Red Blood Cell Count Down IMHA

Started by Kim A Lotti, February 03, 2018, 04:39:09 AM

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Kim A Lotti

Hello There,
I am a new member with a Dachshund called "Ziti" that was diagnosed with IMHA on Nov 11/17.  I have been on a small reduction of Prednisone and that went well he counted at 32.  Then two weeks later he was at 30 but the vet reduced the Mycophenalate by 30 mg as he was on 120 mg of this per day.  He is currently on 90 mg Mycophenate, 10 mg of Prednisone, also Atopica 50 mg per day.  I have a new puppy and suspect that perhaps he has brought Giardia to the house.  I am taking stool samples in tomorrow.  I took Ziti in today because he had diarrhea, and his numbers today are 24!  So they have dropped in the 2 week period from 30 to 24 since cutting back on mycophenalate.  The vet suggested that perhaps the puppy has comprised Ziti as he has a suppressed immune system.  Could the Giardia have brought down his Red Blood Cell numbers.  We :( :( have put him back up to the 120 mg of mycophenalate the original amount.  Any thoughts on Giardia causing the drop?
Many thanks for advice.....  Kim !

Jo CIMDA

Hi and welcome

I am sorry Ziti has IMHA. 

I can't say if this drop is a result of giardia infestation, but certainly a dog with a compromised immune system will be more prone to picking up giardia, and therefore the immune system is less likely to keep the giardia under control.  I would still have the stool analysed before treating Ziti for giardia because he could do without more drugs for his body to process if they are not necessary.   I suppose the red blood cell count could reduce if he developed bloody stools as a result of parasites damaging the lining of his intestines.  Do you know if the anaemia is regenerative or non-regenerative?   A bleed from the intestines, and therefore a secondary cause of anaemia,  would be a regenerative anaemia.  Do you know if his bone marrow is currently regenerating? 

Sometimes a dog that is originally diagnosed with non-regenerative IMHA (destruction of the red blood cells within the bone marrow) can become anaemic with regenerative anaemia due to gastric ulcers (due to the drugs) or perhaps in Ziti's case giardia infestation causing an intestinal bleed.  This is different to an immune destruction of the red blood cells and is not a relapse of the IMHA.  Has Ziti been having a gastroprotectant to protect his stomach from the effects of the drugs, especially the prednisolone? 

I don't know how much Ziti weighs but for your information, the recommended dose of mycophenolate in the treatment of IMHA is 10mg/kg/12hrs. Immunosuppressive dose of Atopica (Cyclosporin) is 3-6mg/kg twice daily or 5-7.5mg/kg once daily.  Immunosuppressive doses of prednisolone:  1mg/kg/12hrs  Ref:  Plumb's Veterinary Drug Handbook, eighth edition. 

If you don't see an improvement in Ziti's PCV soon then is it possible for you to take him to see a specialist - perhaps at a vet school, or ask your vet to call the Royal Vet College for advice?  He has been on this treatment for a long time and it may need to be reviewed.

Jo

 

Kim A Lotti

Thank you Jo for your answer.  I do have all 3 of my dogs today being treated for Giardia.  This is on the advice of the internal specialist that I do take Ziti to, incase any others are carrying it and probably it came from the puppy.  The puppy in the only new variable in the scheme of things.  She called today to confirm from the stool samples that it is Giardia.  I can tell my little guy Ziti ( who weighs 12 pounds by the way) has a hard bloated and sore stomach.  He is the only one with diarrhea, and the only one with IMHA.  I feel like a vet clinic myself with the normal buffet of drugs that Ziti takes with now has 2 more added, and drugs for the other 2 dogs.  They are all on microdiazonel and panacur starting today.   Ziti's number went from 24 on Friday to 26 on Saturday when I had a complete blood panel done on him.  His blood panel looks excellent and he has been on drugs since Nov 2017 and he has no signs of diabetes either.  He does have a bad case of Giardia tho.....and because as you explained a compromised immune system.  Fingers crossed I can get his stomach settled down and get him back to eating....it is a rare day when a Dachshund does not eat and that is today!  Thanks again for the extensive answer, it is much appreciated.   Kim !

Jo CIMDA

Hi Kim

That all sounds very positive.  I do hope Ziti's PCV will continue to increase now. The last thing he needed was giardia.

Jo