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Author Topic: Autoimmune hemolytic anemia (AIHA)  (Read 129 times)

Jules1990

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Autoimmune hemolytic anemia (AIHA)
« on: November 22, 2019, 02:10:02 PM »

Hi folks I am new to this.
I am looking for some information regarding Autoimmune hemolytic anemia (AIHA) my dog which is a Yorkshire terrier female 9 years old has been recently diagnosed with this disease. She has had 3 blood transfusion while in between trying different medication yo see what works. Her recent blood transfuion has lasted her almost 4 weeks where her previous one only lasted a week..  She is on 10mg a day of preds steroids for a few weeks and they weren't increasing her blood count and then 10mg of imuran  was tryed along with the preds which she is only on 4weeks.. the imuran was recently reduced to ever other day and our little dog became very sick anything she ate she was throwing up and had bad diaherria. The vets done a blood test and the bloods have gone down abit. I just feel her gums are pale. So the vets have now taken her of imuran and have not replaced it with anything yet. I feel the vets are giving up on us. I can't lose my little dog I feel she was doing well cause they had seemed to be going up slowly till she started getting sick I feel this took alot out of her. But vets sat it wouldn't have effected her blood count. They also only had ever one experience of this.. I don't know what to do next...
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Catherine

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Re: Autoimmune hemolytic anemia (AIHA)
« Reply #1 on: November 22, 2019, 05:10:07 PM »

Have the vets said whether it was regenerative or non-regenerative anaemia? How much does your dog weigh? She needs to be on the correct dose of Prednisolone and needs to have the medicine gradually reduced only when her HCT is going up to a normal level. What is her current HCT (PCV)? The sickness and diarrhoea may have been the result of not having a gastroprotectant to protect her stomach.

Is she still having the Preds? If your vet does not have experience of AIHA then your dog may need to see a specialist.

Have you seen here: http://cimda.co.uk/smf/index.php?topic=11.0 and here: http://cimda.co.uk/smf/index.php?topic=16.0
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Jules1990

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Re: Autoimmune hemolytic anemia (AIHA)
« Reply #2 on: November 22, 2019, 09:57:40 PM »

Hi thank you for your reply.
I am not sure I do know she has the ability to reproduce red blood cells but she not recognising these cells and her body is attacking these cells.. her pcv was 23 before she got sick and they said last week they are a little down.... her current body weight is 6.5kg. She is on omeprazole 10mg a day. The vets reduced the steorids down to 5mg once a day because she had been very sick for 2 weeks. I recently discovered it was the imuran Azathioprine that was making her sick so she has now been taken of that. I was chatting the vet earlier she said to increase her back up to 7.5mg on the preds. But they don't seem to holding out much hope...
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Catherine

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Re: Autoimmune hemolytic anemia (AIHA)
« Reply #3 on: November 23, 2019, 11:57:11 AM »

She needs to be on an immunosuppresive dose to begin with and then gradually reduced. This does not sound as though this has happened. She should be having 6.5kg TWICE a day. There are other medications, like cyclosporin and, mycophenolate that can be added if the Azathioprine has caused problems.

If it is autoimmune she must have the correct dose and reducing regime. There is hope, my dog survived AIHA.

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!

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Jo CIMDA

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Re: Autoimmune hemolytic anemia (AIHA)
« Reply #4 on: November 23, 2019, 09:41:24 PM »

Hi and welcome

I am sorry your Yorkie has AIHA.   Imuran (Azathioprine) often doesn't agree with some dogs, so this is no surprise.

There are two types of AIHA.  One is when the immature red blood cells are being destroyed in the bone marrow, this is called non-regenerative anaemia, and the other is when the anaemia is secondary to something else going on in the body such as, the red blood cells are being destroyed within the circulation of the blood or destroyed by the spleen, cancer etc. This is known as regenerative anaemia.  If it is the latter then the primary cause of the anaemia needs to be identified and resolved, for example if the red blood cells are being destroyed by the spleen, then it will be necessary to remove the spleen.  After surgery the red blood cells will return to normal level.
   
 The mainstay of treatment for non-regenerative AIHA is immunosuppressive doses of preds, and following a good protocol, such as the one that Catherine has copied for you.   If the dose is not high enough then the immune system will not be significantly suppressed in order to stop the destruction of the red blood cells, and the treatment will not work.  Also, it is worth mentioning that smaller dogs, or puppies, because they have a quicker metabolism, will often need a slightly higher dose of prednsiolone than 1mg/kg/12 hours and they also tolerate the higher dose of preds much better than larger dogs.   So from the information you have given 7.5mg per day of prednsiolone is not sufficient and it is only an anti-inflammatory dose and not an immunosuppressive dose of pred. 

As Catherine has mentioned, there are other immunosuppressive drugs that can be used as 'combination' therapy if necessary.   There are many dogs on this forum who have been treated correctly and have survived, so don't give up on your girl.  Do you live near a specialist vet or a vet college where you can get specialist help? If you do then your vet will be able to give you a referral letter.  If this is not possible, please ask your vet to telephone a vet college, such as Glasgow, or the Royal Vet College in Hertfordshire and ask him/her to talk to an internal medicine specialist, who will be able to direct your vet as to what dose of pred to give your girl and a good protocol to follow, and advise if another immunosuppressive drug is needed.   This is key to a good outcome.  The protocol that Catherine has posted is the best I have come across and it can be confidently used as a guide.

I do hope you can get your vet to work with you and your Yorkie reaches remission.

Jo




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