RE: Non responsive IMHA in a JRT

Andrew Kent — Wed, 02 Dec 2020 21:02:43 GMT

HI Beth,

Apologies for the slow reply - sounds a tricky case!

[quote userid="17578" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29510/non-responsive-imha-in-a-jrt"]Biochemistry NAD. Haematology revealed PCV of 28%. It also showed marked regeneration of the RBC with spherocytes and aggluntination reported by the lab. The lab pathologist said that IMHA was likely.[/quote]

The lab reported changes would certainly be suggestive of haemolytic disease although this is an older dog which would make us worried about secondary disease perhaps.

[quote userid="17578" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29510/non-responsive-imha-in-a-jrt"]

1. Do I need to give the ciclosporin more time to kick in? It has been 3-4 weeks now and there has been no PCV change. I only chose ciclosporin as she was too small for the azathioprine and mycophenylate tablets that I could order in!

2. Should I continue the ciclosporin and preds at the same dose? Can I increase the ciclosporin further to BID?

[/quote]

So evidence suggests that 5mg/kg SID is not immunosuppressive in a significant number of dogs so for IMHA we would routinely start at 5mg/kg BID and I would increase to than now. You could consider an alternative (in which case I would use compounded mycophenolate liquid).

[quote userid="17578" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29510/non-responsive-imha-in-a-jrt"]3. Could this all still be due to a UTI. Sadly costs are becoming a real issue, so could not do a full repeat culture. [/quote]

I suppose its possible this is a trigger but that would be unusual. It may be that is secondary to the steroids.

[quote userid="17578" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29510/non-responsive-imha-in-a-jrt"]4. Could I be missing a cause of this still? Could this be a RBC precursor issue, as I heard that they do not respond as well to treatment? Or could there be an underlying heart issue due to the syncope?[/quote]

I agree we could still be missing a cause but we can only find what we can see. If its appropriately regenerative then doesn't sound like a precursor issue (that should be non-regenerative or poorly regenerative).

I'm not convinced the dog is anaemic enough to be syncopal so would agree there may be another cause for that.

Do keep us posted with how things go.

Andy