6 months old standard poodle

[CristinaLelia]

Hello everyone.
I am Cristina, mother of Tucker, a 6 months old standard poodle who was diagnosed with IMHA 6 days ago.
It started all of a sudden, he became lethargic and instead of being the silly, full of life puppy,he was just a sleepy shadow.
I took him to the vet right away because I thought he ingested something ( usually he eat everything he can catch). The vet did X-rays and cbt, and the result was a severe anemia with PCV at 19%. She gave us doxycycline and told me to come back if he get worst. I couldn't stay at home, and I took him to an ER clinic where they kept him for 2 days. He had a lot of debris in his stomach, but no surgery needed, they make him vomit.
The shocking part for me was the IMHA diagnosis....
After first dose of prednisone , his level went up to 22% and the day before yesterday, another up at 26%.. He weighs 37lbs
The internist gave us:
30 mg prednisone/once a day
150mg doxycycline/2xday
20mg pantoprazole/2xday
And today, the 6th day of treatment she added
Clopidogrel 75 mg/ half tablet once a day.

Yesterday we talked on the phone and she told me the blood test results shows that he's regenerate very good.

Can you please tell me if can I do something else to help him cope with this horrible disease?  Any supplements? Something else? I am desperate, devastated and crushed....
I am so happy I found your amazing forum.

( the photo cannot be seen)

[Catherine]

How much does Tucker weigh? He needs to be on the correct dose of Prednisolone, at least 1mg per kg of weight TWICE a day. 30mg is correct if he weighs 15kg. It is better to give the Prednisone twice a day as it seems better on the stomach rather than one amount all at once.

There is lots of information here: http://cimda.co.uk/smf/index.php?topic=11.0 and here: http://cimda.co.uk/smf/index.php?topic=11.0 You can do a search for IMHA (or AIHA) and find lots of posts or just ask.

[CristinaLelia]

He's 37 lbs

[Catherine]

So about 17kg. Which would be 34mg of Prednisolone DAILY. I am not sure whether the 30mg could be too low. Perhaps you can have a word with your vet. If you look at those links I gave you there is a medication protocol but I have copied it below:

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!

[CristinaLelia]

I've seen these but the DVIM told me 30 mg is enough for him because he is a puppy

[Catherine]

I have not heard of a puppy having to have a reduced dosage. I thought it was by weight as standard but hopefully Jo Tucker will be along soon to clarify - she has had more experience then me in these matters.

When will Tucker have his next blood test? Also who is DVIM?

[CristinaLelia]

Thank you so much for your help. 🌹
DVIM is shortcut for veterinarian internal medicine specialist.

The next blood test will be Monday

[Jo CIMDA]

HI CristinaLelia

I am sorry that your young Poodle, Tucker, has IMHA.

You  say that Tucker is regeneration is very good, so was the diagnosis primary' non-regenerative' AIHA,  and now that he has been on immunosuppressive drugs his bone marrow is regenerating and the drugs are having the desired effect  -  or  was the initial diagnosis primary regenerative AIHA?

If this is non-regenerative and his red blood cell count is increasing then it is very likely that the dose of prednsiolone is sufficient and hopefully this will continue.  One thing though, because he is a pup sometimes the dose of prednsiolone has to be higher than the usual starting dose of 1mg/kg/12hours, because the metabolism of young dogs or puppies is quicker than that of an adult dog, so if the red cell count doesn't continue to rise to within normal limits then an increase in prednsiolone might be a consideration.  You also have the  option of perhaps introducing another immunosuppression drug and using a 'combination' therapy. 

The dose and duration of prednsiolone is crucial to the outcome and Catherine posted the best immunosuppressive protocol that I have come across and it can be confidently used as a guide and tailored to the individual.

I do hope Tucker continues to improve.

Jo

[CristinaLelia]

Thank you kindly.
I have no idea , the ER doctors had my puppy in the hospital for 2 days, suspected IMHA and sent me to a specialist . The internist did other blood tests , confirmed IMHA and she told me this is the dose she will put Tucker on, because he is a puppy and she don’t want to put him on higher dose.  When she called me Tuesday she was extremely excited and told me “ his results are looking good, he’s very regenerative now, that is amazing”.
I told her to send me the CBC result but I didn’t received anything yet.

Edit: I just received them but the insert image method doesn’t work at all

Here is the picture

https://flic.kr/p/2kwyQV6

[Catherine]

I am a bit confused as the blood test result printout shows HCT as 21.8 but you mentioned 26 for the last result. Or are these with two different vets? Would it be possible for Tucker to have another blood test sooner - tomorrow or Saturday perhaps? It seems a long time until Monday and it may help to ease your mind if you know his HCT is still rising.

[Jo CIMDA]

Hi

Well his reticulocytes are certainly responding well to the anaemia, and that is a good sign, so the dose of prednisolone is working for him.  I hope this trend continues.

I hope Tucker is having something to protect his stomach because the pred causes excess acid.  Ask your vet about this.

Fingers crossed

Jo

[CristinaLelia]

Thank you so much for confirming this Jo 🌹
He get 20 mg prednisone twice/day. Is that enough?

Catherine, his PCV was 26 , not HCT. Look here.
https://flic.kr/p/2kwCqAS

[Catherine]

Haematocrit/Hematocrit (HCT) and Packed Cell Volume (PCV) mean the same thing.It is just on the first printout it said 21.8 for the HCT (PCV). https://flic.kr/p/2kwyQV6

In your reply to Jo do you mean pantoprazole instead of prednisone?
I know it can be so confusing at this very stressful time. My dog became very ill with AIHA (IMHA) some years ago and there was so much to learn. But the good news is that she survived and lived to old age. Tucker's illness has been caught early so that is encouraging but you do have to keep on your toes with everything, which, I know is very stressful.

[CristinaLelia]

Oh my, yes Catherine, please excuse me. He take 20 mg pantoprazole twice daily.
The  PCV test was done at the ER clinic and the other ones was sent out to some lab. I had no idea that they are the same. How come is such a big difference between results ?
😢

[Jo CIMDA]

Hi

It all seems to be going well, so just go with it and cross your fingers!   It is a steep learning curve for sure.

Jo