Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - starting recommended prednizone dosage

My head is swimming with all of the information I have been gleaning on AIHA. I noticed another post that the mimium recommended dose is 1Mg per body weight? My dogs PVC is .32, was .36 on Saturday and he started her on pred today and only 20 mg, she weighs 50#. it sounded like he didnt want to start off on a high dose. He said he has been confirring with an internist.

Laurie CA

Hi Laurie. I'm sorry your dog has developed AIHA but this this a great site for support and information. When my dog was initially diagnosed with AIHA, the internists put him on 80 mg. of prednisone per day (40 mg. in the morning and 40 mg. in the evening). He weighed 50 pounds at that time. He was also taking cyclosporine and azathiprine (imuran). BUT, unlike your dog who is still maintaining PCVs in the 30's, my dog crashed to 5 and needed two transfusions before he started to climb back to normal PCVs. I would ask your vet about increasing the prednisone dosage especially in light of the fact that your dog's PCV has dropped since Saturday. I think prednisone is fairly fast acting unlike the cyclosporine and imuran. Another really important thing to give them while they are on prednisone is Pepcid AC and sucralfate. Sucralfate is a prescription medication but very reasonable and will definitely protect your dog from developing gastrointestinal ulcers from the meds. My boy has been on both since the beginning and hasn't had a problem. Definitely ask your vet about these. I noticed that you were asking about food in another post. I feed my dog half kibble and half home cooked liver cleansing diet. The kibble I use is Wellness sweet potato and fish. Here is the site giving the recipe for the home cooked liver cleansing diet: http://www.canine-epilepsy-guardian-angels.com/liver_diet.htm This is a home cooked diet recommended by Dr. Dodds. Good luck to you. By the way, what is your dog's name? Please keep us posted and take care. deb and Duck (my dog!)

Debbie BC Canada

Laurie, The least amount of prednisone that a dog with AIHA/IMHA should be on at the onset of the disease is 1 mg per pound of the dog's weight per day, divided into 2 doses, one dose to be given in the AM, the other dose to be given in the PM. Some vets will give an even higher doseage to dogs with very low PCV's. I have seen as much as 3 mg per pound per day given to some dogs at the onset of the disease. Giving too low of a dose of prednsione at the onset of the disease and lowering the dosage too quickly is a mistake, that far too many vets make and it is the dog who will suffer from this sort of mistake. It is good your vet is conferring with an internist. If you have not read my Web site on AIHA/IMHA as yet, http://www.cloudnet.com/~jdickson/ you might want to do so when you can. Be sure and follow the links on the first page to many other sites on AIHA/IMHA that will be very helpful to you and do read the SUCCESS STORIES pages. They will show you what has worked for other dogs in terms of treatment options as well as give you a lot of HOPE.

Joanne MN

My german shepherd puppy Sofie was diagnosed on Christmas Eve day at 5 1/2months old. She weighed exactly 50 pounds at that time. Her dosage of Prednisone was 100mg daily divided into two doses. She continued on that dosage until she was in the 40% PCV level, then slowly tapered off. She has now been med free, of all medications for three weeks, and doing great. 20mg a day is too little for her weight and your vet needs to up her dosage to give the Pred a chance to start working. On the dose that Sofie had, her PCV on the initial blood test was 14%, she started on the pred at that dosage that day and the next day was already climbing to 18% and she just climbed up from there.. She also received Famotidine for her stomach and doxycillian for an antibiotic. My prayers and wishes are with you.

Joanne Wyoming

Thanks for your comments. I had a lengthy conversation with the vet last night. He talked about using the higher doses in dogs with a more severe problem, like in the 20s. He did agree I can give her 1.5 ea day and come in on Friday. He feels she is borderline. We only have one internist in town at another vet that doesnt come in until tomorrow so I think I will get an appt there. The thing that also concerns me is he did have another office do the test yesterday too and theirs came out at 30. I am tempted to give her the full 1 mg and let him know what I did on Friday. I am feeding her that Dr Dodds diet I found searching. The good news is she is no longer jaundice. Joanne, I love yor site, a great wealth of info Thanks Laurie oh whats the saying when it rains it pours, because I had no sleep the night before I was distracted in the kitchen, and my other dog got on the counter and ate a chicken leg bone. He a #100 lab and swallowed it whole, so I slept with him last night to make sure there is no problem, but he may end up at vet too.

Laurie CA

Laurie, Since you can not see a specialist until at least tomorrow, it might be very wise for you to ask your vet to consult with a veterinary internal medicine specialist on behalf of your dog's prednisone dosage. Most vets know many of these specialists and can usually get a consult as a veterinary "Courtesy". My vet consulted with many such specialists on behalf of my Meisha and I was not charged for any of these consultations. It does take 5-7 days for prednisone to start to work and during that time, it is very normal for the PCV to continue to drop. It looks like you are already seeing such a drop from 36 to 30 so getting on the right dosage is important. But it is important to have a vet very knowledable in the disease prescribing that dosage rather then raising or lowering the dosage oneself, therefore having your vet consult with a specialist might be a good answer for all concerned.

Joanne MN

I live in a very small town and my vet had not really had any experience with AIHA and such a young puppy as my Sofie. Because of this, he consulted with a vet from out of state that has dealt with numerous cases of AHIA, my vet and the other vet talked on the phone many many times during this episode. I was not charged any consult fees, and the protocal they decided on together worked for Sofie. I would not decide my own dosages, but if you are not feeling totally confident with your vet, even if it means going out of town or insist on a consult with a more experienced vet. Inhouse tests can run different than a test done by a human lab or an animal lab, Sofies differed at times, but usually by one percent. I would be a bit concerned that your vet might not be aggressive enough, and with this horrible disease, I would want my vet to go aggressive with the pred, the side effects, if she has any, will go away once it starts dropping the dosage, but also once you do get it under control, it takes along time to wean off the meds.

Joanne Wyoming

I contacted UC Davis via email which is the big vet school here on the West coast, they said they would take a consult from my vet, so I am going to do that. He said is is consulting with an internal specialist at Iddexx, they are a lab in Sacramento. They are listed in the I cant remember site that shows internists across the country. Now did he talk to them about dosage, or is this his normal protocal, I dont know, I didn't ask that. Thanks Laurie

Laurie CA

Laurie -- glad to know your vet is going to do a consult with UC Davis. Also glad to know you found Dr. Dodds' diet. You certainly are doing all you can for your Wylie. I will keep you in my thoughts and prayers.

Brenda VA

Laurie, I'd be interested to know who your vet has spoken with at UC Davis. Today I took my Chocolate lab to the Vet ER. He was lethargic, would not eat, gums completely void of color and was panting constantly. His red blood cell count is very low and though their still are a few things to rule out before a diagnosis can be made, AIHA seems like a likely scenario. As you can imagine my household is on pins & needles at the moment. We had never heard of this disease until today, but the literature I have seen on the web is a bit frightening to say the least. If the diagnosis is AIHA we are only an hour's drive to UC Davis. If there is a vet there who is skilled in treating this, I want to know who they are. Thanks for the help. Phillip

pdenny Oakland

Laurie... You didn't include your e-mail address, so at the risk of boring others who have seen this or know it by heart, I will include the protocol from Jean Dodds, DVM for diagnosing and treating this disease. She also would be glad to consult with you or your vet. Good Luck...Ron Protocol for treating IMHA: (Immune-Mediated Hemolytic Anemia) History: 1. Any history exposure to ticks, any travel to tick infested areas? Other infectious diseases such as leptospirosis, bacterial or fungal or parasitic diseases. Test to rule out Babesia, Ehrlichia, Bartonella, & Rocky Mtn. Spotted Fever, Lyme, as causes. 2. On any current meds that could cause anemia, thrombocytopenia? For example, Sulfatrimethoprim. Estrogens, non steroidal anti-inflammatory drugs? 3 Has there been any exposure to rat poison? Zinc exposure (in the form of coins; seen on X-ray) 4. Were there any recent vaccines (w/in last 3- 45 days? 3. Any concurrent health problems? Neoplasia : Hemagiosarcoma, Sertoli cell tumor, lymphoma. Other conditions: Hypothyroidism, especially autoimmune thyroiditis; Cushing’s disease; Addison’s disease; diabetes; any other recent illness or surgery or stress event including sudden change in temperature? Diagnostics: Minimum data base 1. CBC including platelet count and platelet size (immune-mediated platelets usually have predominantly small platelets). 2. Check Purple Top Tube for auto agglutination, check slide for auto agglutination, look for spherocytes, or stomatocytes on the peripheral blood smear 3. Manual differential, cell morphology (regenerative anemia? (at least 30%of IMHA cases are not regenerative) 4. Spherocytes (near the feather edge don't count) 5. Platelet estimate consistent with low count or due to clumping? 6. Chemistry panel ( Low albumin may indicate hemorrhage) 7. Chest rads & abdominal rads to rule out cancer, pneumonia. 8. Abdominal rads to r/o zinc toxicity (metal coins), cancer, pyometra,etc. 9. Abdominal Ultra Sound to check for Neoplasia(i.e. dog >7yrs) 10. Babesia titer or other infectious diseases if greyhound or if there’s travel history, Ehrlichia, RMSF, Lyme leptospirosis, titer if also thrombocytopenic. 11. UA - look for hemoglobinuria 12. Coagulation panel if evidence of exposure to rodentacides. Or suspected Neoplasia. 13. As the underlying cause can be autoimmune thyroiditis, and thyroxin is needed for normal hematopoiesis, check full thyroid antibody profile. Treatment: (Discounting any current meds!) 1. Prednisone 2mg/kg PO BID divided; start at same time as Dex SP is given 2. +/- Azathioprine (Imuran) 2mg/kg PO SID if dog is not responding to the prednisolone. 3. +/- Cyclosporine (Atopica) starting at 10mg/kg SID for the first week, then 5mg/kg thereafter, if patient is refractory to the above drugs. 4. Pepsid–AC b.i.d. and sucralfate to prevent gastric ulcers from the prednisolone. 5. Doxycycline 5 mg/lb bid just in case it is Ehrlichia *Do not use Cytoxin, Oxyglobin - studies show a decreased survival rate with these drugs. 6. Thyroxine (0.1 mg / 12-15 lbs. of optimum weight BID), to stimulate hematopoiesis, or if patient is hypothyroid Transfusions: a. Better to transfuse sooner than later. b. Transfuse if PCV<15% or ( >12% if reduction in PCV is not peracute). c. Use Packed Red Blood Cells (best) or Fresh Whole Blood. d. True universal donor (DEA 4) is best as you usually can't type or cross-match due to auto agglutination. Monitoring: 1. CBC q12hrs, initially, then every few days depending upon the patient affect. 2. Monitor electrolytes q24hrs if on IV fluids 3. Monitor the slide for agglutination q12 - 24hrs 4. Blood smear every few days to look for regeneration, platelets (platelet half-life is 3-5 days; platelet count may not go up because the new platelets go first into the inter endothelial cell spaces to “plug the holes” as seen by fading of bruises or pinpoint hemorrhages and no more new ones; then the next batch circulates and raises the blood count.) Sending home: 1. Prednisone 2mg/kg PO divided BID for at least two weeks, taper very slowly every 10-14 days for another month until platelet count is above 100,000 or PCV is above 21 and stable. Then decrease dose, whenever the blood tests remain stable for two weeks. Eventually the steroids should be given every other day for maintenance. 2. Dogs usually require low dose prednisone every other day for a year or more. 3. Azathioprine 2mg/kg PO SID if needed, then reduce to 1 mg/kg SID, then to 1mg/kg every other day or three times per week. 4. Continue cyclosporine, if needed originally, at 2.5mg/kg SID 5. Continue thyroxin, if needed originally, at 0.1 mg /12-15 lbs. of optimum weight BID, given at least an hour before a meal to ensure absorption. 6. Pepsid-AC and Sucralfate PO while on high dose prednisone. 7. Recheck CBC weekly to start; CBC at 1 week, 3 weeks, and then q2 - 3 months while on Azathioprine 8. High protein (35%) ,low fat diet, no corn, wheat or soy. Split normal amount of food into four servings. 9. Consider Jean Dodd’s “Liver Cleansing Diet” if liver functions are high. 10. Milk Thistle and/or SAM-e for liver health. 11. Pet-Tinic added to food (for iron, B12, folic acid, copper, necessary to form new RBCs). 12. Have plenty of fresh water available for the dog at all times. 13. Watch dogs skin, especially elbows and blood draw sites, for formation of skin lesions. (I had this protocol and sent it to Jean Dodds, D.V.M. She spent the time to review it and edit and add comments .I hope this is helpful to you or your dog’s vet. Note: Some vets disagree with the thyroid meds.) R. Barr

Ron B San Mateo

This thread was discussed between 22/04/2008 and 19/05/2008

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