No two dogs are every identically the same with "AIHA" (typically in the US it's more commonly referred to as IMHA or Immune-Mediated Hemolytic Anemia altho in a tight technicality AIHA (auto-immune hemolytic anemia) and IMHA are a tiny bit different) --- and if you've gotten this far yeah -- it's ALL confusing as heck.
I'm a bit confused tho -- first -- he's on 40 mg of pred. twice a day How much does he weigh?? Typically the initial dose is at or higher than the dog's weight in MG and I'm just checking logical doses here.
Also -- you said "He was also started on cyclosporine and has completed two rounds of 4 days on and 3 days off." --- are you saying the vet didn't give it to him *every* day??? If so ***very*** -- unusual!!!!!
Cyclosporine has to build up in the body -- it takes 2-3 weeks (sometimes longer) for the level to build to an immune-suppressive level. And **Most** often the cyclo is given twice a day usually until they begin wean-off. But in the early days until you get the immune system to stop hurting the body typically they give the cyclo twice a day to build to that "level" and prevent any hills and valleys that might allow the body to start killing red cells faster. You didn't say how much cyclo so I've no idea if it's a small or large dose.
Vit K is nearly never used. That is typically used to help blood coagulate. I think you were talking about platelets being normal? Sooooo why the Vit K -- that one really confuses me.??? (Low platelets can mean an even further variety of IMHA where the body is killing the platelets).
The reason I ask is because one of the **biggest** challenges when they go on the big meds is that the blood often shows as agglutinating -- or making little clumps together which then lend themselves all too easily to blood clots causing stroke. So VERY often you see these dogs on either a low dose aspirin or an actual blood-thinner like Plavix.
Is there a strong suspicion of tick disease? Typically doxycycline is used for tick disease. There are *some* vets who have used doxy simply because they are trying to ensure that infection doesn't crop up while the dog is immune suppressed, **but** the problem is that doxycycline, in some individuals, can strongly boost the immune system. In humans, unless that person is being treated for tick disease doxycycline is usually for the express purpose of making the immune system work harder.
2-3 years ago it was the trend to see vets using doxy to try to prevent infection while they are immune suppressed (b/c it can be given for months ... *but* that practice has largely fallen by the wayside. I know specifically with my dog, Billy -- we had a "faint positive" to a tick test so he was on the doxy and from the moment he was on the doxy he didn't respond well and in fact he had six transfusions in a month! (yeah I am serious! *sigh*). The instant we took him off the doxy he began to respond.
Is the vet seeing any spherocytes in the bloodwork? Spherocytes are destroyed red blood cells - The tricky thing there is that labs don't "show" spherocytes unless you ASK them. It's a separate step (someone at the lab has to prepare a slide and literally look for them -- it's not machine tested so they don't do it unless asked.
They are doing the bone marrow aspirate to try to determine if the body is actually making red blood but it's being all killed before it makes it into the blood stream OR is the body actually just not making enough blood. Sometimes in a bone marrow aspirate they can pick up cancer if it is present.
However -- with the prednisone it can actually also shut down the thyroid enough that the thyroid stops telling the body to make more blood. It is usually my suggestion to have an owner consult with Dr. Jean Dodds at Hemopet -- she's pretty much the foremost authority on immune-mediated blood diseases in the world ... and often she will simply suggest that the vet supplement the thyroid to see if that will stimulate the body to make more blood.
The pred makes them eat and drink tons. Pred can make the muscles totally weird -- it actually can interfere with the brain's ability to talk to the muscles so you wind up seeing accidents in the house (and it's not because he's not trying to hold it and it's really not because he's drinking so much but rather because his own muscles own't obey what he wants to do.). You may further see symptoms like muscle tremoring (particularly the back legs/hind end) and some pretty severe muscle atrophy.
All in all -- it tends to take a while for them to respond. AND any time you do a transfusion *if* that donor dog had any vaccines recently or had been exposed to various disease (like particularly a dog who was a clinic donor dog in house?? you don't usually see this if the transfusion was done someplace like a vet school) -- that can again make it more likely that the body can find new ways to destroy blood (he stopped regenerating after the transfusion? ). I suspect the fact that the cyclo hasn't been given enough chance to take hold and has been "pulsed" may have allowed the body not to stop destroying.
It isn't a nice and neat mathematical formula unfortunately. The doxy would be the first thing I'd ask to have gone because that can cause problems that vets truly aren't expecting. It's not **supposed to** boost the immune system in dogs but I've seen several times where it has.
It takes some dogs quite a bit of time to respond to cyclo when it's given twice a day every day -- I'm not sure the purpose of pulsing it. I've honestly never heard of it being done (and I've just been helping folks with IMHA dogs for 8 years, but I am certainly not a vet - I'm just looking for ideas for you).
Diet -- try beef heart for extra iron. Liver is good but it's a "dirty organ" -- meaning whatever it had filtered out of the slaughtered beef can be 'kept' in the liver. Heart is a 'clean organ' but even more it is considered muscle meat so it's great source of iron but you don't have to be concerned about "too much" causing the mineral imbalance that too much liver can. (Call your grocery store and speak to the meat "manager" -- not just who answers -- you want the person who orders -- and ask them to order Beef Heart for you). It's cheap and they usually love it.
Don't give up -- I'd try to find out more about the cyclo -- it does take them a long time sometimes to respond so please don't give up.
Neither would I be afraid to just have him seen at UT. I had my Billy up at the University of Florida many times and I know they saved his life. I'm a bit astonished that the bone marrow aspirate wasn't done up at UT.
The other strong suggestion I have is milk thistle. LOTS of it. And honestly, altho you can start him on any milk thistle you can get at a health store, you are better off to send away to somewhere like http://www.leavesandroots.com or www.mountainroseherbs.com and buy the milk thistle powder in bulk by the pound.. It is ***far*** cheaper that way and you get a far better quality of milk thistle with a certified organic product. Why milk thistle? First it helps protect the liver, and detoxes it a bit from the drugs. But the big huge best part? It aids liver function - it literally helps the body process the drugs **better**.
My email is callieatcritturs@yahoo.com -- feel free to email me if I can help you in any way.
Callie