Any ideas or opinions concerning tests or treatment are very welcome! I'll try to summarize what's happened so far. Rumi, 2 yrs. old, has been struggling with Immune Mediated Hemolytic Anemia for a year and a half now. He initially tested positive for FeLV, a follow-up negative test + bone marrow biopsy/aspiration ruled it out. He's also been tested for FIV, had a pathogen panel, Mycoplasma PCR: all negative. Current thinking is that that he was exposed to something toxic prior to birth or shortly afterwards. His sister was born with underdeveloped kidneys and succumbed to CRF in February. I am trying desperately to prevent him from following her, but his doctors are rapidly running out of ideas.
When he developed this disease he was given two transfusions, neither of which helped. A regimen of 25 mg. of cyclosporine + 10 mg. of prednisone helped to boost PCV (red blood cell count) incrementally. A switch to 10 mg. of prednisolone from the prednisone helped even more. He was stable for a few months until another relapse, at which point we substituted Depo-Medrol for the prednisolone (thanks to LDG for sharing her experience and putting her vet in touch with mine). Once we figured out his ideal dosing schedule, the Depo + cyclosporine regimen kept him healthy and stable for over a year. A little over a month ago he relapsed again and was switched back to prednisolone. His condition began to improve and then he suddenly developed a rare corneal disease- Bullous Keratopathy- and a few days afterwards his PCV plummeted to 12% and he was hospitalized and given a blood transfusion. This time the transfusion worked like a charm and he was at 26%, eventually settling at 22% before I brought him home.
He's been out of the hospital for a week now and he is doing Ok. Not great, not terrible, just hanging in there (he gets retested tomorrow). His cyclosporine was doubled to 50 mg. a day, prednisolone to 20 mg. a day, in divided doses. This is a crazy high amount of immunosuppressive medication for him to be doing just Ok. His regular vet and his internist are thinking of switching him from cyclosporine to Leukeran, a chemotherapy drug, to see if something more potent will do the trick. I'm nervous as heck about trying a chemo drug. Afraid of side-effects and afraid that if it doesn't work, that means nothing will help him and all I'll be able to do is watch him slowly decline, or crash again, and that will be that.
So this is where we currently are. If anyone can think of other tests or treatments I can look into, I'd really appreciate it. I've read that Rituximab works wonders in humans with treatment resistant IMHA, but can't find anything, nor could his vet, on using it to treat IMHA in cats.
When he developed this disease he was given two transfusions, neither of which helped. A regimen of 25 mg. of cyclosporine + 10 mg. of prednisone helped to boost PCV (red blood cell count) incrementally. A switch to 10 mg. of prednisolone from the prednisone helped even more. He was stable for a few months until another relapse, at which point we substituted Depo-Medrol for the prednisolone (thanks to LDG for sharing her experience and putting her vet in touch with mine). Once we figured out his ideal dosing schedule, the Depo + cyclosporine regimen kept him healthy and stable for over a year. A little over a month ago he relapsed again and was switched back to prednisolone. His condition began to improve and then he suddenly developed a rare corneal disease- Bullous Keratopathy- and a few days afterwards his PCV plummeted to 12% and he was hospitalized and given a blood transfusion. This time the transfusion worked like a charm and he was at 26%, eventually settling at 22% before I brought him home.
He's been out of the hospital for a week now and he is doing Ok. Not great, not terrible, just hanging in there (he gets retested tomorrow). His cyclosporine was doubled to 50 mg. a day, prednisolone to 20 mg. a day, in divided doses. This is a crazy high amount of immunosuppressive medication for him to be doing just Ok. His regular vet and his internist are thinking of switching him from cyclosporine to Leukeran, a chemotherapy drug, to see if something more potent will do the trick. I'm nervous as heck about trying a chemo drug. Afraid of side-effects and afraid that if it doesn't work, that means nothing will help him and all I'll be able to do is watch him slowly decline, or crash again, and that will be that.
So this is where we currently are. If anyone can think of other tests or treatments I can look into, I'd really appreciate it. I've read that Rituximab works wonders in humans with treatment resistant IMHA, but can't find anything, nor could his vet, on using it to treat IMHA in cats.
