Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Riley - vet update

Riley had a vet appointment today and I was hoping for another big increase in his HCT, as he went from 18% to 27% in the first week of being on prednisone. Well, this week he was at 28%. The vet is happy he is holding his own and that we did not see a drop. Any thoughts on this? I am a little disappointed but at the same time I remember the dogs here who are not doing so well and try to be happy he is at 28%. We actually saw a different vet in the practice today, we really like her a lot and I was impressed with her apparent knowledge of the disease. She stressed VERY SLOW AND CAREFUL weaning off the pred when it is time. She also said he will need to be treated with kid gloves medically from now on - ie, will need to be very careful of any medications given, and she would recommend no vaccines. The best thing she told me was that another vet who worked there for a couple years had a dog with IMHA and all the vets in the practice studied and worked very hard on making that dog well. So I am feeling good that they are at least somewhat up to speed on this disease. It sounded like it was a difficult case but the dog had lived at least 2 years with the disease. She said Riley was doing much better (thus far) than the vet's dog. We got our Pet Tinic today and gave Riley his first dose. I hope it's what he needs to get the HCT higher yet. He is acting pretty normal and happy, eating well and drinking tons of course.

Jennifer

Hi Jennifer, This is certainly good news. I always tell owners to be patient with the PCV rises. When my little Millie was diagnosed in January last year, her PCV was 14. Following a blood transfusion, she increased to 27 where it sat for six long weeks! I was so impatient, but it did rise slowly, and 14 months later she's doing great, and last PCV was 47. I too would be happy the PCV is stable, especially as it is only a week since the Prednisone was started. Is Riley on a second immune suppressant like Cyclosporine or Azathioprine? I love that your vet said "VERY SLOW AND CAREFUL" with the reductions. I am on a Facebook forum, and there is one little dog on there who has had his meds reduced so quickly, I was sure he would relapse. He's still going OK, but if it were me, I'd be cautious. I've reduced Millie's meds by no more than 1/3 at a time. You should ask about the presence of spherocytes (damaged red blood cells which indicate immune destruction is still happening). Once this stops, you should see the PCV will steadily rise. I agree with your vet to not vaccinate Riley unless absolutely necessary. It's great that you are comfortable with your vet, it certainly helps to have that trust and confidence. This disease is so confusing! The PetTinic will help, and you could also consider Milk Thistle to help with the liver. My Millie's liver values stayed normal throughout her treatment, and I'd say this is due to the use of the Milk Thistle. I can't recommned this highly enough. Really pleased to hear Riley's demeanour is normal. This is great news. He will still need lots of rest, and the Pred will cause muscle wasting, so try to keep him calm, limit exercise etc. Good luck and keep us posted, he seems to be on the right track! Sam and Millie.

Samantha Geelong Australia

Thanks for taking time to reply. I have been reading some of the archives tonight and see what a slow process it can be to get the HCT up to normal levels. So I will try to be patient!! It is so hard though, I just want him well! It has actually been just a little over two weeks since the pred was started. He began treatment on March 1. I was a little nervous to see this other vet (our regular one is on vacation) but I was sooo pleased with her manner and her knowledge of the disease. I have faith in them both, but it was a relief to see someone this knowledgable in the regular vet's absence. Our next appointment is with her, and I feel good there are two vets there that I feel that I can trust. I am working on the milk thistle angle - haven't yet made it to the health food store - but will very soon!

Jennifer

Is it just me or does it seem like it's always the mid to high 20's when the crit seems to slow down and stabilize! LOL Keep a good eye on the bloodwork...actually get copies of ALL bloodwork at each visit. If you had these we could comment more but just knowing the PCV alone doesn't really say a whole lot other than the destruction is slowing (or stopped maybe). I (like Sam) also dealt with a PCV that stabilized in the high 20's and this is where it stayed for an eternity! Eight months we were in this range until we finally saw an increase after dropping the meds more and upering the pet tinic. Good to hear you got some good vets to deal with. This always makes things easier! I'll keep Riley in my thoughts and prayers. Johnny & Tessy

Johnny

I do have all copies of the bloodwork from all our visits, are there particular values you'd like to see or should I type the whole thing out? The vet seems to be watching HCT, RBC and PLT - so as a start, here those are. 3/1 (day of diagnosis) HCT 18.5 RBC 3.16 PLT 28 3/5 HCT 21.1 RBC 2.84 PLT 157 3/11 HCT 27.5 RBC 3.41 PLT 361 3/18 HCT 28.2 RBC 3.72 PLT 278

Jennifer

Sorry, typo on the 3/1 PLT PLT 48

Jennifer

To answer a question above, Riley is not on a second immunosuppressant, just the pred. The vet feels he is doing well enough on pred alone.

Jennifer

Jennifer Congrats on the great news! My Brinnie went for bloodwork today and has only been on prednisone since last Friday and went from 18 to 28 so reading your next week only going up 1% makes me even less willing to drop the pred as my vet suggested by 50%. Brin is on the milk thistle and pet tinic so they must help lots too. Hopefully Riley continues to go up in values once you add the tinic. Please keep me posted on what your vet does for her as I feel as though my vets aren't as up on this disease. The support on here has been awesome for me! Keep up the great work with your Riley! Christina

Christina Nashville

Hi Jennifer, Did your vet mention to you that Riley has Evans Syndrome? This is when the immune system is destroying both red blood cells and platelets. From the platelet numbers above (48 on the 1st March), this is quite low. Normal range is 200 to 500 I believe.... Riley's platelets are in the normal range now from the numbers you give above, but you do need to keep a close eye on these as well. This is an extra challenge for you than dealing with IMHA (red blood cell destruction ONLY). Johnny - I think I would have gone crazy waiting for Millie's crit to climb out of the 20's for eight months! 6 weeks was long enough, I know how frustrating it was for you at the time from your posts.... Keep us posted Jennifer, Sam and Millie.

Samantha Geelong

Jennifer, sorry i am not quite as up to date on the forum as i used to be. has Riley's thyroid been checked? Adding thyroid medication can sometimes get the blood building going. It is all connected.... i think it is wonderful that you have vets that are so informed on the newest research. don't forget to check out the Meisha's Hope site and all the wonderful success stories. You can see from them, that it takes time, but there is hope Riley will get better. Best wishes, Brigitte

Brigitte BC Canada

EXACTLY what Brigitte said!!! GET THE THYROID CHECKED if it hasn't been already. If the values seem normal ask the doc to add low dose soloxine anyway. It doesn't hurt anything and like Brigitte said it can help stimulate the bone marrow to make new blood.

Johnny

Feel free to add ALL the other numbers if you'd like. They are the ones I'd be more interested in. :)

Johnny

Thanks all for your comments and ideas. I am so overwhelmed with this medical stuff - I wish I knew better what to ask the vet when we are there! There was no mention of Evans Syndrome, how do they test for that? I will put that on the list and ask next time. Yes, the platelets are normal now, which the vet was very happy about. Thyroid - not sure. They did an extensive blood work when he was first diagnosed, what is the abbreviation I am looking for that refers to thyroid? Please forgive my denseness on this - I'm not well versed at medical stuff. I'm learning though!! I will post the full lab values later. I'm at work now, and they've been so kind about giving me time off for vet appointments, I don't want to push my luck with typing that whole thing out on company time. :)

Jennifer

Quote: "Please forgive my denseness on this - I'm not well versed at medical stuff. I'm learning though!!" LOL, When Tessy was first diagnosed and we were sitting in the vet office talking they mentioned having a CBC done to me. I thought they were talking about a TV station (CBC) and asked them what television had to do with this!!! hehehe I'm sure many of us have been in your exact shoes with the learning curve.

Johnny

I do have a cat with diabetes that I was able to get into remission in very short order with diet change and an alternative insulin schedule that I learned about from a message board and vet I found online - so I have walked the road a bit, but IMHA is a MUCH rockier road and I still have a lot to learn. Thanks for your patience!!

Jennifer

Jenifer, Most of us have never heard of AIHA before our dogs got struck and have no medical background. But it sure is a steep learning curve! I remember asking at the vet what Kahlu's PVC (plastic!) is instead of PCV (packed cell volume) :) After a few months I kept joking that I should get an honorary doctorate in Vet medicine, with specialties in Hematology, Immunology and Pharmacology. and we keep learning! On that note, I am pretty sure Riley's Thyroid was not checked with the blood checks he had. It would be a totally separate check. Please ask for it, it really could make a difference. My dog never had any Hypothyroid signs before getting ill, but a few weeks into the illness, when he got checked on Dr. Dodds recommendation, it was quite low. To supplement helped Kahlu with the blood building and he got perkier as well. It is worth checking, if it is ok no harm done. I am so glad you have kind people at work, that understand that you need to be with your boy at this time. Best wishes, Brigitte

Brigitte BC Canada

OK, as promised here are the CBC's from all our visits. 3/1 3/5 3/11 3/18 WBC 13.9 35.1 27.2 21.9 LYMF 1.9 8.5 7.6 3.4 GRAN 9.7 20.3 13.8 13.9 MID 2.3 6.3 5.8 4.6 LYMF 13.7% 24.4% 28.1% 15.8% GRAN 69.5% 57.9% 50.7% 63.5% MID 16.8% 17.7% 21.2% 20.7% HCT 18.5% 21.1% 27.4% 28.2% MCV 58.8 74.4 80.4 75.9 RBC 3.16 2.84 3.41 3.72 HGB 6.5 6.6 8.9 9.8 MCH 20.6 23.3 26.1 26.5 MCHC 35 31.4 32.4 34.9 RDW% 12.4% 12.4% 12.5% 12.5% MPV 7.6 13 11.2 9.2 PLT 48 157 361 278 NOTE: at the 3/5 visit the vet took a blood smear and looked at it under the microscope to try to find out what was going on with the high WBC's. After doing this, saw immature red blood cells and felt the machine was reading those as WBC's due to their size. For all of us with newly diagnosed dogs, who are climbing the steep learning curve, I found this explanation online of what the CBC values mean. I am finding it really helpful, so I though I'd share it! WBC = White blood cells These are ‘The defenders’ of the body. They help to fight off infections, or react to vaccines if the individual is receiving a vaccination. LYMF = Lymphocytes (absolute number) Lymphocytes are a certain type of WBC. They are most important in viral infections. In the early stage of viral infections, the numbers will be low. GRAN = Granulocytes/Neutrophils Their primary function is phagocytosis. Webster describes phagocytosis: the engulfing and usually the destruction of particulate matter by phagocytes. MID = Monocytes/Macrophage: This is the second branch of the phagocyte system. They can gobble up larger particles within the blood system. They also have other roles such as modifying those foreign particles so the Lymphocytes can recognize them The second part has the percentage of each different type of WBC amongst the total number of WBC’s. LYMF = Lymphocytes. (percentage) In both dogs and cats, the percentage can be low as a response to stress in the body. The stress could be just coming to the hospital, or a serious disease condition. GRAN = Granulocytes/Neutrophils These primary phagocytes should be the highest percentage among the white blood cells (unless you’re a cow) and that relative percentage is very helpful to determine if changes are due to disease, stress, or other conditions. MID = Monocytes/Macrophage They also moderate and ‘recruit’ the neutrophils to the site of infection. HCT = Hematocrit This value is defined at the packed volume of red cells in wholeblood. In our primary machine it is calculated by MCV x RBC. In an emergency it can also be individually measured. MCV = Mean cell volume This number is derived from a red blood cell ‘histogram’ and shows ‘size’ of the red blood cells in relation to the normal size. RBC = Red blood cells The count of red blood cells. This is done by an actual count. The cells are counted by getting them ‘lined up’ and then counting them as they go through an opening. RBC – they have an average diameter 6-9 microns. HGB = Hemoglobin concentration Hemoglobin is the part of the red blood cell that carries oxygen. It is important that hemoglobin be in certain proportion to the red cells. MCH = Mean cell hemoglobin Calculated by HGB/RBC. A low number may indicate an iron deficiency, or a condition that breaks up red blood cells. MCHC = Mean cell hemoglobin concentration is calculated defined as HGB / HCT. It is the indice value which is used to verify the presence of adequate hemoglobin concentration in the cells visible on the peripheral smear (looking at blood on a microscope slide). RDW% = Red blood cell distribution width This value is calculated by the red blood cell distribution curve, and demonstrates the amount of variation in the size of the red cells. If the size is out of the normal for red blood cells, it may indicate several different issues. MPV = Mean platelet volume is determined by the platelet distribution curve size. This value helps to show the size of the platelets. PLT = Platelet count Platelets function to ‘plug holes’ in the blood system. Platelets are the small cells that show up initially and are later followed by fibrin in the formation of a clot. Low platelet counts can indicate that the body is using up the platelets available, or is not able to produce them normally.

Jennifer

Sorry about the formatting on the CBC above. I had it all nicely formatted but when it posted it is all crammed together. I hope you can read it.

Jennifer

Jennifer, It is a steep learning curve but it is surprising how soon you catch onto things you never would have guessed you would ever need to know. I know how hard it is to want to be done with all this and have Riley back to the dog he was. Just remember every step forward sometimes leads to a few back, but hopefully soon you will see all kinds of positives happening before your eyes.

Penny Lytle Creek Calif

Jennifer, I'm going to wait till the next test to try and guess with these numbers. I want to see what the results will be after adding the pet-tinic to the mix. Overall though things look alright to me. The HCT, RBC, and HGB are ALL rising so that's what we want to see. The next test will answer some questions with regards to the "M" numbers. Perhaps you could have the blood sent to a pathologist or even better Hemopet and Dr. Dodds. Having a full morphology helps and if this hasn't been done yet then perhaps this could be an appropriate next step....just to see where thing are. ALSO, like Brigitte was saying, the thyroid test is separate from the CBC and I would HIGHLY recommend you get this done sooner than later. Don't let the vet say this isn't needed. Insist it be done! OR if you sent the blood out for a morphology to someone like Dr. Dodds she does breed specific testing of the thyroid! I think the only other place that does this is Michigan State. If I were you and money isn't a big issue this is what I'd do. It was one of hte best things I did for Tessy!!! How's Riley doing this weekend? Hope all is going well for you and him. Continued prayers and thoughts coming to both of you. Johnny & Tessy

Johnny

Thanks for the input Johnny! I have already decided I will insist on the thyroid panel at the next visit. You've given me food for thought on other good next steps. So much to consider! Riley is acting like his usual self - eating well, etc. I am hoping the Pet Tinic will give his blood a kick in the butt. I trekked to the health food store and got some milk thistle today as well. I may have to wait a couple days to start giving it; I have to go on a business trip Monday and Tuesday and want to be home before starting anything new in case of a reaction. My husband just isn't as observant as I'd like him to be! I think his gums are looking pinker - he is really hating me right now because I am constantly lifting his lip.

Jennifer

Jennifer, in a lot of cases the regular vets will cost well over $100 each visit! Am I right with your case? Anywho, I was just looking at the pricing on the Hemopet site (hemopet.org) and the price to get a "Profile 7200" done is only $115! This is the test that I usually have them do for Tessy as it includes almost everything you'd need. Dr. Dodds does her own analysis of hte blood results also which is why this is the best way to go! Here's a link ot the prices in case you are interested. You'd have to add on whatever other costs there'd be like shipping and handling, and probably a vet fee for getting the blood and packaging it. www.hemopet.org/files/TRF.effective_2010.01.01.pdf MANY of us on here send blood to Dr. Dodds for analysis cause she's literally the best at what she does! She'll tell you what's going on with the blood in much more detail than your regular vet probably and she'll also give you recommendations usually. Very well worth the money!!!

Johnny

I just started looking at the Hemopet site when I saw your reply. Thanks for the recommendation on the Profile 7200. I was not sure which one Riley would need. Does that include the thyroid panel? Are there descriptions of what the different blood tests are? I feel kind of clueless when I look at the site. I must say I am grateful that our vets have been pretty compassionate with their pricing, not charging us for many little extras. The last couple visits have been between $60-80 and that has included the prednisone and an antibiotic for awhile. I think they know the weekly visits, CBCs and medication can be a bit much for people. (The first visit with the full blood workup and ultrasound was well over $200 though, and I don't blame them, they did a lot and we were there for over two hours). I am not opposed to spending the $115 on Dr. Dodds though. Money is not unlimited around here but I am grateful we have not had to do any transfusions or emergency stays at the vet which I know can be costly.

Jennifer

When you say Dr. Dodds does a breed specific thyroid test - what if the dog is mixed breed and we are not 100% sure of the breeds involved? He obviously has a lot of German Shepherd but beyond that, it is anyone's best guess. One vet pointed out some lab characteristics - like the tail and ears so we always just say German Shepherd-lab but who knows if that's correct.

Jennifer

I should move down near you!!! I pay over $100 just about every visit to the vet! Yeah, the Profile 7200 includes the thyroid panel (full panel) not just the T4 like some vets do. It also has the CBC and chem panel as well as the pathology report. Basically everything important for this disease. you can add extra tests as well if you'd like. For example I had her check Tessy's iron levels once as well as her B12 levels. Can't remember the costs though. Breed Specific...just give the best discription of what you think Riley is. She also uses sex and size as well as if the animal is spayed or neutered.

Johnny

This thread was discussed between 18/03/2010 and 21/03/2010

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