Anemia in 8 year old lab

My lab was diagnosed with a chronic form of hepatitis that caused his liver to partially stop working and be very jaundiced. He lost about 20 lbs and was very sick before thhey could finally diagnos him.  

Well, now, he has been anemic again and we thought it was the same condition and medicated him.  But, this has not worked.  His anemia is still present, but he has a full appetite and has not lost any weight or energy. We had hefty vet bills totaling $5k last year. What else could it possibly be? I am trying to keep the testing expense down that we had last year.  I am just very confused.

He just finished his last dose of Azathiaprin & ursodiol and is still on 5mg or prednisone.

[Aleda M Cheng, D.V.M., C.V.A]

I am sorry to hear of your pet's problems.   Without the proper diagnosis anemia will be very difficult to treat, there are many different kinds of anemia, and theoretically they could all have different treatments.  Ideally I would also need more information to be able to give you the best advice.  

From what I understand from the information you have given your dog was anemic at the time he was diagnosed with hepatitis.  Then, the original anemia, and the chronic active hepatitis resolved when your dog was treated with immunosuppressive drugs: Axathiaprine and Prednisone, and a bile acid: Ursodiol.  

But now the anemia is back.  Is this correct?   Did your veterinarian give you a tentative diagnosis as to what kind of anemia your dog now has?  Is it regenerative or non-regenerative anemia?  Does your veterinarian suspect immune mediated hemolytic anemia?  Does your veterinarian suspect blood loss or decreased production of red blood cells?  Has the hepatitis returned also?

Prednisone alone can be used for immune mediated hemolytic anemia.  But it takes a long course of this medication to work, with frequent blood work.  Sam-e (S-adenosylmethionine) at 250 to 350 mg per day has shown to be beneficial for liver disease.  Milk Thistle is also helpful for liver disease (use a adult human dose).  This can be safely given to your dog if the anemia is suspected to be secondary to the hepatitis.

If you could give me some more information I may be able to give you more advice.