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Author Topic: Immune Mediated Neutropenia - my Rosie  (Read 87 times)

KlassyBandit

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Immune Mediated Neutropenia - my Rosie
« on: December 18, 2017, 10:47:19 PM »

Rosie, my 4 year old Shiba Inu, was critically ill in August of 2017.  After being in the critical care hospital it was determined that she had an autoimmune disorder.  The doctor put her on 15mg Prednisone twice gaily and 50 mg Atopica twice daily, plus something to help her nausea and stomach.  After 3 days we were able to bring her home and at that time she looked like hell.  She barely ate had no energy and looked near death.  I understood that she was very critical and that it may take some time to get her healthy again and there was a chance she wouldn't survive.  But she was just getting worse and 10 days after we brought her home, I tried to contact OVRS (Oakland Veterinary Referral Services) the specialty clinic we were referred to and who hospitalized and treated her.  Sadly, no doctor would talk to me and the vet tech said if I was concerned to bring her back so they could admit her and do more tests.  No compassion in her voice at all. 
That evening Rosie started crying out in pain, started vomiting, refused to eat all that day and by the look in her eyes I could tell that she had given up the fight.  Since she was vomiting I was unable to give her any of her nightly medication.
The next morning she was no better.  We called our primary vet and scheduled her to be put down the following day - I would NOT let my baby girl suffer.  In the meantime my primary vet and a friend who is a vet tech from out of state consulted her boss and both said to stop giving Rosie the Atopica right away and monitor her.  Thank GOD I listened to them because within 24 hours Rosie was doing better.  Still very sick, but no longer in severe pain or vomiting.  I was then able to get an appointment at MSU (Michigan State University) 2 days later.  Basically Rosie had a severe negative reaction to the Atopica which almost killed her and she was also put on too high of a dosage of Prednisone.  MSU lowered the Pred amount right away.

To make a long story slightly shorter, MSU did a bone marrow aspiration and biopsy on Rosie to determine what was going on with her cells.  She had healthy rbc, platelets and wbc and neutrofils, just not enough of them, and the neutrofils were not maturing.  The doctor continued treating with Prednisone only and we continued to monitor and do blood work every 2 weeks.  4 weeks later her wbc shot up to twice normal but they remained healthy looking.  We have since gradually reduced her Pred to 7.5 mg a day and continue to recheck blood every 2-3 weeks.  her rbc are normal, platelets slightly above normal range and now her wbc/neutrofils are very high still and still looking healthy (wbc 27.8 neutrofils 22796)

I can find very little information on immune mediated neutropenia, especially in cases involving all blood lines so I am searching for answers and also want to share my story in order to help others.
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Jo CIMDA

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Re: Immune Mediated Neutropenia - my Rosie
« Reply #1 on: December 19, 2017, 08:14:59 AM »

Hi and welcome

Thank you for sharing Rosie's story here.  I am so pleased she is very much better, and it proves how crucial the correct medication and drug regimen is to the survival of a dog with an AI disease.   Incorrect treatment and lack of recognition of a bad drug reaction is the most common problem when treating autoimmune disease.   

Personally, I think vets use Atopica (Cyclosporin) far too much now and they ought to give the correct dose of prednisolone first and see if it brings the disease under control, and then assess and introduce a further drug if needed. I prefer Azathioprine as a combination drug.

Rosie's reaction to Atopica doesn't surprise me at all  - and to think it might have ended her life!  Vets in general practice have very little knowledge or experience in treating AI disease and many think because it  is a serious disease the dose of prednisolone has to be the highest recommended dose - this is so wrong and the side effects can kill the dog as it did my Bonnie.  Autoimmune diseases are on the  increase because of all the inbreeding, so with this in mind vets should have better training in this area of veterinary medicine.

Immune mediated neutropenia (IMNP)  is not one of the more common haematological AI diseases, such as primary immune mediated haemolytic anaemia (IMHA) or immune mediated thrombocytopenia (IMTP) but when IM neutropenia is present it invariably occurs concurrently with either or both IMHA and IMTP.  As with non-regenerative IM haemolytic anaemia and IM thrombocytopenia, IM neutropenia may also be caused by the immune cells targeting the neutrophil precursor cells in the bone marrow.  I have known a few cases of Evan's syndrome (IMHA and IMTP) with IM neutropenia but thankfully it is rare.  It is generally considered the more blood lines affected the more difficult it is to treat. By seeking expert advice and not giving up on Rosie,  you have managed to turn a desperate situation into one that is manageable and I applaud you for that. 

Whether it be one blood line affected or more than one, from now on you have to limit, as best you can, the trigger factors that might cause a relapse. Rosie is genetically predisposed to autoimmunity, and that doesn't change, but by limiting the 'triggers' she may go on to lead a normal and happy, long life without a relapse.

It is great to hear a success story like Rosie's and it gives hope to others who may not write their concerns and queries on this forum but read the posts to gain information to help their dog. 

Thank you for taking the time to write.  Please update us on Rosie's progress. I am so pleased for you both.

Jo
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Catherine

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Re: Immune Mediated Neutropenia - my Rosie
« Reply #2 on: December 19, 2017, 11:49:52 AM »

I have no experience of Immune Mediated Neutropenia but I found reference to it on these two threads on this Forum:


http://cimda.co.uk/smf/index.php/topic,471.msg4265.html#msg4265 and
http://cimda.co.uk/smf/index.php/topic,539.msg4725.html#msg4725
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