Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Archie

We have a Jack Russell 8 month puppy who is called Archie. He appeared to become unwell on the 31st Feb and was taken to the vet on Monday 1st March. Our vet immediately admitted him and did a Coombs test. His PCV was 17%, she had dealt with this before and treated him before the results confirmed IMHA on the Wednesday. He has had an Oxyglobin transfusion and seemed to be making tremendous progress. Subsequent bloods showed 10%, !5% and !8%. We were thrilled on Saturday to hear that the slides confirmed he is making his own cells but knocked back today when his blood test had gone down to 15%. He is very sleepy today and I am worried things are not going well for him. I didn't know anything about this condition before this and wonder if anyone has heard of a dog so young with this? Sue

Sue Cambridgeshire UK

Sue, I am so very sorry to hear that your Archie has recently been diagnosed with IMHA. If you have not read my Web site on Canine AIHA/IMHA as yet, you might want to do so when you can. The URL is: http://www.cloudnet.com/~jdickson/ Be sure to follow the links on the first page to many other sites on AIHA/IMHA that will be very helpful to you and do read the SUCCESs STORIES pages. They will show you what has worked for other dogs in terms of treatment options as well as give you a lot of HOPE. What immunosuppressive medications is Archie currently taking? When will you be doing your next blood work? At the onset of the disease, it is important to do blood work very often so that additional measures can be taken if necessary. I am seeing more and more puppies diagnosed with AIHA/IMHA then I did in the past and most of them do well. However for recovery to happen one needs to have a vet very experience with the disease and up to date on all the treatment options. Please know that you and Archie are in my thoughts and prayers.

Joanne MN

Sue, I am so sorry your Archie has been diagnosed with this awful disease. Here is a link that will provide you with a lot of info. http://www.cloudnet.com/~jdickson/ The sleepiness is normal as they are really low on oxygen. Most of us had never heard of this when our dogs were diagnosed so you are not alone there. I am glad that you have a Vet that has dealt with this before but try to learn as much as you can. I am sure a lot of people will be checking in soon and be assured you will receive much support and answers to any questions that you may have. Yes a lot of very young dogs have been diagnosed. I think it is related to reactions to their puppy shots myself. Take care and keep us posted. Penny

Penny Lytle Creek Calif

I am moved to tears (not unusual at the moment)at the prompt replies. Thank you I am so new to this that I don't understand most of the terms or tests so I may list the wrong things but these have been done as are on the bill: Ongoing Prednisilone 22mg daily (He weighs 5kg) Ongoing Zantac syrup 0.7 mls 3x day 0.3 Synulox rtu inj x2 on 030310, 040310, 2.8 dexadreson inj 020310 pcv/tp 030310, 040310, blood prof haemat with di 030310 Oxyglobin 125.0 010310 Blood test have been done frequntly and smears which showed he was regenerating cells on Saturday but I didn't ask levels. I would appreciate any advice on what I should be asking. Many thanks, Sue

Sue Cambridgeshire UK

I'm so sorry to hear this news Sue. If I were you I'd ask for FULL COPIES of all blood tests that were done. That way you can answer questions we might ask more easily. Most of us on here get copies of tests and it shouldn't be a problem. I'd also recommend you take her back again in the morning to be checked out. A PCV of only 15% is not to be taken lightly. Some dogs get transfused at this level and I'd be wanting to get it checked WITHIN 24 hrs. MAKE THIS A PRIORITY!!! ...just in case it continues to drop. Ask the vet about adding another immunosuppresant. Cyclosporine or Azathioprine (imuran) are among some of the widely used drugs available. Most of us prefer cyclo though over the azathioprine. The fact that Archie is regenerating blood is a very good thing! What have they done thus far for tests? Ultrasounds? Xrays? Have they checked the thyroid levels? IF NOT they should do this tomorrow also. Low dose thyroid meds have been shown to help stimulate the bone marrow and is sometimes recommended in dogs that are not hypothyroid. Have htey checked for tick diseases? Poison exposure (rat poison or swallowing a penny (zink poisoning))? Recent medicines/vaccines/flea meds? Let us know if we can help in any way. If you have any questions AT ALL don't hesitate to ask. Learn all you can about this disease. The site they included above is a PERFECT starting place for you. I'll keep Archie in my thoughts and prayers. Johnny & Tessy

Johnny

Sue, I am so sorry that Archie is so sick. I can completely understand how confusing all of this is to you. Please stay here on this list for complete support. I can explain what these items on your bill. Prednisilone 22mg daily (He weighs 5kg) This is a form of prednisone that is a little easier on the liver. This drug is an immunosuppressive drug in high doses. It is important to use high dose immunosuppressive drugs in autoimmune diseases, they lower the number of rogue white blood cells in the body that cause the trouble. This drug has many side effects but it is a very important part of Archie's treatment right now. Zantac syrup 0.7 mls 3x day Zantac is an acid suppressive drug that is used to prevent or treat ulcers. This is important because prednisone use can lead to stomach ulcers. 0.3 Synulox rtu inj x2 on 030310, 040310 Synulox is what we know in America as Amoxicillin. This is a broad spectrum antibiotic (means it can kill many types of bacteria) and was prescribed probably because they feel Archie has some kind of infection. 2.8 dexadreson inj 020310 Dexadreson is known in America as Dexamethasone. This is another immunosuppressive drug but this one is usually injected and is faster acting. This is an important first medication in a hospital setting. I personally feel this is a great first step your vets took to save Archie's life. pcv/tp 030310, 040310, This is PCV packed cell volume and total proteins. The PCV is kind of a measure of how many red blood cells are in the blood to carry oxygen to the body cells. It's a little more complicated than that, but what you need to know right now is that the normal range is around 37%-55% for dogs. A moderate anemia would be considered somewhere less than 37% but not less than, say about 25 or so. Severe anemia is somewhere in the range of below 18% or so. These numbers are a little vague because it seems that some dogs can tolerate lower PCV's than other dogs. Over time you will want to see this number get a bit higher and stabilize there. If you can reach 25% in the next week and hold it there for a time, you will have good reason to be very optimistic! blood prof haemat with di 030310 I can't be quite sure what this means. haemat might mean hematocrit. This is pretty much the same thing as PCV, just a little different. Just another way to measure the amount of "red stuff" in the blood. Oxyglobin 125.0 010310 Oxyglobin is a veterinary product designed to carry oxygen to the red blood cells. It is used as a short term alternative to a red blood cell blood transfusion. The goal is to improve the oxygen-carrying capacity for about a day. This may provide more oxygen to the body. Regenerative anemia means that the bone marrow is getting a signal from the body that everything needs more oxygen and the marrow is responding by increasing the production of new baby blood cells. This is a very good sign. Overall, your vets have provided excellent emergency care to Archie. I think the one thing that some here may recommend is to ask about low dose aspirin therapy to help prevent inappropriate clotting. Joanne has more information about that. This would be a question for your vet in the next day or two. While Oxyglobin is an appropriate emergency step, there may be a need for a real transfusion in the next day or two. Ask your vet specifically about how they will go about this if it is needed. You want to know what they will use for a blood supply. If they say they don't have donors or a supply for transfusions immediately available you will want to ask them how they will accomplish this. There is an excellent resource for canine blood products in the US that can overnight a blood product to your vet. This is Hemopet.org. my best patrice

Patrice NYS

Hi Johnny, Thanks for the advice. I will discuss with the vet tomorrow, I aren't aware of x rays, thyroid tests. She did test for poisons but nothing unusual there, it is a harsh winter for us so unlikely to be ticks. The vet did talk about bone marrow so may have looked at that, again I will check tomorrow. The vet also said if the results are not better on the next test they may do another transfusion. The only other time Archie needed the vet is for his inoculation when he was a couple of months old. Sue

Sue Cambs UK

Thank you so much Patrice for the excellent explanations.

Sue Cambs UK

Archie's blood count was 11 today, the vet and specialist cannot understand why Archie looks so well, he is presenting as recovering well but the pcv doesn't match this. We are trying to kep him calm as he is so lively and this doesn't make sense. They have delayed another transfusion so far but reviewing things on a daily basis. Can't understand this thing at all and so tired of the rollercoaster of emotions.

Sue Cambs UK

Hi Sue It all sounds very complex, and Archie seems to be coping with it all - poor baby, he is way too young to be going through this, my heart goes out to you. Wishing you all the very best, and lots of prayers. Silka

Silka Melbourne Australia

Sue, sounds like the body is still losing blood somehow. A PCV of 11% is critically low and you should definetely take Archie in TODAY to have the PCV checked. I'd be wanting to take him in sooner than 24hrs with such a low PCV and lots of times dogs will be hospitalized with such low PCV's. This disease can go downhill extremely fast. Get him in to be checked out ASAP. Let us know how things go and ask for copies of testing results. I'll keep Archie in my thoughts and prayers. Johnny & Tessy

Johnny

Hi Johnny, Thanks for your comments, the test yesterday showed that his pcv was 14% We had a different vet and he said he felt that perhaps the 11% was a false reading? I forgot to ask for the blood result print outs and am unsure I would understand them anyway? Archie is a mystery to the vets and specialist as he seems on the surface to be doing well, since the transfusion he has his appetite back and runs out to the garden, he sleeps a lot but forgets he is poorly when anyone knocks at the door. We have been advised to feed him liver although this caused his faeces to be a bit runny this morning, he has since had dry food and been fine. How do you get false readings? the vet said that perhaps they left it on the side for a while before testing? Is there a time limit on doing the tests? Is it normal for the levels to go up and down? We are back at the vets tomorrow and although they seem to know what they are doing we are two weeks now and still don't know what has caused Imha. Sue

Sue Cambridgeshire UK

""I forgot to ask for the blood result print outs and am unsure I would understand them anyway"" ....That's exactly why you want to get them. It's important so that you can answer questions we might have and also for if you want to refer to them when reading online. Have you considered consulting a specialist? Often times our regular vets aren't experienced with this disease. There's just so much to this disease and having someone on board that's familiar with it goes a long way. There are several veterinary schools in the UK that you could contact and there's several others on this forum from the UK that might be able to offer you some advise on certain places that might be best to check out. Another good place to get specialist help is through Dr. Dodds at Hemopet. She'll do phone consults with vets for fairly cheap. She's probably the most experienced doctor in the world for dealing with this disease and lots of us here use her services. Just some thoughts for you really. It is possible for the crit to fluctuate day to day for a variety of reasons. If the blood was sitting around then YES that can skew the results. Time of day, whether the animal is dehydrated or well hydrated, were they fasted, stress, where the blood was drawn, etc etc. If they are running a PCV then that is the most accurate. Have they got him on any stomach protectants? Low dose aspirin? Any type of vitamin supplement (pet tinic is probably the best here)? Milk thistle to help protect the liver? The first two here are VERY important and you should ask the vet about them ASAP. You can do much better than feeding liver. You should really consider using the liver cleansing diet....here's a link for it.... http://www.canine-epilepsy-guardian-angels.com/liver_diet.htm This is a very good diet and is packed full of blood building nutrients. I still give this to my girl Tessy with a few adjustments. You could also add more fiber to the diet to help control the runs. I usually put a tablespoon of 100% pure canned pumpkin in with Tessy's food and htis does the job. Liver is such a rich food and should be givin in only small amounts to begin with. You said you were unaware of the tests done thus far. I'd be on this if I were you. Call and find out what's been done. Ultrasounds, XRays, tick panels, THYROID panel, full cell morphology, etc. Get these done ASAP if they haven't done so already. In my opinion if they haven't at least done these tests then they really have NO experience or very little experience with treating this disease. A lot of the time they never do find a cause for this disease. Tessy was classed as having idiopathic IMHA (no known cause). I suspect chemicals (cleaners, air fresheners, pesticides/fertilizers) may have been the cause so perhaps you can avoid all of these...as most should anyway. Onions are another trigger! Zink or rat poisoning! Past medications! Recent vaccinations! Etc. For the time being with a PCV so low you should really be keeping him calm and rested and totally stress free. This is important. Let me know if I can help in any way. Prayers and best wishes. Johnny & Tessy

Johnny

Hi Johnny, This is so helpful and I will ensure I ring the vet tomorrow and ask for the print outs rather than leave it to the consultation time. My vet has experience of this before so started to treat it as soon as she saw him on the 1st March which was a couple of days before the Coombs test was returned positive. She is puzzled as to why he is presenting so fit despite the severe anemia so has been consulting a specialist to discuss his case a few times, I will ask who this is tomorrow. We do try to keep him calm but he is an 8 month puppy who forgets he's ill, we have separated him from our other Jack Russell at times to give him piece and quiet, our other dog seems to know he is unwell and leaves him alone but it is Archie who pesters her to play! As for hospitals Archie spent time when first ill as he needed 24 hour monitoring, we are just outside Cambridge and there is a university veterinary training hospital there so I will ask the vet about whether referring him would be useful. Many thanks for your help. Sue

Sue Cambridgeshire UK

This thread was discussed between 09/03/2010 and 14/03/2010

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