Hemolytic Anemia
The following therapies are used in the treatment of hemolytic anemia in dogs. However, it should be noted that each dog diagnosed with this disease will tolerate each treatment in a different manner.
DRUG THERAPY
The cornerstone of treatment for hemolytic anemia (AIHA) is the drug prednisone. Prednisone is a corticosteroid drug that suppresses the immune system. Very high doses of this immunosuppressive drug are given initially in an effort to stop the destruction of red blood cells and thus induce a remission. It can take about 5-7 days for prednisone to start to work. The minimum dosage of prednisone given at the onset of AIHA is 1 mg per pound of the dog’s weight per day divided into two dosages. Some clinicians will prescribe an even higher dosage for dogs with a very low PCV. The dosage of prednisone should be tapered off very slowly over many months. The aim is to get the dog to the lowest maintenance dosage possible or off the drug completely. Some adverse side effects associated with prednisone usage are; increased thirst and urination, increased appetite resulting in weight gain, increased panting, muscle weakness and increased susceptibly to infections due to the suppressed immune system. Long term prednisone use may result in liver damage. Dexamethasone, a corticosteroid drug, which is five to seven times more potent then prednisone is also used in the treatment of AIHA. Some veterinarians advocate giving corticosteroids at least one week to work before adding other drugs to the treatment regimen while other veterinarians prefer to add cytotoxic drugs at presentation.
If steroids alone are insufficient, more potent immunosuppressive drugs such as azathioprine, sold under the brand name Imuran may be added. Imuran is a “second-line” or “slow acting drug.” Clinical response may require up to 6 weeks. The principal adverse effect associated with Imuran is bone marrow suppression. Acute pancreatitis and hepatotoxicity have also been associated with Imuran. Because Imuran depresses the immune system, animals may be susceptible to infections or neoplastic illnesses (long term use).
Another potent drug used in the treatment of hemolytic anemia in dogs is cyclophosphamide sold under the brand name Cytoxan. Cytoxan may be used in cases with severe hemolysis and agglutination. The usual manner in which Cytoxan is given is daily for 4 consecutive days per week, stop for 3 days and then repeat. Because of the potential for development of serious adverse effects, Cytoxan should only be used in patients who can be adequately and regularly monitored. Primary adverse effects in animals associated with Cytoxan are bone marrow suppression, gastroenterocolotis (nausea, vomiting, diarrhea) alopecia (hair loss) and hemorrhagic cystitis.
Danazol is a drug primarily used as an adjunctive therapy with corticosteroids (such as prednisone) in the treatment of canine autoimmune hemolytic anemia. There is apparently synergism when Danazol is combined with corticosteroids for this purpose. Once remission is attained, some dogs may have their Danazol dosage reduced or other medications may be eliminated and the disease may be controlled with Danazol alone.
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BLOOD TRANSFUSIONS
Blood transfusions can be used in dogs with hemolytic anemia if necessary. However, adding foreign protein can actually intensify the crisis state, increase the amount of bilirubin and other breakdown products the liver must process and suppress the bone marrow’s natural response to anemia. If blood transfusions are given, they should be done only in a life threatening situation and then done with great caution. The blood must be typed and crossed matched to avoid further sensitization and exacerbation of the problem.
HUMAN INTRAVENOUS IMMUNOGLOBULIN
Human Intravenous Immunoglobulin (IVGG) is a blood product administered intravenously. It contains the pooled IgG immunoglobulins extracted from the plasma of many human blood donors. IVGG is used in humans for many conditions and has been used in some cases of canine AIHA/IMHA when the patient does not respond to other therapies.
SPLENECTOMY
Splenectomy, the surgical removal of the spleen, is occasionally recommended for cases of autoimmune hemolytic anemia that have been nonresponsive to other forms of treatment. This surgery benefits the dog in two ways; less antibodies are made against the red blood cells and the primary organ responsible for the destruction of the red blood cells is removed.
Home Remedies
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