Dog with SLE, how to help better increase his red blood cell count?

[Kestranek8]

Smokie is a 13 1/2-year-old miniature dachshund, who was diagnosed with SLE about 2 months ago after about a month and a half of trying to figure out what was going on. We Had our visit to the vet yesterday to check Smokie's blood work for his SLE and see if there has been any improvement, since decreasing his dosage to 5mg prednisone and switching it to every other day and his Azathioprine to 12.5mg from 25mg, his red blood cell count is improving but very slowly. He is now on a round of Clintabs for his mouth since he has some soars. He is taking Milk Thistle, Omega 3's, probiotics, and colloidal silver. My question now is what can I give him to help better increase his red blood cell count? My vet told me to ask this group what has been working for their dogs and report back to her.

[Catherine]

What is Smokie's HCT (PCV)? It may be that he was not on the correct dosage of Preds or reduced too soon. 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)

He also needs to be having a gastroprotectant for his stomach.

Have yo seen this : http://cimda.co.uk/smf/index.php?topic=14.0

[Jo CIMDA]

Hi and welcome

I am sorry Smokie has SLE.  I do hope he has improved since diagnosis.

How did they arrive at that diagnosis?  What sort of immunosuppressive protocol was he on?

There are so many reasons why a dog can become anaemic, and also why the red blood cells, after immunosuppressive treatment, do not increase to normal limits.  The reason for the low red blood cell count determines the treatment.

How low is his red blood count?  Is the anaemia regenerative or non-regenerative?

Long term prednsiolone can inhibit bone marrow production and also Azathioprine can do the same. This can cause non-regenerative anaemia.  It might be a case that either or both drugs should be reduced and then the PCV will start to rise.  That depends on how long the dog has been on treatment and the protocol eg., was the dosage too high, and given for too long?

Also, if Smokie hasn't had a gastroprotectant then he may have a bleeding gastric ulcer which will cause regenerative anaemia. Regenerative anaemia can be caused by so many different things, including destruction of the red blood cells by the spleen, liver etc., and if the site of destruction is the spleen,  very often the removal of the spleen will resolve the problem.

Jo

[Kestranek8]

Here is when I posted on the Facebook site when he was originally diagnosed.  My 13 year old mini dachshund was diagnosed what my vet thinks is systemic lupus erythematosus. His symptoms started in April. Our vet who is a family friend ruled out cancer and tickborne illness. Our vet originally thought it was some sort of tickborne illness due to his cytology results to rule out lymphoma because of his swollen lymph nodes. She put him on a month of doxycycline which he has finished and there was no improvement.  After 2 weeks and he did not respond to Doxycycline she then put him on a high dose of prednisone twice a day. On 6/17 his PCV was 19% and on 7/1 it was 20% so no improvement with the higher doses of prednisone to help with the increase in red blood cells. Since Prednisone didn't really seem to work she has prescribed Azathioprine on 7/1 in combination with a lower dose of prednisone. His lymph nodes are still swollen after about three months, he is lethargic, and presents with lameness, he is losing hair on his neck, head, and ears. He was pretty swollen before he started the prednisone and his ears were heavy with Adema. His feet were also swollen and a little crusty. Another thing I have noticed since this all started is his hearing has really declined. One of the first symptoms that were present 3 months ago was in his groin area where he had a rash and Adema on one side (with the prednisone it has currently subsided but there is a little Adema still present), his lips also swelled up really bad and that has cleared up with the prednisone. The one things that has been constant even before the prednisone was introduced was his appetite, he has never lost that. He responds to food like there is nothing wrong. Does anyone have any experience with this Auto immune disease? 

[Jo CIMDA]

Hi

I have had a dog with SLE, but SLE carries so many different clinical signs, because there can be so many different systems affected, and therefore not all dogs will have the same symptoms.   From reading your posting, the one AI disease that comes to mind, which can be seen in SLE, or a primary AI disease is immune mediated vasculitis.

The loss of hair can be due to a hormone imbalance such as hypothyroidism or it can be a side effects of the steroids.   I presume your vet checked out his thyroid? Ear problems are common in a dog that is hypothyroid.

Steroids can also cause skin problems such as calcinosis cutis, and steroid use can also allow demodicosis to become active, so that might be something else for your vet to check.  The lesions/crustiness of Demodex is very typically seen on the feet as well as the ears and face. Prednisolone will also make him want to eat double dinners!

I don't know what dose of prednsiolone your boy was on but if it is not an immunosuppressive dose then it will not significantly suppress the immune system and therefore the disease  will not  be brought under control nor remission achieved.  The protocol that Catherine has posted, by Prof Day is the best protocol that I have come across and it can be confidently used as a guide and tailored to the individual.

Ask your vet if the anaemia is regenerative or non regenerative. 

There are other immunosuppressive drugs that could be tried instead of azathioprine and prednsiolone, especially if there is a build up of glucocorticoid (pred) and your boy is showing signs of drug induced Cushing's syndrome.  Mycophenolate Mofetil is widely used these days and good results have been seen.   

If this is an immune mediated disease, regardless of which one (or more than one),  immunosuppressive treatment, in the correct dosages and a good protocol should address the the problem and  achieve remission.  It should also reduce the inflamed lymph nodes.  This is an excellent resource that you vet will find very informative.

  https://www.dvm360.com/view/immunosuppressive-drugs-beyond-glucocorticoids

I hope you can have a chat about this with your vet friend.

Jo

[Kestranek8]

It says the upload folder is full how do I send you smokies bloodwork for the last 3 months?

[Catherine]

I have notified the list owner about it. Could you copy and paste the results or are there too many?

[Kestranek8]

It's on a PDF file which I compressed into a smaller file  there are about Four or five sheets over the last three months from when he was first diagnosed, it won't let me copy and paste it.  I will keep trying. Hopefully I will be able to post them.

[Catherine]

I have contacted Jo as well, just now, so hopefully it will soon work.

[Jo CIMDA]

Hi

If you want, you can send them to this email addy:  cimda@aslog.co.uk and I will pick them up.

Jo