Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - 7 month old Goldendoodle

My puppy, Shashi, was diagnosed with Hemolytic Anemia last Monday. He hadn't eaten or had any water in 2 days ( I thought it was behavioural at first), but so suddenly became weak and appeared to have lost a significant amount of weight overnight. When we arrived at the vet, his PCV was 9. His gums and tongue were white. The vet administered 2 dexamethasone injections and gave him 50mg of prednisone over the course of our 1.5 hour visit. Vet told me to monitor Shashi over night and to take him to emergency for a blood transfusion if he started to decline further, but wanted to avoid transfusion if possible. What a long night. He made it through and we went back to vet for results of Blood count and chemistry, which confirmed hemolytic anemia and showed he has an acute infection. There was a part of the test that said that the body's response to the anemia was 'good'. I'm not sure what that means exactly, but vet said it was a good sign. Shashi was then prescribed 100mg prednisone daily (his weight had dropped to about 59 lbs) and his PCV was checked again 6 days later (just this Monday). His PCV is up to 28, which was a bigger jump than vet expected- he said this was a good result and that the prednisone was doing its thing. Vet said to reduce prednisone to 50mg a day. Shashi is having another PCV test Friday to follow-up. Oh, and he is also on a 15 day course of antibiotics for the infection. My vet seems hesitant to talk medium or long term- we only talk about treatment in 5-7 day blocks. I think he is trying to manage my expectations based on how differently dogs respond to treatment. It has been so helpful to read about other people's experiences- on this site especially. Like many others, I had never heard of this disease before and was in shock for the first week. This week, I am struggling to be optimistic and trying not to think to far into the future (I am being relocated overseas for work this summer, and my three dogs would require a rabies vaccination within 30 days of import into the country). The most important thing is that Shashi recovers, so I am trying to take it day by day and keep him comfortable. He generally likes to rest in a different room, away from me and the other two dogs, but if I get up to move, he follows me. Any advice would be welcome. I am sending my prayers out to everyone else who is going through this with their furry friends. With a heavy heart, Tricia

Tricia Ontario

The only thing you can do is take it day by day. The big jump in PVC is a very good sign. My dog was in the hospital for 7 days on an iv. So I know it is tough but try to hang in there.

Sue PA

It makes it so much more difficult to comprehend when they are still so young. Logic says that they should be active, playful and happy puppies - not fighting a horrible disease. My heart goes out to you and Shashi. So far it looks like he is responding to the meds. Hang on to that hope, and take it day by day. Your right when you said that most of us had never heard of this disease until it happened to one of our dogs (often overnight). So I think that I can safely say that we all understand what you are going through, and our prayers and hopes are with you and Shashi for a full recovery.

Irene Arizona

Tricia, Be brave and stay strong! This disease can be very scary at first. Read all you can about AIHA and the fears will ease. The good PCV numbers are encouraging. I'd be very concerned about giving vaccinations. IMO, that is what triggered my dog's AIHA. You and Shashi are in our prayers. SUE

Susie Delaware

Hi Tricia. I'm sorry you have had to join us here but you have come to the right place for support and information. It sounds like Shashi is responding to his treatment. I suspect that the good part of the body's response to the anemia that your vet mentioned is that he is producing reticulocytes (which are premature red blood cells). I would question your vet's advice to reduce Shashi's prednisone to 50 mg./day from 100 mg/day. Usually a medication reduction isn't considered until a dog's PCV's are in the normal range (37 - 55) and Shashi isn't there yet. Your vet is recommending a 50% reduction in prednisone. Even for dogs who have reached and maintained normal PCV levels for some time, the prednisone is reduced much more gradually than that. I'm sorry I can't find the information about a recommended percentage of reductions but hopefully someone else on this site will be able to give the numbers. The danger in reducing meds too soon and too much is that the dog could have a relapse. Please question your vet about this. I'll be thinking of you and Shashi and hope that his PCVs continue to rise. Please keep us posted and if you have any questions at all, post them here. I know someone will have the answer for you. deb and Duck (my dog!)

Debbie BC Canada

Hi Tricia. I looked back through the archives and found something that Joanne posted regarding medication reductions: "I do have some information that might be helpful to you in regard to the prednisone reduction. This information is from a Magazine called “Veterinary Medicine” subtitled clinical solutions for practicing veterinarians. This is the June 1999 issue. In the article called “Managing immune-mediated hemolytic anemia in dogs” by Stephanie J, Lifton, DVM, Dipl. ACVIM which was peer reviewed before publication we find the following information and I am quoting here: “Once the disease is in remission, the dose of prednisone can be lowered by 25% to 35% every three to four weeks until the lowest dose that keeps the disease under control is reached. This can be accomplished by either decreasing the dose or the frequency of administration (e.g. twice a day to once a day then every other day then every three days and so on.) If the dog is receiving more then one immunosuppressive drug, change the dosage or frequency of only one drug at a time.” End of quote. Even though this is a from a source that is several years old, this is the prednisone reduction schedule that many of the veterinary teaching hospitals follow in regard to AIHA/IMHA" Hope this helps you. deb and Duck

Debbie BC Canada

Tricia, I am so sorry to hear about your Shashi, and great news to hear her numbers are going up. I too would question that much reduction after only being on meds 11 days. Also, the problem with a significant reduction can cause bad side effects. Laurie

Laurie CA

Tricia, I am sorry that Shashi has been diagnosed with this awful disease. I echo what everyone else says about taking it slow on the reductions of the meds. You are right that while all dogs do not react the same, you are always welcome to toss out any questions that you might have as I am sure someone will have shared the same experience. It is definately something you have to deal with a day at a time because things can change that rapidly. Before you panic know that sometimes those changes can be very positive ones. Penny

Penny Lytle Creek Calif

I would echo all that advice - our westie Millie only crashed after the vet reduced the meds by half initially she had responded very well. My thoughts prayers are with you. Clare.

Clare

Here is the pred reduction info I keep in my "Word" files. I do have some information that might be helpful to you in regard to the prednisone reduction. This information is from a Magazine called “Veterinary Medicine” subtitled clinical solutions for practicing veterinarians. This is the June 1999 issue. In the article called “Managing immune-mediated hemolytic anemia in dogs” by Stephanie J, Lifton, DVM, Dipl. ACVIM which was peer reviewed before publication we find the following information and I am quoting here: “The level of medication should be kept constant until the PCV is normal for at least three to four weeks. If the dog is having severe side effects from the prednisone (e.g. polyuria or polydipsia, panting, exercise intolerance) the dose can be lowered slightly after two weeks or another medication such as Azathioprine can be added to the treatment regimen. Remember this medication needs to be given two to three weeks to take effect before the dose of prednisone can be decreased. “Once the disease is in remission, the dose of prednisone can be lowered by 25% to 35% every three to four weeks until the lowest dose that keeps the disease under control is reached. This can be accomplished by either decreasing the dose or the frequency of administration (e.g. twice a day to once a day then every other day then every three days and so on.) If the dog is receiving more then one immunosuppressive drug, change the dosage or frequency of only one drug at a time.” End of quote. Even though this is a from a source that is several years old, this is the prednisone reduction schedule that many of the veterinary teaching hospitals follow in regard to AIHA/IMHA

Joanne MN

Hi All My 3yr old English pointer bitch developed IMHA one week ago very suddenly late in the evening. She hadn't eaten her tea(very unusual) and she got off her chair and was very wobbly. I noticed her lips and inside of her ears were almost colourless. We rang the vet and she was admitted into hosp at 1am. Bloods showed PCV of 18%. She was given Dexamethasone injs and started on oral Prednisalone 25mg twice daily. Azathioprine was added 2/7 later. Blood tests sent away on admission gave result of definite diagnosis of IMHA. She was hospitalised on IV for few days as not eating and still won't after a week. Her PCV is checked twice daily - I wonder is this too much? Her PCV went down to 9% and she was given 2 packs of oxyglobin after she started an irregular heart rythmn( a sign of hypoxia). Her PCV did not pick up at all until yesterday when it was 11%.Yesterday She had a blood transfusion of packed cells which brought her PCV upto 15% which was a disappointing increase. Her prednisalone has been increased now to 50mg twice a day and she is still on the Azathioprine. My big concerns are the fact she won't eat and the vet has suggested we cage rest her at home. I am worried that because she has such a great degree of agglutination(clumping of red cells as they are destroyed) she is at risk of Emboli. this of course could cause her death and at home it would not be possible to save her. Is this a real risk or should I bring her home?how soon will she eat? What do you think? Her blood test 2/7 ago showed only moderate regeneration of RBC.Is that good?

patsy day sevonoaks UK

My doodle was dx'ed on Monday and has bounced back from PCV of 10 to 22. About agglutination - my vet is watching/testing for that with PCV, and he said that if it becomes an issue, a dose of heparin could help immediately, then adding a baby asprin daily would help keep the blood thinner, and counteract the agglutination.

Christina Chicago

Thanks for all of the responses and warm wishes. Shashi's energy level has gone up and today, he looks like himself, for the first time since he became ill. His PCV was 35 yesterday and as of today, he is on 25 mg of prednisone a day. I am watching him closely and he is having his PCV tested again Tuesday morning. I mentioned phasing out prednisone more gradually, but was told not to worry, given how well he is recovering and how closely he is being monitored. This was echoed by another vet who saw his blood work and case history, so I am not sure if I should continue to worry about. Basically still taking it day by day and hoping that Shashi is one of the lucky ones. Thanks again for your support and my sincere wishes that those still struggling through this with their dogs they continue to heal.

Tricia Ottawa

Dear Tricia, I'm so sorry for you & your baby Shashi, So young! I'm new to this heartbreaking club too. My angel, Labradoodle, was diagnosed Dec. 30 w/ IMHA, but PVC never dropped below high 20's. Wow, 9! That's scary. I hope for a full recovery for all the little angels. You can read Layla's story at top of main page. I will especially pray for Shashi, as she is just a baby! What an awful thing to go through! I didn't realise how good I had it when all was well with Layla. When she gets better, I'll appreciate every minute with her more than ever! My best to you! Terese

Terese Rose Erie

This thread was discussed between 11/02/2009 and 23/02/2009

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