Clarrie has AIHA

[belindasteer]

Hi, I have actually been here before, 3 years ago when my beardie boy Clancy was wrongly diagnosed with AIHA, he was anaemic but the anaemia was caused by a gastric bleed. He thankfully went on to recover from the anaemia.

Sadly my 10 year old beardie girl Clarrie was diagnosed with AIHA a few weeks ago, we had been going to the vets for the past few months as she had become very weak and lame on her back end, and her bark had changed. The vets were very thorough and rayed her spine which showed some spurs on her vertebrae so we treated her with anti inflams and rest.

She had good weeks and bad weeks but then suddenly on the 18th nov became very lethargic and stopped eating. Blood tests showed a dangerously low PCV and she was immediately admitted and put on  a drip. They scanned her tummy and spleen which were fine, biopsied 2 lymph nodes and did a Bone marrow biopsy which thankfully all came back with no abnormalities. So it seemed that a diagnosis of AIHA was definite so she started on 60mg preds twice a day, imuran 50mg a day and omeprazole. She had a transfusion from her daughter which helped and she started to slowly regenerate. She came home from the vets after  9 days and has slowly slowly improved. She has daily blood tests and the imuran has now been reduced to 50mg every other day. I have asked repeatedly for copies of the bloods so I have the figures but so far no luck, will keep asking.

She has been brighter and seemed to be recovering slowly, but was subdued yesterday, was sick in the evening and today her gums are pale again. I took her in for her bloods and they decided to keep her. They are going to check her liver enzymes today.

I am worried sick, I wasn't expecting her to take a step back - what can be done if she has done?
Belinda

[belindasteer]

Little update, bloods show little change from yesterday, and liver function about the same. They suspect gut irritation from the preds and imuran, so have increased the omeprazole and I can collect her at 6. So relieved as I have been frantic all day.

Pic of Clarrie taken earlier this year, sorry about the scary eyes!

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Belinda

[Kate H]

My 2 year old doberman was diagnosed with this in October and it has been a really worrying time of constantly watching her and imagining pale gums etc. I had never heard of this awful thing until then. Kellie had a positive coombs test to diagnose the AIHA and I am absolutely no expert but here to offer any support I can.

[belindasteer]

Thanks so much Kate and to Shelagh for phoning. I have a printout of the last few days blood exults, she's making lots of reticulocytes, it says it's in the high zone at retic 193.6 K/ul and WBC 33.90 x 10*9/L which it says is 6.9%.
Her haemoglobin is good apparently (mch 28.6pg and mchc 33.7g/dL) BUT she's continuing to destroy her red cells, RBC 3.03x10*12/L, HCT 25.7% HGB 8.7g/dL but her MCV is high at 84.9fl.

Please don't think I understand all this, just parroting it, and had to use asterisks instead if the funny symbols on the spreadsheet, but am I right in thinking the HCV is another word for PCV which I have heard referred too more often?

I asked about the preds dosage, as Shelagh pointed out it should be less than 60mg twice a day according to the suggested protocol,  but Karen the vet explained that they are dosing her at 2mg per kilo twice a day because they need to really suppress her immune system as she's destroying her red cells and we haven't been on the imuran long enough for it to be taking effect yet.  Does all that make sense?

They have increased her daily dose of omeprazole and have given her an anti sickness jab and will give her another one in the morning. She's pleased to be home but very washed out, has just had some roast chicken and mashed potato and is asleep here next to me.

Thank you again for reading this  and sorry to have been so distracted on the phone Shelagh, a little robin had flown into the house and was flying all over the place hotly pursued by the other beardies!

Belinda x

[Kate H]

Kellie was 3 nights at the vets and wouldnt eat. I think I cooked more roats of meat to get her eating but now I am battling to stop her eating everything. I am getting serious grey hairs:-)

[Jo CIMDA]

Hi Belinda

I'm sorry but I have only just seen this posting.  I can't state this strong enough but your vet is wrong - I'm so sorry if this appears to be affirmative but the stakes are too high for me not to make my point in the strongest way possible.

The dose of preds she is on would have suppressed the immune system so much there would no longer be an ongoing immune destruction. It is more likely that the saturation of preds and the Imuran is causing suppression of bone marrow production and when this happens the PCV plateaus, usually around 25-29%.

Clarrie has done so well to withstand this level of preds thus far but it will most certainly be the reason for the present decline in her clinical signs.  Just because an immunosuppressive  dose of preds is 1-2mg/kg/12hours  it doesn't mean that using the highest does is correct or it will bring the disease under control any better that a lesser immunosuppressive dose.  When steroids are used the dose should be the 'lowest' immunosuppressive dose that controls the disease and that means the treatment regime should be started at 1mg/kg/12hrs and only increased if necessary.  For the majority of dogs this is certainly enough steroids to control the immune system and bring the disease under control, and on the road to remission.  More doesn't always mean best especially when using high doses of steroids.  Larger dogs (and beardies are considered larger) do not cope well with very high doses of steroids.

I urge you to reconsider your vets opinion and seek a specialist for Clarrie.  The protocol below is the best protocol I have come across and Prof. Day is one of the world's top veterinary specialists.


Jo


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.

Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 


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

[belindasteer]

This is so difficult as they are certain they are right, would you be able to speak to them?

[Kate H]

Any update on your girl?