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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - 5 1/2 month old GSD possible AIHA
| I have a 5 1/2 month old German Shepherd puppy bitch. Because of the possibility of exposure of parvo, she was given a booster shot on last Friday afternoon. Saturday morning she would not eat, but was her usual self, we went for a walk, etc. She ate Saturday night. Sunday morning we drove to visit our daughter and grandkids, took her with me. She played with her brother fairly normal. Got home Sunday night, she didn't want to eat, and I noticed she felt hot. Her temp was 104.6. I work for a vet, so called him up, and he had me give her some antibiotics, etc at home. I took her to work on Monday(christmas eve) and when we put her on the table to do blood work, looked at her gums and they were white. Her white cell was up to about 25,000, her PCV was 14%. We immediately put her on prednisone(50 mg two times a day)Famotade (20mg two times a day) and Doxycillian (100 mg two times a day). On Tuesday, her PCV was up to 16%, on Wed it was 20%. She is eating like a horse, she is starting to pink up again, active and starting to get playful again. Thursday her PCV was 20%, and we did a complete CBC and chem panel today. Her PCV was 17%, but it was a small draw and therefore diluted. Her white count is high: 40,000, but her red blood cell regeneration is a very high percent and she is producing red blood cells. She is also regentative. The Coombs test came back negative. Nobody has heard of such a youngster coming down with AIHA. As far as I know she has not been bitten by a tick or mosquito. The one vet is thinking AIHA, but the second vet says its an immune anemia, but not sure of the cause. She is improving everyday. I still wonder if the vaccine is not the problem, but was told it happened to fast: roughly 48 hours. Any thoughts or suggestions? |
| Joanne Wyoming |
| Joanne, I am so sorry to hear about your GSD. This sometimes happens so suddenly and usually the owner has never heard of this condition. You are a very smart and lucky owner that you have access to such good care and you know immediately what to do. You are also very lucky that she has become so highly regenerative in only a few days. Veterinary hematology literature cites this quick response as a good prognosis for recovery. Some of us here had to wait for many months to get above 20% pcv. You will find that there are so many caring people here on this list to help you. Please check out Joanne's web site with success stories and faqs. If you are using an automated analyzer, there may be some small issues with the sample clotting (or if the dog was not fasted) and that will affect the pcv (or hct). I always have a small pcv spun and visually inspected for comparison. I find the manual pcv is always more representative of Chance's actual condition, and is always higher than the automated number. If there was even a small chance that she was exposed to a tick disease, the doxy will cover that if it is in the correct (much higher dose) for tick diseases. It is a very hard drug on dogs and might make her feel quite ill. Tick experts always recommend that there be some food in the stomach before you give it and then follow it with food. The taste is awful to dogs. You will also need to worry about blood clots right now, pick something safe and start that immediately. If there will be an extended period of time on pred you will need to use a general protective dose of antibiotics. Pick one that has worked in the past for you. You are suppressing the immune system and that includes protective white blood cells. You may also see staph pop up. So you may be switching around on different antibiotics. I have done quite a bit of research in the last year for my own dog. One of the avenues I looked at was AIHA occuring in response to recent vaccinations. Chance has not been vaccinated since his first and second series as a puppy. Our breeder advised us against boostering. The complication with this is that he is also a therapy dog and TDI has required yearly boosters for registration. However, Chance developed severe allergies when he was about 2.5yr. He has been on allergy shots since then. That specialist would write us a letter for TDI explaining why he should not be vaccinated except for low titers. Each November his titers come back perfect for everything (even now after a year of AIHA he still has excellent immunity) but....the parvo comes back low. And each year we dutifully had him boostered for parvo. I mention this because my research led me to discover that parvo is one booster that is *particularly problematic* for AIHA. I can't say for sure that his parvo booster in late December 06 had something to do with his developing a severe case of AIHA or not. But I am not going to have him boostered again either, and my vet agrees with me. Your GSD was getting her 2nd parvo series with this booster, correct? There may very well be a connection. Once you have this under control and she is better I would recommend that you read a number of articles by Dr. Jean Dodd about immunity and vaccinations. You may come to the same conclusion that many people have that boosters may not be necessary after the first and second puppy series. A booster doesn't give the dog "more" resistance to a disease. If there is immunity there and the dog is exposed to a disease, it will respond. A titer doesn't tell you how *well* it will respond, only that the dog has been exposed and that the immune system will respond. And exposure can be either a vaccination or the actual disease. You cannot tell later which is which! Tips: Keep a diary in the kitchen and record everything Meds, temperature, diet, gums, poops.. all of it. Everyone should be responsible for making entries. Buy a good digital thermometer and take her temp every 3-4 hours right now. No raw food if you do that. Easy digestible diet, high in quality protein and low on hard to digest grains. My thoughts are with you at this tough time. Patrice |
| Patrice New York State |
| her temp has stayed at 101.5 or 101.6 since Monday evening. She had had all her shots, her last being at 16 weeks, The reason for the parvo booster is because of attending a dog show recently and a parvo breakout with dogs she was with. She has never vomited, nor had loose stools at anytime. She has never had any blood in urine either. No jaundice at all. Most of the symptoms that I have read about AIHA do not fit with her illness, don't know if that is good or bad. Low PCV, high white count, but that is all that she is showing or exhibiting. |
| Joanne Wyoming |
| Joanne, If she has a low pcv and is highly regenerative, she is considered anemic, this is called reticulocytosis. It is a direct relationship to tissue hypoxia or a call from the body tissues for more oxygen. The body responds to the need by sending out baby blood cells willy nilly before they are mature and ready to carry O2. From all the texts I have read, anemia is classed as a *symptom* of a condition, not a condition in and of itself. So you are right in a way, her anemia can be a symptom of many things. A high one on the list is tick borne diseases. There are so many others that are rarer... There are foods like onions that can cause Heinz Body anemia, heavy metals like coins, certain classes of medications etc. In a puppy you could almost look at ingestion of something bad as a reasonable cause! There are very specific blood smear results for many of these that can tell you a lot. It might be worth it to have her blood sent out to a specialty lab for pathology. Protatek Labs is world known for looking at tick diseases. Dr. Jean Dodds at Hemopet does all kind of specialty blood testing or could refer you. Your vets are really trying to sort out primary vs secondary. The important difference, splitting hairs, between whether it is primary or secondary is the mechanism of destruction. Does the body suddenly see the *blood cells as foreign* and destroy them (AIHA) or is there something that has attacked the blood cells (like a tick disease), the body responded to get rid of the "not self" and then just kept destroying blood cells too (IMHA)? It's far more complex than that, I have made it far too simple and I don't fully grasp all the differences myself. But in the end, one vet wants to make sure that they "rule out" ALL causes, the other vet seems to think this is a straightfoward case! Sometimes in the end, trying to figure out what caused the problem is hard to determine. Obviously if there is a coin floating around in her intestines, that needs to come out. But in many cases, owners and sometimes even the vets remain totally clueless. We saw a specialist. He said we had a case of severe non regenerative anemia of unknown cause. The bone marrow biopsies showed no cells at all. Looking for a cause was pointless after all the tests were done because none of them pointed to us *why*. Our focus became, *can he survive?* It's important to know that he did not/could not tell us Chance had AIHA! We only discovered that a couple of months later! As far as we knew, he had aplastic anemia. I have seen so many variations in symptoms and treatments on this list this year that it's hard to point to a group of symptoms that are common! Your GSD may very well have been exposed to a tick disease without your knowledge and the doxy is doing the trick! I am also on a tick list and this is probably the most common thing I hear.... Let's treat the dog with doxy and see if they improve.. and if they do, let's assume there was a tick disease. Sometimes even the most sensitive tests don't show a tick disease, the vet refuses to treat a suspected tick disease and the dog begins to crash. Or they undertreat the dog and the dog suffers for a long time before crashing. I have a good friend who lives near Long Island, totally tick infested area. She developed severe pain and other strange symptoms. She lost her job and finally after a couple of years she was finally diagnosed with Lyme. She now lives in constant pain and is unable to work. She can't go back. And her dogs were both finally diagnosed and treated as well. I have learned a lot from her. Now that I go back and read her history again, what sticks out to me is this travel to different homes. Puppies eat anything and everything. Could she have eaten anything with onions? How about a coin? Any older adults there on medications that she could get a hold of? Maybe you should do an xray to see if there is a coin in there? I agree that maybe this puppy needs a good workup rather than just accepting a AIHA diagnosis. Patrice |
| Patrice New York State |
| She is doing great today, active, eating, playing and generally being a silly puppy that she was. Her PCV is 24% this morning, so she is climbing up everyday. No hookworms, stool was clean of any worms. Whatever the reason, I am going to lean towards a tick born disease, or mosquito born disease, instead of the AIHA. All these possibilities would be treated with the same thing: presnisone and doxy, so we are doing the correct treatment either way.My vet is good and thorough, he feels the Coombs test was a false negative,specialists that he has spoken to feel she has AIHA, but she has had none of the other symptoms at any time: vomiting, diarreha, jaundice, dark urine, just low blood count and high white count. I am just going to get her over this, then go from there. |
| Joanne Wyoming |
This thread was discussed on 29/12/2007
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