New and really needing AIHA Advice

[Julie]

Hi Everyone,

I really need some help and hope. I brought my Naya in to Emergency on Sunday after 2 days of lethargy and depression she could no longer stand up sunday morning. Her PCV was 11 and they did an immediate transfusion. The Dr Dx AIHA Her post TF PCVS were all holding steady at 35 (1-24 hrs Post TF) but this morning (36 hrs post TF) it is down to 31, which is alarming. :( Is there hope? Im not sure what im looking for at this point beyond maybe some words of encouragement or maybe what i could or should expect. Im lost.
Theyre discharging her later since at this point all of her therapy is oral medications but they want me to bring her back tomorrow for a recheck.

[Patrice]

Hi Julie,
I am sorry to hear about Naya. You were very smart to take her to the vets immediately after these symptoms. Good job Mom!

First I want to reassure you that this is not a cause for alarm. The PCV, packed cell volume (or hematocrit, which is a similar values) is a dynamic value and varies continuously over time in small amounts depending on many things such as the time of day, activity, dehydration, stress . In addition, it is not unusual for the PCV or HCT to decrease some after a transfusion.

Anemia is defined by a decrease in oxygen going to the body cells. When there are decreased numbers of red blood cells there is also a decrease in the value of hemoglobin, the molecule that carries the O2 to the cells. When we look at the severity of anemia, PCV values generally below 20% can be considered moderate to severe anemia, while 20-30% could generally be considered moderate. Values from 30-37% are mild. In most dogs the average normal value range is around 38-50%, some breeds have a bit different normal.

So a PCV of 31% is not severe, but mild, and quite acceptable considering where she was at just a few days ago.

Of more importance is to know if there is a diagnosed cause for the sudden anemia? AIHA and IMHA can arise from many different triggers and combinations of triggers. Some of these triggers are “treatable” (secondary) while sometimes the disease is considered primary, the body just lost tolerance to self, the immune system began attacking self, with no identifiable cause. A complete history is the best way to determine if all treatable triggers have been identified.

Can you tell us if the vet ruled out some of these conditions that might be treatable? At the top of my list is always if the vet checked for tick diseases. These diseases can contribute to IMHA and are treatable with antibiotics. There are other diagnostic tests that could also be done. Can you give us a history of what tests were done and what things did you notice about her in the weeks before this happened? Does she have allergies or digestive problems? What kinds of medications is she on or has been on previously? Recent vaccinations? Injuries, bee stings, snake bites?

Do you have any questions?
My best, patrice

[Julie]

Thank you so much for your reply, Patrice! So a bit of a lenghty and complex history on Naya. She is a 7 year old Puggle. She was Dx with bladder cancer in November of 2015 and she was given 6-12 months “at best” with treatment. we opted to do a low dose oral chemo along with Piroxicam (NSAID) and Pepcid. As of November 2016, 12 months post Cancer Dx there were no more visible signs of cancer, cancer meds were continued until Feb 1 of this year. Thats when she became slightly anemic and her platelet level dropped sgnificantly(20,000). We removed all Cancer meds and had follow up B/W done March 17, Her platelet count was 150,000 and her RBC was in normal range. The oncologist wanted her to remain on Piroxicam to wield off the cancer as its a very very aggressive type of cancer. Friday morning i gave her her first dose of piroxicam along with Pepcid for the first time since February. Within hours of that i noticed she seemed tired and depressed and from there it escalated quickly.

She does also have bad allergies which we have treated for 3 years with desensitization shots and antihistamines, although she has been off the injections since the fall due to a severe allergic reaction them.

Shes had no immunizations since she was 2-3 yo. She was tested on March 17 for tick borne disease and was negative.

What an emotional roller coaster ive been on with this sweet puppy. 6 weeks ago she was cancer and chemo free, even a week ago she was running around like a puppy and demanding to play. Im just shocked at how quickly this all transpired.

[Julie]

I truly appreciate you taking the time to post back!

[Patrice]

Julie,
Oh my, what a difficult journey you have been on. I am so sorry.

I’m short on time but I didn’t want too much time to elapse before responding. So this will be abbreviated.

I asked about triggers and you responded with so many that it will take a lot of time to explain their relationship to what is happening. Be patient.

But in particular I want to note that chemo drugs are very similar to the action of the kinds of immuno-suppressant drugs that are used to treat IMHA and AIHA. Some of these drugs have a common and well known side effect of bone marrow suppression. I don’t know exactly which drug you have been using but I can say that it probably has a side effect of bone marrow suppression listed in the product information. At any point during chemo treatment the bone marrow itself could have been suppressed. This could result in a form of non-regenerative anemia. This type of anemia would not be termed AIHA or IMHA.

An allergic reaction to an NSAID could be quite common. I’ve had them myself. This could result in something similar to shock. This can result in many internal changes that may include a drop in blood pressure.

Any dog that has a history of atophy, canine inhaled allergies, will have an extremely reactive immune system. How do I know this? My dog Chance had atophy as severe as your girl’s starting when he was only about 2 years old, including shots etc. Chance later developed a life threatening bone marrow failure at 7 years old. It was very serious and he could have died, but we saved his life. I made this website to help other owners treat these diseases. I truly believe in having hope even against the most dire circumstances.

While this seems abrupt and sudden, it isn’t. Just like Chance there have numerous triggers along the way, combined with significant stress.

What is important to determine is if this is actually a form of hemolytic anemia or something a bit different. If you are able could you obtain and send your more recent blood work and lab results so we can view them? Use the Urgent Advice page to upload them.
My best Patrice

[Vally]

Hi Julie and Naya, and welcome to the site.

Well your girl is certainly a fighter!!! Yes, do ask for a copy of blood tests and also her discharge papers maybe, as they usually have a good summary and send them through on the Urgent Advice at the top. Patrice is brilliant at understanding them.

Piroxicam is one of the drugs that can causes AIHA. Is the oncologist aware of what’s happening now? Just wondering if there are alternate meds that could be used. When you actually look at the list, you’ll see that there are many many drugs that can trigger drug induced anaemia. See this:
https://www.secondchanceaihadogs.com/AIHA_Terms/drugsantibiotics-can-trigger-aiha/

For complicated cases, and I think your girl fits, Dr Jean Dodds is brilliant with the immune system. If it were me, I’d also do an owners consultation with her. It’s not terribly expensive (very worth it if you ask me) and once you’ve contacted her and she responds, you can email any further questions at no extra charge. The second box on this page:
https://www.secondchanceaihadogs.com/hemopetresources/

Ask anything at all Julie.

Vally

[Julie]

Thank you so much! Brought Naya home tonight, she sure is happy to be here! I have to take her back for recheck Thursday am and I will ask for copies of her recs. I appreciate all your advice!

[Vally]

Julie,

I’m certain Naya is very happy to be home. It’s good to check bloods often in the early days. We were checking 3 times a week until Bingo started to steady up a bit.

And sorry, just need to correct my comment on the Piroxicam, whilst the drug can’t cause AIHA, it can cause very common allergic reactions, which can lead to hives, problems breathing, blood pressure can drop leading to white gums and collapse.

In addition this drug has severe cautions about using it with many of the common drugs we use to treat dogs with AIHA, in particular prednisone and cyclosporine. Like many NSAIDs, it can interfere with platelets and lead to bleeding.

Good luck on the next test.

Vally