AIHA in lab

[nikirushka]

Hello

I have just had a lab diagnosed with what the vets think is infection-triggered AIHA.  Regenerative, in her case, thankfully.

She's currently on 25mg prednidale once a day (she is 31kg, 6kg overweight) and cephacare three times a day to sort the infection, if that was the trigger (high temp and high white blood cell count suggest it was).

Her haematocrit on Tuesday this week (first visit) was 22%, she's been on the meds since wednesday as the vet wanted to ultrasound to rule out internal bleeding from cancer first.  She's in today to have the crit redone and a free T4 test as she is hypothyroid also (not autoimmune) and she needs a dose increase.  Her poo has been intermittently orange for nearly a week - stupidly I thought that was down to my increasing her turmeric as her arthritis had been a bit worse with it being cooler!  I hadn't realised it was a symptom so I will be letting the vet know about that today.

I just wondered if anyone could offer any suggestions for how I could help her at home - I've already stopped walking her as exercise intolerance was her first and biggest symptom - but I have her on natural supplements for severe osteoarthritis and I want to be sure those are safe with this (turmeric, DLPA, devil's claw, coconut oil).  I've just started her on kelp powder for nutritional support.

Many thanks for any help - autoimmune is new territory for me, I've dealt with all sorts of other things with my dogs but not this!

[Pam13]

Hi Niki

Glad (not really but you know what I mean ) to see you here. There are very knowledgeable people that will be able to offer you advice and support.

Pam

[Catherine]

Is the vet sure it is AIHA and regenerative as regenerative can be suggestive of something else causing the anaemia?

If your dog has AIHA she needs to be on an immunosuppressive dose of steroids - in her case she should be on at least 62mg of Preds. a day preferably split into two doses. Also she needs to be on a gastroproctectant to protect her stomach. See here:

"......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!......."

When will you know today's haematology result? How is your dog? See here for more info:    http://cimda.co.uk/smf/index.php/topic,11.0.html

[nikirushka]

Not certain no, but it's fitting with the symptoms.  I've queried the pred dose today and the vet thinks the 25mg per day is fine - you're not the first person to say she needs to be on a lot more.  I need to find some papers/evidence to print out and show him I think.

PCV today though is 30% so heading in the right direction   And I should have her FT4 result today or tomorrow.  She's fine in herself - quick to tire but as I'm not walking her while this is going on and as she is generally a very lazy dog anyway, she's not actually getting tired!  Still very cheerful and waggy and her appetite is fine.

I don't have her on a gastroprotectant yet, my vets never mention it (had a dog with a slipped disc last year who should have been on it and nothing), but I can go get some ranitidine for that (I will let them know, of course).

[Penel CIMDA moderator]

Hiya - I'd definitely add the ranitidine.
I agree the dose of pred isn't high enough.  1 - 2 mg per kg every 12 hours...

[Catherine]

The 25mg a day would not have been an immunosuppressive dose for her so her PCV would have not gone up (I think) and certainly not by that amount if it was AIHA. So perhaps it was something else causing the anaemia and in that case I am not sure she should still be on the Preds. although you would have to consult your vet to see if that dose needs reducing gradually rather than coming straight off. If you are continuing with the Preds. though she needs the gastroprotectant.

Did your vet rule out a gastric bleed? Did you have a full biochemistry blood test done for her including electrolytes?

As regards the supplements, I would not give her anything extra at the moment whilst all this is going on.

How old is she?

[nikirushka]

She is 10 today!  I've just realised I've forgotten all about her birthday, what a useless mum I am!!

Anyhoo... she's had the ultrasound front to back and the vet couldn't see any evidence of a bleed anywhere at all, everything looks in good condition (especially considering she's 10 and technically obese).

I've run her symptoms and test results by Dr Jean Dodds for her opinion, she says that with her PCV not being desperately low then a response to the pred at that dose is not unusual as the condition hasn't gone so far that it wouldn't respond.  Hopefully the dose increase on the soloxine will really kick the butt of this thing, I'll have that test result on Friday (vet rang me back to say he was sending it off to get it done the same way as the last test, which is the more reliable method considering her symptoms too so it'll take a little longer).

She's doing better in herself, happier this weekend and her gums are looking much better

[nikirushka]

FT4 result is in - 12pmol/l, so too low as I expected (should be at least 18).  It's only gone up two units from the last test last year.

She is still doing well though, almost back to normal so I've booked her in for Friday for her next PCV check. It was the earliest I could see the same vet and he's said that if I take the emails from Dodds then he'll be happy to up the soloxine dose.

[Penel CIMDA moderator]

Good to hear her gums are looking better and that you've got JD on the case 

[nikirushka]

She's definitely improved, it's not just hope on my part!  PCV is up to 34 today   And we have our soloxine dose increase too

[Penel CIMDA moderator]

Good news! have a great weekend.