Ariel, AIHA dog from Italy

[Sara]

Hi ! My name’s Sara, I’m italian and I’ve a 3 and a half years old pomeranian mixed dog, Ariel.

She fell ill about early October, she started to be strange, She had the mucous of the mouth pale and temperature was 39.5°.
Blood tests showed a severe anemia and thrombocytopenia, and Reactive protein C was high.
For all the exams it resulted that she was affected by splenomegaly and meteorism.
She had a Bone Marrow Aspiration that show: myeloid series prevalent compared to the erythroid one that is strongly depressed in the maturation phase, compatible with myeloid hyperplasia.
Since October we had to blood transfuse her 3 times, the last one on Monday 11 december.
Only 3 weeks ago a vet understood what she had: AIHA non-regenerative.
Since then she is in therapy with mycofenolate and prednisone, but her reticulocytes are still under 1% (last time was 0.28%, but it has been 0.44% 2 weeks ago).
The reactive protein C now is in the range(saturday 25 november was 8, now is 0,14).
Now, after the blood transfusion on 11 december, the RBC is 4.10, HCT is 26% but she is platinopenic again and still no reticulocytes.
What’s your suggestion?

thank you a lot Sara&Ariel

[Vally]

Hi and welcome Sara and Ariel.

I’m sorry you have come looking for us because that means Ariel is very sick right now. Is she back home with you now?

Do you have a copy of blood test results? If you do, can you send them through on the Urgent Advice and Patrice can have a look at them:
https://www.secondchanceaihadogs.com/urgent-advice/

Is Ariel on anything besides the mycofenolate and prednisone? Also what doses of drugs is she getting and what is her weight?

My best, Vally

[Vally]

Sara, I’m posting this for Patrice as she’s help up in work. Chance was her dog and the dog and the site is named after him.

Patrice:

“This is the exact same thing as Chance, bone marrow failure.

The cells are being destroyed in the bone marrow (maturation stage) at the point where they begin to mature (as reticulocytes) and this is due to a very strong autoimmune attack in the bone marrow. Just as Chance.

The best treatment, if the vet will go along with it, is Dr. Dodds protocol for bone marrow failure, starting with a high loading dose of cyclosporine using a pulsed dose. I’ve attached an older version, but it is basically the same thing but doesn’t mention the Atopica brand version. The newer version can be found here:

https://my.imatrixbase.com/clients/14145/documents/Blood_Literature/Immune-Mediated_Hematologic_Disease_and_Bone_Marrow_Failure.pdf

The pulsed dosing is critical because this is a very high dose and the Saturday Sunday off give the dog a break. This is literally saturating the tissues with cyclosporine, which works deep into the bone marrow. Repeat this cycle as many times as required, about 2-3 times as she says. Chance responded by the 3rd or 4th cycle, about one month. Then taper as she suggests. It will work. depending on how long the dog has been on prednisone, it may be necessary as you start this to begin a more significant decrease of this asap. I think she wanted me to decrease really fast, and I let her tell me the dosage!

Yes, Dr Dodds can manage this with you. Today she is on religious holiday. so won’t respond until later in the weekend.

All the other stuff like Denamarin, Pepcid, easy to eat diet etc all apply. Ariel will get worse before she recovers.

This is not a death sentence. if this was a human we would not could not put them down, we would help them with transfusions and treatments until they could make blood again.

The spleen may have a growth on it and in that case they should ultrasound and see if it is most likely benign or malignant. If benign remove asap as it could rupture leading to a painful and sudden death. This is the same as Chance, his growth was 7lbs. the spleen can be removed without too much impact to future life.”

[Sara]

Hi, thanks for your answers.
For vally: her weigth is 8kg.
She had prednisone for the first 5 days as 15mg(about 2mg/kg), for the following 2 weeeks she had 10mg(1,25mg/kg) and since today she is taking 5mg(less then 1 mg/kg).
About mycophenolate since 3 weeks ago she is taking 80 mg every 12 hours.

For Patrice:
we have read Chance’s story and as you said the sintoms seems to be the same.
Our vet gave her mycophenolato instead of Cyclosporine because we live far for from him(250km) and cyclosporine need her to be monitored frequently.

I’m giving her vitamins containing iron, vitamin B12 and folic acid and other vitamins(the name di Acme Bloodder).
She also taking homotoxicological products for liver and kidney protection(Heel products).
She is fed with homemade food such as rice, chicken, turkey and vegetables.

The vet told us to repeat the blood exames next Thursday and he want to repeat
erythropoietin exams(2 months ago she already had the exams and the value little over the range).

i’m so worry about this bone marrow failure :(

[Vally]

Sara, that prednisone dose is too low. It should be 2mg per kilo so Ariel should be on 20mg (10mg twice a day) until she’s stable. See: https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/

Is there not another vet closer to you than 250 km. That’s a huge distance to drive.

If it were me, I would do an owners consultation with Dr Dodds. She is an expert in this and you can contact her by completing an online form. Your vet can also contact her. This is where you will find the form:

https://www.secondchanceaihadogs.com/hemopetresources/

It is the second item on that page is the consultation. The cost is US$150 and she answers quickly. Once you have made contact you can use the email to keep in touch with her and there is no additional charge.

Also on that page is where her protocol is for marrow failure. The third item.

Patrice is on the East coast of USA and I’m in Sydney Australia, so excuse delays in response. We’re keeping an eye on the site though. You can use the urgent advice as well as that will send us an email.

Regards, Vally