Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Tessy Update 04/23/09

Hi all. Tessy was in today to have her CBC done again. Everything, for the most part, remained the same. The only difference was that her WBC rose again to 30.7. I was really hoping and praying for a rise in her HCT. It rose but not near what I'ld hoped for. It went from 27.5 to 27.7. Tessy seemed to be doing better this week and I really thought the number would be better. That's almost 3 weeks of constant numbers now. I was fearing this would happen. It seems the more a person learns about this disease the more apt I become of predicting trends. This just all seems like Deja Vu again. The last time her numbers leveled she ended up relapsing. I guess that'll be my new worry now. I know not to linger on the numbers and to go by how she's acting but it's just so hard to ignor the numbers. We are going to wait and see what her numbers are next week before we decide on reducing her meds. Her doctor was thinking of reducing her azathioprine first. I find this is all just so hard to deal with. I'm sure all of you on here know what I'm saying. Just wondering if the hill keeps going higher and steeper. I'm willing and determined to get through this and make my little baby well again. I only hope the funds don't run out. This horrible disease is especially hard on those who can not afford it. If anyone knows how to rob a bank or win the lottery please let me know. Anyhow, I'ld like to say I'm not stressed over all this but that would be a lie. I know one of the worse things to do is stress or worry cause lots of dogs can pick up on this. I just can't help it though. I am happy that the HCT didn't decline so I guess that's a good thing and something to build on. I'll continue to keep you all informed. I hope and pray daily for everyone and their pets to have full recoveries. We all deserve it. Hugs and wags from Tessy. Johnny & Tessy

Johnny

Just one more thing...are the % LYM, MON & GRA as well as the # LYM, MON & GRA important numbers to watch with this disease? Thanks, Johnny & Tessy

Johnny

Johnny, First, 27% is not extremely low, it would be termed moderate to mild anemia. I understand your fears that this could indicate a relapse. However, holding steady at this number is an indication that there is likely no current autoimmune destruction. So what are the causes of a lower than normal but steady hematocrit number? Well, there can be some underlying condition that is influencing this process. You have done a number of tests to rule out other conditions like tumors. The kidneys have a large influence on the production of blood, they secrete a hormone that stimulates the process. The thyroid also contributes. Nutrition that includes all the building blocks to make blood is very important. A hiccup in the absorption of these nutrients can negatively influence the process. Did they do a full CBC panel? What are the "M" numbers? These 3 numbers tell you the size of the red blood cells, the amount of hemoglobin inside and the average amount of hemoglobin overall. I would watch these numbers from test to test. And in addition you should continue to monitor the reticulocyte numbers. This level of anemia should be moderately stimulating the bone marrow to send out these baby blood cells a little early into circulation. Anything over 1% and 60,0000 would be indicative of this. % LYM, MON & GRA are white blood cells. Lymphocytes are the wbc that you are currently attempting to suppress (T-killer cells). They are the soldiers of the immune system that get confused in their job and end up attempting to destroy the body's own blood cells. (Lymphocytes are part of a group of wbc called agranulocytes, or cells that don't show up with a grainy look when stained) Granulocytes are a group of three wbc that show up with a grainy look when stained for a microscope. They target bacteria, fungi and can be active during allergic reactions. Monocytes are most often the "clean up" wbc, PacMan like stuff. They also collect stuff that they think the immune system needs to protect against and alert the immune system so it can either produce antibodies or destroy. Is your vet offering a possible diagnosis for the stable but low hematocrit? Sometimes this can be called anemia of chronic disease, or some underlying disease is contributing to the anemia. Anemia as a term really is a symptom and not a disease. So anemia can be a symptom of many different conditions. When we say autoimmune hemolytic we are saying that the "body's immune system is targeting RBC for destruction." Someone with iron poor blood had a nutritional deficiency of iron so the production of rbc is faulty. A person with a bleeding ulcer has anemia because of chronic loss of blood. It is the clinical expertise of the vet or doctor that helps determine what the cause of the anemia is. They can determine this from test results such as the CBC and chem screen. my best patrice

Patrice NYS

Thanks Patrice, you always do a great job of expaining things. Tessy's M numbers are... MCV 77 down 1 point from 10 days ago (high) MCH 26.6 down from 26.9 (high) MCHC 34.5 stayed the same (normal range) RDW 14.4 stayed the same (normal range) MPV ....did not read on the test...was 6.2 on a diluted sample of 1:2 (I think this sample was over diluted ... would guestimate a number around 15 or so maybe) #LYM 0.6 down from 0.6 (cyclosporine?) (low) #MON 0.3 stayed the same (low normal?) #GRA 29.8 up from 16.9 (High)(wonder if this number is up from her staph she has/had, which by the way is getting better!) The only other positive increase was her RBC...up to 3.59 from 3.54. Her chem numbers are starting to look a little better also. Her Urea and GGT are higher than normal but lower than they used to be! Johnny & Tessy

Johnny

Johnny, Keeping you and Tessy in our prayers that she stays on the road to recovery. It is very hard to say, I have learned over the past 2 years, how high the hill will be. Every dog is different, I have seen some on here recover in just months and have been so envious of them. But at the same time, even though for Holly it has been such a long road, I am happy for each and every day with her. If you find that bank let me know! Linda

Linda Sapphire

Johnny, Good thing is that Tessy is holding her PCV numbers. I wish I could tell you that everything is going to get better from here. Although in some cases that is true. There are dogs that get AIHA and fully recover, never to be stricken again. Then there are cases like my Ren. She took months to recover only to have a relapse one year later. One piece of advice that was given on this website; do not become too fixated on the numbers. They will fluctuate from time to time. The disease itself and all the powerful meds alter the blood chemistry so much in these dogs. After a while, "normal" blood counts take on a whole new meaning for an AIHA dog. Basically all we do is take one day at a time. When Ren and I retire for the night I always say to myself, "today was a good day, and thank you Lord". SUE

Susie Delaware

Well said Suzie and I do the same thing with Ginger, I am so grateful for everyday I get to spend with her. And we just take one day at a time too. Ginger's PCV stayed in the 20's for about 5 weeks, I think it took the cyclosprine 4-6 weeks before it began to kick in,and during that time she acted just fine so I tried not to worry to much. Hang in there and I think that since it is not dropping that is a good sign. I don't think Dr Dodds recommends reducing the meds until they have had a good PVC reading at least twice or something like that,so you might want to check before you begin to reduce the meds without her pcv being in the normal range. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Johnny, Slow and steady, that's ok. I know you had hoped for a higher number, but Tessy is climbing, albeit slowly. I know how frustrating that can be, but her body is doing what it can, and you are doing everything you can for your sweet girl. Did you ask about the marrow suppression with the Aza? That definitely could be a contributing factor. Did I mention that Tiggs was only ever on 30 mg/day and he is 75 lbs? Not that that is necessarily the right dose, but maybe Tessy's could stand to be slightly lower to help her produce more cells. I'm not an expert there, just putting it out there. We are thinking of you guys, just try to take it one day at a time, and like everyone has said, try not to fixate too much on the numbers, look at her clinical signs- how is she acting? Hugs, melissa and tiggs

melissa slc

Dear Johnny, I hope this makes you feel better, but our dog Millie held her PCV at 25-27 for 5 weeks (since her blood transfusion at diagnosis), until she started rising slowly to be at 42 now 3 months after diagnosis,. Hang in there, Samantha & Millie.

Samantha Geelong Australia

Jonathon, RDW 14.4 stayed the same (normal range) Red cell distribution width. Measures the sizes and shapes of the red blood cells. The more surface area they have the better they can pick up O2 to move to body cells. Normal is good. MCHC 34.5 stayed the same (normal range) Mean corpuscle hemoglobin concentration. This measures the volume and attributes of hemoglobin. This is a very accurate measurement. Normal range is excellent. MCV 77 down 1 point from 10 days ago (high) Mean corpuscle volume. MCH 26.6 down from 26.9 (high) Mean corpuscle hemoglobin. Both of these numbers are high because they represent the size and level of hemoglobin of red blood cells. This is most likely because newer (and larger) reticulocytic cells from the bone marrow are in circulation. They will take some time to mature, drop their RNA and become their smaller and more efficient cousins the red blood cells. This is a great sign. It means that she has successfully made new red blood cells, they are healthy and they will eventually mature to increase the number: RBC...up to 3.59 from 3.54. Each time a million of these cells matures you will see a 1.0 increase in RBC. Ideal is around 5.5. Your chem results are good too. GGT is a marker for a kind of cell damage and this is most likely representative of the side effects on the liver of processing drugs. Going down is very good. Urea is a marker for the kidney's capability to clear the by product of digestion of protein: urea. This can also be represented on a test by BUN. She is having some trouble clearing urea from her blood by her kidneys. It can become toxic to the body. Watch this marker and discuss this with your vet. Kidney problems in dogs are best caught and treated very early. Signs of kidney disease often do not show up until there is a serious problem. Discuss with your vet about temporarily putting her on a diet with less protein. This will also help the liver. One suggestion is Dr. Jean Dodds' liver diet. Links to this can be found in the archives here. Johnathon, you are doing a great job and your interest in learning about this disease and the speed that you pick up this information is wonderful. You have become a great asset to this forum. I am hoping that Tessy improves daily and is in fine condition for the upcoming summer! my best patrice

Patrice NYS

Thanks again Patrice. You surely know how to calm someones nerves. I've got Tessy on R&R as I write. She had a long day yesterday so I'll let her rest all she wants. I broke down and let her have a timbit today....she really loves them and does not get them anymore. She also found a milkbone in the car today and ate it before I could even say her name. I've been trying to keep her away from all these types treats. She gets nothing but the best foods nowadays. I think I'm going to make the gradual switch to a diet with more focuss on the lower protein. Do you think it would be a good choice for all dogs with AIHA (especially the ones on Pred/aza/cyclo/etc) to be on a low protein diet regardless their chem numbers? Just for protection to reduce the strain on the liver and kidneys? I know one thing I'm going to have to buy is a food scale. I'm awefull at estimating size portions. Just one more thing about vitamins. I give Tessy a multi-vitamin (vitasorb i think) with her dinner everyday. I'm wondering if I should consider switching to a more specific vitamin regiment. I've read quite a bit on this on here but I'm not sure if it is dog specific or if amounts are just generalized. Anyhow, a friend of mine was able to get some cheap lobsters today so I figure I'll be eating lobster for supper today. They are so cheap nowadays...almost cheaper to eat lobster than bread! Tessy will be at my feet all day till their cooked. How are you doing today? Are you recovering well? How is Chance? Is he getting around better now? Give him some hugs from Tessy and I. I'll keep you all in my thoughts and prayers today. Johnny & Tessy

Johnny

Jonathon, Chance is doing pretty good. He is an old dog with a heart problem and is on some pretty serious meds. But that said, he did walk for 45 min today up to the woods, slowly (much to Cassie's displeasure) but got some off leash time to investigate the "smells." It is a change for our family. Chance has always been an extremely powerful and active dog. I try not to get too sad about it, but I think sometimes Chance is puzzled about what has happened. Thank goodness dogs don't really understand what it means to be sick. I am hoping rather than him failing over a long period that one morning I will come downstairs and he has passed in the night. That said, heart dogs can survive very well on these meds, esp a new one called Vetmedin, for a very long and healthy life. I just had a cortisone shot in my shoulder yesterday, ouch. Had to bring Mark with me so I had someone to hold onto as they did it. I am hoping this will be the end of it. If it works, I will just be doing therapy for a couple of months. I am still waiting on the lawyer to get back to me. I have gone through a lot of money in copays and Chance's meds are a pinch on my budget too. my best patrice

Patrice NYS

Glad to hear tessie is stable regarding a liver diet, have you read this? I had Wylie on it when she was first diagnosed http://www.b-naturals.com/newsletter/liver/ have you read this, it gives some really good info for a liver diet, basicly saying its not the protein thatsbut a rich red protien diet. I dont remember how long Tessie has been on azi, and that can take 4-6 weeks to kick in. hang in there Laurie

Laurie CA

Laurie, The vet nutritionist from Cornell said that one of the jobs of the normal liver is to process and dispose of the parts of old red blood cells from our body. Thus, if it is already compromised, you can overload it by having it attempt to dispose of the parts of digested red blood cells from red meat in the diet. Thus the reasoning behind not giving rich meat that has lots of red blood cells in it. patrice

Patrice NYS

This thread was discussed between 23/04/2009 and 25/04/2009

Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index

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