Page 73 – Second Chance AIHA Dogs

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Keymaster

Hi Teddy

I’m very sorry to hear about Duc. Although this is a serious disease, it can be beaten with the right treatment.

Onset can be extremely fast or it can happen gradually. The faster the onset, the more difficult it is to treat and hospitalisation is the best option. It is IMPERATIVE that your Vet does as many tests as possible to determine the cause – I would recommend finding a specialist in internal medicine who has experience in treating dogs with this illness AS SOON AS POSSIBLE. An inexperienced vet could cost the life of the dog.
The basic principles of initial treatment;

1. Prednisone or Prednisolone dosage 1mg per pound weight of dog divided into 2 equal doses. This is to suppress the initial auto-immune reaction quickly as it is fast acting (5-7 days). Injectable dexamethasone is a more potent immunosuppressant drug used in hospital for severe onset cases). Prednisone and prednisolone can cause dehydration – ensure the dog drinks plenty of water – use a syringe (without the needle of course!) to put water gently into the corner of their mouth & encourage drinking. They will also urinate more frequently & with great urgency sometimes.

2. On definite diagnosis of AIHA/IMHA – IMMEDIATE addition of a different type of immune-suppressant, azathioprine or cyclosporine, etc for example. There are many, many drugs of this type available for treatment and your dog may need one, two or even a cocktail of these drugs before they start to produce new red blood cells (called reticulocytes when they are “baby red cells”). Sometimes it takes time to find the drug or combination of drugs that works best. This is very important – prednisone and prednisolone on their own will not be sufficient and dogs suffer side effects after long term use. A dog’s primary treatment protocol should include more than just prednisone or prednisolone if the dog will be treated for long periods. I have read about too many cases where the vet has not added another immuno-suppressant quickly enough, or not at all, and the dog has had a more difficult recovery.

3. If there is any indication, even a vague suspicion, that the dog has an infection they should be tested and THEY MUST BE GIVEN ANTIBIOTICS. If not, recovery can be severely impacted due to a compromised immune system.

4. Inappropriate Clotting risk – it is ABSOLUTELY VITAL that your dog is given ultra-low dose aspirin (or if in hospital heparin). Ask your vet if any of the following are present in the CBC blood test and chemical screen (liver and kidney)

A)”Damaged” or abnormal red cells due to immune system partially destroying or biting lumps out the cells, causing them to clump together.

B) Complete breakdown (haemolysis, the H in AIHA) of LARGE numbers of red cells (erythrocytes), overloading the liver and kidneys with their component parts (haemolysis) – the faster the drop in PCV the more likely this is. Presence of large numbers of spherocytes (abnormal red cells) can be a problem – they are destroyed in the spleen as they are too big & wrong shape to get through.

C) Thrombocythemia/thrombocytosis – platelets 1,000,000 or above (this usually resolves when the cause is treated and is the least likely clotting problem)

D) Auto-agglutination – clumping due to antibodies “joining” erythrocytes together (Coombs Test positive – but test is NOT 100% reliable)

E) Blood transfusions – risk of clotting due to increased auto-immune reaction to “foreign” blood.

There are STILL too many deaths from inappropriate clotting because dogs are not being given an anti-coagulant and it really upsets me.

5. Stomach protection – sucralfate and famotidine (brand name pepcid) are extremely important in preventing & healing stomach ulcers which are caused by the medications like prednisone. Again it is VITAL your dog receives this to prevent /stop bleeding in the stomach & GI Tract.

6. Transfusions (if needed & it looks likely for Duc) – Vet should evaluate the patient very carefully before transfusing a dog with a PCV/HCT level of more than 25%. If it goes over this level, your dog may not produce new red blood cells on their own as their body thinks they have enough cells already, therefore SMALL transfusions are best. This is very important and some vets forget this basic fact from their initial training.

7. Very basic blood test facts & figures for most breeds:
HCT, haematocrit, is the percentage of red cells present in the blood – normal levels are between 35 – 55. PCV, packed cell volume, is a direct visual measurement of this same value. These values can be slightly different to the use of an automated analyzer to measure HCT.

Haemoglobin normal is 12-20 roughly depending on the particular lab’s value ranges.
Platelet count normally around 170,000-400,000
Total White Blood Cells 4-15 mm/m3
The term regenerative means reticulocytes are being produced in the bone marrow. The term non-regenerative means they are not being produced in the bone marrow. Regenerative is GOOD – the dog is responding to treatment. However, if there is large value of reticulosis and there is little increase in the number of red blood cells, there may be blood loss, perhaps due to an ulcer or tumour.

8. Pancreatitis can be a common side effect of prednisone with this disease – look out for vomiting &/or diarrhea, refusing food and dog in stomach pain, perhaps arching their back and groaning. Take them straight to the vet.

PLEASE REMEMBER – THIS IS JUST AN OVERVIEW. If you want more detailed information, please do not hesitate to ask us more questions- someone on here can help.

THIS DISEASE CAN BE BEATEN – HOPE IS ALWAYS THERE.
Best wishes for a speedy recovery
Sheena x

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