Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Blood Transfusion Questions

Hello all. I have decided to take Summer in and have her blood tested again tomorrow. If there is no significant change, I was going to push for a transfusion. Okay, questions: What type of blood product do they use for this(Packed Red Cells, Whole Blood, frozen plasma)? What is the usual cost in the US, I am specifically in Texas. My understanding is depending on the product, it can be upwards of $500/unit. How many units do they usually need? Thank you! Carrie & Summer

Carrie DFW

Hi Carrie, I am certainly no expert in transfusions, I can only tel you what happened with my dog. He had a whole blood transfusion from a universal donor. It was actually our vet's dog! The cost was $450 Canadian if I remember correctly. Kahlu needed one unit and felt better right away. I think it would be good if you could find a specialist (internal medicine) or a teaching hospital. We live a bit out in "the sticks" and went with our regular vet but consulted several times with Dr. Dodds. This was the perfect solution for us. Here is the link for the home made food again, I hope this works: http://www.canine-epilepsy.com/Liver%20cleansing%20diet.htm Best wishes and good luck, Brigitte & the poodle boys

Brigitte BC Canada

Carrie, If Summer has not had any previous transfusions in her lifetime, then her first transfusion is "free." This means that her blood type does not need to be taken into consideration and she will accept most any canine blood product with a good deal of safety. After the first transfusion, this is not the case (as her blood reacts to the first transfused blood and develops antibodies) and each transfusion must be carefully matched to avoid transfusion reactions. There can be upwards of 11 different canine blood types. So you can see that this is a not as straightforward as human typing and matching. Most local vets do not perform transfusions on a daily basis (with the exception of emergency transfusions.) They are very time consuming and labor intensive. However, I suspect that many local vets can do a very adequate job with a little bit of preparation and outside help. However, they are not prepared to do the kind of typing and matching that is needed for a second transfusion. So it is always a good idea to prepare ahead of time, if possible, for a transfusion by sending a sample to an outside lab. If a transfusion must be done as an emergency then the best place to be is in a specialty emergency clinic. Otherwise scheduling a transfusion for a quiet morning or afternoon in the local clinic is a good time. I used my vet's donor dog for several of Chance's transfusions. He was a steady Black Lab who wagged his tail throughout the blood draw in the next room. The fresh whole blood transfusion was exactly what Chance needed. But I did have to type him with Chance's blood for the second (third etc) transfusion and I was pleased that he typed to be a good match for Chance. We also used a bag of superwashed universal donor blood for one transfusion and my vet had to study beforehand to administer it correctly. We were charged about $350 for these transfusions, plus the cost of the bagged blood. So these variable determine the cost. If a specialty clinic does the transfusion, there is an advantage of the blood typing available immediately and the high skill level of the techs. But that will cost a lot of money, upwards of $800? Your local vet using their own donor dog or a doggie friend of your families will cost less. Ordering bagged donor blood is not as expensive as you would think. I ordered it and had it overnighted to a specialty clinic in the city. They held it for us when we could pick it up and bring it to our vet's office. If your vet feels that they could accomplish a transfusion then you have two options, use a local donor dog or purchase blood. Your vet may have a favorite organization to order from. Dr. Dodds' organization Hemopet is devoted to serving the needs of canine patients around the world by providing safe blood products. If you wish to use her services you can check out the information she has on her website about transfusions. Go to this page about products and click on some of these different links to pdfs to read about what each product is for. In addition, the pdf on Immune-Mediated Hematological Disease and Bone Marrow Failure will go into more detail about which products are best for certain uses and Evaluation of Hemostasis will explain the guidelines for how a dog is evaluated for the need for transfusion. http://www.hemopet.org/products.html Blood Products* Canine Fresh-Frozen Plasma Canine Packed Red Blood Cells Canine Whole Blood Canine Platelet-Rich Plasma Canine Cryoprecipitate (*Please call for pricing on Blood Products and Blood Banking Supplies) Articles and Literature on Our Products Evaluation of Hemostasis Immune-Mediated Hematologic Disease and Bone Marrow Failure Indications and Use of Canine Universal Blood Products my best patrice

Patrice NYS

Carrie...DO NOT PUSH FOR A TRANSFUSION unless it's absolutely necesary!!!! Transfusions should only be used for emergency and worse case scenarios! You say that Summer is showing no significant changes so in other words she might not be getting worse! A PCV of around 12% is nearing the danger area BUT if it isn't dropping and Summer is handling things well and still eating and drinking then I definately WOULD NOT want to give a transfusion! Summer has only been on the immunosuppresants since the 23rd ? so they likely haven't fully kicked in yet. If there's no improvement perhaps you could ask them about adding cyclosporine (Atopica) to the mix as it works much faster than all the other drugs. NOW....if you do need a transfusion OR want to go ahead with one then it will depend on the clinic/hospital you are using. Most places use whool blood drawn from local donors. These dogs are likely very healthy (or at least they're thought to be). Ask the vet about the donor dog. Your best bet would be to contact Dr. Dodds (or have your vet do so) and purchase the blood from her at Hemopet. By getting blood from hemopet you are guaranteed the best donors. All the donor dogs are screened for just about everything!!! They are also TRUE universal donors whereas some vets may just claim to have universal donors!! ALSO...depending on the full CBC and chemistry panel taken beforehand...your vet and Dr. Dodds will decide whether to use Whole Blood or Packed Red Blood Cells. Most of the time they'll use Packed Red Blood Cells. Other options *some* and very very few vets use is HIVGG or IVIV (human IV immunoglobulin) and oxyglobin. I know very little on these two so can't really comment on them. Again though...I'd only want to do a transfusion if it was a last resort! They carry their own risks which can be severe in themselves! They can be hard on the liver and can even cause the suppression of the bone marrow...which we don't want! I don't want to scare you away from transfusions cause they do save many many dogs here....I just don't want you to ask for one unless it's needed! Sounds appropriate right! A transfusion is what saved Tessy's life when her crit dropped to below 10%!! Anywho, I'll keep Summer (and you) in my thoughts and prayers. Good luck tomorrow. Johnny & Tessy

Johnny

Gosh, I love this site.You guys have been just wonderful with so much information. The blood bank we were considering is http://k9bloodbank.com/index.htm They are here in Texas. I guess I am concerned because here gums are still so white. It is just scary. I will speak to the Doctor about cyclosporine, stomach protectant and low dose aspirin tomorrow. Or should I just wait until the scheduled appointment on Wednesday? Sorry, If I am having a hard time here. I also have a diet question, from the canine-epilepsy.com website: Raw Food Diet Study: In collaboration with Dr. Susan Wynn, we investigated the basic clinical laboratory parameters of 256 healthy adult dogs of varying ages and breed types being fed raw food diets for at least 9 months. The same laboratory (Antech Diagnostics) analyzed the samples from 227 of the dogs. From this group, there were 87 dogs fed the classical BARF diet of Dr. Ian Billinghurst, 46 dogs were fed the Volhard diet of Wendy Volhard, and the remaining 94 dogs were fed other types of custom raw diets. There were 69 dog breeds represented, including 233 purebreds, 16 crossbreds, 1 mixed breed and 6 of unknown breed type. The predominant breeds represented included: 28 Labrador Retrievers, 21 Golden Retrievers and 21 German Shepherd Dogs, 10 Whippets, 8 Shetland Sheepdogs and 8 Bernese Mountain Dogs, 6 Rottweilers, 6 Border Collies, 6 Doberman Pinschers, and 6 German Pinschers, and 5 Cavalier King Charles Spaniels, 5 Australian Shepherds, 5 Borzoi, and 5 Great Danes. Most of the dogs were neutered males (73) or spayed females (85), whereas there were 31 intact males and 32 intact females. Another 6 dogs were of unknown sex. The mean age of the group was 5.67 ± 3.52 years (mean ± SD); and the mean length of time fed a raw food diet was 2.84 ± 2.54 years. The data from this group of dogs were compared to the same laboratory parameters measured at Antech Diagnostics from 75 healthy adult dogs fed a commercial cereal-based kibbled diet. Preliminary statistical comparisons of results for the raw and cereal-based diets found them to be essentially the same with the following notable exceptions: • Higher packed cell volume (hematocrit) in all raw diet fed groups (range of 51.0 ± 6.6 – 53.5 ± 5.6 %) versus cereal-based kibble (47.6 ± 6.1 %). • Higher blood urea nitrogen (BUN) in all raw diet fed groups (range of 18.8 ± 6.9 – 22.0 ± 8.7 mg/dL) versus cereal-based kibble (15.5 ± 4.7 mg/dL). • Higher serum creatinine in the Volhard raw diet group only (1.20 ± 0.34 mg/dL) versus cereal-based kibble (1.07 ± 0.28 mg/dL). While a more detailed analysis of other parameters has yet to be completed, initial results indicate that dogs fed raw meats (natural carnivores) have higher red blood cell and blood urea nitrogen levels than dogs fed cereal-based food (obligate omnivores). Thus, the normal reference values for dogs fed raw food diets should probably be revised. http://www.canine-epilepsy.com/doddsnutrition.html So why would I start cooking the food? Am I missing something? It would not surprise me if I was. Carrie & Summer

Carrie DFW

Carrie, You are coming in on the tail end of a discussion that has been going on for many years. I have the original book written by Dr. Billinghurst here in front of me called Give Your Dog A Bone. Proponents of his original diet began calling it BARF or bones and raw food. However, the acronym BARF wasn't so good for its notoriety LOL. Others tried to call it biologically appropriate raw food. The concept that Billinghurst was trying to convey was that we cannot feed dogs exactly as they might eat in the wild. But that we can feed foods that mirror this diet. I like to explain that it would be like feeding a rabbit to my dog. In the wild he would eat all of it and that would include the entrails that contain small bits of well digested vegetable matter, nuts, berries etc. and he will also eat the raw bones. He will savor nutrient rich organs like the liver and heart. And he would value the high protein muscle meat. He might also snatch an egg from a nest now and then that provides important nutrients. So the trick, according to Billinghurst, is to feed small amounts of veggies that have been processed to "break down the cellular wall." (Dogs are unable to digest vegetable matter like humans.) Feed eggs and organ meats. And feed raw meaty bones. Not cooked bones, they are sharp, brittle and very dangerous. If you have cleaned a raw chicken, you know that the bones are elastic and soft. The dog must crush the bones through tough raw meat and this pulverizes the soft bones so that they are digestible. I came across Billinghurst's book and diet when my breeder advised all her puppy buyers to feed this diet. She said she would guarantee the health of all puppies she sold. She explained in detail the benefits of raw food and raw meaty bones. I have been feeding in this way for many years. The diets I make have been modified over the years to accommodate new concepts and the bits of research that surface. Billinghurst, in the early years, recommended using cooked rice in his diet. More recently, he changed his diet and said that he has found that dog's diets should be carbohydrate free. He recommended that grains are indigestible to dogs and can cause allergies and gas. What he really meant to say was that dogs shouldn't be getting wheat, soy or corn (and a few other grains). I altered what I was doing. There have been many other changes to this general concept about feeding dogs over the years. And there are probably as many different variations on what this diet looks like as there are owners who make the diet. Research is slim. Dog food companies that might have enough money to pursue a truly scientific double blind study would never fund such a diet because it would probably show that cooked kibble isn't the best food for dogs. The lab results that you reference are anecdotally borne out in many dogs who are fed raw food, including raw meaty bones. It is important to note that this study is looking specifically at the results of lab tests, not the overall advisability of feeding this diet to dogs. This is the way studies have to be done to be scientifically acknowledged. It is interesting to note that some dog food companies have become active in attempting to shed a negative light on feeding a home made diet. Recently, a well known therapy dog certifying organization made a new rule that the dogs who were certified and actively visiting could not eat a raw homemade diet. There was a great uproar over this. Some quick research showed that this organization had recently agreed to become affiliated with a particular dog food company who had made a significant contribution to the organization. It was enough to cause many hundreds of owners to turn in their certifications and certify with another organization who says "whatever decisions you make about your dog's diet and health are between you and your vet." The debate goes on. Vets don't get enough nutrition education in college to be experts in this subject. They often get nutrition information provided by dog food companies. Most vets will become quite anxious if you tell them you are making your own dog food. Some will back off when they see how healthy your dog is. Others, like my vet, turn a blind eye and help me by providing fresh country eggs, knowing that somehow those eggs are going to a good place. My specialist became alarmed at an object on an x-ray and had to be calmed down by my vet who said it was just a bone from breakfast going "through." So be prepared for all kinds of resistance from many different sources. I must caution that the most important part of any homemade diet is to make sure there is a proper balance of calcium to phosphorous. If calcium in some form is not included in the diet, it will be unbalanced and will eventually be detrimental to the dog, causing health problems. Raw meaty bones fulfill this requirement but are not necessarily the only way to accomplish this. Calcium carbonate tablets, bought in any vitamin section or simply including ground egg shells to the diet will suffice. Dogs on this list that have bone marrow failure and the white blood cell counts are dangerously low should not have raw food. They are at risk of opportunistic infections and cannot fight them off easily. Their systems cannot fight the normal levels of bacteria in most raw foods. Healthy dogs are quite able to handle raw food. Wolfs are quite fond of and can eat all manner of carrion. I am wondering who told you to start cooking the food? And why do you have this sudden interest in this diet? You can cook food if you want or you can leave it raw. But either way you must put the time into studying how it is done correctly so it will be nutritionally balanced. Short term unbalanced homemade diets for dogs on this forum are ok. Sometimes it is hard to get a dog to eat and anything will be fine, especially easily digested cooked food. But for long term it is important to make sure it is balanced. my best patrice

Patrice NYS

Patrice, thank you. But iI am bot bew to this conversation. I studied the RBM or prey model diet, for quite some time before we got Summer, she has been on raw since she was 12 weeks old. She is now 4. We are not new to raw. It is our way of life. Two different posters on the "We got our Diagnoses Today" thread pointed me to the Dodd epilepsy diet. Saying that it was better for this disease. I know a lot about raw, but am very new to this disease. I only have a "sudden interest" in getting my dog healthy, and saving her life after just finding out about this horrible disease. I agree that most pet owners and vets are clueless about the raw diet. My vet is good with either. He understands raw is natural. And supports it. He has seen though, many ignorant raw feeders. Those who do not know how to balance raw, and just blindly feed meat. I know the ratios and percentages. We are pretty vigilant. So, I gather from what you are saying, continuing raw is safe for this disease? Carrie & Summer

Carrie DFW

Excuse the misspellings in the above post. Darn phone keeps changing words!

Carrie DFW

Carrie, I was probably one of the ones that recommended home cooking for Summer and I still think that would be your best route! The BARF diet is great for healthy dogs with a good immune system but not entirely safe for an immune compromised dog. Patrice described above the reasons. This home cooking wouldn't be permanent. Only meant to help protect the liver and GI with easily digestable low bacteria food. You could switch to a good quality kibble but kibbles are also known to be full of bacteria. ALSO, keep in mind that everything you read on the epilepsy site is geared towards a dog with epilepsy...not AIHA. BUT the diet is excellent for a dog being treated for anemia. It's basically a liver friendly diet. Not all dogs get liver problems but a large percentage do and it's just good to pretreat the problem before it becomes one! Johnny & Tessy

Johnny

Carrie, I am sorry I have offended you. I didn't understand that you are already feeding a raw diet. I try to explain things on this forum in a way that others here can understand as well. Many people do not feed raw and often are alarmed when I say I do. It is good to understand the background of this diet. When Chance was ill I had to cook his raw diet. He had a very serious case of non regenerative anemia but he also had stopped making white blood cells as well. This would be considered bone marrow failure. He was at great risk for infections and I was told to monitor his temperature several times a day and bring him into emergency if it went above 103. I had him on some antibiotic continuously for several months. The specialist advised me to not give him any raw food. I didn't want to take any chances. As soon as he began to recover, I returned him to a raw diet and his recovery was spectacular. my best patrice

Patrice NYS

Patrice, I was not offended at all. Sorry if I came off that way. I think for now, I willdo Wharton and others recommend and cook her food. She had some canned pumpkin and left over turkey fir breakfast. Later, I think she will hade some turkey or chicken hearts and some steak. Question about cooked. I know the weight and percentage ratios for raw. How do figure it out fir cooked? Summer weighs 40lbs. Thank you so much!!

Carrie DFW

Hello all, I find this discussion very informative but also confusing. Right now due to Gracie's pancreatitis I am feeding her cooked bland, lowfat food but I am not sure what to do afterwards. I hope I am not hijacking your thread Carrie, especially when it began with a question about blood tranfusions? Maybe I will start another thread at some point but I am truly afraid to begin a raw diet with Gracie even when she is better due to her compromised immune system where she has had bone marrow failure. Gwen and Gracie

Gwen Rhinebeck

GWEN, Let me start a new thread about diet :)

Carrie DFW

Any news on Summer??? Johnny & Tessy

Johnny

Johnny, Thank you for asking. She is hanging in there. She has an appointment tomorrow afternoon. She will be getting a complete recheck. Same office, different doctor. The other doc is on vacation. I think it will be good to have some fresh eyes look at her anyway. We have a blood donor set up,just in case. I made Summer the Liver Cleansing Diet. She actually likes it! It only made 5 cups, not 8...am I doing something wrong? Carrie and Summer

Carrie DFW

just a word of caution about raw, as it can cause digestive problems in an auto immune pooch, i would stick to whatever they will eat until the blood counts have stabalized themselves, as their already stressed systems do not need anymore, the vets should have special diet food for this purpose. take care

Bev canada

Bev, we have switched from raw to cooked for now. She is not used to cooked, so it iw a bit strnage for her. Thank you for your concern. Carrie & Summer

Carrie DFW

The ICU at our vet hospital did a cross match for Chloe after her first unit. Packed cells were used and cost ~$200/unit ( these were pediatric size). Chloe got two units at a time and in one month received 8 units total. I think the price must vary depending on the source of the blood. Live donor and fresh whole blood I think is much more expensive. I hope Summer is doing better. Cheri and Chloe

Cheri Maryland

Cheri, Thank you. She is better today. Our vet does not charge for blood, just the procedure itself. They have a few dogs that are regular donors.

Carrie DFW

This thread was discussed between 27/12/2010 and 31/12/2010

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