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AIHA (aplastic)

by amymatthews - November 29, 2009

Hello Steve,

The patient is a 6 year old, MN bichon frise cross who was diagnosed with AIHA about a month ago. He was placed on pred and azathioprine, and his HCT has been stable. Then the owner gave some transfer factor and he had a crisis, PCV dropped to 13%, transfusion given and cyclosporin added.

I've only seen him once. Are Thoresen pulse diagnosis was LI Excess, TH Def. HIs tongue was pale pink with a thin white coat (but he's on pred and azathioprine, so I don't know how representative this truly is). His pulse was rapid and thready.

I was thinking of starting him on Qing Ying Tang or Xiao Yao San. Any recommendations?

Thanks so much.

Amy

by naturevet

November 29, 2009

Wow, that's quite a reaction to Transfer Factor. I have to assume there were some antibodies in there as well that caused an agglutination? But they should have been digested. So is it the immune stimulating effect that is suspected to be at the bottom of this?

At any rate, I'd go with Qing Ying Tang to start, as long as there is a thin rapid pulse. The formula hydrates and cools, so it's appropriate. It also moves.

Some other thoughts. Cyclosporine essentially tonifies and moves Blood, so where a case responds well to it, formulas like Xue Fu Zhu Yu Tang are also worth considering.

Lastly, some animals have ended up with a chronic remittent sort of anemia that is worrisome, but not life-threatening. Thos patients respond well to Yi Guan Jian, which also fits the hot, deficient, pale picture of your patient. So Yi Guan Jian would be a good one to try as well.

Hope that gives you some ideas,

Steve

by amymatthews

December 9, 2009

On QYT for 4 days, O feels like he's lethargic on this herbal combo. Despite being on cyclosporin, he had to have another transfusion, so no signs of improvement yet. I'm wondering if QYT is somehow too cooling for this patient (haven't seen him due to the transfusion taking precedent over his appointment here), and it would be appropriate to start Yi Guan Jian. His anemia is potentially life-threatening but otherwise may fit.

Thanks as always!

Amy

by amymatthews

December 9, 2009

Okay, revamp that, he was only quiet for a few hours after the 2nd dose, again after the 3rd dose but not for as long - I'm currently hoping this is a responsive quietness, as after these episodes he is active and happy. Will continue and let you know how he does!

by amymatthews

December 9, 2009

Okay, revamp that, he was only quiet for a few hours after the 2nd dose, again after the 3rd dose but not for as long - I'm currently hoping this is a responsive quietness, as after these episodes he is active and happy. Will continue and let you know how he does!

by naturevet

December 10, 2009

Thanks for the update, Amy. It's important to realize that an overt response to QYT in chronic AIHA may take a week or two, so the necessity for a transfusion on day 4 does not mean it won't work eventually. If it's not having an impact, then YGJ may be a better call, since QYT is best suited to more acute cases and YGJ to chronic cases.

S

by amymatthews

December 14, 2009

Okay, saw patient today. Tongue was somewhat pale pink with white coat. Pulse is stronger and fuller on QYT, in fact creating a throbbing overall pulse. He had another transfusion, but his PCV was stable, so he really hasn't had a 2nd crisis. His energy was good for 5 days on the QYT, then he got really droopy (maybe the cyclosporin, maybe some mild back pain from moving around in the snow?) - hence the transfusion (despite the stable PCV). The owner thinks the cyclosporin actually makes him lower in energy for a little while.

His responsive acupuncture points have completely shifted, though! Today, GB34 really settled his pulse; he's still responsive to LI11-S, but not as much.

Thanks for any thoughts.

by naturevet

December 14, 2009

Hi Amy,

We'll see active GB points in animals that respond to QYT, so it's still appropriate to stick with it another week or two, particularly if the down turn in energy was not known to be due to a resurgence of the AIHA, and may have been due to something else (such as him putting his back out). All that being said, if you wanted to send him home on a week or two's worth of XCHT as well, that would theoretically enable the QYT to do a better job (at least from a TCM perspective) and would fit the pulse and reduced mobility. Just a thought, and thanks for hte update!

Steve

by amymatthews

December 28, 2009

Still getting transfusions, though the PCV started at 19% and hasn't dropped below 18% for these transfusions (2 at this point). The transfusions were given due to waning energy that has proceeded low PCV's in the past.

At this stage (over 2 weeks on QYT) should I start thinking about the Yi Guan Jian, or is it reasonable to keep watching and supporting him? I know it's not crystal clear since his PCV hasn't dropped precipitously.... I just started acupuncture targeting support for RBC production yesterday.

Thanks as always!
Amy

by naturevet

December 28, 2009

Hi Amy,

Things sound stable enough that I think it's time to start the Yi Guan Jian. Things should move along a bit now, I think.

Steve

by amymatthews

January 3, 2010

Hi Steve,

Oi, I forgot to mention that his pulse is still rapid and strong...though I want to call it "bouncy," when it settles with acupuncture it becomes deep. His tongue is not uniformly pink now, but pink along the edges around the HT/LU areas and dull grey-pink centrally.

Still, at his last transfusion his PCV was 30% afterwards, which is the highest it's gone. GB34 still does wonders for softening his pulse, and piquring LI points (LI16, LI11) slows his pulse.

Still sound okay? I'd hoped his pulse would settle a bit more on the herbs....

thanks as always!
Amy

by naturevet

January 4, 2010

That pulse and tongue description gives me another idea. If the dog has any splenomegaly, a better choice for right now might be Xiao Chai Hu Tang. It fits the pulse, tongue and point data, and can have an excellent effect on reducing mitogenic splenomegaly, with the end result being a release of any sequestered by normal RBCs and platelets into circulation. I'd give that a try.

The other option, given your data, is to try Xue Fu Zhu Yu Tang, since it also clears Stasis from the center of the body, yet is a Blood tonic (in western and eastern terms). It isn't as good a fit, but is not inconsistent, with activity at GB 34.

For now, hold off on the YGJ. It sounds like you're dealing more with Stasis than pure deficiency from a TCM perspective, and YGJ isn't quite moving enough for what you need, given the tongue and pulse description.

All the best in 2010!

Steve

by amymatthews

January 21, 2010

Okay, we started him on XCHT and he's started having loose stools. I'll check on his tongue and pulse later today, as well as his recent transfusion history - but is this a sign that it's a bad match, or a minor side effect that's acceptable if he is maintaining energy and PCV? Or could it be either?

I'll post back with more info!

by amymatthews

January 21, 2010

Dang, wish I could edit! I won't see him for several more days, actually, hence the post and wondering if the loose stools are a sign i should pay attention to.

Thanks as always, and all the best in 2010 back to you!

Amy

by naturevet

January 21, 2010

Hi Amy,

It should be okay to just wait and see. If there are improvements in the anemia, we at least know how to modify things to eliminate any loose stools.

One thing we could do as well is add Wu Wei Zi (Schizandra) to the XCHT. I've used that to stop diarrhea when the XCHT seems well indicated. If you're using powdered versions from Dr. Boudreaux, she can easily add it for you.

Let us know how it goes,

Steve

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