Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - riding the roller coaster

We had quite a week with Kola. He was doing really well, tapering off Prednisone while holding Azathioprine constant at 50mg every other day. His PCV was up to 48 at last 2 week check. Well, we reduced his prednisone from 2.5 to zero, and at next check he was down to 34! He also was not eating well in past few days, and had diarrhea midweek. We took him to UPenn yesterday, and they suspected relapse. After many tests, it turns out he is not in hemolytic crisis (??) He is regenerating red blood cells and had a 42 PCV. They also ruled out Addison's. Still, they put him back on the 2.5 pred again. So I'm wondering whether others have noticed strange changes when their dogs come off prednisone completely, even from a low dose? I realized today that perhaps his appetite is off from coming off of the prednisone. It was not mentioned as a possibility, but now it seems likely. I wonder too if eventual next step should be reduction of Azathioprine while keeping him on the low dose prednisone. Thanks for listening! I appreciate it!

Leslie Philly

Leslie, The only changes that I noticed when weaning off pred have been positive things. Alex is back on pred after his relapse several weeks and we are weaning him off it again. In his case he does poorly on it. I am wondering if you are right about the appetite and the pred reduction. It's like trying to fit the piece of a jig saw puzzle together isn't it? It's really good that Kola's PCV is up to 42 again! Chris

Chris Pa

Hi Leslie, I'm sorry about the potential setback. Is there any way there is an underlying infection? Hoping you get to the bottom of it, at least there is regeneration, hopefully it's on it's way steadily back up! melissa and tiggs

melissa slc

Leslie, I would be highly suspicious in this case that there was something wrong with the blood draw. If it isn't done carefully, red blood cells can be damaged during the draw or by rough handling of the tube. You mention he had diarrhea. This would dehydrate the body and make a blood draw more difficult and increase the risk of damage to the sample. If this happens to anyone, question the vet when they present a very odd result like this and ask them if they can do a quick PCV. This would require a small blood draw. The blood is put into a tiny tube and spun for a few min. Then it is held up against a chart and read visually. There are generally no errors with this test. You may even find that the PCV is higher generally than the HCT. It is the correct number and is a very reliable test. This happened on several occasions with Chance and the automated analyzer. I questioned the vet and she said, you are right, let's do a PVC to check this. Normally with a healthy dog, the vet would probably not even mention it to the owner, knowing that the number was probably an error. But in this case, you are making important medication decisions based on this information, and you must have an accurate number. I always request a separate PCV anyway because it is only $8. at my vet's office. Oh, and I never buy coffee in coffee shops because they cost about $8 when you add up the bagel and the coffee! I am very glad that it ended up ok! my best patrice

Patrice NYS

I have to agree with Patrice. I had the same problem with Ren's blood work. One day up the next day way down, then up again. After taking Patrice's advice, I insisted on a spun PCV. It was very inexpensive and a much more accurate reading. We have a "spin" PCV test done each time now. There are always discrepancies between the lab machine and the spin test. SUE

Susie Delaware

I can not offer any advise or guidance with regards to reductions and whether they may have caused the drop because Tessy is not there yet. There does sound like discrepancies with the draws though. To go from 48 to 34 then back to 42....something doesn't sound right. I'ld assume that by them saying there is no hemolytic crisis they mean that there is no destruction of RBC's. That's a good thing! If it were me I would recommend a more gradual reduction of the pred. Maybe 2.5mg every day to the same amount every other day. I plan on having full tests sent out before deciding to reduce any of Tessy's drugs. Just to check for retic numbers, spherocytes, etc. Might be worthwhile getting this done for Kola (unless UPenn already did this for you). Either way....I'll keep Kola in my thoughts and prayers. Keep us informed on how she is doing. Johnny & Tessy

Johnny

Well I really don't know what to make of all of this because Kola seems to be doing well in last two days. He's back on 2.5 pred daily and taking pepcid. He seems to be eating ok now. And my husband said he ran full sprint back and forth at the park yesterday with his ears pinned back, something he hasn't really quite done since he was first diagnosed. Thank you, Patrice and Susie, for the information about the difference in blood tests. I was also wondering about the accuracy of the test. I think the spun method was the method used when the count came out to 34. The cost was minimal ($16 = two bagels and coffee at a coffee shop!), done by a vet tech, and the result obtained within 10 minutes. I feel more informed to know to ask questions about the blood draw at our next visit next week. I had been thinking the same thing, Johnny, about more gradual reduction of the low dose prednisone next time we taper. I'm actually wondering now about the azathioprine coming down a bit first. This is such a perplexing disease - i.e. what's correlation? what's cause? Also strange to be questioning the experts based on what you think is your intuition about your dog (which sometimes I worry is my superstition!). Anyway, I so appreciate the quick support and helpful information from everyone!

Leslie

Our beloved MIki became lethargic late on the afternoon of May 15th. I monitored her closely over the weekend and by Monday was sufficiently concerned enough to take her to the vet the morning of the 18th. Our vet ran a panel of tests and a PCV which was at 18. Miki was immediately started on an antibiotic and prednisone. Her appetite was non-existant and I had to try Nutrical and an peanut butter. She took both grudgingly. Wrapped her pills in cream cheese as she didn't particularly care for the pill pockets. Took her back for more blood work today (tMay 20th) and the PCV was 15. The vet immediately hospitalized her, started her on IV's and cyclosporin, in addition to the other 2 meds. She has a dog on standby to come in tomorrow to give a blood transfusion if needed. Right now, we don't know how this is going to play out. Miki belongs to my 83 year old mom and naturally, she is beside herself. Pray for us, please!

Judi SC

Hi everyone New to this but need some advice on my beautiful Shih Tzu 11 year old Phoebe who has AIHA. She was admitted to the Royal Dick Small Animal Hospital in Edinburgh, Scotland and with a PCV of 11 in May 2009. She stayed there for 3 weeks (and as she had never been away from me, ever this was a very traumatic time but we new we had to give her the best possible fighting chance). she was given two transfusions of Oxyglobin as she is RH negative and did not have a cross-match. She has been on Prednisolone, Fersamal, Pepcid, Antepsin and Azathioprine since returning home. She came with a PCV of 15 and this increased firstly to 20 (think we had won the lottery!!) and then 22.5 which is were it has stuck. Initially her blood was not regenerating, but had good news (some at last!) when slight improvement was noticed by the lab and sent to Royal Dick. The advice I need is: how long before PCV levels start to steadily rise (had another test this am at Vet and still 22.5 - bloods sent off to lab), and is there anything I can do to help in this process. One tip I did receive from another AIHA sufferer is at Phoebe was suffering from upset tummy and runs from medication she was put on Pro-Kolin but was taking too much of this. The advice I was given was to give her Pumpkin to stop the runs or even to help with constipation. After significant time searching on the internet I found tinned pumpkin in a deli in London which I had posted out. This works a treat - phoebe takes it from a syringe and licks it as it comes out of the tube. My vet cannot believe how it has helped and I would recommend this to anyone whose pet has upset tummy. I will never be without it in my store cupboard. Have been reading all your posts and it helps to know that beloved pets are recovering from this awful disease which seems to come from nowhere and affect all of our lives. Will keep you all in my prayers. any replies will be most welcome Kind regards Gill . UK

gill morrison united kingdm

This thread was discussed between 13/05/2009 and 19/06/2009

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