Page 3 – Second Chance AIHA Dogs

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Keymaster

Lucy,
I’m so glad to hear that Jean advised you to do this! Not every vet will know of her and some will not believe her protocols. They tend to have difficulty understanding the supplementation of L-Thyroxine. Others think she is famous and admire her work.

We have seen some dogs on this forum who recover from ITP and don’t appear to have more problems. But there is a subset that do appear to have the risk of relapsing in the future. You should develop a comfortable relationship with your vet and ask them to let you keep a current prescription of prednisone at home for this. It’s not an expensive drug and it will give you a head start if this happens again.

Also it would be a good idea to get a routine checkup once a month for about the next 6 months if you can afford that. After that, do it about twice a year. Our dogs that come out of these conditions are a bit more fragile than when they started. Their immune systems may always remain a bit over alert.

So be cautious with exposing her to other dogs you don’t know, avoid exposing her to wild animals (especially due to rabies concerns.) The rabies vaccine is mandatory in most areas of the US and hopefully where you are should be on a 3 year cycle. Each state and locality has their own specific laws about rabies vaccines, exposure to wild animals and human bites. Find out exactly what they say.

When Chance recovered I had to agonize about giving his upcoming rabies vaccine a year after he had become sick. I talked at length with my vet and researched NYS rabies laws, plus my own locality.

It was pretty clear that if I failed to give it to him he would be considered “un-vaccinated” and not just elapsed. The law stated many things about this un-vaccinated state but the most concerning was that any dog not vaccinated could not be “at large.” That means never in public, on or off leash. If a dog that is un-vaccinated bites someone or has a tangle with wildlife, authorities are allowed to impound and quarantine any dog, for as long as 6 months. If there is a bite incident, they may prefer euthanizing the dog immediately to examine the brain. The health department is more concerned about human health than the dog’s health.

This wasn’t going to work with him, he was well and I wanted him to go back to a normal life. So I talked with the vet about a waiver. But she said she had tried many times to get a rabies vaccination wavers for her clients and was only given it once or twice for very old dogs with final stage cancer who were home bound. Chance was neither sick nor housebound. No enforcement officer is going to give one whit about this waiver paperwork, NYS makes it clear that they do no recognize it as a valid document if a dog is at large.

So Chance did have his vaccine and there were no ill effects. He lived three more years to the good age of 13 and passed from an unrelated heart condition.

This is an important discussion to have with the vet you trust the most. Avoiding the topic and hoping for the best isn’t the best option. If he remains un-vaccinated your vet is legally not allowed to treat him, they would lose their license to practice, again the community is more concerned about human health than pet’s health.

Be sure to update us now and then so we know he is ok. We worry about each dog when we hear nothing!
my best, patrice

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Patrice

Keymaster

Hi Lucy,
I am glad to see that Shaka’s HCT is up to 39.97%, this is considered normal. It may never get up to the general average for most dogs which is 45%, but never-the-less this is a good value. The WBC count is dropping towards normal which is also a good sign.

I am alarmed the platelet value. Far more than simply concerned.

Yes, it could be a blood sample error, which are very common depending on who collected the blood, how they collected the sample and handled it after collecting. How long it sat before being processed. Did they do blood smear and examine it under a microscope for accuracy? All these play a factor in determining a platelet count from a blood sample. But if there is a consistent lowering of the value from one test to the next, say over 3 tests, that is more likely a true drop in the platelets.

Low platelet levels (thrombocytopenia) can be extremely dangerous. Spontaneous bleeding can occur if platelet levels fall to 30-50.

Platelets are critical to proper blood clotting. Once they reach a low value like this there is great risk of this internal uncontrolled bleeding. One sign of this is to look at his belly and gums to see if he has petechiae. This is numerous small red dots or even large whorls just under the skin. If you see this he must be seen immediately in a vet’s office or emergency clinic.

Dogs that develop IMHA and recover can sometimes go on to later develop ITP, immune thrombocytopenia, via the same autoimmune condition they experienced with their red blood cells. The best treatment is immunosuppressive (high) doses of prednisone, just like you did before. Dogs that have a relapse like this tend to have quicker and more successful recovery if the prednisone is administered immediately.

Below is the treatment recommendation from Dr. Dodds. Please copy and print this to carry with you to the vets. Dr. Dodds owns and runs Hempet.org. They provide canine blood products, testing services and owner advice around the world. If you have more questions, please ask. My best Patrice

THROMBOCYTOPENIA
1. Identify underlying cause (e.g. immune-mediated, infectious, neoplasia, drug-induced, etc.) and treat as appropriate.
2. Use L-thyroxine therapy at 0.1 mg per 10 pounds body weight twice daily for 7-10 days. Start 48 hours prior to elective surgery where applicable. Continue thyroid replacement if patient is still bleeding or has thyroid disease. Thyroid supplementation promotes hemostasis by improving platelet function, stimulating thrombopoiesis in bone marrow and other sites, and enhancing protein synthesis of von Willebrand factor and other coagulation factors.
3. For patients with PCV at or below 15%, transfuse Packed Red Blood Cells in saline at 3-5 mL per pound (or equivalent volumes of fresh whole blood) given once or twice daily. There are insufficient numbers of platelets in freshly collected whole blood to achieve hemostasis in severe thrombocytopenia or thrombopathia (platelet dysfunction). However, the plasma component and platelets present can provide some thrombopoietic and hemostatic benefit to sustain the patient until the underlying problem and requisite therapy have been managed.
4. For control or prophylaxis in special situations of severe, chronic thrombocytopenia (e.g. oncology patients on chemotherapy) or acute life-threatening bleeding from thrombocytopenia, fresh Platelet-Rich Plasma (PRP) can be provided. This treatment is not recommended routinely for immune thrombocytopenia as platelets are rapidly destroyed. Repeated use of PRP is not advised as immune sensitization (alloimmunization) to platelets and white blood cells is likely to develop. To reduce alloimmunization, PRP should be processed after collection through a special filter set that removes most of the white blood cells. Only filtered PRP should be used for sustaining the platelet needs of chemotherapy or other patients with severe platelet disorders.
5. Avoid drugs or biologics that impair hemostasis and/or induce thrombocytopenia. These include:
• trimethoprim – sulfonamides • modified-live virus vaccines
• ormetoprim – sulfonamide • estrogens
• aspirin • heparin
• promazine tranquilizers • warfarin
• phenylbutazone • furacin

In poorly responsive immune thrombocytopenias (ITP), an initial dose of vincristine (Oncovin, 0.01 mg/lb IV) may be helpful to release remaining platelet stores, and danazol (Danacrine, 2.5-5 mg/lb BID initially and then tapered to SID) has been effective along with steroids and thyroid for longterm maintenance.

The most severe cases with autoagglutinating red cells or profound thrombocytopenia may recover completely with the aggressive therapeutic approach outlined above, although a subset of these dogs convert to having a chronic low-grade nonresponsive anemia over the longterm.

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Patrice

Keymaster

Hi Samantha,
I am sorry to hear about your Terrier. You must be very worried as this happened so suddenly. Please do not be scared. We have been helping owners for many years and we can explain many things to you so you will have information to make decisions based on fact, not on emotion. You may not understand everything we tell you but we will try to help you make good decisions. We can take on some of the heavy lifting. We want you, most of all, to be calm around your Terrier and act normal. Your next job is being a good home nurse for him. You will take care of his meds and give him appropriate food. His health depends on you to continue to keep your wits about you. We are here to help you do this.

IMHA is a condition that tends to happen after several triggers activate the immune system to begin destroying red blood cells. The vet hopefully asked you questions about his history and if there were any signs of him not feeling well prior to your first visit. With this information the vet can decide if there are things that are treatable.

So one thing I see is that he prescribed doxycycline. This is now a common treatment in case a dog has contracted a tick disease. This can be one of the triggers that push the immune system to begin destroying RBC. Your vet may not know if this is the case, but is being proactive. You can ask your vet if they did test for tick diseases and what the results were, that would be helpful to know.

The prednisone is always given, at rather high doses, to suppress the immune system immediately. This is intended to stop the destruction of RBC. It is a life saving drug but it does have side effects that become worse over time.

So the vet has also started your Terrier on another drug, cyclosporine, which is also an immunosuppressive drug. It works differently than the prednisone, only targeting the specific white blood cells that are actively destroying the RBC. This drug has less side effects and takes a bit of time to start working effectively.

Both of these drugs are standard and your vet did a very good thing by starting this immediately.

He has anemia, which is a shortage of oxygen to the body cells. RBC have a molecule inside the cell called heme that has an iron molecule attached that “carries” oxygen and delivers it to the body cells. So when there are less RBC in circulation, there is less oxygen going to the cells. This stresses the body organs and will make your dog feel very fatigued. Dogs do not generally feel pain from this condition, they are just very tired. Let him rest as much as he wants and avoid a lot of household activity that interrupts his rest.

Finally your vet has prescribed clopidogrel which is an anti-clotting agent. In the early days of diagnosis, when a lot of red blood cells are being destroyed in circulation, there is a risk of inappropriate clotting because of the amount of debris from the cells. This can lead to problems. So your vet has done another proactive correct thing by reducing the risk of incorrect and massive clotting.

All dogs are different when it comes to this condition. And I don’t know all the tests your vet ran and those results. The vet may have some idea of what the specific triggers are that led to this.

But in general, the early days tend to be the rockiest. Once the drugs kick in, the craziness slows down some but then there may be setbacks, perhaps another transfusion, maybe the vet finds another trigger that needs treating, your Terrier could have a reaction to one of the drugs. So it’s similar but different for all dogs.

What are some common triggers. The four main causative factors of autoimmune disease have been stated to be: genetic predisposition; hormonal influences, especially of sex hormones; infections, especially of viruses; and stress.

What we often see are certain breeds that have a genetic tendency towards autoimmune diseases in general and specific genetic tendencies to IMHA. Another common trigger is autoimmune thryoiditis or hypothyroidism. Many breeds can be affected by this.

So an example is an older overweight female dog of a specific breed for instance a Cocker Spaniel, that has not been spayed, has autoimmune thyroiditis and has received recent multiple vaccine boosters. She had some predispositions and the vaccines set her immune system off.

So the vet is always looking for these kinds of triggers. There may be more specific ones such as a recent insect or snake bite, a lifetime of digestive allergic problems, atophy or canine atopic dermatitis which is an inhaled dog allergy (pollen, molds etc), a bag of bad food. There are really so many that it’s often hard to figure them all out. Treating each one is critical for success.

So sit down tonight and make a list of all the unusual things that may have happened in the last 6 months and also anything that has been a lifetime problem. Let’s do a little detective work to help your vet.

If you are able, please obtain copies of the most recent blood tests: CBC complete blood count, Chemical Screen and other like tick tests, urinalysis etc. You can upload them to me on the Urgent Advice page you see in the menu above to the right. Please don’t send to many at once, and you can fill out the form multiple times to do this.

Start a kitchen diary today and write down each medication, the dosage, the instructions on when to give and then make a small chart to mark off the times when you administered the drugs. On this diary you can note other things such as negative or positive signs, his general overall demeanor.

I am sure you have more questions. Please ask anything.
my best Patrice

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