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[BritInSydney]

Hi Everyone,

I'm Nick - just introducing ourselves after finding this amazing forum as I was trawling through information online about IMHA/ITP. 

Nia, our lovely 3.5yr old Rottie/Kelpie, was diagnosed with IMHA/ITP last Sat, 15th June. Up until last week I hadn't noticed any symptoms of illness, but over a period of 72 hours, Nia became very lethargic, lost her appetite, then stopped eating completely followed by not drinking.  I took her to the vet as soon as she wouldn't drink water and, luckily, the vet suspected IMHA and tested for it straight away, so she was started on Presdnisolone immediately.

Since then, it's been a terrible rollercoaster as her body is not tolerating the cocktail of drugs she's been on. She is now hospitalised at a specialist animal hospital with Pancreatitis, and I'm now anxiously waiting to hear from them as to how she's doing this morning.

[Catherine]

Nick,how much does Nia weigh? She needs to be on the correct dose of Prednisolone - she may not be able to tolerate too much and too little will not make her better. She also needs to having a gastroprotectant as well to protect her stomach. Here is a good medication protocol:

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 also seen here:?


http://cimda.co.uk/smf/index.php?topic=11.0 and http://cimda.co.uk/smf/index.php?topic=13.0 and http://cimda.co.uk/smf/index.php?topic=16.0

[Jo CIMDA]

Hi Nick and welcome

I am so sorry Nia has IMHA/ITP (Evan's syndrome). 

Evan's syndrome can be tricky at the beginning but as long as your vet is prepared to give blood transfusions to sustain Nia until the drugs start to work, and her body starts to produce new red blood cells and platelets again, then it is hoped that she will stabilise and get through this.

The dose of prednisolone is very important - as Catherine says.  1mg/kg/12hours of prednsiolone should be enough to suppress the immune system significantly enough to stop the immune destruction.  If the dose of steroid is not high enough this will not be effective and if it is too high then she will not cope well with the side effects of the drugs.  Prednisolone can cause pancreatitis, so it might be that the dose will have to be reduced and another immunosuppressive drug used in combination.   The gastroprotectant is very important too.

The protocol by Michael J Day is the best I have come across and it can be confidently used as a guide.  If Nia is being treated by a vet who doesn't have much experience in autoimmune disease then, if it is possible and Nia can travel, it might be prudent to get referred to an internal medicine specialist - or at least ask your vet to telephone a specialist at a vet hospital for guidance.

I do hope you see improvement in Nia very soon.

Jo