Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Tessy came home today

Hello everyone....just wanted ot let you all know that Tessy came home today. It was such a long drive all I want to do is lay down for a week. Her PCV thismorning was 25 so they said she was good enough to go home. The PCV seems to be rising 0.5 - 1 point per day. She has an appointment with her regular doctor on Monday to check the Atopica/cyclosporine levels in her blood......any advise on this might help. Currently she takes 200mg per day taken twice (so 100mg each time). All her other meds get taken at the same time...Prednisone (50mg), Azathioprine (3/4 of a tablet...37-38mg), aspirin (8mg), and a new stomach protectant drug called Omeprazole (10mg). I haven't looked up this new one yet and I was also surpised to find they upped her Azathioprine dosage. It just seems like such a large amount of drugs to take. Anyhow, when I get some more time tomorrow I'll try to get a little more info in here for those who'ld like to know. Thank you all again for your thoughts and prayers. They mean so much to Tessy and I. Johnny & Tessy

Jonathan NS

Jonathan, I am so glad to read that you are both home again. Hopefully you both can have a well deserved rest for a while. Looking forward to your next update. Penny

Penny Lytle Creek Calif

Johnny, great to hear you are back home. Tessy is such a fighter and you are a great puppy dad. Best wishes, have a good rest, Brigitte and Kahlu

Brigitte BC Canada

Jonathon, Good to hear she is home, you must be very relieved. A small rise every day is excellent! Omeprazole is prilosec, a product used for people when they have duodenal ulcers (among other things). It reduces stomach acid. There are a number of cautions and side effects, as there are with many drugs. I see allergic reaction as a possible serious one. I also see precautions for anyone with liver conditions. Prednisone can raise liver values uncomfortably high. There might be stomach issues like diarrhea etc, dizziness and constipation. However, there is one contraindication I would ask the attending vet about and it has to do with the cyclosporine: "Although in normal subjects no interaction with theophylline or propranolol was found, there have been clinical reports of interaction with other drugs metabolized via the cytochrome P450 system (e.g., cyclosporine, disulfiram, benzodiazepines). Patients should be monitored to determine if it is necessary to adjust the dosage of these drugs when taken concomitantly with PRILOSEC." This is most likely why they want to do a trough test to measure the blood level of cyclosporine at exactly 12 hours after the last dose. They want a certain minimum level of it to be in the blood stream. If the prilosec interferes with the absorption or alternatively increases the uptake of it significantly, the dose could either become ineffective by being too low or absorption could be enhanced and it could remain in the blood at a high dose for too long a time. Either of these scenarios would not be appropriate. I guess it's good that they are concerned enough to protect the stomach and esophagus, but I am wondering why they picked this drug over the otc pepcid. That would be a good question to ask. my best patrice

Patrice NYS

Johnny, SO glad you have your sweet girl home with you, please just get comfy and take a nice, cozy nap with her. You both deserve it! I'm sure you'll get everything sorted out, just one day at a time. Praying for you and your Tessy! melissa and tiggs

melissa slc

So glad to hear Tessy home. Please let us know how she is doing, I am sure she is happy to be back home with her Dad. Sending hugs your way. Cheryl & Ginger

Cheryl & Ginger Pineville Pa

Hello all. Just sitting here worried as usual thinking maybe I'll give some of Tessy's results out. They mostly did PCV tests but also did 2 CBC's during her stay. Here was her PCV results... Apr.1 - 20% (Tessy admitted)(drug sched. changed) Apr.2(am) - 22% Apr.2(pm) - 23% (Atopica/cyclosporine started) Apr.3(am) - 23% Apr.3(pm) - 24% Apr.4(am) - 25% (Tessy sent home) CBC Results: April 2 (from blood taken evening of April 1st) Moderate macrocytic, hypochomic, strongly regenerative anemia. Moderate thrombocytosis. Moderate leukocytosis characterized by a marked neutophilia, There were 2+ spherocytes and 3+ anisocytes. April 3 (Evening) Moderate macrocytic, hypochomic, strongly regenerative anemia. Moderate thrombocytosis. Moderate leukocytosis characterized by a marked neutophilia with a mild regenerative left shift, a moderate lymphopenia and a moderate monocytosis. There were 2+ spherocytes and 3+ anisocytes. Serum biochemistry: Phosphorous 1.93 mmol/L (0.84-1.83) Urea 23.1 mmol/L (2.8-9.8) Amylase 2023 U/L (324-1005) ALT 107 U/L (13-69) Gamma-GT 15 U/L (0-7) Is it just me or are all these numbers really high? The printed results were sent to Tessy's regular doctor so I'll get them tomorrow. Her ultrasound showed an enlarged liver and that was all. No abnormal findings on the radiograph. I was told to give her meds with a little food also. Shouldn't cyclosporine be given on an empty stomach? Shouldn't aspirin be given at different times than prednisone. Shouldn't Omeprazole also be given on an empty stomach? Too much to worry about right now. Overall....Tessy is doing better. Her gums aren't exactly pink anymore but they are not white either. I've got some pics of her that I took when I visited her in the hospital that I'll add sometime soon. Thanks for the jumpstart Patrice. Tessy goews tomorrow for her Cyclosporine level tests. I'll try to get it for 12 hours past the last time she took it I guess. That would be around 8:00pm. She takes all her other meds at 5:00pm. Will this be alright I wonder? Anyhow, It's great to be back home and I hope the best for everyone and their dogs. Thanks again from Johnny and Tessy

Jonathan

Johnny, the quick increase in Tessie's PCV is fantastic!!! Best of all, she is doing better. Don't get too hung up on all those numbers. Main thing, she looks and feels better. I am no help with how and when to give the meds, they are different from what we have. Hopefully someone else will have some insight. We are thinking of you and praying Tessy will keep improving like she did the last few days. Best wishes, Brigitte and Kahlu

Brigitte BC Canada

Hi Jonathan and Tessy, I am not expert but I thought I would tell you what I have been doing with Henri. Henri was diagnosed with vaccine-induce IMHA on 02/25/09. He required 1 blood transfusion to stablize his hematocrit. His IMHA was classified as severe macrocytic but regenerative. His hematocrit pre-transfusion was 11% and post-transfusion was 21%. Henri was started on a cocktail of immunosuppresants while he was in the hospital. He was on the following: cyclosporine (25mg/2xday), AZT (12.5mg/day), prednisone (10mg), aspirin, and pepcid. He is currently on cyclosporine (25mg/day), AZT (ever other day), prednisone (7.5mg/day) and pepcid. Last week was his first drug reduction, we reduced the cyclosporine to 1x/day. His next drug reduction will be in 2 weeks, and depending on his labs, we will likely reduce the prednisone. I talk with the internist on Tuesday to plan the next reduction. I am telling you all of this because so far Henri is doing very well. Last week, his hematocrit was 41%! I believe the cocktail of drugs he received is what gave him a fighting chance. I do not give the cyclosporine, prednisone, or AZT on an empty stomach. I try to give Henri a little food with each drug and try to space out his meal over an hour--so he gets food with each drug. Cyclosporine, even in humans, makes stools loose but since we back down to 25mg/day, his stools are firmer. Henri has tolerated his meds well. It sounds like Tessy is doing great. We wish her a speedy recovery. Furhugs, Ella, Bella, and Baby Henri Henri, West Highland White Terrier, 6-months, 13-lbs, diagnosed with vaccine-induced IMHA on 02/25/09, medications: 25mg/day cyclosporine, 12.25mg/every other day AZT, 7.5mg/day prednisone, and pepcid.

Ella Seattle

Hi Jonathan. I'm glad to hear that Tessy is home now and that her numbers are on an upward trend. That's a really good sign. Once our dogs are through the initial crisis I believe that there's no place like home for their continued recovery. The internists that I saw at Washington State University prescribed cyclosporine for Duck. They said it was okay to give this med with his food and that is what I have always done. Since then I have learned that there is quite a debate about whether or not this medication should be given on a empty stomach. I don't know if there have been conclusive findings on this point or not. I just wanted to let you know that I have always given Duck's cyclosporine with food and his PCV did return to normal. Good luck with this. Another good piece of advice I got from one of the internists in the early days was to focus on the whole dog, not just the numbers. It's so easy to get wrapped up in all the test data. The CBC's are an important indicator of how Tessy is doing but I think her behaviour is an equally important barometer. I remember being ecstatic when, after what seemed like months, Duck barked again and when he started to shadow me around the house again. Looking back, I realize that those were significantly positive signs. Good luck to you. Please keep us posted and give Tessy a hug from all of us here. And, take care of yourself. You've been through a lot in the last bit. deb and Duck

Debbie BC Canada

Jonathon, I like the gradual increase in PCV, this indicates that she is regenerative and is slowly but surely turning those baby blood cells, reticulocytes, in her blood stream into mature red blood cells. This takes some time. While this is occurring, the CBC's will show RBC that are not exactly the normal size (slightly larger), nor have the correct amount of hemoglobin in them (hypochromic), thus this remark on your test results: "Moderate macrocytic, hypochomic, strongly regenerative anemia." In addition, the bone marrow is responding with increased numbers of platelets (clotting agents) as indicated by: "Moderate thrombocytosis." Another result, Gamma-GT 15 U/L (0-7), is an indicator of damaged liver cells. This is a direct result of using high doses of prednisone. The liver cells metabolize the prednisone so that the body can use it. In this process the liver cell is damaged. The body then begins to regenerate new liver cells. Until you get the pred dose lower, you will see this high number. The phosphorus level is moderately high, phosphorous 1.93 mmol/L (0.84-1.83). This mineral, along with the calcium level, are very important to the body. If there are changes to these two indicators, it is important that they monitor this closely. It could have something to do with a possible urinary tract infection and the kidneys. Ask them if they have ruled out struvite uroliths. The Amylase level is high, Amylase 2023 U/L (324-1005). This increase may or may not be important. This is a pancreatic enzyme, but is also shows up in intestinal and liver cells. So there is a possibility that this is just another marker that there is liver damage. However, it can also indicate pancreatitis (signs are vomiting and abdominal pain) or possibly a kidney problem. The use of prednisone can lead to an increase of amylase. Watch this carefully and ask questions. The ALT is slightly elevated, ALT 107 U/L (13-69). This is most likely another indicator of damage to the liver cells by the prednisone. It is only moderately elevated, but does need to come down. It may be time for them to begin thinking about slowly decreasing the prednisone? It seems to be very hard on Tessy. Each dog reacts somewhat different. Chance had other markers that were extremely high, but never had the same chem results that you are showing. Ask that they explain some of their interpretations of these results to you. I am not an expert in this kind of clinical analysis and your vet is. Ask them if Tessy should be on a prescription diet right now. my best, patrice

Patrice NYS

Well, all I can say is that the stress levels are so high I feel like I'm going ot have a heart atack myself. On a good note...Tessy had her HCT checked last night and it was just over 25%. Her platelet numbers did not register so that got me concerned again because that usually means the number is over 1000 again. She was going to dilute the sample last night and call me sometime thismorning with the results. I gave Tessy her 100mg dose of cyclosporine thismorning at 8:00 and at 9:10 she puked. Now I'm concerned even more. I'll keep you all posted today as news comes Johnny & Tessy

Jonathan

Jonathon, This a fairly common side effect. Call your vet, but it might help to try giving the dose with a small amount of food for a few days or asking it they can decrease the dose temporarily until this side effect subsides, then increasing it back up. patrice From Novartis's product information for (Atopica) cyclosporine use in dogs: "The most frequently observed undesirable effects include gastrointestinal disturbances such as vomiting, mucoid or soft stool and diarrhea. They are mild and transient and generally do not require the cessation of the treatment. Very rarely (muscle cramps, muscle weakness) anorexia, gingival hypertrophy, veruciform lesions or change of hair coat have been reported.

Patrice NYS

I did not call the vet because she has been doing well with it up till thismorning. I'll try her again tonight to see what happens. She has to take her thyroid meds with her cyclosporine now so hopefully that doesn't add to the problem. The doctor said it shouldn't hurt taking them at the same time. Her first dose of thyroid meds starts today (tonight). On another positive note...her retic% was over 12 when her last CBC was taken in PEI. This is good isn't it? I'll keep ya posted on how the meds tonight goes. Thankyou so much for your help. It really means so much right now. Johnny and Tessy

Jonathan

That is an amazing number. Yes, it is possible to have a retic % as high as this, indicates very regenerative. Watch it carefully, it should diminish over the next few weeks as they mature into RBC. When she finally reaches a normal pcv/hct (38-50), the number should settle out around 1-1.5%, that is normal.

Patrice NYS

This thread was discussed between 04/04/2009 and 07/04/2009

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