Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - AIHA - our story and some questions

Hi forum, my dog Linus, a Tervuren 3yrs, was diagnosed with AIHA. In our holiday he developed a high fever after a sportive day. As the fever was still high on the second day, I went to the vet. Fever was aouround 43°C - so he was nearly dying. The vets in Croatia, where we have been on holiday, gave him a fever reducing medicine, vitamins and antibiotics and sent him home with me. He was better, but after a week, already back home he again developed such a high fever. This time I went to my dog-clinic. His bloodwork was a mess. Nearly no hematocrit and red blood cells, high leucozytosis. Again Anitibotics and a lot of blood-tests to rule out all the infectious diseases. Everything came back negative. So it seems to be a AIHA. He finally got Prednisolone. That worked. We startet reducing it from the beginning on and now after 4 weeks he is Prednisolone free. The last bloodwork (he was still on low Prednisolone) showed improvement. My dog is a working dog (rescue dog). He was sportive and active (I walk around 10km a day normally). Now he is very weak (clearly after such an illness). Does anyone have experience with working dogs and this illness - will he be able to work again, or will body-action trigger a new hemolytic crisis? If you have a dog who has to take Prednisolone in low dosage for a life-time, does it work fine or do the dogs have troubles (eating, fur, tiredness, low immunsystem). Does anyone have a dog who has been healed? (I know that this illness is incurable, but in some dogs it seems that there are no further crisis after the first) Anyone has a dog like that? Greetings from Austria Steph and Linus

Steph Austria

Steph, I am so sorry about what you had to go through with Linus. i would recommend you go to Joanne's website: http://www.cloudnet.com/~jdickson/index.html reading it will give you a bit more of an understanding what AIHA is. Also please go to the success stories. You will see there that many dogs have recovered. I don't think there has been a rescue dog, but a couple of Agility dogs that have recovered. My agility dog Kahlu, a Standard Poodle was able to do agility again after about 8 months. He had severe muscle loss, but his strength came back eventually. I would be concerned about doing too much exercise with Linus too soon and cause an injury. I am also a bit concerned that he was on prednisolone for only a month. It can take up to a month before medications are reduced with this illness and the reductions should be VERY slow. I would keep a very close eye on him to be sure he is not relapsing. Take care and best wishes, Brigitte & the poodle boys

Brigitte BC Canada

I have read nearly everything I could find about this illness, I have a medial background so theoretically I understood everything. I haven't found anything about working dogs and AIHA, but hearing that agility is possible with a aiha dog seems to be a good sign that other dogwork will be possible. I even tried to find reasons and other things that would cause this, but nothing turned up :-( would have been easier in some cases to know that it is healable. My Vet and I discussed the Prednisolone treatment and we decided to reduce the Prednisolone fast. He reacted very well to the first doses. Fever was gone after the first dose and his bloodwork was nearly normal after 3 weeks. We started with 75mg (he has 33kg) for one week, then went on with 50 mg for one week, 25mg for another, then 12,5 mg for another week, and 10 and 5 and 2 mg for 2 days each. His bloodwork improved over the whole time. I am very carefull with him. He only is allowed 5km every 2 days (normal was 10 each day and ball play and work or play). I let him sleep a lot and he gets lots of red meat and heart/liver to built up new blood cells. I get his temperature every day (stays normal for the whole treatment) and the last Prednisolone free days. Anyway thanks for your links and your information about your experiences... Greetings Steph and Linus

Steph Austria

Dear Steph, I am so sorry to hear that Linus has been diagnosed with AIHA. Dogs DO survive this disease with no relapses, my Millie is the May success story on the website Brigitte refereed you to. Some triggers for AIHA include tick bites, vaccinations, cancers, stress. Have you tested for ticks and had ultrasound done to check for any tumours? Four weeks is very quick to have the Prednisone reduced, if this is indeed IMHA. Do you think that Linus could have somehow eaten onion or something else that might cause hemolytic anemia? Sam and Millie.

Samantha Geelong Australia

We have tested Linus for nearly everything, borreliosis, ehrlichiosis, and all other testable diseases causing secondary AIHA. Ultrasound was clear, X-Ray too. His spleen was a bit bigger than normal. No vaccinations were done within the last year. There is no AIHA case known in the whole bloodline (brothers, father, mother and grandparents) - something that wonders me. He indeed had "stress" but nothing unusual. We had been swimming a lot those days, something he usual is not stopable and we had an 1 hour walk in a very hot city the next day. But he showed no signs of overheating also my other dog who did the same stuff and ate the same stuff had no problems (and he is a lot smaller)...I thought it could have been the stress from swimming, but as he is a water rescue dog, he already had done a lot more swimming without problems...he was quite fit so this should not have done any harm. He had no onions or anything poisoned...I normally barf them, but due to our holiday outside of the country both of my dogs got orijen-dry-food. The vet is a specialist for inner medicine and she said that we could start the Prednisolon again if he shows signs of hemolysis. In 2 days there will be another blood test, then we will know if the haemolysis started again. Greets Steph and Linus

Steph Austria

Hi Steph, It certainly is the case sometimes that no cause can be found for AIHA. I can only speak from personal experience and my knowledge from dealing with this disease, but it took me 8 months to wean Millie off the Prednisone. We did not start the initial reduction until Millie's PCV was in the "normal" range - 37-55. Millie reached this range about 3-4 weeks after diagnosis. We also made sure there were no spheryocytes (damaged red blood cells that would indicate there was still immune destruction occurring) in Millie's blood before commencing reductions. The standard protocol for reduction is no more than 25-33% every 2 weeks or so. I personally worked on a 4 weekly schedule with Millie. Start with a PCV test - if normal, reduce the prednisone no more than 25-33%. 1 week later return for a full blood screen. Leave for 3 weeks at this dose then return. We have not relapsed in nearly 2 years, and Millie remains on a maintenance dose of Azathioprine. This is not affecting Millie at all, and I continue to do 3 monthly blood screens to check this drug is not doing any damage. The faster you reduce, the more likely a relapse, and you have to start all over again with the high doses of prednisone. I really do advocate slow and steady reductions. As many people say on this site "AIHA is a marathon, not a sprint". Just thought I'd let you know my experience with this disease, and that my darling girl is here with me nearly 2 years after coming down with this condition! Sam & Millie.

Samantha Geelong Australia

Steph, it almost sounds like a toxic reaction to *something*. What this something is you may never find out. Usually these cases respond rather well to therapy and recover fairly quickly. This, of course, is speculation on my part and I may be wrong. Stress can definetely cause this also. I can't see exercise being a problem so long as the numbers are back to normal range. If they're low then it can cause the body to overwork and could potentially cause secondary problems. If it were me I'd keep things onthe light side till you get him back to full health. Did they ever test for AIHA or did they just assume it was this? Lots of thoughts andprayers for you both. Johnny & Tessy

Johnny

Hello, thanks Samantha for your long answer. @ Johnny: We testet everything causing AIHA (Ehrlichiosis, Babesiosis...), including the antibodies and the coombstest. Everything was negative, including the last two. The vet said it was not uncommon that in AIHA cases both tests for AIHA were negative. I am not so sure with that. But I am a human doctor not a vet. I have read nearly all vet-inner-medicine books I could find about AIHA and I am still not sure if this could be AIHA, I guess time will tell me that. That is why I am so interested in experiences with meds and relapses (when/why). I know that an immune disease can hit anyone, but somehow I still hope to find the lack in my logic and it was toxic or caused through an infection.... Toxic was my first guess too, but I can put my finger onto nothing. He ate nothing he normally doesn't eat, as we were in Croatia they were on the leash all of the time and I can guarantee that he ate nothing outside (something he found or so)...sea water could be toxic (if he drank too much) but this can cause no hemolysis...so this is ruled out. All illnesses that cause hemolysis he could get from ticks and moscitos have been ruled out by bloodtests. The intersting point is that he got a very high fever, after one long day on the beach and a longer walk in a hot city the next day (he did not overheat), and I thought he cought a cold because the switch between the hot city and the cold sea water... After the visit to the vet after a day in high fever (not so easy to find there) he got antibiotics and an antiphlogistic. And the next day he was well again. Happy and active as usual. I was very carefull with him the following week. Back to Austria I went for a walk (2h) and did some rescue dog training (3 short searches)...nothing extreme. The next morning I went for a run (10 km). In the afternoon he was getting tired everything hung down...in the evening he got a fever and the next day he was on 43°...the rest of the story was already told... Linus is off the meds for 3 days now and seems quite happy, no fever everything normal. Thursday is the next blood-work then I will know more about it... Thanks for all your answers... I will keep you updated.. Greetings Steph

Steph Austria

Hi Steph I own a 2 yr. old Standard Poodle who does "agility"---it is a very demanding physical sport. Mercedes was diagnosed at 16 months with IMHA/IAHA. We have no idea what triggered the disease. Toxins, vaccinations, cancers, etc. all ruled out. Dr Dodds suspects it may have been a sex hormone surge, as Mercedes was due to have her first heat cycle. (This is a common trigger for IMHA). The reason for my email is, Mercedes is a "survivor". She was on very high doses of prednisone and suffered extensive liver damage. Her liver has recovered, however, and her last blood tests were completely normal. She was weaned from the prednisone much more slowly than your dog, as Dr. Dodds advised that we could have a "relapse" if it were withdrawn too quickly. Mercedes has been off the pred. since the middle of August, but is till getting 35mg of azathiopine "twice weekly". You had questioned whether or not your dog would be able to go back to his previous "active" lifestyle. Well, in our case, Mercedes is back doing agility five days a week, and there has been no negative impact on her, healthwise. She is a VERY high energy dog and requires a lot of exercise. Every dog is different, but I would say that as long as your dog stays "healthy" there should be no reason why he should not resume his normal active life, as a water rescue dog. We wish you and Linus a long and healthy life. Warm regards, Maureen and Mercedes

Maureen BC Canada

Hi Steph, So confusing and somewhat of a mystery! My initial thoughts were also that this was induced by something toxic (I think I mentioned onions or something)... It certainly seems like it given that Linus has responded so well to the medication. A dog with AIHA/IMHA that had the meds reduced this quickly would have a high chance of relapse I would have thought.... Let us know how is next round of blood tests goes. At least you have learnt a lot about AIHA from your research - even if Linus does not have it! :) I certainly hope it's not AIHA, that would be great news. All the very best, Sam & Millie.

Samantha Geelong

This thread was discussed between 10/10/2010 and 13/10/2010

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