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 21 
 on: June 08, 2021, 12:54:50 PM 
Started by srrice - Last post by Catherine
Are you saying that your dog has been on the medication since 2019 or should that be 2021? How is he coping? He really needs to have the medication reduced. It may be that your dog has a normal HCT at the lower end of the scale anyway but he still needs to aim for coming off all medication eventually.

Here is a good medication protocol that your vet could follow:

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 based on a dog receiving an induction dose of 1.0mg/kg/q12hrs (every 12 hours).

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!


 22 
 on: June 07, 2021, 10:44:13 PM 
Started by srrice - Last post by srrice
My 8 yr old sheltie was first diagnosed with IMHA Mar 19.  His PCV dropped to 18% while he was in a specialist’s hospital.  The vets added Mycophenolate (100mg twice a day) to his prednisolone 20mg.  ((Also on Plavix, Nexium, B12.). His PCV rose to 26.  On Apr 13 the prednisolone was dropped to 15mg but the weaning has been stalled at this level.  His HCT has increased by only 1% since then and is now at 36.9%.  Is it appropriate to consider adding atopica and maybe dropping Mycophenolate?  I would love some suggestions to run by my vet….Thanks…

 23 
 on: June 07, 2021, 10:17:29 AM 
Started by trudiej - Last post by Jo CIMDA
Hi and welcome

I am sorry that Fergus has non-regenerative anaemia.  Unfortunately this is a known inherited condition that can be seen in beardies. 

Catherine has given you the information that you need, so there is not a lot more than I can add,  just to reiterate that Fergus should be on 1mg/kg/12hours prednisolone and it is best to give a low fat diet and give perhaps four smaller meals than one or two larger ones.  This makes it easier for this pancreas to deal with and may prevent pancreatitis.  Also, as far as I am concerned, there is no good reason not to give a gastroprotectant because if it isn't given there is a risk of the stomach becoming ulcerated and  if an ulcer develops then it may bleed which will cause regenerative anaemia.    As Fergus' immune system is significantly suppressed you should be careful about taking him to a popular dog walking area where he may pick up infections.  Often a course of antibiotics is given at the start of treatment as a precaution. 

I do hope Fergus  is starting to feel better. 

Jo

 24 
 on: June 06, 2021, 08:53:06 PM 
Started by trudiej - Last post by Catherine
The normal range approximately in the UK for PCV (HCT) is 37 -55 so even allowing for variations 22 is quite low. So yes I personally would want to test Fergus as soon as possible. Hopefully the PCV will have started to increase again but I would still test more regularly. It would not hurt to keep an eye on his kidneys and liver but the liver enzymes will rise anyway with the steroids so do not be too shocked.

Omeprazole is one gastroprotectant but it did not agree with my dog but I found Zitac (Cimetidine) was good. Some you have to give apart from other medication.

I can not see any reason for an antibiotic unless Fergus has other issues. Also if he has been fine on his normal food I would stay with it - you do not want to change too much at once.

 25 
 on: June 06, 2021, 07:21:05 PM 
Started by trudiej - Last post by trudiej
Hi Catherine

Thanks for the reply; Fergus's PCV was 21, 19 and 22 - the 22 being the result of a test done on Wednesday 2 June.

Would you consider this low enough to warrant another blood test during this coming week (he's booked in at vets for next blood test on 15 June), and should we consider a biochemical test, as well as the PCV test, to check liver and kidney function?

I will speak to the vet regarding a tummy protectant - is there one you'd particulary recommend for Fergus's condition?

On reading the articles you linked to; should Fergus be on a broad spectrum anti-biotic? And should we consider a low fat food; he is currently on a grain free salmon, trout, asparagus and sweet potato kibble (it says the crude fat content is 11%).

Many thanks.

Trudie


 26 
 on: June 05, 2021, 09:19:57 PM 
Started by trudiej - Last post by Catherine
What was Fergus's PCV amount? If it is quite low I would want to have his PCV tested every few days, certainly more often then every two weeks at first. Also I would definitely want him having something to protect his tummy otherwise he could get more problems.

Here is a good reduction protocol for when his PCV starts to rise:

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 based on a dog receiving an induction dose of 1.0mg/kg/q12hrs (every 12 hours)

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!


Have you checked out the information here?: http://cimda.co.uk/smf/index.php?topic=11.0 and here: http://cimda.co.uk/smf/index.php?topic=16.0

 27 
 on: June 05, 2021, 08:27:38 PM 
Started by trudiej - Last post by trudiej
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


 28 
 on: June 01, 2021, 01:51:25 PM 
Started by Mambo - Last post by Mambo
Thank you Jo, you have been so helpful already to me.

 29 
 on: June 01, 2021, 01:07:51 PM 
Started by Mambo - Last post by Jo CIMDA
Hello and welcome

I am so sorry for your loss, and I do hope that get the additional information that you need from the stories on this site.

Best wishes
Jo

 

 30 
 on: May 31, 2021, 03:11:40 PM 
Started by Mambo - Last post by Mambo
Hello. I'm looking for other owners' experiences with dogs who exhibit very low platelets as shown on blood tests (low as 4K) but with no other symptoms such as bruising, bleeding, lethargy, etc.

Out of the blue, my ten year old previously healthy and robust dog suddenly collapsed three times in one evening and quickly recovered. Cardiac issues were ruled out, infectious diseases such as babesia and heartworm were ruled out. He was put on doxycycline and fenbendazole as a precaution for parasites. As well as severe thrombocytopenia, he initially had polycythemia which was later resolved.

My dog continued to act normally, was bright and active with healthy appetite. Two CT scans and an ultrasound revealed splenomegaly and a mass in the abdomen. A splenectomy was recommended as the only course of action. No immunosuppressive treatment was ever considered. The specialists were concerned he had cancer which was one of their reasons for not using immunosuppressants and the fact they recommended surgery only. An aspirate of the lymph node was benign.

The splenectomy was put on hold until my dog's platelets rose to an acceptable level for surgery and he kept going back to the clinic for blood tests over a period of six weeks, but his platelets never rose sufficiently, he was hovering around 10K.

Unfortunately without any meaningful treatment over this period, one day my dog started tiring, was reluctant to eat, was panting and became anaemic. He was admitted to the clinic for observation and it was decided that he should have an emergency splenectomy regardless of his low platelets and the overall risk.

He came through surgery but then sadly developed severe complications - he went into acute kidney failure (he had never had any kidney problems before) and started throwing clots. My suspicion is that the use of cyclosporine predisposed him to thromboembolic disease and he became hypercoagulable.

He was never found to have cancer - the histopathology of his spleen and abdominal mass (large clot) showed no signs of any neoplasia.

To my immense distress he died after ten days in the ICU fighting multiple conditions in addition to sudden kidney failure - he developed severe water retention, he had anorexia, pyrexia and was jaundiced.

My main concern is how the vets involved were unable to diagnose him, as a result of which they failed to treat him properly. In the end, it seemed that he had primary IMTP, which became IMHA and then he developed DIC (disseminated intravascular coagulation).

It seems that my vets were so perplexed by the fact my dog presented normally to them that they didn't know how to treat him. The result was that he deteriorated and then surgery was inevitable, which had fatal consequences.

I just wanted to find out if other owners' dogs have experienced severe thrombocytopenia with no classical symptoms such as bruising or bleeding and how their vets treated it.

I have been told that my dog's case is extremely unusual so I would like to find out if that is indeed true. No one could figure out how he could function so normally for so long with such perilously low platelets.

That the vets let this situation continue with no meaningful intervention until it was suddenly an emergency is baffling to me and I am looking for answers.

Grateful for any insight, thank you!






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