Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Ups & downs?

Ren had a vet visit today. Her PCV has dropped a few points, back down to 32. Over all she seems in good health. Of course she is not the hyper little Chihuahua she once was but she is happy. My question is, do PCV's drop occasionally? The vet right away upped her pred. I dread the thought of poor little Ren having to take more pred. It is so hard on her body. Last time she had gastro bleeding from the pred even though she took carafate 3X daily. I do not want to slip into that panic mode thinking that this few PCV points are going to be a downward trend. In one thread here I read that variables do happen with blood diagnostic machines, etc. And perhaps this the mid 30's is going to be the new normal PCV for Ren. This last bout with AIHA really took a toll on Ren. It is now three months that we are fully medicating her. She is on Pred, Atopica (cyclosporine), Imuran and an antibiotic. Carafate three times a day for digestive protection. Please continue to pray for my little girl. I pray for complete healing and for this horrible disease to NEVER afflict her again. Heavy hearted today but not giving up the fight. SUE

Susie Delaware

Dear Susie, I am finding a similar thing with my Millie, who was diagnosed nearly 2 weeks ago. Last Tuesday she had a PCV of 27. Wednesday she was struggling to breathe, so straight back to the vet. Apparently PCV of 21. Our vet referred us to the vet hospital and they re-tested her twice just a few hours later, and Millie had a PCV of 27 both times. They told me that there can be discrepancies resulting from the way the sample is handled etc, amount of fluid she has in her blood.... They said always re-test when they see a dramatic drop and don't worry if it's only minor. Millie has been 27 for a week and a half now. I'm still waiting for the PCV to climb!! Vets have said to be patient and that low PCV's in immunosuppressed dogs is normal when taking Imuran as the drugs can cause bone marrow suppression. The vet also told me to look for other signs - eg. energy level, gum colour, appetite etc as indicators of general help and don't get hung up on the PCV fluctuations. I'm confused too and scared every time we test Millie's blood. It's hard not to be negative, but if they do slip back there are things that can be done to help them. Keep fighting and good luck to you and Ren. Samantha.

Samantha Australia

Susie, Poor Ren. Is the Vet just doing in house PCV's or are you doing CBC's and sending them out to the lab? A lot of things can affect the reading. Handling, dehydration etc. Try not to panic yet. It is good that she seems in good health other than not being as wired as she once was. Hopefully things will get back on track soon. Praying for you both Penny

Penny Lytle Creek Calif

Susie, Holly's blood work is always sent out as CBC, and although she cannot eat before her blood draw, I give her a little fat free milk to keep her hydrated, and then we listen to music on the car ride down to the vet, nice relaxing music. Does Ren get nervous going to the vet? I know the first year Holly's draws were up and down also, but we have since learned how to calm before them. You are both always in our prayers. Linda

Linda Sapphire

Susie, I think things can effect the PVC like examples mentioned. I think getting excited has something some effect thats why I always schedule Wylies tests first thing in the morning, so there is no waiting. If I go later they are usually so behind, by the time Wylies gets her test, she is in a tizzy. I would go back in 4-5 days and get it re-tested. Just curious why is Ren on both Imuran and Cyclosporine? I really know nothing about these drugs and always thought they were used one over the other and not in conjuction. Good luck to Ren Laurie

Laurie CA

Thanks for your concerns and prayers! I never thought about Ren being nervous before the blood draw. Do you think that can influence the results? Also, she ate a hearty meal before we went to the Vet on Monday. That might have something to do with the numbers. I will ask for an earlier appointment next visit. The Vet does do the blood work in house through a diagnostic machine. However, once Ren's PCV came back as 50.3 and the Vet questioned that so she sent the sample out to an independent lab and the results came back as PCV of 37. So indeed there was a discrepancy in the results. To answer your question about Imuran and Atopica used together; this is the second time that Ren had battled AIHA. The first time she had the disease it was very difficult as most of you know. But this last time when she had a relapse, the disease was much worse. Ren was so close to death. It was only through a second opinion that we were given hope for her survival. This Vet placed Ren on Imuran for long term usage. The cyclosporine was added because the disease was not responding to conventional treatment. It was almost three horrible weeks before the meds kicked in. I am trying not to be set back by the PCV numbers. I know that the disease can be scary but manageable. I look at her little face and see only love there. She has been through so much. I said to my Husband yesterday, “I wish that Ren was normal". In his great wisdom he replied, "she IS normal". When we have beloved pets with this disease, normal is the checking the gums and counting numbers. And valuing every day that we have with them. SUE

Susie Delaware

Sue. I think it was Patrice that talked about the impact of levels and stress and having the test done after fasting. My vet gets different # from the spun one and the other. He said the spin is the most accurate and luckily Wylies # is about 8 points higher on this. Laurie

Laurie CA

Susie, I certainly agree with the stress. Does Ren seem stressed out at the vet before the blood draw? When Holly first started, of course next month wiill be 2 years, but during that first year, while we were still learning and going for blood draws almost every week, she would get so excited in the office, sometimes they had such a hard time just finding the vein because she was so wound up. Then as time went on, we would arrive early and sit in waiting room until she calmed down somewhat. I think now after almost 2 years she is just so used to going there to have blood drawn, she actually enjoys it, HA! She does love her car rides and seeing other doggies there. I know lots on here are not required to fast before blood draws, but our vet has always required it, I think it is the labs. Linda

Linda Sapphire

Yes, Ren starts going in to the "Chihuahua shake" as soon as we turn right out of the driveway...lol. She knows whether we are going for a pleasure ride or if we are going to the vet. I'm sure she senses my unrest so she reacts accordingly. I am going to try a couple of things different on the next vet visit. First off I'm not going to feed Ren right before we go and I'm also going to try to make it a more pleasurable experience. That might be hard but I have a couple of ideas. Since Ren is so small most of her blood draws come directly from the jugular vein. She doesn't seem to flinch too much but I can only imagine that it is uncomfortable. The poor soul has had more blood draws in one year than I have had my whole life! Thank God the vet is a good blood sample taker and hits the vein nine times out of ten. SUE

Susied Delaware

A good blood draw starts with patient compliance and follows up with a tech who is experienced and careful and ends with an observant vet consulting directly with you, the owner. A fasting test is really the best way to go, about 8-10 hours. Fat (lipids) from a recent meal can still be in the blood and cloud the sample. However, fasting should be accompanied by good water intake so your dog isn't dehydrated. That makes getting the needle into the vein very hard. Extreme excitement can cause many stressful events in the body that can alter the test also. It can make it difficult for the tech to get the syringe into the vein and the sample can be damaged in the attempt. This can cause red blood cells to be broken and artificially lower the hematocrit and number of red blood cells while increasing the bilirubin count. Sometimes the platelets can clump, making it appear that the dog is deficient. I think scheduling a time when the office is nearly empty is a good idea. Perhaps choosing a time of day when your dog is normally napping might make them a little sleepier and calmer. You might have to arrive 30 min before your blood draw and just sit quietly in the car or office to achieve calm. Sometimes the tech will not allow you into the room while the blood is drawn, owners can upset their dogs if they find the process alarming. I don't like this and I always asked to be present. I don't always get my way, but I try... Always ask for a spun PCV packed cell volume to be done in addition to the automated analyzer test. This will be a more accurate measure as is done visually. The analyzer uses a laser to identify and count blood items and, while it is an ideal method for determining many cellular items, it can be misleading when determining a value like the hematocrit (which should be the same as the PCV, but never seems to be). Chance's hct is always lower than the PCV, by as many as 5-6 points. We use the PCV as the measurement. A PCV should not cost more than 15-20 dollars top. I pay 8. my best patrice

Patrice NYS

Ren has a vet visit on Tuesday. I set a time later in the day when she is usually most relaxed. I will not feed her for about an hour before we go. Also this time my Husband is going with me. He seems to have a calming effect when Ren is nervous. Please pray that Ren's PCV is higher. And that her blood work looks good all around. Last visit the vet increased her Pred dosage (only by 1.25mg per day) but I can see the increased thirst and urine as well as the muscle weakness. Also pray that we can start to decrease the medication that Ren is taking. Poor little soul takes sooooo many dosages per day. Thanks all, and I'll post later on tomorrow. SUE

Susie Delaware

Sue, I will be praying for you all. Hopefully with the change in the routine it will not be as stressful and you will get good news. Two of our dogs are terrified of trips to the Vet. I know what they mean by the "smell of fear" When I had titers run on one of them some of his levels were very elevated but the Vet said it was just from the stress so hopefully Ren will be calm and you will see a big difference in the results. Penny

Penny Lytle Creek Calif

Ren's PCV was back up to 39 today. She was much calmer going to the vet at this later hour and she was not fed. I asked the Vet about the possibility fallibility in the diagnostic machine. We both looked at the machine results and the PCV was only 31 on there. So the spun and read by hand results are much more accurate! And you were right Patrice, the test was very inexpensive. The Doctor wants Ren to continue with her current medications until re-check in two weeks. We also discussed using the "Sam-e' and she thought that was a great idea. So we are going to that a try. Thank you all for your thoughts and prayers. Please continue to pray for complete healing for my little Ren and all the precious dogs on this web site. SUE

Susie Delaware

Sue, Sounds like it was a great day for Ren. I am glad you have a Vet that is open to your suggestions. Penny

Penny Lytle Creek Calif

Susie, Excellent news! I love the diplomatic way you worked with your vet. They appreciate you more as a client when you make these efforts to assist them do their jobs better. They will look forward to your visits and say things like "oh I wish all the dogs were this easy!" Sam-e is a natural coenzyme that is involved in metabolic reactions in the body. It is very involved in these activities in the liver. When we dose our dogs with high levels of prednisone, the liver must work very hard to metabolize it. Sam-e, (along with silymarin, the essence of milk thistle) assist the liver to restore new cells as cells break down processing prednisone. Both of these supplements aid the liver during this time and as the prednisone dose is reduced will help restore the liver to it's original health. You can use over the counter Sam-e and milk thistle. There are also excellent veterinary formulations of these supplements that are dosed properly for dogs: Marin, Denosyl and Denamarin. These can be very expensive esp. in large dogs but they are very worthwhile. The best price I have found for Sam-e is through the NSI brand at Vitacost. Sam-e is known to be very stimulative and is best given in the morning to avoid insomnia. Chance seemed to be a little buzzed after his dose. Also, make sure that there is adequate B vitamins in the diet. Sam-e requires them to metabolize properly. Dr. Dodds often recommends Pet Tinic which has B's in it. I use normal human B-50 vitamins for B balance. Patrice

Patrice NYS

I'm always learning something new on this site. I did not know that SAM-e can cause insomnia. The vet said to give it on an empty stomach, so we opted to dose late in the evening before bedtime. I guess I will have to change that to AM. Ren already takes the Pet Tinic so we are good there. SUE

Susie Delaware

This thread was discussed between 03/02/2009 and 11/02/2009

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