Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Update on Holly (Dachshund) 5-14-08

Hi All, Just wanted to let you know the sort of good news. Holly had blood tests done on Monday and her Hematocrit (PCV) came back in at 47.8! Last month was 44.1. We have been doing only 1mg pred reduction for the last 4 months and are down to 3mg broken up twice a day and she is still on daily Imuran. The bad news is her retic is on the rise again! So upset! Last two months while doing the reductions her retic held at 0.5 and I really thought this month would be good to, but no such luck, she is back up to 1.1, so destruction is still going on. I just don't know what to do anymore. She also gained another lb this past month and her diet has not changed in any way. She is up to 16lbs. and was 12 when we first adopted her. Still always starving out of her mind, she just cries all the time for food when we are home, and she has been on the same food schedule for the last year same times no more or less of the veggies, etc. I know the internist is going to say up the prednisone again, and I really don't want to do that, she has been on prednisone now since March 2006. Just at such a loss now, I think the Hematocrit is great, but just don't understand if that keeps rising why the retics are also rising?? Could it be something in her diet making the antibodies continue to grow? I am so tempted to do this next reduction to 2mg of prednisone, but don't want her to relapse after all this time, or wondering if should hold for another month at the 3mg of pred and see what happens. Also tempted to start the Imuran on an everyother day schedule as her WBC is always boderline low. Just at such a loss, just want this to be over after 14 months! Thanks for listening! Linda

Linda Sapphire

Hi Linda. Have you thought of contacting Dr. Dodds for advice on this one? Don't you just love this illness? Even when things are looking good, we're still guessing and worrying! I hope you get some answers and that Holly continues to maintain such a great PCV level. Take care. deb and Duck

Debbie BC Canada

Linda, The normal condition of any living body is always in a state of adjustment. When you look at reticulocyte counts, it's important to look at the big picture. In a normal dog (or human) the number of retic circulating in the blood is generally somewhere around .5 to 1%. Small fluctuations are to be expected. Each blood cell has a life of about 120 days and then, worn out, they are broken up and replaced. What is generally ominous is when you see higher counts of retic, like 5.5%, and fast slides of pcv (hct), as from 45% to 35% in a short period of time. Also, most specialists like to use another number, the absolute count of retic, rather than the % of them. This gives a more accurate look at the actual response according to the severity of the anemia. They use a math formula to arrive at this, but most automated analyzers can do this. This number, when normal, is somewhere less than 60,000 (if paired with a normal range of pcv). Your pcv, 44%, is well within normal range. And the change from 47.8% occurred over a longer period of time than a few days. What would be auspicious would be to shorten the time between cbc's and watch the relationship between the pcv and the retic count more carefully. If this were me I would have a simple pcv spun once a week to see if there are quickly sliding values. But, I suspect, the next time you go for a test, you will see a slight rise in the pcv and a slight decrease in the retic count. If I can help you in any way, please let me know. Patrice

Patrice NYS

Linda, I agree with Debbie and would email Dr. Dodds. We lost our Jack Russell last July to AIHA which I believe was brought on by the administration of flea/tick prevention. We are looking into getting another dog now, so I asked her what she recommended we use since we live in GA. She emailed me late that night. She obviously is quite generous with her time and would be willing to give you her input. I am so glad that Holly is doing so well. I have watched her progress since last June. Keep it up! (p.s. for those interested, Dr. Dodds recommended Interceptor every 45 days for heartworm, Advantix for flea/tick if you do not have cats and Frontline if you do...I am still concerned about this as Advantix is what we used on Skip 3 days prior to his AIHA diagnosis)

Barbara GA

Linda...the other thing to consider is the reticulocyte count will rise from any loss of RBCs forcing the dog's sytem to replace them and show more immature cells in the count. If your dog got cut for instance, and lost alot of blood, there would be an increase in the reticulocytes. What happened to my dog was she developed a bleeding ulcer from the prolonged high doses of prednisone the bleeding causes the loss of RBCs and increase in reticulocytes. If the dogs stools are dark or black, that is an indication of digested blood, unlike the orange stools that arise from the excess bilirubin that you may have seen initially from the internal destruction of the RBCs.

RonB San Mateo

Thanks everyone for your advice. Patrice I have a few more questions, if I may. On 4-8-08 Holly's Hematocrit was 44.1 and her retic was 0.5 (absolute Retic's 32250) that was when we were giving her 4mg of pred, 2.5 in morning and 1.5 in evening. Now on 5-13 her hematocrit is 47.8 and her retic is 1.1 (absolute Retic's 78100) and this was after one month of 3mg of prednisone, 2.5 in morning and .5 in evening. I haven't heard back from internist in Atlanta as of yet or my vet, but then again our vet up here in NC does not make a move without the advice of the internist, I think he is leaving up to me to figure out. Basically all he does are the blood draws, UGH! And like I said the internist will tell me to increase the pred again which I do not want to do. If it were you, Patrice, would you keep the same on amount of pred 3mg and test in one month to see what happens?? I know you did say about having done once a week, but we just cannot afford to do this right now and especially with gas prices, it is 1/2 away for us to go. It just seems like whenever we start the decrease in pred and get to a lower dosage is when the retics go back up, but we have not kept at the same for two months like this. I had contacted Dr Dodds several months ago when Holly had her setback and numbers were on the rise again, but she just said all looked good and eventually decrease pred. But that is the problem each time we get anywhere below 4mg the retics start to go up. I know some have said the vets don't even test the retic's if the PCV is good, so maybe I should not be worrying about this so much?? And Ron that you for the information, I value each and every piece of information that anyone gives to me at this point. Good thing is HOlly's stools are very normal and have been except that one time several months ago, and no cuts or any other signs of bleeding. Maybe then could explain this retic problem. Thanks again to everyone for advice and suggestions. Linda

Linda Sapphire

Linda, I would not alter the pred dose. Isn't there a vet anywhere nearby that will spin a simple pcv for you? My vet does it for $8. and the hazardous waste fee. I don't even have to see the vet, the tech does it for me. I would not let a month pass between these fluctuations. I am not trying to worry you, but something is causing the retic count to go up and down slightly. Dr. Dodds might say that this is anemia of chronic disease. By that I believe she means that there are other conditions, such as nutrition, that affect the blood making process. One good example is the kidneys. Their good health is very important in the manufacture of a hormone that stimulates the making of blood. If the kidneys are operating at less than optimal function, they don't respond as well to the request for this hormone. The prednisone may very well be modulating something else in the body, such as the adrenal glands, that is necessary right now at this dosage or slightly higher. If I remember Holly is only about 10 lbs? It's a toss up whether 3mg is acting as an immunomodulator or is in a therapeutic dose. Maybe there is a nurse that lives near you or in your church community that could help you find some way to have pcv spun more frequently? A local college? Explore all possibilities. You have an internist so you can easily confer over the phone with them about the results. Patrice

Patrice NYS

Patrice, Thanks again for all the information. I just wrote a detailed letter to the Internist in Atlanta that treated Holly in the hospital and has kept up with all of her bloodwork and has given her advice since March 2006 to our local vet who is less then concerned at this point. I will fax to her tomorrow, but I expressed my concerns of the constant flucation in the retic count and why this continues to go up when her PCV is high. When we first got Holly she was 12 lbs. but since that time (Dec 05) and her onset of the anemia in March 06 her weight has risen to 16lbs. In fact like I said she gained 1lb over the last month with NO diet change what so ever! I guess I don't understand about the PCV spun, because for the last 4-5 months her PCV has done nothing but continue to rise, never decrease at all. It is only once we get down to 3mg or 2.5 mg of the prednisone that her retic count rises, we can never seem to go below that without danger of rising the retic count. The only other issue is that she is also on Imuran and has kept her WBC low for the last year. This bloodwork showed 5.1 which is good for her, but her lymphocytes for the last several months have been low, this past month was 510 (normal-690-4500). Our vet is about 11 miles away from us and I will have to call and see what he would charge to do a PCV spin, problem is, Holly gets to excited and tense when going to the vet anymore, really hard to control her there. Very dramatic for her there, so hate to subject her to this being done this often. We will continue for now on the 3mg. All of her other counts are good, liver, etc. Thanks again for all your advise and help. Linda

Linda Sapphire

Linda, I am sorry, I said it in a backwards way. What I mean is that you would want to know if there is a sudden significant decrease in the pcv as indicated by the higher retic count you saw on the full cbc. I doubt there will be any, but this quick look directly at the pcv will tell you if she is stable. Minor fluctuations, 47 to 44 to 46 to 43 to 48 etc wouldn't be very upsetting to me. If we could be so lucky! Chance hovers right around 36-37-38, very stable, so indicates his "proper" operating pcv.

Patrice NYS

Patrice, Ha, yes, I was a little confused on that with the PCV because Holly's has done nothing but increase for the last 4 or so months. So you think as long as her PCV is good in the 40's not to worry about the retic's rising?? Only if her PCV should start to decrease again?? See in the beginning when fist diagnosed I spoke with the internist about this alot and asked with a PCV reading of 8 how was she even able to eat and function because even with the seizures she was having she always came running for food, the internist explained to me that her body adjusted to the decreasing PCV rates over time and hers was a very gradual decrease. I guess that is why she is always so concerned when she sees the retic count on the rise again, because she knows in time the PCV will go down as the disease takes over again. But as long as I don't see the PCV go down and just stay around the same or even maybe increaase I should not worry?? Thanks again, Linda

Linda Sapphire

Linda, After a certain time with Chance, I began to see those small fluctuations with the retic and the pcv and realized that they were minor, his condition was good. That is when I began doing just the pcv's to monitor him. What you would be specifically looking for would be a drastic change in the pcv from one week (or two) to the next. That would be your tip off that something is changing that is not proper. That is when you would fall back to doing a full cbc to see that retic count. The retic count is what is used to determine the severity of anemia caused by hemolysis. High retic count and rapidly dropping pcv indicate either serious bleeding or red cell destruction. It is in relationship to a pcv that is LOWER than 37%. This process is called reticulocytosis. When the pcv is in the normal range (37% - 45% or so), minor ups and downs in the retic count don't factor into the mathematical formula because there isn't clinical anemia. Small fluctuations in pcv within the normal range may indicate normal body changes or some underlying body function related to the production of blood that is not working as well as it could, such as kidneys. Drugs can impact the production of rbc also. In fact, the list of things that could impact blood production are as long as your arm! What is important is that the pcv remains relatively stable within the normal range. If you match that with the dog's condition (doing fine) then the vet would say that they are pleased with the numbers. I hope I have helped and not confused... again. Patrice

Patrice NYS

Check these two links out: http://en.wikipedia.org/wiki/Reticulocyte http://en.wikipedia.org/wiki/Reticulocyte_production_index

Patrice NYS

Hi Patrice, Thanks again so much. You know I have read in the past all about this over and over for the last year and finally today I think it finally clicked. No, you never really confuse me, only help me. For the last few months we have not done a superchem, just a CBC & retic count,because her numbers, liver & kidneys have always been good, but once a month we do the CBC & retic, because again the internist has always stressed the importance of the retic count to me. Again her PCV has remained good in the 40's since March of this year, and her retic count at 0.5 for two months, it wasn't until this month that the absolute retic's more then doubled from 32250 to 78100 and seems like only because of the decrease in prednisone to 3mg. So, now I wonder because this happened, and again I should not worry so much and just wait and see what happens next month, what if next month her PCV is still in the high or mid 40's but her retic jumps up again higher like over 1.5? I understand now that an increased production of red blood cells to overcome the anemia, the retic will go higher to compensate for it. I am just hoping that Holly is not one of the dogs that will have to remain on prednisone for the rest of her life being she is only 3 years old. I have read that this can be a congential or hereditary condition. Sometimes I wonder if it will ever be over for this little one and all the other ones suffering here on this board. Anyway, thanks again for all the info. Linda

Linda Sapphrire

This thread was discussed between 15/05/2008 and 17/05/2008

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