Monitoring

Mucous membranes, heart and respiratory rates, and temperature can be monitored at home between vet visits.

Urine color can be monitored for reoccurring signs of hemolysis by folding a paper towel into a 3" x 4" rectangle and slipping it into the urine stream. Feces color can also be monitored by picking it up in a paper towel as soon as it's defecated! It shouldn't be black or tarry or contain any visible blood. Check the paper towel's color to see if it absorbs any blood that the human eye can't detect.

Hematocrit checks:

• During the acute crisis, monitor PCV daily to access therapy's effectiveness and the need for transfusion.
• Try not to get too upset with minor PCV fluctuations. Since many factors influence the result, including time of day, water consumption, stress, the centrifuge, etc. The margin of error is +/-5 %. If it's making you crazy, please discuss with your veterinarian.
• During the first month of outpatient, monitor bi weekly until it is normal, then gradually reduce to weekly, every two weeks, etc.

Reticulocyte count should be monitored if the PCV is not rising as expected.

White blood count and platelet counts should be monitored frequently during outpatient therapy.

Immunosuppressive reduction Once the PCV has reached a normal range and has stabilized for three or four weeks, a reduction of the immunosuppressive drugs should be discussed with your vet. While monitoring blood work and reticulocytes, these drugs must be reduced slowly, generally reducing by 25% in 2-4 week increments while monitoring the PCV weekly for early signs of relapse. If the dog is on more than one immunosuppressive drug, change the dose only one drug at a time. Reductions can also be achieved through decreasing the frequency of drug administration, but before taking this approach, question your vet about how long the drug remains in the body before excretion.

• I personally would never completely wean all immunosuppressive drugs and risk a relapse, but instead would weigh the risks versus the rewards, and find the smallest maintenance dose I feel comfortable with to try to avoid a relapse at all costs.
• Studies estimate that 2/3 of dogs with AIHA need lifelong, immunosuppressive treatment.

Lastly, DO NOT administer flea prevention, heartworm medications or vaccinations during an AIHA crisis. Only after a complete sustained remission is achieved should administration of these drugs be discussed with your vet. Discuss this matter thoroughly with your vet and consult an internist or specialist.

 

Supportive Care

Provide a quiet, peaceful, stressfree place to rest and be left alone.

Excessive thirst can be quenched with plenty of fresh cool water. Ice cubes are a refreshing treat!

Frequent potty breaks (every 2-3 hours) around the clock, provide great relief! Due to the muscular atrophy and prednisone, potty accidents happen. Do not discipline for potty accidents! The last thing your dog needs is to feel worried about upsetting her master.

Baby Wipes are extremely handy to have around the house to pick up piddle leaks. They are also a great way to clean up your patient's bottom.

Muscular atrophy from prednisone can make climbing stairs difficult. Don't make your dog exert any more energy than needed. If your dog is too tired to go up the stairs, get some exercise yourself and carry her up!

Eating may not be the highlight of the day anymore. Appetite can be a great indication of how your dog is feeling. Foods to incorporate into the diet that have inspired other AIHA patients to eat include boiled lean ground beef, boiled skinless chicken or turkey, white rice, puffed rice, low fat cottage cheese and baby food. Since AIHA isn't caused by iron deficiency, liver will not help your dog. Please discuss any diet changes with your veterinarian.

Attitude can be improved by plenty of kind words and gentle loving. Since animals read emotions so well, try to act happy and normal. Try to keep things as upbeat as possible for the sake of your patient. Plenty of reassuring words and petting can only help in the healing process. Overall, continuously let your dog know how much fun she is, how happy she makes you and how much she is loved. Some examples include:

• creating a fun song for mealtime, medicine time and potty time.
• make each vet visit fun by giving a special treat or something special at the end of the outing.
• sit outside in a cool, shady area so outdoor smells and sounds can be enjoyed.
• avoid crying or getting upset in the presence of your AIHA patient. Instead of walking around with a heavy heart, go on a walk or into your backyard out of earshot to cry when feeling overwhelmed with fear and grief.

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