Repeated Blood transfusions keep Jack Russell in great shape

A case of unresponsive anaemia is causing young Jack russell terrier Matilda to need multiple blood transfusions to survive. DVS’s close work with the terrier’s owner, pet blood bank uk and her primary practice, Hyde Park Veterinary Centre in London, has resulted in a smoothly managed treatment protocol and a very good quality of life for Matilda.

Clive Elwood, internal medicine specialist at DVS, reports:

“Matilda first presented to us in May 2010. She had initially become ill in February because of a severe anaemia. Investigations at her primary veterinary surgery and at another referral centre had indicated primary erythroid hypoplasia and myelofibrosis. The presence of spherocytosis suggested a primary immune mediated aetiology, but no inciting cause had been found, despite extensive investigation. She was referred to us for further advice and treatment.

“Our investigations have been limited because of the previous extensive work up, so our long term goal has always been to trial treatments whilst maintaining Matilda’s quality of life. A range of immune-suppressive medications have been trialled, with limited success, including prednisolone (corticosteroid), azathioprine

(a purine synthesis inhibitor), leflunomide (a pyrimidine synthesis inhibitor), mycophenolate mofetil (a purine synthesis inhibitor) and ciclosporin (an inhibitor of activated T-lymphocytes). Her haematology has been fluctuating, but with a persistently declining PCV and inadequate regenerative responses throughout.

“Whilst these treatments have been tried, we have been able to support Matilda with multiple blood transfusions. To date, she has received a remarkable eight cross-matched DEA 1.1+ blood transfusions and we are extremely grateful to the Pet Blood Bank who have supplied samples of blood

for prospective cross-matching in anticipation of her needs. We have seen some low grade transfusion reactions (vomiting and shaking), but these have been short-lived and have stopped upon cessation of the transfusion. In between transfusions Matilda’s quality of life appears very good, and she has adapted to very low PCVs, appearing normal even at 11%. She has developed some proteinuria, attributed to probable glomerulonephritis resulting from antigen-antibody deposition from the foreign protein challenge of the transfusions.

“Despite the lack of a definitive treatment, Matilda has shown us  that repeated blood transfusions are viable and have not, as yet, been associated with limiting incompatibility. We are continuing to explore new treatment combinations but are concerned that underlying secondary myelofibrosis may be limiting her capacity for a complete regenerative response. “

DVS’s efforts have been supported with those of Andrew Prentis and Odile Sicouri MsRCVS at Hyde Park Veterinary Centre in London.

Andrew Prentis and Odile Sicouri MsRCVS of Hyde Park Veterinary Centre in London report:

“Matilda started her veterinary trajectory with another local vet who had referred her to a university referral centre where they made a diagnosis of erythroid hypoplasia. She had already had several blood transfusions there but a poor long-term prognosis had been given.

“She first came to us on the recommendation of one of our clients on 11th May 2010. At that time she was on multiple medications and in addition she was receiving homeopathic remedies from vet Richard Allport and healing from Helen Hilliard.

“This was never likely to be a straightforward case. Our role over the past six months has been to be the centre point of her local care, offering close monitoring, day-to-day advice and support as her health status changes. We have regularly monitored her physical condition, blood counts, liver and kidney function, bodyweight and blood pressure to allow for the most appropriate medication to be given and to help judge the most appropriate timing for the multiple transfusions that she has received at DVS during this period.

“We arranged for bloods to be sent to California for specialist thyroid assessment and have been liaising between her owners, vet Jean Dodds in California and Clive Elwood and Nat Whitley at DVS. Matilda has remained remarkably cheerful and enthusiastic throughout all this, despite the number of vet visits, injections and samples taken. A lesser dog might well have lost the will to go on and many would have lost their patience with the amount of intervention. This would not

only have made ongoing treatment difficult but have drawn into question whether it was appropriate to continue. This has never been an issue for with Matilda. Where the normal red blood cell count for a dog is 35-55%, we have become accustomed to Matilda trotting in, all waggy tailed, with counts down into single figures!

“Lola is an extraordinarily involved and pro-active dog owner, whose dedication to Matilda’s care has been an example to us all, and Matilda’s permanently pricked ears in particular have inspired us to keep going when at times her prospects have looked bleak. This is a complex disease process that in truth is

still not well understood, and the underlying reason for it in Matilda’s case is still not clear...” 

Matilda belongs to Lola Marlin and her husband Simon, who is a member of the famous London- based house music production duo the shapeshifters. Lola explains:

“I spotted Matilda at the Mayhew Animal Home in London and, being a Jack Russell lover, I just couldn’t resist her. She was only two and seemed so full of health and vitality

– and to start with she was just that. Her illness came on slowly – one she day she ran upstairs and simply fell over. Initially the prognosis

was all gloom and doom but I was determined not to give up. My spirits were bolstered by Jean Dodds, an American vet I found when I was researching Matilda’s condition on the internet. She has experience of cases like Matilda’s in the States and has become an invaluable advisor and friend, helping to steer me on the right path and keep me focused on Mattie’s survival!

“I am so lucky to have such a sympathetic team of veterinary experts on Matilda’s case. No one knows how her illness will progress but I take comfort from the fact that we are working on the same side and are all determined to give Matilda the best possible quality of life while she still has the spirit to fight. Matilda sees Andrew or Odile at least once a week for a check up and routine tests and we see Clive at DVS every three to ten weeks, depending on how each blood transfusion is going and when she needs the next one.

“Matilda is in great shape between transfusions – so much so that if you didn’t know her history you wouldn’t think there was anything wrong with her. I have a very open mind when it comes to complementary therapies. Hyde Park Vets combine all the benefits of modern medicine and surgery with complementary medicine so Matilda has regular acupuncture, homeopathy and healing as well as her conventional veterinary treatment. Clive is so reassuring every time I see him at DVS. At first I was worried that the specialists would peer over glasses and say it was wrong to keep Mattie going on transfusions but they have all reassured me that it’s OK. In fact her eighth transfusion has been the best-tolerated so far; while the protocol is working and my little dog is happy it has to be the right thing

to do.”

Matilda sees Andrew or Odile at least once a week for a check up and routine tests and we see Clive at DVs every three to ten weeks, depending on how each blood transfusion is going and when she needs the next one.

Davies Veterinary Specialists. news issue 12 - winter 2010