. Some dogs can be carriers of babesiosis and be totally symptom-less. This is well known. We discussed whether perhaps babesiosis is latent in the spleen in these dogs. Could a trigger cause this disease to flare again? On Tick-L we recently heard about and discussed a number of dogs that were exposed to Babesia canis (formerly called Piroplasma canis) and have become very ill. Some dogs have died. See this page: http://www.wusv-2011.com/en/ (World Union of German Shepherd Dog)(Schutzhund). They even have a special announcement on the front page about this exposure. Remember I mentioned above that GSD seem to have unusual problems with their spleens? Is it coincidence that all of these were GSD dogs that were exposed to Babesia canis and that many became very ill or even died? This particular disease can cause immediate and serious anemia as the spleen attempts to destroy those red blood cells that contain the tick disease. Were the spleens of those dogs that died unable to fight the disease successfully? Babesia canis is certainly found in many places in US. There are other tick diseases in the US that can cause serious disease. In my search tonight I came across one that I personally had never heard of before, but will probably sound familiar to you. Colorado Tick Fever. I found some interesting information: "It is defined as a disorder in which there is a viral infection which is transmitted from the bite of wood tick. It is also known as the CTF. The other names are mountain fever and mountain tick fever. The Colorado tick virus affects the blood cells and mainly the red blood cells and so the virus gets transmitted by the blood sucking ticks. It can also be transmitted by the blood transfusion. The Colorado tick virus is 80 nm in diameter. It is not enveloped. There is a double stranded viral genome which is long and is divided into few segments. The replication of virus is in link with the cytoplasm granular matrices. The presence of virus in a mature red blood cell is related to the division of virus in a red blood precursor cells. The infected immature cells get mature and there is a direct entry and division of the virus in mature red blood cells." and this: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC240408/ Replication of Colorado tick fever virus within human hematopoietic progenitor cells. What does this tell us? That Colorado Tick Fever inserts itself in the progenitor cells in the bone marrow and divides there to reproduce itself. This causes disease at the level of the bone marrow, anemia. Is is possible that you are dealing with a re-infection of Colorado Tick Fever? I have no idea if this can be tested. However there is a lab called Prototek that is famous world wide that specializes in testing for tick disease. Dr. Holland is an expert and often consults directly with vets or even owners to track down tick disease. See this brochure http://www.protatek.com/PDF/ProtaTek%20Diagnostic%20Testing%20Services%203.12.07.pdf my best patrice

Patrice NYS

"What does this tell us? That Colorado Tick Fever inserts itself in the progenitor cells in the bone marrow and divides there to reproduce itself. This causes disease at the level of the bone marrow, anemia." I am printing out this message and your links to share with my vet. I do know that 2.5 years ago a tick screen was completed and was not conclusive for infection. But I am not certain that it can still be ruled out, especially given her history and the manner in which, as you describe, Colorado Tick Fever can manifest in the bone marrow. She has been on Cephalexin, which is an antibiotic used for soft tissue and skin infection, as she had a cyst removed while under anesthesia for the bone marrow biopsy. I wonder if the Cephalexin would have been an affective treatment for any fever or infection caused by a tick bite and blood transmission.

RobertN Superior

Robert, I was so concerned that I wrote Jean Dodds to ask her what she knew about Colorado Tick Fever. She told me that this particular disease is relatively mild and is usually treated easily. She felt that Maggie's symptoms were more indicative of serious bone marrow failure. I wish, in a way, that it could be this simple. Treat for a tick disease. I felt that way when Chance was diagnosed. I was hoping it was tick related and I could just give him some doxycycline to resolve the issue. So I apologize for making this seem more important that it appears to be. However, I still feel that testing for tick diseases prevalent in your area of the woods is an important diagnostic. They may have already done this. Reassure yourself that they have. How is Maggie today? my best patrice

Patrice NYS

Richard, thank you for your feedback. Your point that each case is different is well-taken. Even in cases where the trigger and the manifestation are the same, one dog may react differently than another to the same treatment, both positively and negatively. Patrice, Maggie seems pretty good. She is still resting a lot but perks up to look longingly at the bunnies out on the grass. Yesterday, she be-bopped around at a good pace, but her stamina ran out after a bit (20 minutes). I did check her gums towards the end of our walk and they were nice and pink and immediately refilled upon pressing and releasing. My vet mentioned a tick screen right away to rule it out the first time, 2.5 years ago, and it came back negative. What was weird in that case was she was at first non-regenerative then all of the sudden starting regenerating. So Richard's point about Dylan's case being unusual rings somewhat true for Maggie. We will have our first CBC blood draw after two weeks of medication this Thursday. Honestly, I believe that her numbers will improve but I want to manage expectations. I suppose that if she is at least stable, that is good news enough at this point. Since we are at altitude, low-normal is considered 42. Thanks, Robert and Maggie

RobertN Superior

This thread was discussed between 30/10/2011 and 31/10/2011

Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index

This thread is from the Vetnet archive. The live Vetnet forum is active now.