Camilla, AIHA-dog from Italy

[eleonora]

here i am, i’ve the result of marrow’s levy, i’ll try to upload it. the hematologist wrote me: “the investigation of the bone marrow showed an almost normal blood production, except the presence of erythrophagocytosis typical of an immune-mediated process / hemolytic”. he said to decrease again prednisone (from 1 tablet a day to half tablet a day) and add azathioprine 50 mg (half tablet a day).He wrote to use gloves to touch the azathioprine … why?and what side effects should I expect from azathioprine? next control between 10 days. thanks!

[Brigitte]

Hello Eleonora,
I know you were a bit disappointing that Camilla’s PCV did not go up. Just remember that staying steady is better than going down!
I am a bit concerned to cut the prednisone by 50% we usually recommend to reduce no more than 33% every 2-3 weeks. One of the side effects of azathioprine is it can supress the blood cell production in the bone marrow. So I am not sure if this medication is a good option. I will be interested to see what the others say. I know that I have already touched the subject of hypothyroidism and your vet does not think it is a good idea to add thyroxin for hypothyroidism. However, we have seen it so many times here that dogs make a big jump in PCV one thyroxin is added. Sure the thyroid test might be affected by the prednisone, but the thyroid levels are most likely still low so adding the thyroxin would in my opinion help greatly. I saw it in my dog and have seen it here in many others. I am convinced a small dose would help Camilla producing more RBCs.
Best wishes,
Brigitte

[Vally]

Hi Eleonora, it’s true that sometimes when a dog recovers, the PCV may not go back into the “normal” range. The other thing is do you know what the PCV was before Camilla got sick. It’s always possible she was always on the low side. I think very few people know anything about a PCV until regular blood tests are taken.

I too think the 50% cut is too much and is risky. Also, as Brigitte said, the Azathioprine can suppress marrow production. See https://www.secondchanceaihadogs.com/AIHA_Terms/azathioprine/

I can only also add that the thyroxine has made a big different to many dogs. Especially the ones stuck on the lower levels. With Bingo, he had already been on it but Patrice told me the correct way to dose it, away from food, and Bingo started making an instant recovery from that point.

Vally & Bingo
xxx

[Sheena]

Hi Eleonora & Camilla

Oh that’s a bit disappointing, but certainly not too worrying. I agree with Brigitte completely – stable is much better than a drop!

Erythrophagocytosis simply means red cell destruction by macrophages – nothing sinister or enlightening sadly from the result. This is what we see with this disease, in the bloidstream itself or in the bone marrow. If you can send the pathology report, it might help us further.

I don’t know how to put this politely! So, I will be factual. Don’t reduce the pred, please. Brigitte is telling you the facts – thyroxine is not an option, it’s ESSENTIAL for so many of our dogs. Your vet must start doing some open minded reading of the information on thyroxine. I can provide the research if needed, but you must make them take notice – not easy for you, but Camilla only has YOU to protect & support her. I know you want to get Camilla into remission, you must try everything to help. That might mean changing vets – I am always wary of teaching hospitals (I have good reason, I promise) – you can contact Dr Dodds & she can be your specialist via the internet. I would do that if Camilla was my baby because she is happy to work alongside any vet. I did contact her because Worzel is MY baby & I would trust Dr Dodds over any other vet anywhere. My specialist was really good, but Dr Dodds gave great advice which he took on board. The important thing is that he listened & agreed – if he hadn’t, I would have changed vets in an instant!

Thyroxine is proven to help whether your dog is hypothyroid or not & I must make it very clear that dogs do NOT have to live their lives with a low PCV as their “normal”. This is simply not true – not until every single treatment option has been tried and sadly we have heard this all before. Another reason for me to be worried about the vet.

Onto azathioprine. It is extremely dangerous for anyone who may conceive & dogs cannot breed on this drug. It causes mutation of DNA, so do not handle it without rubber gloves, full stop. My dog was put on azathioprine at the start of treatment & it did save his life. Dr Dodds prefers cyclosporine as a first measure & adds azathioprine for “stubborn” cases. I hope it will help Camilla turn the corner & will only be in used in the short term.

Brigitte is again absolutely correct – azathioprine can suppress the bone marrow, but saves many lives too – Worzel was lucky & did very well on it. It is a widely used drug for this disease but you must be aware of the risks – smaller breeds do not do well with it & we have had pancreatitis cases too. It can cause pancreatitis, especially during the first weeks of use – I hope your vet told you about this (my vigilant specialist was adamant that I must watch for vomiting, diarrhoea, abdominal pain & distress & stop the drug, food & water immediately, then go straight to the surgery) – you must be aware of what to look for as pancreatitis is a medical emergency requiring immediate hospitalisation. Please see:
https://www.secondchanceaihadogs.com/AIHA_Terms/azathioprine/

Azathioprine takes at least 10 days to have an effect, so we have to be patient. I hope it helps Camilla – let’s see what happens over the next few weeks & hope she improves!

Sheena x

[Sheena]

To clarify Vally is right – maybe a normal PCV for our dogs is not as high as before onset, but we must never accept a PCV well below normal readings as “the new normal”! Some owners have been told that mid 30’s is a new normal – no way! Apologies if I confused things
Sheena x

[Sheena]

Hi again

Thank you for uploading the biopsy results – the conclusion is that it is pretty much normal, which is wonderful to hear. Let’s keep our fingers crossed that the azathioprine will help her reach a higher PCV – it will probably take at least 10 days for you to see any change – patience, my dear.

Worzel started azathioprine on the 6th December 2012 (NIL reticulocytes at that point & at death’s door) & became regenerative on the test on the 18th. He suddenly pumped reticulocytes out in huge quantities – by the 26th he was almost a normal PCV! I hope the same will happen for YOU.

Love Sheena x

[eleonora]

thanks Sheena! i’ll let you know….the next control will be probably around 20 january….

[Vally]

Eleanora, that’s good to hear that the report hasn’t found anything. Please ask for the thyroid medication. Truly, we have seen that do magic for our dogs.

Vally
xxx