Rosie, my shiba with immune mediated pancytopenia

Started by KlassyBandit, December 08, 2017, 06:45:44 AM

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KlassyBandit

Hi everyone,
This past August my Shiba Inue, Rosie, became very ill very quickly.  My primary vet ran a cbc on her and once results were back referred us to a specialty clinic.  She had a temperature of 105.8 and very abnormal blood work.

August 9, 2017 -  CBC: WBC 2.3, RBC 7.0, HGB 13.6, HCT 40%, MCV 56, MCH 19.4, MCHC 35, Neut 0, Lymph 1,886, Mono 414, Eos 0, Baso 0 - noted inappropriate metarubricytes Chem: TP 6.6, Alb 2.9, Glob 3.7, A/G Ratio 0.8, ALT 22, ALP 178, BUN 9, Creat 1.1, BUN/Creat Ratio 8, Glucose 93

August 10, 2017 - CBC: WBC 2.1, RBC, 5.62, HGB 10.8, HCT 29.2, MCV 52, MCH 19.2, MCHC 37.0, Neut 2.0, Lymph 58.0, Mono 34.0, Platelets 28

A Coombs test was performed and it was positive 1:128 suspecting immune mediated disease

Basically, all blood lines were critically low.  Her platelets and rbc did respond to steroid based treatment,but for 5 weeks her wbc and neutrofils remained very low.  MSU performed a bone marrow biopsy and it was determined that her neutrofils were not maturing - the cells looked healthy but not maturing and not many cells.

The doctors at Michigan State Univ told me that they have not seem blood act as Rosie's is and I have been researching and talking to other dog owners who have pets that suffer from autoimmune diseases and I have yet to find another case similar to Rosie's.

Does anyone here have any insight or know of similar cases?

As of right now Rosie is doing well.  We almost lost her twice in August but then she did start to respond to being on Prednisone alone (severe reaction to Atopica) but I worry so much especially since I don't know of anyone else who has a similar experience.

Jo CIMDA

Hi and welcome

I am sorry Rosie has been so unwell. It seems Michigan State Uni have done a good job in getting her through this.

I have known other dogs to have immune mediated neutropenia alongside haemolytic anaemia and thrombocytopenia (or Evan's syndrome), but to have all three haematological autoimmune diseases at the same time is rare.    IM neutropenia is more rare than the other two blood AI diseases.

The treatment should be the same as if Rosie had just one AI disease, and that is with immunosuppressive drugs, such as prednisolone but the fact that she has more than one haematological AI disease is an added concern.  As she has responded  well to prednisolone, and this is great news, and in future, should she ever relapse, you know exactly how to treat her. 

The best way to avoid a relapse is to limit any potential triggers such as vaccination, regular spot-on treatment, worming etc and of course try to feed her naturally etc.

Jo





CDASH

Hi, sorry to revive an old post, but what you've experienced with Rosie seems very, very similar to what we're experiencing with our Charlie. He's a 3 year old Collie mix and he became ill in July with infections and neutropenia. Bone marrow biopsies showed the same as with Rosie - his neutrophils weren't being allowed to mature. Other blood cells were affected at times, too, and nothing has lined up exactly with a diagnosis so we've both heard IM neutropenia and IM pancytopenia.

He went on high doses of steroids but his neutrophils kept getting better and then bottoming out again. So he's now about a month into having a immunosuppressant added to his regimen (mycophenolate) and it seems to really be helping - his last few blood checks have been good.

Unfortunately, though, we're still dealing with some issues. He's lost weight (about 2 lbs. - he typically weighs about 42) and muscle mass, and he recently had issues with bloody diarrhea.

So we're still on this journey, trying to get him stable and hopefully to remission.

I wanted to see - is there an update on Rosie? How are you all doing? Have you been able to get any additional answers?

Thanks!

Jo CIMDA

Hi

I hope Rosie's owner will see your posting.

I am sorry your Charlie is unwell with IM pancytopenia.

Mycophenolate seems to be a very good addition to prednsiolone when dealing with neutropenia and other IM bone marrow disease.  I don't know how long Charlie has been on prednisolone, and how high the dose is now, but the weight loss and muscle loss (and sometimes bloody diarrhoea)  can be attributed to long term prednisolone use so maybe, as Charlie is on Mycophenolate as well as pred, the dose of pred could/should be lowered.   

A dog can't stay on high doses of pred for a long time, or even a middling dose for a prolonged period, without it taking its toll on the body.  When the blood results and clinical signs considerably improve then the dose of prednsiolone should be reduced.  The best immunosuppressive  reducing protocol for prednisolone is by Michael J Day.  This regimen can be confidently used as a guide and tailored to the individual.

Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

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/q 12hrs (q = every)
Dose                           Duration (based on clinical effect)
1.0mg/kg/q 12h                          10-28 days
0.75mg/kg/q 12h                       10-28 days
0.5mg/kg/q 12h                         10-28 days
0.25mg/kg/q 12h                        10-28 days
0.25mg/kg/q 24h                        10-28 days
0.25-0.5mg/kg EOD                    at least 21 days
0.25-0.5 mg/kg every third day      at least 21 days

Every reduction is made after consideration to improvement of clinical signs, blood results and side effects of the drugs.
Prednisolone:  "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight."  Plumb's Veterinary Drug Handbook Eight Edition
.

I do hope you can resolve the current issues with Charlie very soon.

Jo


CDASH

Thank you so much Jo, I really appreciate this info. Charlie seems to be doing well now! He's regained some muscle tone and has even started playing again. Fingers crossed that we're on the right path and can continue to decrease the prednisone after our next appointment and blood draw.

Jo CIMDA

That is great news. 

Very often you have to go through the crisis to get to the other side.  Of course it helps if the drugs are correct and being well controlled and tolerated, but those anxious moments are inevitable with some AI diseases.

Fingers crossed for Charlie now.  Thank you for the update.

Jo