CIMDA - THIS FORUM IS NOW READ-ONLY

Hi there

Our beardie has been diagnosed with PIMHA and IMHA, he is on Prednicare, Atopica and Clopidogrel to prevent clotting.

We are trying to manage the costs as the Atopica and Clopidogrel is quite expensive through the vet. I can find Atopica easily online, but am having trouble finding the Clopidogrel. Has anyone out there purchased 18.75 mg tablets of Clopidogrel (Plavix) online, if you have, where did you get it from?

Thanks.

Regards.

Trudie

Hi there

I have an 8.5 year old male bearded collie who, just over a week ago became listless and lethargic. Prior to this, he had been having regular anal gland checks following recurring infections which took several courses of antibiotics to shake off (the checks had all been fine). He had also had what we thought was an allergy, with some sneezing and a runny nose, for which we were giving him Piriton - this hadn't totally cleared up, but had seemed to improve.

Following a check at our local vets his bloods showed he was very anaemic and an ultrasound showed a mass on his spleen, so we were referred to a specialist vet, who following a series of tests, have given the diagnosis and treatment plan below:

TESTS PERFORMED:

External blood smear examination: this showed evidence of very mild regeneration, but this was inadequate for the degree of anaemia. A type of red blood cell called spherocytes were observed, which are most commonly seen with IMHA.

Urinalysis: the urine was concentrated and did not contain excessive protein. Some crystals were observed, which occur with storage of urine. Bilirubin with bilirubin crystals were also present (likely secondary to IMHA).

Splenic nodule cytology: evidence of new red blood cell production, with some inflammation (common in conditions which cause systemic inflammation such as IMHA).

Splenic parenchyma cytology: evidence of new red blood cell production, with some inflammation (common in conditions which cause systemic inflammation such as IMHA).

Bone marrow cytology: there was evidence of an increase in the number of red blood cells within the bone marrow, which were then being consumed by white blood cells. This is consistent with precursor immune mediated anaemia.

Bone marrow histopathology: pending.


DIAGNOSIS

Precursor immune mediated haemolytic anaemia (PIMA) and immune mediated haemolytic anaemia (IMHA): these are conditions in which the body attacks its own red blood cells. In the precursor form, this occurs within the bone marrow. With IMHA, this occurs within the circulation.


TREATMENT

Prednisolone 20 mg twice daily

Ciclosporin 100 mg: give one capsule twice daily with a 50 mg capsule. This is an immunosuppressant. Side effects can include a reduction in appetite, vomiting and diarrhoea. We recommend freezing these tablets to reduce these side effects.

Unlicensed medication:
Clopidogrel 18.75 mg: give 2 tablets once daily. This helps prevent the risk of blood clots, which can be seen with Fergus' condition.


FOLLOW-UP

If Fergus remains clinically stable, repeat PCV is advised approximately every 2 weeks to assess for a regenerative response. Once PCV is within the normal range, we would advise sending a blood smear externally to assess for ongoing spherocytosis If resolved, then dose reductions of prednisolone can be commenced. Prednisolone should be reduced by 20-25% every 3-4 weeks, with repeat PCV performed prior to every dose reduction to ensure there is no relapse in anaemia.


QUESTIONS

This was a bit of a shock....., is there anything I should be doing to help Fergus?
Any questions I should be asking of the vet/specialist?
I notice on some posts, a tummy protectant is advised, I asked the specialist vet about this, and she didn't consider it was necessary?

Anything else you think I should be aware of?

Any/all help most gratefully received.

With thanks; Fergus' worried parents