Page 24 – Second Chance AIHA Dogs

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Keymaster

Hiya Cindy

Thank you for sending the blood tests – got the 11th & 14th August. Sorry to be a pain, but could you send us the whole pages as there are often blood pathology reports at the bottom which are useful – sometimes they have done a blood smear & that can tell us a great deal. Also, the one where her PCV was 19, I don’t have that one. I also would like to see a reticulocyte count (baby red cells) figure.

Firstly, it’s nice to see her PCV has gone up a little. It’s early days. Usually, the immunosuppressant(s) are continued indefinitely, until everything comes back to normal.

I am a bit concerned about her platelets – they are very low on the 11th & have come up slightly on the 14th – don’t panic about this, but please keep a close eye on her for anything that looks like bruising, bleeding from gums/eyes, or petechial haemorrhaging – picture below

http://www.vetbook.org/wiki/dog/index.php/File:ITP01.jpg

Straight to the vets if you see anything like this.

It looks like she may have Evans syndrome, which is very similar to IMHA, but it means the platelets have been affected as well as the red cells. The treatment is the same, so it’s no big deal. We have quite a few people on here with dogs with Evans, so you are not alone. I know she is on aspirin (anti-clotting medication), so I suspect the vet has seen something on the blood smears (that was why nosey here wanted to see the results!) to make them think about clotting risks – this doubles the reason to keep an eye on her for any bleeding/bruising. Platelets can be “made” or produced by the bone marrow much quicker than red cells, so hoping they are up a bit already.

The prednisone, cyclosporine & azathioprine need to be continued indefinitely, not just for 5 days, in my opinion – until she’s back to normal levels of red cells & platelets. From personal experience, azathioprine takes 10 days or more to really work – here’s hoping you’ll see an improvement all round – some dogs get better quickly, others take a long time – patience, yet again!

I feel very strongly about the thyroxine – Abby needs it as soon as possible. It has made a huge difference to the speed of recovery for many of our dogs. Yes – I am nagging – sorry! Shih Tzus do have a predisposition to this. The wonderful Dr Jean Dodds that I & many others get help from – our very special specialist – has written about this in detail
http://www.manchushihtzusociety.co.uk/thyroiddisease.htm

Dr Dodds protocol for IMHA & Evans syndrome includes use of thyroxine. There is another immunosuppressant called Vincristine which can also be used in Evans syndrome/IMTP (low platelets), so you do have other options. I have permission to send you a copy of this & will send it to you directly via e-mail.

The other thing I wanted to mention is very high neutrophils. This is usually (but not always) because of infection – is there anything that makes you think Abby has an infection? Has she been tested for tick diseases? It’s worth looking into anything like that as it could be the cause. I am highly suspicious about this. Extreme stress & the drugs may also affect their numbers.

Sorry – another LONG reply – hope I’ve helped a bit. Please keep Abby quiet & don’t let her get bumped or bruised, just in case. I know this sounds a bit worrying, but many others have had to get through this too – so keep going Cindy – you are doing a great job.

Any questions, just ask

Loads of love, Sheena x

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Keymaster

Hi again Cindy

You never need to feel alone now – I felt the same until I found this wonderful group of people! Goodness, you must have a lively, happy household with all your lovely doggies.

I am relieved to see aspirin as part of Abby’s medications – this will prevent any clotting that our poor babies are often at great risk from – good call by your vet. So am I right in saying Abby is on cyclosporine (atopica) & azathioprine (Imuran)? Just wanted to be clear I’ve understood properly. These drugs do take a while to take effect fully, so we have to be a bit patient while they start to work. A PCV of 19 is a nice rise from before – good news, Cindy & I can see you’ve already got your head around the figures & abbreviations.

The level for transfusions is usually about 15 or below, but it depends how well they are coping – some dogs do not do well at all at 17/18/19, so it’s a matter of judgement sometimes. If it is only her red cells that are low (we can tell you when we see the tests) then she may only need Packed Red Cells, rather than a full transfusion. Let’s hope she isn’t going to need one anyway – fingers crossed! If she does, it should be small amount(s) & not take her PCV above about 25. If you want to read more about transfusions, have a look at
https://www.secondchanceaihadogs.com/AIHA_Terms/transfusion/

I couldn’t agree more with Brigitte – Abby needs to be on sucralfate – it’s really important to protect tummies from these drugs. I must re-iterate what she said about thyroid testing too – thyroxine supplementation is recommended with this disease, even if our dogs are not hypothyroid, as it encourages blood cell production.
Sorry to repeat these things, but they make a big difference.

You are going through a rough time on the weakness side of things – it does make them very lethargic. Worzel was in a terrible state at this level too – weak, wobbly & not able to do an awful lot. There are more ups & downs than a rollercoaster with this disease for sure.

Something you need to be aware about – pancreatitis which can be caused by the azathioprine (& the prednisone to a lesser extent). Please DO NOT get over-worried about this as it is easily treated by your vet (who sounds excellent) but it needs immediate attention. Have a good read:
https://www.secondchanceaihadogs.com/AIHA_Terms/pancreatitis/
My vet told me to stop the azathioprine immediately if I saw any signs of pancreatitis & to take Worzel straight in – there is a simple test for it. He tolerated the azathioprine just fine, thank goodness – most dogs do – but some don’t & we’ve had a few people on here who have had to stop it.

Take one day at a time – things don’t happen overnight. It’s a long road, but we’ll help you along it. Apologies if I’ve repeated anything!

Love & hugs to you all
Sheena, Worzel & Ollie (both in bed right now, waiting for biscuits!) xxxx

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