Bull Arab X 7 years old with AIHA / blood transfusion

Sheena

Guest

For info – in reply to Lizzie’s urgent advice message, Sheena wrote:

I’m so very sorry you are going through this. It is very scary, stressful & you feel like you are completely at a loss as to what to do – we are here to support you as we have all experienced the same feelings & “isolation” – like you are on your own.

Lola’s chances are really good. Most dogs make a full recovery if they get the right treatment & the vets make every effort to find (& eliminate when possible) the cause of the IMHA. There is no reason to think otherwise – it’s early days & the drugs take a while to work. The prednisone is the cornerstone of treatment to suppress the immune system in the short term & the azathioprine is used to suppress it in more of a longer term action – it takes 7-10 days to start to work, at least. My dog Worzel didn’t respond for about 2 weeks to the azathioprine. Some dogs take longer. That 2 weeks seemed like an eternity as he had been so ill before hand & we thought we would lose him because he was non-regenerative. I am so happy to read Lola is regenerative – that means she is trying hard to produce new red cells, but they are just being killed off at the moment. The drugs will stop this happening, but NOT overnight. I know it’s hard to be patient, but we all have to be.

The drug of choice generally these days is cyclosporine – so you can use that if necessary. There are many other drugs available too, so you have many options to try. We never give up.

I have attached some general information which I hope will help you. Don’t feel you have to be an instant expert – you don’t. We are here to help you. Ask anything, anytime.

There are two important things you need to ask your vet straight away.

1. Is Lola on stomach protectant? We recommend sucralfate (the best) & famotidine.

2. Is Lola on an anti-clotting medication such as low dose aspirin or clopidogrel (plavix)? Clotting is the biggest risk to our IMHA dogs – your vet can tell if she needs it by doing a blood smear. I would bet she needs it – regenerative cases usually do because they are destroying blood cells within their blood vessels, giving a risk of clotting. I know this is scary, but it is quickly resolved by adding an anti-clotting medication. Some dogs receive heparin whilst in hospital – it has to be injected – so maybe Lola has that at the moment? Also, transfusions increase this clotting risk too. All this is explained in the attachment more fully.

The attachment also explains that transfusions should only be given to take them up to a PCV of 25 approximately. I assume Lola is getting fully cross matched blood? If not, only one transfusion of non-matched blood can be given. Some dogs do need more than one transfusion (nothing to worry about at all & not uncommon), so being prepared is good.

Have your vets given you an indication of the cause? If you have any test results, could you upload them to the urgent advice please:
https://www.secondchanceaihadogs.com/urgent-advice/

Your vets will be doing regular blood tests & blood smears (if they aren’t they need to!) plus other tests such as ultrasounds, x-rays etc. You have a right to copies of all these things & it would be great if you could ask for copies of everything. We can help you further by looking to see what’s going on.

You will find lots of lovely ladies to support you here – & remember they have all been through this horrible disease, so you can ask absolutely anything. I am sure you’ll hear from other moderators, but if you go on the site, you can talk to everyone, not just us. We also love to see photos – on the right of that page you can see “upload photos”. It will take a while to appear because of the site security keeping spam & so on off the site.

Hang on in there, Liz – with the right treatment, Lola will soon be doing better. Never be afraid of transfusions – they save lives & make our dogs feel a lot better. The are not in pain, but they are incredibly tired because they can’t get enough oxygen around their system. A transfusion makes them comfortable if they are struggling. As long as it is cross-matched after the initial transfusion, it is fine to do that if necessary. The usual bottom PCV figure is about 15 – below that, they often need transfusions, although some dogs are really ill even at 17-18 – it depends how quickly they drop – dogs who drop quickly struggle more. Dogs who drop slowly seem to cope better at lower levels because their body has had a chance to “get used to it”.

I noticed the prednisone dose is 120mg – what weight is Lola please? I suspect this is a high inital dose that will be lowered fairly quickly – like a loading dose. The usual pred dose is 1mg per pound or 2mg per kilo. My dog weighed 23kg, so was given 25mg twice per day, twelve hours apart, totalling 50mg, which is usual. But many dogs are given a much higher initial dose, which should not be continued too long otherwise you get problems with bad side effects.

Anything I can help with further?

Huge supporting hugs
Sheena, Worzel (diagnosed with bone marrow failure Dec 2012, in remission at the age of 15+) & his friend Ollie xxxxx

Details

Sheena

Guest

Sheena wrote by e-mail:

Hi again Lizzy

Vally is in Australia, so you two can have a really good chat! You are SO VERY WELCOME! We love helping. And we have lots of “new people” on the site at the moment, going through the same thing.

Actually peanut butter is OK as long as it doesn’t have artificial sweetener – but they seem to add that horrible stuff to it. Xylitol is toxic to dogs. If it’s good old unadulterated peanut butter, that’s a good way of pill popping.

Is this the Chinese medicine?;
http://www.ncbi.nlm.nih.gov/pubmed/25371738

If so, it doesn’t seem to boost the immune system, otherwise I would have said to stop it. Anything that boosts the immune system is not a good idea – we want to suppress it to prevent those T-lymphocytes from killing of cells they shouldn’t be. Has Lola had any signs of pancreatitis? When I read the above it says it’s to prevent lung damage from pancreatitis. If Lola has pancreatitis, azathioprine is not the best option, I’m afraid – it would be better to change to cyclosporine straight away.

Vitamin C is not generally used & I personally wouldn’t bother, but Lola may need extra B vitamins – vets need to check that out though. However, Vitamin B12 is of huge benefit & is not toxic, even at high levels, so a lot of us give vitamin B12 – well done you for adding that in. It can make a big difference, especially as some dogs don’t absorb it that well from their food, plus with losing so many red cells, the body’s store will probably be depleted. Iron supplements should never be give unless your vet advises it as it is toxic (iron overload) in higher doses. You can also use a supplement on the attachment called denamarin – it contains milk thistle & Sam-e which are good for the liver. I am a huge fan of pre- & probiotics too.

Diet – you need to be careful about fat content – fat aggravates the pancreas & prednisone patients are always told to keep their fat intake low. Azathioprine must always be given with food, and the pred too. This is important to prevent stomach irritation/ulceration. Red meat – avoid it completely if Lola has haemolysis because the poor old liver is struggling to break down & deal with the component parts of the red blood cells, & then we go giving them more red blood cells & we are making it work even harder! White fish, chicken, turkey, crushed boiled green beans, pumpkin, sweet potato are great foods & are also easy to digest & are gentle on the liver.

I’m not surprised about the fast resps & high bpm – Lola’s heart is working hard to keep her tissues oxygenated. The transfusion will make her more comfortable. My dog Worzel didn’t need a transfusion – he went down hill with bone marrow failure over about 3 months & we were really lucky the pred kept him from dropping further when he reach 16/17/18. He “coped”, but he was really weak. We were ready to give him a transfusion as he was borderline. When the azathioprine kicked in, he soon started to go up. If he hadn’t he would have had as many small transfusions as needed to keep him going until the drugs worked. No way would we have stopped – the specialist was of the same opinion too.

Hope you & Vally can have a get together – Bingo was transfused, so I bet she can help you with sourcing blood etc too if you need to.

I have a feeling you have a medical background – you are very on the ball – I was a nurse many years ago, but I knew very little about this disease when Worzel was diagnosed – totally green. It’s a steep learning curve!

Sheena xxxxx

Details