Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Schnauzer with IMTP after AIHS

Our Schnauzer has been battling AIHS since February 07. He was off all meds for the last three months but has relapsed with IMTP - Thrombocytopenia - and is in critical care at our Vets, who is treating him with all available medicines for this. Yesterday after his first treatment he was up and moving around, but this morning is depressed,can not stand, and has swollen joints. We are trying very hard to find any information, new treatment protocols, anything, that might help him. We would also like to talk with any specialist veterinarians who have done studies on this disease or with significant experience with AIHS and IMTP. Thank you!

Christine Palm Beach

Typos: email is corrected. Our dog is experiencing AIHA and IMTP, not AIHS, sorry!

Christine Palm Beach

Christine, I am so sorry to hear about your Schnauzer. I have 2 of my own. What tick disease tests have been done? This could be very much related to one of the more severe tick borne diseases. If I read that you are in Florida, there are ticks in your area. Patrice

Patrice New York State

Hello Patrice, He has been tested in February when he first became ill for all tick-borne diseases possible. All tests negative. He was treated with Pred, then off the pred for 3 months, but has this week relapsed with Trhobocytopenia - essentially his platelets have dropped to almost zero. He is not doing well, bleeding from one eye, swollen joints, depressed, not moving at all. He is at the Vets, and I am urgently looking for additional treatment information - anything new, any new wonderdrug, new treatment protocalls, anything at all. I would appreciate also talking to a vet experienced in both AIHA and IMTP - some are calling this Evan's syndrome. There is a great degree of urgency right now. We do not know if he will come home, and it does not look good.

Christine Palm Beach

Christine, I am checking with an expert about this and will hopefully know something later today. Thrombocytopenia is the loss of platelets and is very serious because of the bleeding, esp internal. Have you discussed transfusions at all? I hope you have some more positive information later. Patrice

Patrice New York State

Hi Christine, I am so sorry to hear about Schnauzer. But I wanted to write to you because my miniature dachshund Tipsi was diagnosed with AIHA back on September 21st and then in addition to the AIHA, was diagnosed with ITP. And you are correct, they do call this Evan's syndrome. Her platelet level dropped dangerously low and they were concerned about her hemorraging but I am sure you are aware of that. Tipsi was treated at the NC State Veterinary Teaching hopsital. The internal medicine department was amazing in her care and treatment. I know they gave her several transfusions of plasma to increase her platelet count and to increase her coagulation times. Tipsi was also on dexamethasone which is the IV form of prednisone. She was also on mycophenolate which is another immuno suppressive drug. The combination of these drugs proved beneficial in her case because she is doing much better now. Although I must warn you that after battling the Evan's Syndrome Tipsi also battled another condition called Disseminated Intravascular Coagulation (DIC for short). This is where her blood has the ability to throw clots to vital organs. To help treat this condition the vets gave her injections of heparin. This also helped a great deal in her recovery. I hope this information helps. Also if you have any other questions please let me know. I would strongly suggest trying to take you Schnauzer to an internal medicine specialist if possible. Especially in crisis situations such as this. If one is available then maybe you could get your current vet to call an internal medicine specialist for advice. I wish you the best of luck!!

Layla Raleigh

Christine, If you have not read the Success Stories at the Meisha's Hope AIHA/IMHA Website you might want to consider doing that. The URL is http://www.cloudnet.com/~jdickson/successstories.htm Be sure to read the current November 2007 Story of Tess who also had Evans Syndrome (AIHA/IMHA and ITP) at the same time. Tess was very very ill but now is doing well. Her human mom, Claudine posts on this forum from time to time. It would very wise for you to seek an addtional opinion from a veterinary internal medicine specialist or a veterinary teaching hospital.

Joanne

Patrice, Joanne, Layla, Thank you. We discussed transfusion with our Vet, who does not recommend it at this point in time. Kents levels were yesterday not low enough to warrant it, and as for a platelet transfusion, over 75% die before they can get into and used by the dog's body. Apparently, 50% of platelets die before the transfusion can already begin, and our Vet does not think this would help Kent at this point in time. Thank you for checking with your experts, i look forward to hearing what they might say. Our Vet has been consulting with internal specialists, and their recommendation is what he has been doing anyway. Joanne, i have read Meisho's page, in fact i am pretty sure i sent you an email there. It is very inspiring and i think a great resource. I also looked at the work the Morris Animal Folks are doing, but i did not see anything that is current or completed re thromocytopenia. There is a specialist in England, a Dr. Day, with his own research group on Cytopenia and Immune disorders in dogs. His link is: http://www.bris.ac.uk/vetpath/cpl/mjd.htm Right now we are at a standstill, waiting to hear how Kent is doing. Everything has been done, and it seems we just have to wait, which everyone here knows is extremely frustrating, and distractions from waiting are few and far between. I have been on the net all day and cleaning house.

Christine Palm Beach

Christine, Sorry for the length of this following attachment but read it over and see if anything fits with you. If it does, print for your vet. Some of the tests and treatments may be updated from this post but the testing locations, esp Protatek, are still current. Your vet can call Dr. Holland and talk to her about testing, she will also do consultations. I am sorry for the crummy formatting. I don't have time to clean it up too well. Patrice EHRLICHIOSIS Lynda Adame adamel@applique.dh.trw.com 9/8/99 What Is It: Ehrlichiosis is a tick-borne rickettsial infectious blood disease. The organism is called Ehrlichia, the disease is called Ehrlichiosis. Species: Ehrlichia canis, Ehrlichia risticii Primary Vector: Brown Dog Tick (must feed a minimum of 2 -3 days to transmit)for E. canis. Horse manure and other unknown sources for E. risticii. Other Vectors: Deer tick, blood transfusion, contaminated needles andinstruments, transplacental. Diagnosis: There are three tests being used by Veterinarians to detect infection: 1) The IFA (Indirect Fluorescent Antibody Assay) test is used to detect the presence of antibodies to the disease in a dogs blood serum. This test will determine a titer level; less than 1:40 is considered Negative (minimal exposure),titer above 1:80 is considered Positive for an active infection. The IFA is considered the most reliable test for detecting infection. Ehrlichia titers can climb much higher than Babesia titers. 2) The Giemsa Smear is used to locate the actual organism in the dogs blood. Despite appropriate staining technique and intensive film examination, the organisms frequently cannot be found. 3) The PCR (Polymerase Chain Reaction) tests for the presence of the organisms DNA in the dogs blood. This test is not widely available. Titer info: Titers counts double: 1:10, 1:20, 1:40, 1:80, 1:160, and so on. A high titer can be caused by repeated exposure to the disease, a large number of active organisms in the blood, or a better immune system response of a specific dog. (i.e. a dog responds naturally with more antibodies than another dog). Titer is an indication of exposure to a specific foreign protein. It does not indicate that there are active organisms in the blood. Comments: Ehrlichiosis is believed to go through patent and dormant periods, much like Babesiosis does. It has been the experie- nce of people who have owned many Ehrlichia infected dogs, that this disease does not remain dormant, it slowly and steadily grows within the dogs system. If used soon enough, both Tetracycline and Doxicycline (at variable treatment lengths) have a 98% success rate at curing dogs of Ehrlichiosis. Phases: Acute - This phase is of short duration, and is where the dog is initially infected with the disease. If the dog does not die outright from the infection, then it moves on to the next phase. Subclinical - This phase can last months or years. It is characterized by a fine equilibrium between the parasite and the immune system of the host. This equilibrium can be disturbed by a number of things: environmental stress, additional diseases/infections, (especially Babesiosis),immunodeficiency, spleen removal, surgery, stress, hard work, imunosuppressive treatment, use of corticosteroids (Prednisone is a no-no). The dog may exhibit few clinical symptoms during this phase, beyond intermittent fever and loss of appetite. If the equilibrium is disturbed, the parasite will begin to slowly grow in number and the dog will move into the next phase. Infected Greyhounds are often in this phase when they are adopted out. Chronic - If the dogs system remains unable to clear the parasite, it enters this final phase. The most obvious initial signs to an owner are a cycle of: lethargy, loss of interest in food, and a gradual loss of body condition especially evident around the eyes and along the spine. Other symptoms are: hemorrhaging even when blood count looks normal, clotting problems, seizures, muscle wasting, skin infections, neurological signs (repetitive obsessive actions, or palsy), diarrhea, low Platelet count, vomiting, hyper reflective eyes, low White Blood Cell count, anemia, glomerulonephritis, bleeding from the nose or eyes, ocular signs, arthritis, weakness, pallor, incontinence, pneumonia, cough, kidney failure, increased thirst and urination, incoordination, neck or back pain, bleeding under the skin or a rash (purpura), swelling of the legs or joints, enlarged lymph nodes, irreversible bone marrow suppression. Misdiagnosed as: reticulosis, systemic lupus erythematosus, brucellosis, blastomycosis, thrombocytopenia, endocarditis, immune mediated disease, myelophthisis, cancer of spleen or liver, Valley Fever, plasma cell myeloma, leukemia. Treatment: Doxicycline at 11 mg/kg b.i.d. for 2 - 4 weeks, or longer. OR Tetracycline 22 - 33 mg t.i.d. (oral) for 2 - 4 weeks or longer. Imidocarb (Imizol) can be used to treat chronic cases of Ehrlichiosis that do not respond to Tetracycline or Doxicycline. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Here are some Labs that perform tick disease testing: University of Illinois (This Lab can run the PCR test) Laboratory of Veterinary Diagnostic Medicine ATTN: Dr. Kakoma P.O. Box "U", 2001 S. Lincoln Urbana, IL 61801 PH: 217/333-1620 or 217/333-1859 FAX: 217-222-4628 +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Protatek Reference Lab ATTN: Dr. Cynthia Holland 574 E. Alamo St. Suite 90 Chandler, AZ 85225 (602) 545-8499 Instructions for Tick Fever Panel: Draw 3cc of blood, use a serum-separation tube, spin down, refrigerate until mailing. Try to mail early in the week, ship tube upright in ice and use priority mail. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Dr. T. McElwain Washington State University Vet Diagnostic Lab Pullman, WA 99164 +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Dr. E.B. Brietschwerdt Dr. M.G. Levy North Carolina State University College of Vet Medicine 4700 Hillsborough Rd. Raleigh, NC 27606 +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Dr. D. Huxsoll Louisiana State University School of Vet Medicine Baton Rouge, LA 70803 +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Corning Clinical Lab P.O. Box 305125 Nashville, TN 37230 No instructions available. ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Here is the name and address for the Lab out here that does PCR testing. Antech Diagnostics 13633 N. Cave Creek Road Phoenix, Arizona 85022 602-971-4110 ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ --

Patrice New York State

Christine, Also see this excellent web site: http://blackgsd.googlepages.com/ehrlichiosis

Patrice New York State

Christine, Has your vet considered adding Vincristine to the treatment regime? It does work well for some dogs in getting the platelet count back up. Here is the URL of a site that contains info on vincristine http://www.marvistavet.com/html/vincristine.html What meds is Kent currently on?

Joanne MN

Christine, I consulted today with one of the tick borne disease experts on a tick forum I am a member of. They responded this evening to my request for help. The comments are below. You live in an area where it is commonly known that Greyhounds get tick diseases. If this were me, I would ask the vet to call Dr. Holland at Protatek Labs tomorrow and consult on the phone about possible tick borne disease tests. Dr. Holland is an expert, this is all she does. If your vet does not feel more testing is appropriate think about consulting with an internal specialist in your area asap. Some people who come to the tick forum for help are guided on how to ship blood samples to Protatek lab themselves. I tell you this because when Chance was first diagnosed with aiha, I was on the phone with my vet immediately to get a blood sample shipped out to Protatek overnight. Dr. Holland chatted on the phone with my vet about the required tests and how to pack them properly. You can also go to the link below and join the tick list and ask for help. We have a vet on the list full time and there are several experts that can help you with questions. The are extremely dedicated to helping owners whose dogs may have a tick disease. http://saluqi.home.netcom.com/ticklinks.htm You will see this message, click on it to join: Managing your TICK-L subscription options, etc. Subscribe, sign off, change options, or search the list archives from the TICK-L home page These are selected comments that were sent to me this evening: "Depressed, swollen joints, cannot stand, thrombocytopenia... yes, this dog may have a TBD. What tick tests were actually done?" "Was the dog given doxy? Did they consider the less common forms of ehrlichiosis? N. risticii, E. ewingii, E. chaffeensis? Did they test for babesiosis? Was he tested for bartonella? http://www.vet.uga.edu/vpp/clerk/hopkins/ Was he tested for RMSF? http://www.vet.uga.edu/vpp/clerk/otis/" I will be thinking about you tonight and hope tomorrow brings some answers for you. patrice

Patrice New York State

Hello All. Patrice, thank you for the information. Kent was tested fully in February when he first crashed for any tick related disease infections. We really don't believe that this is now causing his thrombocytopenia. We are consulting with a local internal specialist today, hoping it is not too late. I have called and emailed several specialists around the world, and not received any replies. When speaking with the vet late last night, I asked him to call some specialists on the east coast and gulf coast that i found, but sadly it seems that no one will consult with him without seeing the dog, and we dont believe it is in Kents best interest to go on a 8+ hour road trip right now. Kents CBC continues to drop, which is odd because at first it was only his platelets, and no one understands why his red cells are now dropping when they were normal before. He is not getting up, responding to his name, eating, or drinking. We are going to visit him at the end of the day today and talk to vet and get latest results.

Christine W Palm Beach

Update on Kent: This morning he got up and ate a little. This afternoon during a walk he collapsed. He was put on oxygen and remains on it. He is bleeding rectally, nothing else like poo coming out. He is completely out of it. He is taken off baytril and put on something else, i am trying to find out what. We will have test results tomorrow. Vet has not been able to reach his internal specialist. Kent has friday appt with specialist if he survives. We will see him at 5:30 today. I feel like i have overwhelmed our vet with my research and suggestions and am afraid he will tell us to take him somewhere else. He did look at Meisha's hope last night. We are all feeling helpless. His prognosis is now poor. Any and all suggestions and prayers are appreicated.

Christine West Palm Beach

Looking up Baytril it can react with Cylcosporine, causing kidney problems.... Don't know if Kent is on cyclo.... Prayers to you for this fight. Mary and Missy.

Mary Tx

Christine, I am so sorry about this horrible situation you are going through right now. I do know the panic you are feeling. I still have a strong feeling that Kent was either not tested for ehrlichiosis or had a subclinical value when he was tested in Feb. It is very possible that after going through the acute stage he entered the subclinical stage and it has now reemerged in the chronic stage. If you are not getting help from any specialists please contact Dr. Jean Dodds. http://www.itsfortheanimals.com/HEMOPET.HTM Be prepared with the results of the latest blood tests and any paperwork with diagnosis on it. Patrice

Patrice New York State

This thread was discussed between 13/11/2007 and 14/11/2007

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