Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Tessy Relapsing?

Hey everyone...I wish the news I had was a little more positive but I am fearing that Tessy is in the stages of relapsing. Her HCT had dropped today to 20.3 from 29.5 last week. I've noticed a difference in her gum colors over the last couple of days and todays numbers confirmed my fears. Here's her new numbers from today. WBC down from 42.8 to 37.6... which is better RBC down from 3.73 to 2.59 HGB down from 10.7 to 7.3 HCT down from 29.5 to 20.3 PLT down from 1022 to 708...which is good news I guess I started Tessy on 8mg of aspirin/day on Saturday as well as 1/2gram of sucralfate twice a day (also started on Sat. 1/2g in the morning and 1/2g in the evening). Her gum colors started to go paler the next day and have gotten worse over the last couple of days. Does anyone think or have experience with this happening to them from the aspirin or sucralfate? I've been giving the sucralfate 2 hrs before her meals and medications. The aspirin is givin mid day 6 hrs before and after her medications. I'm wondering if the sucralfate is affecting the medication absorption or not. She was showing so much promise over the last 3-4 weeks. Needless to say I'm absolutely terrified at the thought of my poor Tessy getting worse. She is still eating and drinking and still has lots of energy. I fear I'm going to wake up in some morning and find her laying there. I can barely contain the stress right now.

Jonathan

Jonathon, Oh dear. Well let's look at this carefully. The sucralfate can definitely interfere with absorption of meds. But you are giving it 2 hours before meals, that should be sufficient. How about switching it to right before bedtime so it is working overnight? But no, I don't think this is what is causing this relapse. I would not discontinue or reduce the prednisone. Your vet should help you with this dosage now. It should be at a immunosuppressive dose. If you have not added another immunosuppressive drug, now is the time. I used cyclosporine, others use azathaprine. There are pluses and minuses to each of these and others here can detail those. They take some time to begin working so the pred is the most important drug for the moment. Can you find the reticulocyte count on the blood test? You should be seeing high numbers, 5% or more and something like 250,000 or higher. If it is sitting at less than 1% and lower than 60,000 absolute, then she is becoming non regenerative. That would account for the declining numbers across all three lines (RBC, WBC and platelets). Did you do a chem screen? Is there a high bilirubin count? This would be indicative of rbc lysing. Any red or orange coloring to her feces or urine? Do her gums and eyes look yellow? If so, and this were me, I would seriously consider putting her into hospital. They could administer Dexamethasone as a fast acting and high dose immunosuppressive. Please keep us up to date patrice

Patrice NYS

Thanks Patrice, Tessy takes Prednisone (25mg/twice a day) and Azathioprine (25mg/once a day). As far as dropping the meds....I was talking about the aspirin and sucralfate. She was doing good until these were added. She did not have a Chem screen. What would the bilirubin come up as? Reticulocyte numbers were given when her blood was sent away the last time. This was on March 18th and her retic # was 3.69%. I put a picture of her last blood results up at ... http://www.picturetrail.com/sfx/album/view/21764279 ...just in case you wanted to look. She had blood taken today to send to Dr. Dodds as well. She is going to do some thyroid testing. I just hope to GOD she gets better.

Jonathan

Oh yeah....the doctor mentioned something about putting her on cyclosporine maybe. That might be another option.

Jonathan

Jonathon, Do that immediately. If they have veterinary Atopica on the shelf, as most vet clinics do, you can start today. That is the same thing as cyclosporine. It is packaged for allergies but at higher doses it is an immunosuppressive. If you are in contact with Dr. Dodds, then email (hemopet @ hotmail .com) (remove spaces to use) her the specifics of what you have just told me and ask her for treatment advice. She will respond very quickly to this email if it is short and concise. Remind her you are sending a blood sample her way today. She gives advice to clients obtaining blood services. my best patrice

Patrice NYS

I just sent her an email after I got home. She said she needed more information but also suggested I stop the sucralfate. I just wrote her back asking if I should also stop the aspirin if I stop using the sucralfate. I JUST DON'T KNOW WHAT TO DO. One thing I find really weird is that the hospital Tessy goes to can not get a Retic number from her CBC's or the machine they use. This is a newer hospital and all! Her old vet with older equipment could get these numbers! Anyway, I'm going to go cuddle her some....I think she needs it. I'll keep you all posted. Thanks, Johnny & Tessy

Jonathan

Jonathan, Try reading some of this information. It's pretty well written. http://www.peteducation.com/article.cfm?c=0&aid=98 http://www.peteducation.com/article.cfm?c=0+1302+1473&aid=987 I will be thinking about you and Tessy all day. patrice

Patrice NYS

Thanks Patrice. The links did not work though.

Jonathan

Go here: http://www.peteducation.com/ and then in the search engine type: 1. Blood Cells & Complete Blood Counts (CBC) in Animals Second page to read: 2. Chemistry Panels & Tests for Pets patrice

Patrice NYS

URL's from Drs Foster and Smith do not seem to work well when posting them on a forum such as this. However I have the CBC information page listed on my FAQ page: http://www.cloudnet.com/~jdickson/faq.htm Look for the hotlink after the second answer which will take you to the CBC page. There is a hotlink on that page which will take you to the chemistry panel page

Joanne MN

Jonathan, I wish you and Tessy the best through this setback. Certainly, you are a diligent dad, and seem to always do your homework, even when you don't know the answers. Patrice has obviously given you some good advice, I don't have much to add, other than thoughts and prayers. We were never on Atopica/Cyclo. Only AZA, which does take much longer to work. So, maybe the Atopica is the way to go here in this case. We are thinking of you and praying for Tessy, sometimes there are setbacks for no obvious reason. Tiggs had an episode like that after he had been doing so well, his PCV just dropped suddenly. The vet added a 21 day course of Doxy (he doesn't have tick borne IMHA that we know of, she just wanted to try that antibiotic). He did much better after that. Please keep us posted, hugs to you and Tessy. melissa and tiggs

melissa slc

Thanks for your words and prayers. Tessy's gums still look pale. I'm going to wait it out until morning to see how she does. If it is still bad I will take her back to the hospital. I've gotta say this stresses a person out so much it sometimes feels like I should check myself into the hospital. I think this will be a sleepless night for me. I'll keep you all posted on how she does. Johnny & Tessy

Jonathan

Johnny, I know exactly how you feel. I had to learn that all the worrying is very exhausting too. Everybody on this board knows how you feel, because I don't think there is a case where it is just straight forward. Please know you are not alone. I wish you and Tessy a good night and I will keep you in our thoughts and prayers. Brigitte and Kahlu

Brigitte BC Canada

Hi Jonathan I am sorry Tessys numbers were not as good as we all hoped for. The cyclosporine worked well for Ginger and after taking it for 4 weeks her number were finally in the normal range. She did not seem to have any side effects and still takes 25 mg EOD. Keeping you and Tessy in our prayers, Cheryl & Ginger

Cheryl & Ginger Pineville PA

Atopica....would that require a trough test like cyclosporine?

Jonathan

Jonathon, I researched that carefully at the time we started the drug. It's essential in human medicine, esp since most people receive this to avoid rejection of a transplanted organ. I talked it over with my vet who said that they would have to call Cornell to find out what test would be needed. Then I asked Dr. Dodds who advised me not to bother with it. In fact the dosing schedule she had Chance on was monday through friday with saturday and sunday off. He was clearly not getting any cyclo over the weekend so that must have meant his blood levels were low for 2 of the 7 days. I wasn't much worried as I trust Dr. Dodds. And indeed, in about 3-4 weeks, Dr. C came in with Chance's blood test and a big smile. He had begun to regenerate RBC and WBC. There was no better indicator that the atopica had worked than that! We continued it for a few months after that, slowly decreasing both it and the prednisone. Chance is a big dog at nearly 100 lbs so you can imagine it takes a much higher dose of meds to work and a much longer time to decrease those high doses. His high Atopica dose was 220 mg a day. His prednisone was 80 mg a day. Of course, if your vet were to decide they wanted this test, then that is a choice you must make. patrice

Patrice NYS

Ren has to take Atopic. Pred & Aza alone did not suppress her immune system. Ren has been taking Atopica for four months with no adverse side effects. A couple of drawbacks about Atopica, it must be given on an empty stomach and it is very costly. Tessy will be in our prayers. SUE

Susie Delaware

Hi Jonathan Ginger did not have to have the trough test as her numbers were rising and that was a very good indication she was on the correct dosage of the cyclosporine. Her vet said she would only have to do the test if her PCV did not increase. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Johnny, Praying for you and Tessy that her numbers will improve and that you'll make the right decision as to what other meds, if any, should be added to her regime. If she's eating, drinking, and has lots of energy that is a very good sign. Karen

Karen NC

I am so sorry that Tessy is not feeling well. I second some thoughts on the trail. Each time my Tess has had low PCV counts she was started on Cyclosporine. Although expensive, I am personally convinced that this in combination with the prednisone was instrumental in her recovery. Claudine and Tess

Claudine Burlington

Jonathan and Tessy, We are thinking of you and sending healing wishes to Tessy. I noticed that Tessy was diagnosed about 3 weeks before our puppy, Henri. So you are a few weeks ahead of us on this journey. Since we are relatively new to this group, could you tell me what drugs and doses Tessy was started on? And were you in the process of weaning meds when this relapse started? Henri, also, received only one blood transfusion to stablize. He was started from the beginning on a cocktail of prednisone, cyclosporine, and AZT. We have just started the weaning process. We just reduced the cyclosporine dose a few days ago. I am terrified of a relapse but I also know the level of drugs Henri is on cannot be used long term. I hope Tessy and you take care and breathe through this stressful time. Furhugs, Ella Bella, West Highland White Terrier, 3yo, diagnosed with Primary Addison's Disease on 04/28/08, maintained on 0.40ml DOCP/28-days and 0.33mg/day prednisone. Baby Henri, West Highland White Terrier, 6-months, diagnosed with vaccine-induced IMHA on 02/25/09, medications include: 7.5mg/day prednisone, 12.25mg/every 2 days AZT, 25mg/day cyclosporine, and pepcid.

Ella Seattle

Jonathan: I'm sorry to hear that Tessy's numbers are dropping. Our GSD/Cocker Spaniel mix Sheba was on both pred and Atopica and I think the Atopica definitely made a difference. We didn't have any trough tests done and none of the vets she saw ever suggested it. (She was treated at ISU's VTH and by our local vet.) She was originally taking 250mg per day (125mg AM and PM) and it was the last thing we weaned her off of this past December. It is expensive but I would gladly have paid more. Hang in there and know that we are keeping you and Tessy in our thoughts and prayers. Rita, Mike and Sheba

Rita IA

Jonathan, I am keeping you and Tessy in my thoughts and prayers. I hope that you can get her back on track. Penny

Penny Lytle Creek Calif

This thread was discussed between 31/03/2009 and 02/04/2009

Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index

This thread is from the Vetnet archive. The live Vetnet forum is active now.