Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Tiggs Confirmed ITP dx- back on Pred

Well, unfortunately, despite good clinical signs and going on Doxy, Tiggs Platelets are still dropping. We tested him yesterday with both an in and out of house panel. His platelets are now at 28. I was afraid this would happen and that I would feel guilty about not starting him on Pred sooner, but he's been doing so well clinically...honestly, I'm shocked that they are so low. Here's the synopsis: WBC 12.6 RBC 7.47 HGB 18.3 (H) HCT 52- yayy MCV 70 MCH 24.5 MCHC 35.2 Neutrophil SEG 63 Lymphocytes 22 Monocytes 4 Eosinophil 11 (H) Bsophil 0 Auto Platelet 28 (L) "Platelet count reflects minimum value. Large Platelets present. Platelets appear moderately decreased (50,000-120,000)" "Reactive Lymphocytes presnt) Absolute Eosinophil 1386 (H) So, he's back on 40mg Pred/day...no word of Aza yet...vet will call me Monday to discuss, but I've just started him on meds this afternoon. I am really hoping we can get through this bump. To me it seems strange that he would develop ITP now...does anyone recall other dogs that this has happened to (in NON Evans cases)? Why now? What could be going on...I think I will push for a SLE (Lupus) test...also we should rule out cancer, I just can't even bear to think of it. My heart is worried and sad for my Tiggs, but I'm so comforted that he's acting his normal self. I just hate to think of him back on Pred. At least this isn't a crazy high dose (if you'll recall, he was on 120mg/day when dx with IMHA). Thank you all for your friendship and support. I am confident we will get through this. melissa and tiggs

melissa slc

Melissa, I am sorry to hear Tiggs is not improving. I have done some research and what keeps coming back to me over and over is that eosinophilia in dogs is most often related to parasitism. These are the white blood cells that are most directed towards dealing with parasites: nematodes, trematodes, anthropodes (fleas, ticks) and protozoa (ie babesiosis). There is a very long list of other possible causes that include all kinds of infections, drug reactions, allergies and neoplasia (cancers of all kinds). This is where my lack of clinical experience hampers my understanding. The question is: what condition can cause low platelets and also cause the body to respond to some kind of infection, most especially something related to high eosinophils? I keep returning to *my experience* from reading the tick list and how tick diseases can cause both of these kind of reactions. Sometimes this tick list, in the face of equivocal test results, will suggest treatment with high dose doxycycline to see if there is improvement. If there is, then it can indicate there is some kind of tick disease. The problem is that most vets are not excited about just prescribing doxy in these cases and some owners have to jump through hoops to get this drug on their own. Talk with your vet and see what they feel about this. my best patrice

Patrice NYS

Oh.....Melissa, I am so sorry. We are still waiting for results from Dr. Dodds. It is so hard to think that Tiggs is clinically ok and still you have to put him on pred. I am thinking now, that we might be in the same boat. My vet also asked;why now. I thought that if we have to deal with a relapse i would ask about cyclosporin. I hope Patrice has some insights about Tiggs numbers. thinking of you and your boy, Brigitte

Brigitte BC Canada

Melissa, Email me privately. patrice

Patrice NYS

OMG Melissa, I am so sorry you have to deal with this now. You and Tiggs have been through so much already and things were starting to look up for both of you. I think Patrice has some great info and advise there and if it were me I'ld be exploring every avenue possible. At least the pred is at a lower dosage. I'm not too familiar with ITP but is that going to be a high enough dose? I'm assuming you'll have to wait at least a few days to retest and see if it is working. Are you going to try to get him on the doxy? Always remember that you have all of us here to help in any way we can. I'm saying prayers for Tiggs and sending him some more strong healing vibes from Eastern Canada. Give him some hugs for me. Mum's gonna take care of you Tiggs. Johnny & Tessy

Johnny

Melissa, I have seen lots and lots of dogs that have been diagnosed with ITP some time after having been diagnosed with AIHA/IMHA and being in remission for some time. The good news is that most of the time, ITP is much easier to treat then AIHA/IMHA, that is the dog responds to the treatment much quicker and gets into remission sooner then he/she did with AIHA/IMHA. Be assured you and dear Tiggs are in my thoughts and prayers. Please give Tiggs a BIG hug from me and the Magpie.

Joanne MN

Melissa, I'm so sorry to hear about Tiggs set back. I know how devastated you must be. My dog was diagnosed with IMHA in May 2008. I was dreading end of May 2009 as I noted some dogs had relapses around the 1 year mark. At 11 months into this, when he was down to his only meds being 25 mg Atopica twice a day he developed bruising on his belly. What's strange is that my other dog developed marks on her belly at the same time too. When I took them both to the vet, my other dogs bloodwork came back normal however Alex's platlett count was 30,000 and they said normal was 175,000 to 400,000. Both dogs were put on Doxy. At that time my regular vet put Alex back on prednisone 60 mg daily; 300 mg Doxy daily; and 500 mg of Atopica daily. What a set back! I remember telling my vet that this amount of medicine was a death sentence for my dog after what we went through the first time. A visit over the next few days to the Internal Medicine doctor confirmed ITP however she reduced his Atopica to 300 mg daily ( I think my regular vet had calculated the dosage too high). The pred stayed at 60 mg daily however she started weaning him off that after 14 days. She said ideally the pred time should be extended but due to his previous side effects she thought it was best to get him off asap. He weighed 75 lbs at the time. What I noticed was a much quicker bounce back from this set back. It didn't knock him on his behind for many months like the first time. We are still going monthly for bloodwork and his only medicine is 75mg daily of Atopica. I don't want to jinx things but he hasn't been this strong since before May 2008. As discouraging as it is that Tiggs has had this set back, he hopefully can pull through it quickly. We are hoping the best for him. Chris & Alex

Chris Pa

Melissa -- sending best wishes to you and your dear Tiggs.

Brenda VA

Hi Melissa & Tiggsie Im sorry to hear this news, but I believe it can be beaten, given what you have already been through. I guess this is the same as Immune Mediated Thrombocytopenia? This is what Riley had first - and he was NOT anaemic at the time, that came after a bleed later in the evening, and I honestly suspect this is because he was on a drip at the vet, spent the night on his own, and ripped out the drip - not good with low platelets. His platelets were 9. I could be wrong about this of course - as he did have a major bleed at home later on in the evening. The platelet levels were the easy part, after a blood transfusion in emergency, up to 50+ which they say is over the danger number. I dont know what constitutes Evans Syndrome - I was told that regardless of what happens first, or whether its concurrent, it is called Evans Syndrome. Riley's platelets now are over 700, oddly enough, but they still classify him as having that. I would not have known Riley had low platelets as he was behaving normally, just blood in his stools when I took him for a walk, gave it away. If you havent had any of that, and you know what you are dealing with now, and the medication has started, I believe you are well on your way. I remember the vet saying at the start "at least he is not anaemic, thats a good sign". Riley was started on prednisone and azathioprine. Honestly I dont know, but Im sure Patrice will have some good advice; we are lucky to have her! Man, I want this to be ok, you WILL get through this, and a great PCV number, double yay on that one. Best wishes to you both, we are all pulling for you. Silka

Silka Melbourne Australia

Thank you all for your support once again as we head down this path. Johnny, Tiggs has been on Doxy (300mg/day) since last Monday and has had no response in the platelet level, hence the decision to add immunosuppressives. The vet called today after she had been thinking it through and she doubled the Pred dose, so we're on 80/day (40 in the am, 40 in the pm). We may add AZA on Monday after she consults with a few internal specialists. She would like to have him on the 80mgs for at least three days, then decide whether to keep him at that dose. I do believe that while that is less than the 120 mg he started when dx with IMHA, that he will still probably experience significant side effects. But, we will deal with that. He's a trooper, his spirits are high as usual, she said to keep him extremely calm. That's easy enough because when he wants to, he can be a big couch potato. We'll love him up a ton and sort through the next steps early next week. Thanks to all of our friends here as always. melissa and tiggs

melissa slc

I don't know what to say besides hang in there and I am thinking of you and Tiggs. You caught this quick and early and I'm sure Tiggs will be better in a very short period of time. Take care.

Mardi Nothern Calif

Hi Melissa, I am so sorry to hear about Tiggs. He's a fighter and he has a terrific mama that is on top of things. The good thing is you will see a very rapid increase in his platelets now that he is on pred. The platelets seem to rise much faster than the rbcs. My thoughts and prayers are with you and your gorgeous boy! Teresa

Teresa va

Hi Melissa, Our hearts go out to you and Tiggs and wish both of you the very best with his current treatment. From the very beginning you have always been there for Tiggs and along the way you have been there for so many of us with your words of wisdom, loving nature, and inspiration to keep going. Tiggs is so very lucky to have you at his side and I am confident that both of you will get this latest siege worked out as well. Good luck my friend, Ron & Cooper

Ron Florida

I second what Ron and Cooper have said so beautifully.

Silka Melbourne Australia

Melissa, So sorry to hear Tiggs has had a set back.. I am sure with all your love and support he will get better in no time.. Thinking of you both. Samantha & Madison

Samantha Perth

Melissa and Tiggs Just to let you know I'm thinking of you and hoping this will be just a small bump in the journey ahead, and that Tiggs will return to good health very soon. Take care Kathleen and Nollaig

Kathleen North Ayrshire

Melissa, as other s have said I hope this is only small setback for Tiggs and he gets better soon. Take Care Laurie and Wylie

Laurie CA

Melissa, Just wanted to let you know Tiggs and you are in my thoughts and prayers. Hopefully things will get sorted out soon. Penny

Penny Lytle Creek Calif

This thread was discussed between 19/12/2009 and 22/12/2009

Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index

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