IMHA (anemia) kitty not doing well and not sure what to try next.

the3rdname

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He was in amazingly good health just one short month ago with an HCT of 44% and now HCT is down to 27% and falling
 (HCT = red blood cell count.) The only thing that changed in this time period was a neuter surgery (he's been sick since kittenhood and I finally got him fixed after the last remarkably good CBC). He *was* excessively hormonal when the hct was so high (marking everywhere and sexually aggressive), so now I'm wondering if the sudden loss of testosterone is what did him in. Does that make sense to anyone? 

His internist wants to double his cyclosporine, which would increase the dosage to 50 mg./day. I'm not convinced this will help because he barely made any progress on a cyclo/prednisone combo and only began to show marked improvement when switched from prednisone to prednisolone. I'm of the opinion that, if anything, he may have developed a tolerance to the prednisolone- unless the sudden hormonal change had an adverse effect on his immune system- and the next logical step is trying a different steroid, like depo-medrol. 

I may be slightly biased against cyclosporine because the side-effects have a been a nightmare to manage. It seemingly wiped out all beneficial flora in his intestinal tract and a potent probiotic cocktail just recently got things back on track. The thought of dealing with the IBS-D all over again gives me the sweats! 

His regular vet has left the decision in my hands: double the cyclosporine or try depo-medrol (in place of prednisolone). What would you do? 
 
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the3rdname

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So I've decided to try the depo and hope for the best 
  He gets his first injection tomorrow.  If that doesn't do the trick, we can always increase cyclo. I've also got a script for Aranesp from his internist, from early days when HCT was in the teens, to use as a last resort. *knock on wood* it doesn't come to that! 

If you can spare a good thought or two for sweet Rumi, we'd really appreciate it 
 
 

I'm also still very curious about the possible connection between cessation of testosterone production and immunity.  Rather, if it could send an autoimmune disease spiralling out of control.  If any sciencey/medical people can help answer that one, I'd really appreciate it. 
 

goholistic

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the3rdname

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Hi there. Sorry about your kitty. I do not have direct experience with this, but another TCS member just recently went through this specific type of anemia (IMHA) with two of her cats. Here's the most recent thread where she expains what protocol she is using (with success):

http://www.thecatsite.com/t/304036/immune-mediated-hemolytic-anemia-its-happening-again-beanie

(Sorry if it doesn't link correctly. I am on my phone.)

Sending lots of vibes...
Thanks for the response and vibes 
   He's regained a wee bit of color, but still sitting here waiting on tenterhooks since it can take Depo a day or two to fully kick in. (Darnit, I am not that patient, Depo!
)   I've also restarted him on the herbal blood builder his holistic vet prescribed (I took him off  it when he was having digestive issues because of mild laxative properties).  *twiddles thumbs furiously*

I didn't know Laurie was dealing with this problem again (!) and I'm sorry to hear that.  Happy to hear Beanie is feeling much better, though.  Poor Laurie...I've bugged her so many times for advice.  I swear she is the most gracious and helpful person I've ever "met".  


Her experience with Depo is what inspired me to discuss it with our vet earlier this summer, so without that knowledge I feel like we'd be completely lost right now.  I just don't have much faith in the cyclo and that's the only trick the internist has up her sleeve.  Thank goodness our vet is open to trying new things.  
 

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Ouch. Sorry about your kitty.

I went through this with one of mine some years ago. He not only lost his red blood cells, but whites and platelets as well.

Hct was 11% WBC 1.5 and platelets were none seen.  He was critical for several weeks, bleeding from gums, behind the retina and had large bruises on his body.

Was later told that NONE of the 18 vets in the hospital believed that he would make it... (Except the internal specialist who

was in charge of his treatments.)

Our treatment protocol was Prednisolone in massive amounts, and Doxycycline.

I also gave certain vitamins in large amounts, homeopathic Iron in small doses (which made a dramatic, immediate effect)

and I also did a TON of an energy therapy very effective for allergies. Tapas Acupressure technique. (Auto immune problems is like an allergy, the allergen is just a part of yourself

not some foreign substance)  He was also continued on a raw, nutrient dense raw diet.

The first time I brought him back for lab work I was told the entire staff was watching as the results were printed from the instrument, and they were all dancing and hugging :) :)

Against all odds he made it through :)  That was about 5 or 6 years ago. Today he is healthy and happy.

Best to you and your kitty. I can sure relate to the stress... Hope your outcome is a good as ours!
 
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the3rdname

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Ouch. Sorry about your kitty.

I went through this with one of mine some years ago. He not only lost his red blood cells, but whites and platelets as well.

Hct was 11% WBC 1.5 and platelets were none seen.  He was critical for several weeks, bleeding from gums, behind the retina and had large bruises on his body.

Was later told that NONE of the 18 vets in the hospital believed that he would make it... (Except the internal specialist who

was in charge of his treatments.)

Our treatment protocol was Prednisolone in massive amounts, and Doxycycline.

I also gave certain vitamins in large amounts, homeopathic Iron in small doses (which made a dramatic, immediate effect)

and I also did a TON of an energy therapy very effective for allergies. Tapas Acupressure technique. (Auto immune problems is like an allergy, the allergen is just a part of yourself

not some foreign substance)  He was also continued on a raw, nutrient dense raw diet.

The first time I brought him back for lab work I was told the entire staff was watching as the results were printed from the instrument, and they were all dancing and hugging :) :)

Against all odds he made it through :)  That was about 5 or 6 years ago. Today he is healthy and happy.

Best to you and your kitty. I can sure relate to the stress... Hope your outcome is a good as ours!
So glad to hear your success story!  Rumi had dangerously low platelets as well when this drama first began back in February, but he didn't experience any abnormal bleeding- that sounds like a nightmare!.  His internist said any minor activity could cause a life-threatening hemorrhage...which just added a whole new level of terror to that experience.  His platelets bounced back before RBCs, curiously enough.

Was he taking more than 10 mg. of pred?  I was told you can't get more than 10 mg. compounded into capsule form, so my curiosity is piqued.  Size 3 caps, anyway.  

Very curious about the homeopathic iron!  Where do you get this?  I'll definitely look into the acupressure technique.  It sounds intriguing  
   I like to mix it up with the alternative and traditional medicine.

Well, he is responding positively to the Depo 
  He had a bit of a rough time with side-effects, but they seem to have subsided now.  He was quite the frisky boy yesterday, reveling in getting some semblance of good health back, and today has been a more relaxed sort of day.  He was frightfully pale Friday (HCT must've gone down even further) and now he's white-pink-white-pink, etc., like a light bulb flickering and trying to come back to life.  (That's a good sign, for anyone reading this who's unfamiliar with IMHA 
)  

Everything I've read about testosterone and immunity points to the hormone having an immunosuppressive effect, and someone in a different thread inadvertently answered my question.  Apparently intact males get a big surge of T around the 16-17 month mark, which is exactly where Rumi was when his HCT was 44%.  So it was helping keep his disease under control, and then the supply was cut off...and here we are!  Castrated males in good health get a nice immune boost...and that's the opposite of what Rumi needed 
  
 that we get over this bump in the road quickly!  
 

mrsgreenjeens

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So glad to hear the Depo is working
AND that you got your answer on the testosterone bit.   Wow!  Pretty interesting thread
 
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the3rdname

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So glad to hear the Depo is working
AND that you got your answer on the testosterone bit.   Wow!  Pretty interesting thread
Thanks!  Rumi is up to 29% PCV and his color has improved, so I'm finally breathing easier 
 
 
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