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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - treatment isn't working
| I have reached a point where I am not sure of next steps to take -- I'm hoping with your experiences you can give me some ideas. My terrier mix, Gretel, was diagnosed with IMHA in May - her pcv was 16. Initial treatment was with prednisone, cyclosporine, low dose aspirin and 30 days of doxycyline (she had tick fever as well). She climbed up to a pcv of 34 in July at which point the pred dose was dropped from 30 to 25 mgs. In August the pcv was 32 and the vet added pepcid, but the pcv dropped to 30 the first of September so she added sulcrafate. First of October the pcv dropped to 28 so myophenolate was added as well as denosyl and vitamin E. Today the pcv was 21 and the vet says without doing an MRI and/or drawing a bone marrow sample she isn't sure how to proceed with treatment. An MRI done in May showed many targetted areas on the liver and a slightly enlarged heart but no other problems. Stools and urine look normal. Frankly, I'm reluctant to do more invasive testing when the probability is highest that what will be found is something like cancer -- and she's too weak to survive the treatment. Does this sound like a situation where Gretel simply isn't going to respond to treatment or are there some suggestions you have? Thanks, Crista Should we consider doing another round of antibiotics on the theory that the tick fever has reactivated with the addition of another immunosuppresant? |
| Crista Arizona |
| Crista, As for your very last question... I also belong to a tick discussion forum and we have owners come to our list all the time with dogs that have been very sick, possibly with a tick disease. The consensus we are reaching is that tick diseases in this country, and perhaps around the world, are being under diagnosed and under treated. Many vets are just not up-to-date with current testing and treatment protocols. So what we generally see are vets that prescribe a dosage of doxycycline that is too low and for too short a period of time. The dog begins to respond but then fails to continue to improve as the tick disease spreads throughout the body tissues. Tell me what the tick disease was, what the test was they used to determine that, the drug, and the dosage (and Gretel's weight). 30 days is on the shorter end of the recommended treatment duration, but can be an adequate amount of time if the dosage is correct. It is quite possible at this point to do another special blood test to determine if the treatment was successful or not. And it's also possible to begin treatment again at this point too. It really sounds very familiar to me, a dog that responds well to the doxy but is on too low a dose and taken off too soon. The other issue of course is the prednisone being dosed at the same time. This makes it very hard for the immune system to fight the tick disease on it's own. A handful of folks have used it for tick disease treatment, but it's just not the standard treatment. That's usually when the dog develops an immune reaction of some kind. Then prednisone has to play a part. You can read a lot about tick disease at this website: http://blackgsd.googlepages.com/home Read here about Ehrlichiosis (and Calvin at page bottom): http://blackgsd.googlepages.com/ehrlichiosis "Changes in the blood may show up as nonregenerative anemia, thrombocytopenia (an abnormal decrease in platelets) or leukopenia (an abnormally low number of white blood cells). In the severe chronic stage, secondary immune-mediated hemolytic anemia (IMHA) may cause a dog to have a hemolytic crisis in which destruction of the red blood cells is so rapid that the body just can't make replacements fast enough. Or the dog may develop pancytopenia. " Read here about Calvin, a dog that did survive ehrlichiosis with the additional use of prednisone: http://www.njcorgis.com/Calvin.html I hope some of this information will help you. my best patrice |
| Patrice NYS |
| Gretel, who weighs 20 pounds, was diagosed with erlichia canis and was treated with 50 mg doxycycline 2xdaily for 30 days. When her pcv dropped I asked for and was given another 30 days of doxycycline for her. I don't know the specific test used -- was just told that a tick panel was run. This is not the first time she was treated for erlichia as she had it and we treated it with doxycycline when I adopted her 7 years ago. After reading at the websites you provided links to (thanks very much!) I'm wondering if when the mycophenolate was added to Gretel's treatment her immune system because so compromised that the erlichia is raging again. To this end I've put in a call to the vet. I am concerned about using doxycycline again as I've been told that her liver is enlarged and the values are very high. Thanks for your ideas, Crista |
| Crista Arizona |
| Crista, Ok I see where you are at now. I would highly suggest you join this tick list and run some of this by the experts on this list. We have a vet that monitors the list as well as several other experts. I trust this list to provide accurate information. Go to this webpage: http://saluqi.home.netcom.com/ticklinks.htm And click on this: Managing your TICK-L subscription options, etc. Subscribe, sign off, change options, or search the list archives from the TICK-L home page How to set your mail program to post in "plain text" (and six reasons why you should do so) This will take you to where you can join the list and search the archives. You should post soon also with a summary of your problems. Folks will respond and ask you more pointed questions and help you sort this out. My best Patrice |
| Patrice NYS |
| Thank you for the Tick-L list. I joined and will run our situation past the members. Crista |
| Crista Arizona |
This thread was discussed between 23/10/2008 and 24/10/2008
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