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Author Topic: Addisons Disease and autoimmune haemolytic anemia  (Read 199 times)

MrsC

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Addisons Disease and autoimmune haemolytic anemia
« on: April 30, 2020, 09:05:32 PM »

Hi there,

A lovely lady in a group for dog owners with Addisons disease directed me to this forum, after I posted for some advice regarding my 7 year old spaniel cross who suddenly went downhill on Wednesday morning with a suspected Addisons crisis. He was diagnosed 3 years ago in July with Addisons and has been stable since that diagnosis with only a handful of issues with dosing, I would say that for the last 22 months his lytes have been consistent.

We initially took him to the vet thinking that he was in crisis, the morning played out very much the same as when he has his last crisis, found cowering under the bed in the early hours of the morning, only made it a few minuets into their morning walk before having to come home, diarrhea on return to our garden, them vomiting, refusal of food, although I was able to get his 1mg of Prednisolone with a small piece of scrambled egg down. I then felt what appeared to be a mass in his stomach, it was at this point I called the vet and was told to bring him in as soon as possible.

The vet immediately hooked him up to an IV line and administered fluids, ran some blood tests and gave antibiotics as initially they suspected an infection that was causing his raised temperature. Several hours later I received a phone call in which the vet described that his symptoms and blood test results were pointing more towards the possibility of Autoimmune Haemolytic  Anemia than an adisonian crisis but that they were having to send his blood test off to a better equipped pathology lab as due the this whole Covid 19 situation, they are operating with a drastically reduced team and were unable to carry out further testing with the available staff.

I collected him from them at 11:45pm last night as we agreed that leaving him unattended was not an option and there were no staff available to stay over at the practice with him. Moving him to an out of hours practice came with the risk of crisis due to the stress of being moved and  new environment and so we decided to bring him home and monitor him ourselves, armed with the vets mobile phone number and contact with their head nurse, who has become a close friend over the years and the ability to have him at an out of hours practice within 10-15 minuets, should he deteriorate and a plan to return him to them first thing in the morning.

He made it through the night and seemed willing to take water when offered every hour or so, he urinated in the garden at around 4am although at that time it was far too dark to inspect what he had done. I handed him back into the vets at 7:45am where he was put back onto IV fluids, the vet nurse reported that apart from a slightly elevated temperature his condition had neither worsened or improved.

Around 3:30pm the vet called to say we could come and collect him as his condition was stable, and he was confident that we were able to manage his care at home, and advised on new medications and doses.

Upon returning home I let him into the garden and he urinated almost immediately, alarm set in as it appeared to be almost entirely blood, I quickly called my vet nurse friend who had been the one to bring him out to me around 20 minuets previously and she told me to bring him straight back in. They ran another blood panel and seemed certain that the discoloration was due to Billy Ruben?

Due to take him back in the morning providing nothing changes, he is jaundice but putting that down to the Billy Ruben.

Any advice gratefully received.

Thanks in advance from one very worried dog mum x 
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Jo CIMDA

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Re: Addisons Disease and autoimmune haemolytic anemia
« Reply #1 on: May 01, 2020, 12:26:30 PM »

Hi and welcome

I am so sorry you have been through this dreadful time with your boy.   

When a dog has had one autoimmune disease, they can be predisposed to get another.   How are your vets treating this current disease?

Do you know if the anaemia is regenerative or non-regenerative? 

 Non-regenerative haemolytic anaemia  is caused by the immune cells destroying the immature red blood cells or the precursor cells within the bone marrow.  This is a primary AIHA with no underlying disease.

Regenerative anaemia can be cause by several different things, destruction of the red blood cells by the spleen etc.,  or other diseases that may cause the red blood cells within the circulation of the blood to be destroyed.  Jaundice and bilirubin is often seen in regenerative anaemia.    If the anaemia is regenerative then other causes have to be ruled out before immunosuppressive treatment can begin, and when identified,  the underlying disease has to be dealt with.

If your boy's red blood cell count gets below 12% then he should be given a blood transfusion.

Regardless of whether a dog has Addison's disease or not the treatment for non-regenerative AIHA is with immunosuppressive doses of steroids.  This will not be a problem for a dog with Addison's disease because the steroid used is prednisolone. I will post an excellent immunosuppressive drug protocol by Prof. Michael J Day which can be used as a guide.   

If the anaemia is regenerative then  other causes have to be considered before starting immunosuppressive treatment.

Example: Reduction Protocol for prednisolone:

Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 


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/q 12hrs (q = every)
Dose                           Duration (based on clinical effect)
1.0mg/kg/q 12h                          10-28 days
0.75mg/kg/q 12h                       10-28 days
0.5mg/kg/q 12h                         10-28 days
0.25mg/kg/q 12h                        10-28 days
0.25mg/kg/q 24h                        10-28 days
0.25-0.5mg/kg EOD                    at least 21 days
0.25-0.5 mg/kg every third day      at least 21 days

Every reduction is made after consideration to improvement of clinical signs, blood results and side effects of the drugs.
Prednisolone:  "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight."  Plumb's Veterinary Drug Handbook Eight Edition.

If you have any queries, please get back to us here.

Fingers crossed for your boy.

Jo

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Lovemedogs

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Re: Addisons Disease and autoimmune haemolytic anemia
« Reply #3 on: May 10, 2020, 10:56:35 AM »

Thankyou Jo for helping Natalie. It is really tough when we see dogs with Addison’s then develop another AI condition, which is much harder than Addison’s to get under control. Clearly the dose of steroids has to be increased in order to treat the disease, but the effects of doing so, will hopefully just be the same as for a dog that doesn’t have Addison’s.


Take care at such difficult times for all of us.

Pam
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Jo CIMDA

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Re: Addisons Disease and autoimmune haemolytic anemia
« Reply #4 on: May 11, 2020, 12:42:28 PM »

Take care all of you too.

 It is indeed a tough time and especially when you have to take your pets to the vet.

Stay safe

Jo
 

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