Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Setback

After much optimism that Maggie could come home as early as today, we have a setback. Maggie has thrown more clots. The doctor thinks she knows what is causing them and is still in the realm of treatable as long as she does not throw another clot. However, her condition is more serious. More hospitalization and less certainty. Her Reticulocyte response is good. 233,000 Her PCV, is only 24. Maggie's regular vet is focused on the PCV, while the vet at the hospital is more encouraged by her reticulocyte count. I am going to ask them, if it doesn't affect Maggie's treatment, to treat Maggie for bleeding ulcers, if at all possible. Hopefully there is something that can coat her stomach. They think there may be some hypercoagulobility caused by the Prednisone. They are reducing the Pred dosage and increasing the Heparin from 2 to 3 doses. She is also getting aspirin. So as long as the doc says Maggie is still treatable we are moving ahead. She just can't throw another clot which is possible. Update: Just saw Maggie and she looks fully engaged, pink, doing the prednisone pant (which should go away since they cut her dose down to a quarter) enjoying the food I fed her and the affection. She has a fighting chance of beating this thing. After I hugged her in the oxygen chamber, she made like she wanted to go with me. I told her to beat this thing, destroy those clots.

RobertN Superior

RobertN and Maggie, You will both remain in My Prayers. I hope that your Maggie will be home with you soon.

Kathy Calif.

Kathy, thanks. The clots are called PTEs. Nasty little buggers and depressing to research. But Maggie has better than a 50% chance of winning given that they are on top of this and she is otherwise still in decent condition.

RobertN Superior

Robert, I am so sad to hear this. I will be thinking about Maggie today as I go about my day. The Morris Animal Foundation, in combination with Meisha's Hope (Vetnet moderator's excellent website) does significant research, on our behalf, of AIHA and the associated complications of treatments. They have two completed studies that you would be very interested in right now. Please read these and print them out for your vet, in case they have not seen them. my best patrice http://www.morrisanimalfoundation.org/our-research/results.html?animalspecies=dogs&study_area=blood-disorders&active=active&completed=completed&vssstudy= Computed Automated Thrombogram®: a New Approach for Monitoring Low-Molecular-Weight Heparin Therapy in Dogs Completed: May 20, 2010 Results Study Reveals Insight That Improves Treatment for Blood Clotting Many illnesses, including infections, immune diseases, cancer and heart disease, can predispose an animal to developing fatal blood clots. Low-molecular-weight heparin is an anticoagulant used to prevent clot formation. Monitoring therapy is essential for the drug’s safe use and to ensure that it is working, but reliable methods of monitoring this type of heparin were not available until this study. Researchers from the University of Montreal analyzed the use of calibrated automated thrombogram (CAT) to monitor the anticoagulant effects of heparin therapy in dogs. Researchers learned that CAT can be easily and reliably used to monitor the effect of heparin on coagulation in dogs, making it easier for veterinarians to choose optimal doses and dosing intervals. They also determined that the drug’s effect varied significantly among the dogs, indicating the importance of adapting the therapy for each animal, and that the drug’s overall effect lasted longer than previously reported. This is a significant discovery because it indicates that the drug can be administered twice a day, rather than the current recommendation of three times a day. Less frequent dosing makes it easier for owners to administer the drug at home and dramatically reduces the cost of therapy. Another important discovery was that dogs experienced a period of increased coagulability after heparin therapy. This is the first time this has been documented in animals and merits further investigation regarding its clinical impact. In particular, animals being weaned off heparin may need to receive another anticoagulant to lower their risk of clotting. Veterinarians can use the results of this study to improve treatment for dogs at risk for developing fatal blood clots. Principal Investigator: Dr. Christian Bedard, University of Montreal Study ID: D08CA-082 Comparison of Aspirin and Heparin in Treating Dogs with IMHA Immune-mediated hemolytic anemia (IMHA), a common form of severe anemia in dogs, is associated with high mortality rates. Many dogs die due to related blood clots. Investigators will expand their previous research on heparin therapy, which showed that individually adjusted heparin dosing was significantly better than standard-dose heparin therapy in reducing mortality. A recent retrospective study reported improved survival in dogs with IMHA that received low-dose aspirin therapy, which resulted in aspirin becoming standard therapy for dogs with IMHA. However, multiple studies comparing aspirin to heparin in humans have shown marginal to no benefit with aspirin as opposed to significant reduction in blood clots with heparin. Researchers will establish whether aspirin or individually adjusted heparin therapy is more effective in enhancing survival in dogs with IMHA. Principal Investigator: Dr. David J. Polzin, University of Minnesota Co-sponsors: Meisha's Hope AIHA/IMHA Fund #338; Arlene & Ron Klein, in memory of Buttons; Evidence-based Veterinary Medicine Association (EBMA) Study ID: D10CA-026

Patrice NYS

Robert, I have been following Maggie's story, and please know I am keeping her (and you) in my thoughts and prayers. This is an awful illness, and I so hope that the issue with the clots can be resolved quickly. Wishing you both all the best, Sally and Bentley (OTB 10-29-11)

Sally Louisiana

I'm so sorry for this setback Robert. How did they come to this conclusion I wonder. Do you know if they are just assuming that's what it is or did they do appropriate tests? I'd think the thromboembolisms are due more from antibody coated red blood cells sticking together than the pred but I may be wrong. Patrice likely knows more about this. I'll be keeping you both in my thoughts and prayers! Johnny, Tessy & Sadie

Johnny

Johnny, Inappropriate clotting like this can be caused by disseminated intravascular coagulation, DIC. It is a complex condition that can be accelerated by an existing medical condition, such as autoimmune diseases. This may have also been a side effect of the transfusion, for instance, if there was a transfusion reaction. This webpage explains it really well for the layman. http://www.vetinfo.com/disseminated-intravascular-coagulation-in-dogs.html my best patrice

Patrice NYS

Patrice, Maggie's clotting is categorized as a PTE. However they did mention yesterday that Maggie could have mild DIC. What I'd like to know is whether her previous clot was resolving. All clinical indicators: eating, drinking, bodily functions, responsiveness and daily improvement showed her getting better. She is a little more lethargic today but still responsive. Its like she took a bit of a step back by one day. They really think Prednisone could have been a contributor. She still responds well, breathing normally, while in the oxygen chamber. Increase in her Lovenox, decrease in her Prednisone (down to one quarter dosage). She will still get walked out for bathroom breaks and to see tolerance outside the oxygen chamber. During my visit, she indicated to me she really wants to go home. She ate and drank for me. Tried to follow me out from the oxygen chamber. She is a fighter! Headed back there for evening visit hours. Clot defeating Warriors, Maggie and Robert

RobertN Superior

Robert, Think of Pulmonary thromboembolism (PTE) as a description of a location of a clot, along with the negative effects that clot can have in that location. Think of disseminated intravascular coagulation (DIC) as a condition, a cluster of events that causes inappropriate clotting. DIC is a complicated condition to treat. It can develop slowly or very suddenly. When it happens fast it is very difficult to keep it from escalating. It can be a cause for sudden death. It takes great deal of skill for a human doctor or a vet to halt this progression. Please read the information about individually dosed heparin above. I think it is a significant advancement in treatment protocol. my best patrice

Patrice NYS

Patrice, I did read the information about individually dosed heparin and printed it out for the vets. Thanks for the clarification. Robert

RobertN Superior

Robert: Just wanted to let you know that we are thinking about you and Maggie and hoping for the best. We will keep you in our thoughts and prayers. Rita, Mike the (angel) girls and Jake

Rita IA

Robert, you and Maggie are truly being lifted up in prayer! This fight is won by facing each battle and knowing that we are doing the best we know to do for our furbabies! We don't know the outcome, but we have hope as long as they are responding to the protocol that you and the vets deem necessary for your pet. Maggie is blessed to have you! Blessings, Cindi & Tori

Cindi Fl

Cindi and Rita, Thank you for your comments. Maggie was more energetic this evening than this morning. The vet says that she is probably resolving her clots. The task now is for her modified heparin treatment to keep her from creating new clots. I read a Meisha success story with a dog who had clots and it was much more serious than Maggie's. Maggie was really affectionate and ate enthusiastically for me. She is still taking her cyclosporine and azathiorpine but is down to 1/4 dose of prednisone. She is taking medicine also for her pulmonary hypertension and when that shows easing in her lungs, it will demonstrate that she is not throwing clots. Mostly you can tell by her behavior that she is responding to treatment. Today she is responding, so that brings us one step closer to her coming home. Vets say she has a 50-50 chance. I say that they don't know Maggie if they don't think the odds are stacked in her favor!

RobertN Superior

Don't like ending on message 13. so here is a filler message.

RobertN Superior

Hi Robert, I will never forget what our daughter said, "Where there's Life, There's Hope." We will keep you and your Maggie in our Thoughts and Prayers. She's in good hands but will be in better hands when you get her home. ;)

Kathy Calif.

chance candle on in the kitchen for maggie tonight. patrice

Patrice NYS

Sending our prayers for your Maggie. Please let us know how she is doing today. Cheryl & Ginger

Cheryl & Ginger

Brief update: Maggie had a peaceful evening. No news was good news. She ate, slept, drank water. Her respiration at 40% in the oxygen chamber was between 28-35 which the tech called "excellent". She did not want to come out of the chamber for the tech which the rather dour overnight crit care vet attributed to IMHA. But the tech seemed to think it was because it was his first night there since she'd been admitted and that she did not know him well. He did walk her around inside the lab. Most importantly, knock on wood, no symptoms like the previous night, that would indicate more clots had formed. In my opinion, she is winning! She is working towards a recovery so she can come home. My visits, I believe, are crucial at this point. They tether her to her life and motivate her to heal.

RobertN Superior

Robert: I firmly believe our daily visits made the difference in Sheba's recovery when she was in the ICU. I also had running conversations with her in my head. I'm not sure if she could hear me but they made me feel better. Hang in there - we're all rooting for Maggie. Rita, Mike, the (angel) girls and Jake

Rita IA

Robert, Just checking in this morning, and hoping that sweet Maggie has had a good night, and is closer to coming home to you!! Keeping y'all in our thoughts and prayers. Sally and Bentley (OTB 10-29-11)

Sally Louisiana

RobertN- What were Maggie's symptoms when she was throwing the clots? Gertie had her 6th transfusion last Wednesday and it went horribly wrong. The vet says that she either developed Pneumonia or she threw a clot. She was vomiting, congested labored breathing, coughing, fever...on oxygen for 2 days, in icu for 4 days. Any info on your experience would be very helpful. Thanks.

Stephanie Seattle

Maggie was very hypoxic, labored breathing with not enough O2 to tissues prior to going in the oxygen chamber. She developed pulmonary hyper tension and congestive heart failure, which were confirmed by a heart echo (electrocardiogram). She could hardly get around at first when outside of O2 but was stable with it. She was stabilized with O2 and given three injections daily of Lovenox (blood thinners) daily. The vet also reduced her prednisone from 80 mgs daily to 20 mgs daily as it was believed to be causing Maggie to be more hyper-coagulable and she was already immuno suppressed with the Cyclosporine and Azathiorprine. It sounds as though Gertie could have pulmonary embolisms like Maggie did. Immediate and round-the-clock care would be required in this case. I am so sorry, but Maggie made it through this. It was tough. My thoughts and prayers to you and Gertie! I emailed this post to you as well.....

RobertN Superior

This thread was discussed between 17/11/2011 and 16/12/2011

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