AIHA

[Kate H]

Hi everyone. My 2 year old doberman bitch has been diagnosed with this disease this week. It has been such a stressful time with lots of tears shed and I am glad to find such a forum to help with any queries. She went from bouncing around last Saturday to very down on Sunday, off her food and drinking lots. My now former vets hadn't a clue and so I sought care from a specialist hospital 50 miles away. Diagnosis and treatment started within 24 hours. She stayed there until yesterday which was awful for her as my dogs are spoiled rotten and would have no experience with being away from home. All the staff loved her as she is so sweet while I was at home crying myself to sleep. I just wanted to say hello and hopefully be able to ask questions as they arise.

[Penel CIMDA moderator]

Hi Kate,
Hello - I'm sorry to hear your poor girl has been diagnosed with AIHA.  Very well done for taking her to a specialists so fast though - you probably saved her life.
How is she doing now - are you confident she's on the right treatment regime now?

[Joanne]

So sorry to hear about your girl.  You did absolutely the right thing in getting her treatment that is appropriate.  Our beardie, CeeCee, experienced the same disease, plus several others, and fortunately our local vet got us to the specialist immediately.  Cee was diagnosed at 3 yrs old, survived her diseases, and is now 13 and a half and doing well for an old lady beardie. 

What drugs is your girl on?  How often are you blood testing?  It is important to do that often so you know if the levels are coming up or not.  Defeating this disease takes time, sometimes months and months.  It is not an easy one, but they can survive. 

Ask questions...there are many here who know this disease and can help guide you.  This forum was a life saver for me when Cee was in crisis.

[Kate H]

Well here is our update so far. She came home Friday. Her PAC level had dropped from 20 to 18 but I was hopeful she would begin eating at home. She is on 100mg of predislone daily and had a blood test on Tuesday and her pac level was 28. She is beginning to return to doing little things with my other dogs such as going down the lawn to see the neighbours cows looking in at her. She is drinking gallons and while she had always been excellent regarding housetraining, she is wetting during the night. But thats a small price to pay. On Tuesday her steroids are to be dropped to 50mgs daily with a blood test 3 days later. She is eating well and hoping she continues to improve.  Paws crossed:-)

[Catherine]

Do you mean her PCV (HCT) level? It is good that her PCV level is rising. Is she having the Preds twice daily or just the once? It is recommended to divide the dose and also to give a gastroprotectant with them.

Is the vet going to test her blood on Tuesday before they reduce the steroids? I do not think it would be a good idea for them to reduce the steroids (unless they were having really adverse affects) without knowing if the PCV level is going up. Also regular blood tests in the beginning (every 3 days say) is a must to keep an eye on the PCV level.

Also in my opinion halving the dose and so soon seems to be risky. Here is the treatment 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 base on a dog receiving an induction dose of 1.0mg/kg/q12hrs

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!

Also the link to more info. on this site: http://cimda.co.uk/smf/index.php/topic,11.0.html

[Kate H]

Oops sorry I meant pcv level. Am new to all this lingo . She is on the 100mgs daily that is split into two doses. I will be on the phone first thing Monday and discuss the tablee below with the vets there. I am taking absolutely no chances with her treatment and really appreciate your input and advice. she raided the cupboard tonight and had a pig ear. I never thought I would be so pleased to see Kellie eating a stolen treat

[Penel CIMDA moderator]

Hi again - I'm guessing if you first posted on the 26th Oct it all probably started on about the 24th? so she will have been on 100mg (split into two doses over 24 hrs) since the 24th Oct? so that will have been about 12 / 13 days on that dose?  I do agree with Catherine, I'd feel better if they checked her PCV just one more time before reducing the medication.    Also a lot of people have experienced that halving the dose is too much of a shock to the dog - and can cause a relapse - hence following the treatment regime recommended - where you drop it by a quarter.
How much does Kellie weigh? am guessing something like 32kgs maybe a tad more?
It's great to hear she nicked a pigs ear!
The weeing will get under control as you gradually reduce the meds but for now it's par for the course.

[Kate H]

Kellies Pcv level on Fridays bloods was 39 so her steroids have been reduced by a quarter for 4 weeks. Plan is test again and reduce by a quarter again. Pleased to see an improvement:-)

[Catherine]

That is good news! But I am a bit confused about the reducing regime. When is her next blood test and what amount of medication is she on at the moment please?

[Kate H]

She was on 100 mgs daily of predilisone since the Weds before the October bank holiday here whish was split into 50 twice a day. We had bloods done Friday and had results today so now she is on 75 mgs a day for 3 weeks after which we will do another blood test.

[Catherine]

I would never wait that long to retest, I am not sure why your vet has suggested it! Although Kellie's PCV has risen very quickly it did go low, and I am afraid to say can do so again during the reducing of the medication. If you test her blood at least weekly then not only can you catch it early if her PCV does start to go down again after a steroid reduction, but if it is still going up or remaining stable then you can carry on reducing the medication sooner rather than having  her stay on a high amount of steroids for 4 weeks.

Not only would I be testing her blood weekly (and then eventually every 10 days, fortnightly etc.) I would also now and again have her biochemistry tested as well to check out how her liver etc. is coping with the disease and steroids.

[Penel CIMDA moderator]

Hmm I'm not sure I would test weekly if all her other signs are ok.
It also depends on how stressful the dog finds going to the vets and having blood taken - don't forget that stress can be a trigger for a relapse too.
Let us know how you get on Kate.

[Catherine]

With a dog with AIHA it is difficult to go by any other signs and a dog can still be behaving fairly normal with a very low PCV. Even if one went with the idea of the gums looking paler that still would not tell the owner whether the PCV was 25 or 13 say. The only way for that is with a blood test.

Yes, having blood taken can be stressful for the dog but I do not think there is much of a choice. Kellie was only started on treatment 3 weeks ago and to wait 4 weeks to retest again not only risks not knowing that her PCV could be falling and not acting on it, but also means she could be on more steroids longer than necessary.

[happydogs]

My lurcher has IMPA and she isn't being tested either - we go by clinical signs and how she is when making decisions with regards to reducing her meds. The whole idea is to make vet visits as stress free as possible.

[Catherine]

I am not sure what bearing this has with regard to a dog with AIHA - Autoimmune Haemolytic Anaemia is a different disease to IMPA!  AIHA (you can read more about it here : http://cimda.co.uk/smf/index.php/topic,11.0.html) involves a dog becoming anaemic and its PCV dropping. Some will have the PCV drop slowly, others quickly so the sooner a dog is diagnosed and put on the correct medication the better. Some will, unfortunately have to have a blood transfusion, for others they do not get the chance to survive. Even when a dog has been diagnosed and is on the correct medication it is not out of the woods.

I feel strongly that a dog diagnosed with AIHA only 3 weeks ago and having its medication reduced needs to have its blood tested sooner than 4 weeks' time. Whilst I appreciate that other people have different ideas on blood tests in general, in this case,  comments on the very importance of the blood tests would be better served by people who have experience of AIHA. Then at least it would be a better comparison.

I have had a dog with AIHA who had regular blood tests and survived. With AIHA I would never rely on clinical symptoms alone.

Obviously it is up to people how they proceed with their dog's illness. I am just giving my thoughts.