Auto immune anaemia?

[Anna]

Hi

Teddy
Our 10 month old Cockapoo is now suffering from a second bout of AIHA.  She first contracted it in May, had a transfusion, was then treated with a human drug which is given as anti rejection treatment to transplant patients (I don't know the name but I'm sure you do) . She improved steadily and was on Preds and Azathioprine for a couple of months. The vet was pleased with progress and she slowly came off Preds but continued on Aza. She seemed fine but was clearly in slow decline. Two weeks ago we took her back to vets.  She seemed quite bouncy still but her PCV was 6 ! She had a second transfusion and her level increased to 12 but stayed at that level for the next week. She was pescribed Prednisolone, Metronidazol, Antepsin, Omeprazol and Promax.  But the lab advised to stop AzThioprine as its side effect can suppress blood cels across the board which was shown on Teddys blood test.  After a week, her PCV is down to 9 now.  They have now pescribed Atopica on top of everything else.  Teddy still seems lively and bouncy, she's not ravenous like last time but she seems happy.  I think we should try to Aza again. It clearly worked last time.  The vet is worried and thinks there may only be a couple of other drugs we can try.  But we're getting close to needing another transfusion now.  I not sure if I want to subject Ted to that again.  I don't know if there is anything else we should or could do? Do you think we should try Aza again? What else can we do? Are we missing anything? We'd really appreciate any advice you can give.

Anna

[Catherine]

Obviously I do not have all the details but my first thought here is that maybe the steroids were reduced too quickly. I know the Azathioprine could cause bone marrow problems but this has not been my experience. Here is a link to AIHA on this site:

http://cimda.co.uk/smf/index.php/topic,11.0.html

It is best to make sure Ted is on the correct dosage and in the beginning to have his blood tested every few days. Then when it is not so dangerously low, you can test it every week, then 10 days etc. This way, if the PCV (HCT) starts to go down it can be caught before it gets too low.

Also here is the medication protocol:
Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

This example is base on a dog receiving an induction dose of 1.0mg/kg/q12hrs

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h                         10-28 days
0.25mg/kg/q24h                         10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!

[Penel CIMDA moderator]

In some dogs Aza does cause problems but that is pretty rare.
However it may be that Atopica might be more successful for Teddy.  I think it's quite possible that the drugs were reduced too quickly - if he came off everything within a couple of months that's too quick in my opinion.  Quite often dogs need to stay on a maintenance dose of the drugs for months and months before trying to take them off completely - Ted may be one of those dogs.

[Tammie]

I read your post and Im no expert but we have been treating Riley for Evans Syndrome since last November.  Transfusion came in Jan to the best I remember and we just dropped the Atopica a couple of weeks ago.  It has been a very long road and I too believe that the meds were decreased way too soon.  Good luck to you and yours!