Border Collie X Diagnosed with AIHA

[Amy Wicks]

JD, my 10 year old Border Collie mix landed in the animal emergency the evening of March 28th. He was lethargic, drooling, refusing food and has pale gums. His HCT was 16. He was transfused with two units of blood. Testing after the transfusion showed a HCT level of 17. A third unit of blood was given at this time.
When re-testing the sample, the HCT reading was actually 24 after the first transfusion and 26 after the third unit. JD was sent home with prednisone, azathioprine and instruction to give prilosec and 1/4 of a baby aspirin daily.
At the follow up visit, on March 30th his HCT was holding at 25.6
He developed liquid orange colored diarrhea early on the morning of March 31st. At his follow up on March 31st, his HCT was 24.22 and he was prescribed metoclopramide for the diarrhea. Lab work showed reticulocytes of 131.5 K/uL
It’s now the afternoon of April. JD was continued to have loose stools with a small amount of blood several times today. He was eating well, but has not showed much interest in food since about 10 pm last night. We have an appointment in an hour with the vet. What sort of questions should we ask? Should I request sucralfate for his GI issues?

[Patrice]

Amy,
I am so sorry to read about JD.

Can you please tell me what the blood in the diarrhea looks like? Red blood would more likely be due to something like colitis whereas dark brown or black would be blood from higher up in the digestive system.
my best
patrice

[Vally]

Hi Amy, I’m so sorry you’ve had to come looking for us.

First of all, it’s not unusual for the bloods to drop down after a transfusion. The transfusions are only buying time for the drugs to start working and stop their destruction.

Sucralfate is magical stuff for stomach ulcers and to look after the stomach while on these horrid drugs (that are saving JD’s life). That’s why its important to know the colour of the stools. As Patrice said, dark means is coming from higher up. Bright red is lower down, possibly irritation from the diarrhea.

The blood tests have been emailed, so one of the others will repond about those

The drugs take a little while to start. HCT of 24.22 isn’t dangerous, but I know you’re keeping an eye on your boy.

Ask anything at all. Someone has been through it and we all love to help as much as we can. We all know the terror of finding our mutts so very sick. Don’t forget to take care of yourself too.

Vally & Bingo (diag Nov 2011 in remission)
xxx

[Linda]

Hi Amy. I am so sorry to hear you and JD are going through this. But this is why WE are here, to help in any and all ways possible.

I think Patrice and Vally have you covered on your immediate questions and concerns.

It sounds like your vet(s) have the right meds going and adding the Sucralfate will hopefully help. It did with my pup, Sadie.

Please stay with us and, as Vally said, ask any questions. Good catch on the Sucralfate. You’re already doing an awesome job.

Thinking of you both and sending our love,

Linda and Sadie

[admin]

Hi Amy,
I am so sorry your JD is so sick. I very much hope that in the mean time you did get the sucralfate because it could very much help with his digestive issues. Remember to give it away from all other medications because it could interfere with absorption.
I am sure you are very worried about JD not wanting to eat. I remember feeling horrible about my dog not wanting to eat. I became obsessed with trying to find something that he would eat with gusto. I felt like a failure not being able to find something he would eat. Of course it was not my fault but just a fact that he was sick and not feeling well. Once the prednisone kicked in he became a food monster. So be patient, try not to show him that you are worried, be matter of fact. Always have lots of clean water for him. You have to remember that JD is very sick and just does not have an appetite. Some of the drugs might make him feel nauseous, maybe even hurt his tummy. But these drugs will save his life and there is no way around them. Try to make him some little bites of boiled chicken with rice or scrambled egg.
Best wishes,
Brigitte

[admin]

Hi Amy

So glad you’re here with us – I’m sure you are still very worried & we are all here to support you through this as much as we possibly can. As Vally said, the drop in PCV after transfusions is really common & you must not worry – JD is not in danger at this level. He’ll just be very, very tired & lethargic for now.

I am very impressed with what your vets have done so far & I think you are in excellent hands. The medications look like they have covered everything, but like everyone else has said, sucralfate would be the best thing you can add to JDs drug schedule. As mentioned, it must be given well away from the other drugs – at least 2 hours before/after would be ideal. It will help massively with JD’s tummy troubles. Juggling the pill schedule is no easy feat either!

My Worzel went off his food completely at the beginning too (I think most of us had that problem), but as soon as the prednisone kicked into action, he was ravenous! Brigitte has given you great some ideas on tempting food in the meantime. Once JD’s tummy has settled down with the sucralfate & prolisec, that should make a difference to appetite too.

Getting the bloody diarrhoea to stop will help JD feel better & stopping blood loss is important – the sucralfate will do wonders for that, I’m sure.

Did your vets tell you what they thought was the cause of the AIHA/IMHA was? It’s not always possible to find out, but sometimes we do know exactly what it is, for example a tick-borne disease or infection, or even something toxic they may have eaten, like onion poisoning or metal poisoning – swallowing a coin for example. Has JD been ill before this happened? Or vaccinated lately?

Wonderful news to see that JD’s reticulocyte value shows regeneration – I am so happy to see that. Sometimes this interferes with the automated blood count on a machine which can mistakenly count reticulocytes as WBCs – white blood cells – giving a higher WBC reading, so a manual count is sometimes done. You can read about this here if you want to:
https://www.secondchanceaihadogs.com/AIHA_Terms/reticulocytosis/
I see JD’s WBCs are a little bit high, so it’s possible that has happened – but we do sometimes see high WBCs anyway – possibly infection or even the drugs. The most recent blood test is looking better than the early one – all good news. Generally, they look like the usual “abnormal” blood tests for dogs with IMHA.

So, Amy, you & your vets have done a brilliant job with your lovely boy & I hope he will continue to make great progress – when are the next tests? Please let us know what’s happening, especially on the diarrhoea front. If you are concerned about anything, just ask.

In the meantime, sending you both a big supporting hug
Love Sheena, Worzel & Ollie xxxx

[Leza]

Hi Amy

I’m so dreadfully sorry that JD is so poorly but you and your vet Team are all over this.

My Molly was diagnosed 3 weeks ago with IMHA and we’re in the UK where treatment is waaayyyyy behind the rest of the world so take it from me, you’re both doing an absolutely amazing job already.

Given the above there isn’t much practical help I can give you but please know that I’m thinking of you and sending you both happy, healthy wishes.
3 weeks ago I felt like I’d been hit by a train but thanks to this wonderful team here I’m helping Molly make good progress through (very fast) education from all of these fantastic people. You’re in very experienced and supportive Company right here.

Keep posting and working with everyone here and if you just need someone to have a digital blub with (that’s English for sob) then don’t hesitate to get in touch – the Team has my email address.

Stay strong ..

Much love and licks..

Leza and Molly xxx

[Amy Wicks]

JD still has liquid stool with a bit of blood at the end. He woke us up at 3 and again at 5 vomiting. Our vet gave us some paste type food. We desperately tried to get him to eat some of it and managed only 3 or 4 ounces. His weight has dropped from 61 lbs at the start of this to 57 yesterday afternoon. We have been referred to a critical care specialist in Salt Lake City for an ultrasound and follow up care and will take JD in as soon as he’s in his clinic this morning.
We have been unable to identify a possible trigger for the event. No recent vaccines, no odd things ingested, we don’t use chemicals on our lawn or in our home.
They found clostridium when they checked his feces at our vet yesterday but were hesitant to add another drug until he’s seen by the specialist.
We have a really sick boy.