Help please

[Chris Dannan]

Our Miley has IMHA, Her pcv on diagnosis was 8, she has had 2 transfusions Miley is not good this morning, pcv 17, a silght drop from 19 but very flat, potassium was low but has been supplemented and has risen. She is now very jaundiced and her calcium is high. She is not producing urine and her bladder is very small. She has fluid in her abdomen which looks cellular and they think fluid is collecting on her lungs, her breathing is laboured when listened to through the stethoscope. Any ideas at all, the vets are not coming up with anything we can do

[Catherine]

How much does Miley weigh? She needs to be on the correct dosage - too little will not work and too much may make her very ill.

It could be that the dosage is too high and this is causing a blood clot.

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

This is the 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!

[Jo CIMDA]

Hi and welcome

I am so sorry Miley has IMHA.  I do hope she is responding to treatment.

As Miley is jaundiced it is likely that the anaemia is 'regenerative', meaning that the bone marrow can't produce enough red blood cells to maintain a normal level  because the red blood cells are being destroyed/lost within the circulation of the blood or spleen etc.  This may mean that the anaemia is secondary to something else going on in her body - and these can be numerous. 

The primary cause of the anaemia has to be found and treated, in addition to treatment of the anaemia, eg., drugs and blood transfusions etc.  If the red blood cells are being destroyed by the spleen, the removal of the spleen resolves the problem.   This is a good article.

https://www.petmd.com/dog/conditions/cardiovascular/c_multi_anemia_regenerative

If your vet is at a loss, and Miley is well enough to travel, then a referral to a specialist veterinary hospital would is advised.

I do hope you see improvement very soon.

Jo