Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Update on Riley

Hi everyone The latest blood results for Riley are in, and the Antinuclear Antibodies test came back as Positive>=1:40 which the vet said is a good result as it means he can be weaned off the medication and not be on it for the rest of his life. The blood test is showing slight improvements with the red cell count rising from 3.32 to 3.58 (normal being 5.50-8.50) and the Hematocrit (PCV)rising from 0.28 to 0.30 (normal being 0.37 - 0.55). Unfortunately the white cell count has risen from 31.4 to 32.4 and the neutrophils from 25.4 to 28.5. The vet checked with the pathologist and seems this indications that there is an infection somewhere, so they have started Riley on antibiotics. I said I wasnt so sure about that as I had read they contributed to the disease, but they said they knew that and the one they have given Riley is not one of those. The band forms have reduced from 4.7 to 1.0 (normal being <0.4). There is a little blood in the stools and this vet feels it is part of the infection, so we shall see what the next days bring. Riley is still lethargic and sleeping a lot, but I feel the old Riley is in there trying to get out, I can always tell by the direction of his tail, if its down he isnt good, and if its up, then there is hope. He waddled out with me for a little walk out the front this morning. The vet felt with these results the prednisone could be reduced as she felt this was contributing to some of his symptoms. Are we on the right track?

Silka Melbourne Australia

Sorry, I should have added that Riley's platelets are up from 227 to 309 (normal being 200-500) and the plasma proteins up from 60 to 66 (normal being 56-82). Also recticulocytes down from 302 to 75, big drop from 9.1% to 2.1%. On my copy of the blood results, the vet had some handwritten notes saying "more than just responsive bone marrow - infection/antibiotics - PCV monitor. I know I have to monitor the platelets with the reduction of prednisone, next blood count next Tuesday. Previous results had indicated some inflammation.

Silka Melbourne Australia

Hi Silka. Riley PCV nos seem good. Perhaps an email to Dr. Dodds (something I wish I had done) with those blood results would be a good idea. The vets will have to watch the reticulocytes count which has dropped. (scruffy's was less than 0.01 nil regeneration so Riley's are good but you need to monitor the nos dropping. I am no expert and others know heaps more especially Pratrice who will give you better advice. regards Julie.

Julie Australia

Hi Silka, That's great news! What an amazing turn around. The Pred side effects are normal, and it's sometimes hard to watch our dogs struggle. Be comforted to know it's for the best and only short term. Our vet advised us to start reducing the Pred only when Millie's PCV had gone up to the normal range (which at the time of the first reduction her PCV was 38). This was from memory, around 6 weeks after diagnosis. We stayed on PCV 27 for 3 weeks (after crashing to PCV 14 prior to blood transfusion), then slowly climbed. I err on the side of caution with Millie's reductions, and I still do. I've discussed this with the vet, and she's supportive of this. Millie's first reduction was 25% (10mg of Pred down to 7.5mg daily). The high doses of Pred aren't harmful unless the dogs are on them long term so I felt comfortable in being conservative that I wasn't contributing to any long term damage to her body. Good luck, Samantha & Millie.

Samantha Geelong Australia

Thanks Julie and Samantha, I did wonder about the reticulocytes dropping so much - I should have said that there was a comment on the bottom of the results saying "poorly regenerating" when previously it was "moderate". I will email Dr Dodds, she has such a good following here. Samantha, I am aware that reducing the prednisone too quickly could cause difficulties, and I guess they have reduced it by half, from 25mg to 12.5mg per day - I gather the 25 mg was fairly high to start with. I suppose as there is an infection to deal with as well. The next blood result on Tuesday will tell, but I will ask given that Riley's PCV is not yet in the normal range. Silka

Silka Melbourne Australia

Hi Silka, I see what you mean! 25mg is quite high.... I imagine that is why your vet wanted to reduce now. Everyone raves about Dr Dodds. It's definitely they way to go. Sam.

Samantha Geelong Australia

Hi again, I have sent off an email to Dr Dodds with the results etc. Julie, in regard to the reticulocytes dropping, and I noted that too, but I found a paper presented at the World Small Animal Veterinary Association, and the presenter talked about this and said that "a hematocrit of 30% or more in a dog causes little tissue hypoxia (deprivation of oxygen supply) and thus little stimulus on the bone marrow. So one expects little regeneration with an anemia with a hematocrit of 30% compared to one with a hematocrit of 15%" I hope thats right, given that the drop came when Riley hit the 0.30%. PS. My vet just called me to chat about the results as I had been speaking to another one, and she agrees with this as well. Back to the vet to get more gastroprotectant.

Silka Melbourne Australia

Silka, for a PCV of 30% the retics sound about right. As the PCV rises the retics will start to fall within normal ranges. This can be expected and also shows regeneration. I think it's the sulfa antibiotics you'ld want to avoid. I think there's links to thoose and AMHA. Antibiotics sounds like the proper coarse of action to me. There's also an oral paste called Diarsanyl (might go by different names elsewhere) that will coat the intestinal mucosa.....Tessy's doctor said that I could use this if I saw small traces of blood in her stool....safe to use/try. I've used it with another one of my dogs with great results. From what I've seen here the results sound good. You're heading in the right direction Riley. Keep on fighting. Johnny & Tessy

Johnny

Thanks Johny for your response, and also the support. I looked up Diarsanyl and it looks good, but cant see it anywhere in Australia. Riley is back on the Carafate.

Silka Melbourne Australia

Im back with the next blood test update. The hematocrit has risen from 0.30 to 0.34, red blood cells from 3.58 to 4.06, platelets from 309 to - wait for it - to 691! The white blood cells have climbed again from 32.4 to 41.9. Comments from the pathologist say the red cell numbers mildly improved and now mildly regenerative. The platelets mildly increased (I think the word of the day is "mildly"). White blood cells may be reactive/responsive tubt with such high numbers may be inflammatory and band cells occur with infection or tissue necrosis. More antibiotics of the "good" kind, for a little bit longer. Prednisone has been reduced by another half as from today. Something I read on the marvistavet site says that "classically, in IMHA the stimulation of the bone marrow is so strong that even the white blood cells lines are stimulated - this leads to white blood cell counts that are spectacularly high. Some good news, some not so good news, but Riley seems more responsive of late.

Silka Melbourne Australia

Silka, Mild regeneration is a good sign! what worries me is that you are talking about a prednisone reduction of another half. A reduction of 50% is very high and could throw Riley into a relapse. Reductions are usually done when a dog is stable and not more than 25-33% every 3-4 weeks. this is from an article that Joanne has posted many times. I know Riley has been on a very high dose in the beginning and this is probably why the vet wants to reduce faster. Has Dr. Dodds recommended this reduction? What is Riley's weight and what is his pred dose now? I am so happy that Riley is more responsive. Take care, best wishes, Brigitte & Kahlu

Brigitte BC Canada

Hi Brigitte, I think I typed it incorrectly, not by another half, just a half a pill, so only by 2.5mg, down from 12.5 to 10mg. I understand that the first dosage was extremely high, but I believe from what I have learned it is necessary to do that. I know from all the posts here that the reduction has to be slow. I did email Dr Dodds about Riley's situation who did not have anything to say about the medication Riley is on, but sent me information about hyperthyroidism which I am wading through and will talk to my vet about. I understand that is her speciality. Sorry for the misunderstanding. I was careful as my regular vet is away at the moment, so this was another one. Does that make sense? I was somewhat concerned about the high platelets and white blood cells now but perhaps that is part of the regeneration. Sorry for the mis-type. Silka

Silka Melbourne Australia

Silka, Phew! I am relieved now. It makes perfect sense and that seems a reasonable amount to reduce. I have not enough to worry about my own dog, now I want to worry about other peoples dogs too:) Best wishes, Brigitte

Brigitte BC Canada

Hi Silka, it is great to read that Riley has responded so well. Hopefully, the worst is behind you now and it is just a matter of med reduction. What a great problem to have. I wish you well with Riley. Julie.

Julie Australia

Thanks Brigitte and Julie for your responses. Riley actually stole my lunch today as I was getting ready for work - came out to find him eating the chicken, cheese and tomato roll in the passageway, getting agitated as I got closer as from the rear I thought he was throwing up! He did well to get into such a deep bag - must have smelled the chicken. Must be the cortisone.

Silka Australia

Silly Riley! That sounds so cute. Good to hear he's on the path to recovery. I can't recall but is Riley on anything to thin his blood? Aspirin etc.? When Tessy's platelets started to rise they decided to put her on small dose aspirin. Tessy's platelets have been between 500 and 700 for as long as I can remember and at one point have been as high as 1000+! I know some reference ranges go as high as 8-900 so I'm not overly worried about her current number of 607. Just something to keep an eye on if it keeps consistantly rising. Best wishes to you and Riley. Johnny & Tessy

Johnny

Hi Johnny, thanks for your post, that helps me a great deal. No, Riley is not on aspirin, I did mention it to the vet as I had seen it somewhere, here and on the net - she didnt think it a good idea with the Thrombocytopenia - but now the platelets are up. I hope the "infection" resolves with the antibiotics. Its always good to hear what others are experiencing as well, to learn from it. I know this is slow going. Best to you and Tessy. Silka

Silka Melbourne Australia

This thread was discussed between 01/10/2009 and 11/10/2009

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