IMHA

Re: IMHA

Sarah Keir — Tue, 24 Jul 2012 11:44:52 GMT

Anyone else having a spate of IMHAs the past couple of weeks? I have had two definates and one possible. One defiante on pred and doing very well , one defiante (PCV plunnetted overnight and tunred yellow between a collegue seeing it and myself seeing it) went to heaven, the possible went to heaven before confrimed as found masses in liver and O didn't like the though of more tests... Is it the season for IMHA or coincidence or things come in threes/sixes...?

Sarah

Re: IMHA

Julian Earl — Mon, 23 Jul 2012 23:39:29 GMT

[quote user="Rajat"]

I like to use Cyclosporin with Prednislone. Even in cases which respond to preds, it allows earlier weaning off preds. Azathioprine takes longer to kick in as someone mentioned, also if going by cascade we should use Atopica first. IV mycophenolate mofetil for the nasty cases is a good choice as kicks in ASAP vs oral drugs. I use zantac and omeprazole as pred dose by itself can cause GI ulceration (not worried re low dose aspirin which I do start at the same time) - omeprazole may also take time to reach peak effects ie 3-4 days.

RBCs or oxyglobin useful if clinical for anaemia..shame now oxyglobin not available, well at least we had it longer than the US did ;)

Cheers

Rajat

[/quote]

That's misinterpreting the cascade: if you want to use azathioprine then use azathioprine. If you want to use cyclosporine, then you have to use Atopica first-line. The cascade applies to the drug otherwise you wouldn't be allowed to use any other but vet-licenced antibiotics for example.

Re: IMHA

Kate Richardson — Mon, 23 Jul 2012 22:06:39 GMT

Did you find an underlying cause to the IMHA?

Re: IMHA

Busybee — Mon, 23 Jul 2012 21:16:06 GMT

I have a dog that was responding to pred alone (at 1mg/kg bid) who's PCV had got up to normal range, but now it's PCV has fallen (from 42% to 34% in a week) and it's agglutinating on a saline slide again. Do I a) go looking for other causes, or assume it's an IMHA relapse b) increase the pred dose to 2mg/kg bid or c) add in azathioprine/cyclosporin?

Re: IMHA

Rajat — Tue, 08 Feb 2011 22:59:43 GMT

RBCs or oxyglobin useful if clinical for anaemia..shame now oxyglobin not available, well at least we had it longer than the US did ;)

Cheers

Rajat

Re: IMHA

Stuart Fitzgerald — Tue, 08 Feb 2011 07:38:03 GMT

I don't think there's any need. Off the top of my head I think the Formulary quotes the anti inflammatory dose of aspirin as 10-20 mg/kg so presumably at 0.5mg/kg the effect on the gastric mucosa is negligible.

Re: IMHA

Laurence Webb — Mon, 07 Feb 2011 23:19:37 GMT

Do you give proton pump inhibitors or H2 antagonists if you're using preds and aspirin

Re: IMHA

michael madden — Mon, 07 Feb 2011 22:28:03 GMT

Prednisolone and aspirin. Experts reckon that most of the complications and thus death is due to clots forming in vital organs like the kidneys so apparently aspirin at a very low dose(can't remember what the book said) is a good idea

Re: IMHA

Christopher Saul — Mon, 07 Feb 2011 21:20:07 GMT

[quote user="Stuart Fitzgerald"]

I would also start on ultralow dose aspirin (0.5mg/kg/day), shown to increase survival rates. See

Evaluation of prognostic factors, survival rates, and treatment protocols for immune-mediated hemolytic anemia in dogs: 151 cases (1993-2002).

JAVMA Volume: 226, Issue: 11, Date: 2005 Jun 1, Pages: 1869-80

[/quote]

there's an article in this month's JVIM about clopidogrel in these cases, I havent had a chance to read it yet!

Re: IMHA

Stuart Fitzgerald — Mon, 07 Feb 2011 12:50:09 GMT

I would also start on ultralow dose aspirin (0.5mg/kg/day), shown to increase survival rates. See

Evaluation of prognostic factors, survival rates, and treatment protocols for immune-mediated hemolytic anemia in dogs: 151 cases (1993-2002).

JAVMA Volume: 226, Issue: 11, Date: 2005 Jun 1, Pages: 1869-80

Re: IMHA

Rob Loxley — Fri, 04 Feb 2011 19:56:23 GMT

[quote user="Laurence Webb"]The alternative is giving pred, losing a few days before deciding it's not working then having to wait another week for azothioprine to kick in.[/quote]

Or adding cyclosporin to pred which I believe kicks in quicker than azathioprine, is less myelosuppresive but much more costly.

Re: IMHA

Laurence Webb — Fri, 04 Feb 2011 15:02:12 GMT

I depends on how bad things are.

If they're really anaemic I'd start both - if it improves on Pred before the azothioprine has had a chance to kick in then it can be withdrawn. The alternative is giving pred, losing a few days before deciding it's not working then having to wait another week for azothioprine to kick in.

If they're not too bad then pred on its own

Re: IMHA

Mark Holmes — Fri, 04 Feb 2011 13:39:01 GMT

Thankyou everybody, very helpful

Re: IMHA

Christopher Saul — Fri, 04 Feb 2011 13:14:30 GMT

I also go for straight prednisolone in first instance. Azathiaprine takes a fairly long time to reach peak effects anyway so not really a first line drug.

If PCV very low and critical and in hospital then I consider oxyglobin or in rare occasions even a packed cell transfusion (Regarding the 'fueling the fire' arguement, if it needs red cells it needs red cells). If hospitalised I also think about low dose fragmin - risk of thromboembolic disease.....

Chris

Re: IMHA

Kate Richardson — Fri, 04 Feb 2011 13:07:19 GMT

Nope, I start with prednisolone.