Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Can someone PLEASE Help-My Dog has AIHA

This is a really bad time in my life as my beloved Tessy was diagnosed on Valentines Day with AIHA. Tessy is a 4 year old female cocker spaniel. I guess I should start with the whole story. The symptoms came on fairly quickly (only a few days before valentines day). When we took her to the vet because she was not eating well and was very lazy, the vet diagnosed her with AIHA. Her RBC count was 18.6. This was on a Saturday. She was given Prednisone (25mg/twice daily) and an antibacteria drug cephalex. On Wednesday we took her back to get checked again. Tests showed now that her PCV was down to 17. That night she started to act even more lethargic and was barely eating. The next day (Thursday) we took her back to the vet and the new PCV reading was 15. Tessy was then given another drug to take (Azathioprine). The vet had said that if the PCV reading dropped below 12 that Tessy may need a transfusion. Later on in the day on Thursday things started to get even more bad for Tessy as now she wasn't eating and could barely move. I called the vet and they said to bring her in the first thing in the morning. As of Friday morning she was not eating a thing (since Wednesday night) but was drinking lots of water. She was taken to the vet the first thing in the morning on Friday where a new PCV reading showed a count of only 10. She was then taken to an animal hospital where a blood transfusion could be done. This was about mid morning on Friday (today). My poor little girl looked so scared and she doesn't even have enough energy to stand. The docter there said that we would have to come back later in the day to see her after they had started the infusion for at least 3-4 hours. I cried for hours while I waited. They recieved the blood from a donor and it is unknown if it was a match or not. At 5:30 today we went back to see her and she looked much more better than she was earlier in the day. She even ate a couple pieces of food for me (but not much). The doctor there said that things are looking good for her because her body had no bad reactions to the transfusion. I'm still a little concerned though because there still is no cause for the anemia found yet. When we left at 7:30 she was still in the process of the transfusion which we were told would last till lunch time tomorrow. Tonight will be the final dosage for cephalex and her second dosage of Azathioprine. I'm worried as to what there might be to expect in the coming days. If anyone can help me or give me some advise on what to expect it would be extremely appreciated. Thank-you to all responses, Jonathan

Jonathan Nova Scotia

Dear Jonathon, I am so sorry to hear about this scary time with Tessy. If I could be there, if all of us could be there, we would give you a big hug. It is so hard to be calm right now, but you can do it. You have her in the best hands right now. Don't worry about the transfusion too much, the first transfusions are "free" for dogs, they don't have a reaction to this one. It is the 2nd etc transfusions that need to be matched carefully. A pcv of 10 is low, but many dogs have recovered from that given proper and careful nursing care. And that is what Tessy is getting right now. You might never know what caused this, although I am sure they are doing a number of tests to make sure that it isn't one of a number of causes that might be treatable. The treatment they are administering is common and appropriate. She's not going to want to eat for a bit and that's just natural for a dog to do that. She will be given a drip to keep her hydrated. That and the transfusion will increase her blood volume and that will make her feel A LOT BETTER. A few questions you want to ask are, do they feel she needs to take a low dose of aspirin to prevent inappropriate clotting? Why are they prescribing the antibiotic cephalex? Is there an infection? What tests have they done so far? Ask for and keep copies of ALL the paperwork, including all tests. Even if you don't know what they mean now, you will begin to understand it and we can help you here as well. Write down as much as you can remember of each days medications, dosages and times given. Note her condition as well. If you have time go to Joanne's web site to read some more about this condition. http://www.cloudnet.com/~jdickson/faq.htm Try to get some sleep. I will be thinking about you and Tessy all night Patrice

Patrice NYS

I cringe every time I read of a newly diagnosed dog. All of us on here have been where you are now. AIHA can come on so quickly. Sometimes the symptoms are overlooked and by that time it is often too late. Thank God that you took your dear little Tessy to the vet right away. And thank God that your vet was familiar with AIHA. It sounds like the vet used the proper treatment for the disease. Aza however, can takes weeks to combat the disease. Pred is the foremost medication. Yes, it has terrible side effects but it is a trade off in combating the disease. The transfusion was given to "buy time" until the medications can take hold. I must tell you that this is a difficult disease. It is not something that is "cured" overnight or in a few days. AIHA must be treated over a period of many months and even then there can be relapses. It has been said on here many times; "riding the roller coaster". It is so true. There will be good days and there will be setbacks. Personally, I have found that not giving up hope was the most important thing in my dog's treatment. Also, read all you can and inform yourself. This website and Meisha's hope web site are invaluable. http://www.cloudnet.com/~jdickson/index.html Please keep us posted on your beloved Tessy's progress. You are in our prayers. SUE

Susie Delaware

Thanks Patrice for the words of comfort. I can still barely contain myself. They haven't really done many tests other than blood tests. They have not done an ultrasound or an x-ray or even a Coombs test. The vet said that they were pretty sure it was AIHA and a Coombs test would not be needed. I have been saying things to this regards each time I see the vets and they seem to be brushing it off and saying it is not necesary. Regarding the transfusion....I have asked the vet about if the time comes to have a second transfusion what should we do and they said that they would not be able to do a second one because it would be too hard to find a matched donor. I'm starting to think i might have to take to to the Veterenary College on PEI. I think you are right about trying to get some rest as I haven't been able to sleep good for a few days. Thank-you so very much for your response....you will never believe how much it helps. Jonathan

Jonathan NS

I'm off to bed now and will be going in to see Tessy in the morning. I will keep you all posted on any new information. Thanks again everyone. Jonathan

Jonathan

Jonathan, I am sorry that your little girl has been diagnosed. If you have access to a Vet college you would probably be well served to take Tessy there. A number of dogs on this board have needed multiple transfusions so I don't understand why your Vet is saying that is not possible? Yes they do need to find a suitable donor but to say it is not possible is ridiculous. I am suprised they let her go home initially with such a low PCV. The drugs can take days and weeks to start working so don't be discouraged. Be sure to read the success stories at Joanne's site and know that we are all here to offer support in any way we can. Get as much rest as you can manage this is a very emotional ride you will be on. Thinking of you and Tessy. Penny

Penny Lytle Creek Calif

I hope Tessy improves. My cocker female Molly, was diagnosed mid December with one transfusion, a week in icu at my vet and ongoing home meds, she seems to be holding her own and almost back to her old self. Have faith this can be beaten! Keeping you and Tessy in my thoughts! Amy

amy texas

Jonathan, I am so sorry to hear about Tessy. My little cocker, Buffie, was diagnosed Feb 3 '09. Like Tessy it came on quick. I got her to the vet and her PCV was 12 and they admitted her for 3 days. I don't understand why your vet hasn't admitted Tessy to the hospital. The predisone takes a couple days to start doing it's thing. If your vet keeps brushing you off about xrays and other blood test or they seem non chalant about her, I would take Tessy to the vet college you mentioned. Prayers for you and Tessy.

Barb Texas

Hi again everyone. I was in to see my little Tessy this morning after the transfusion was done and the good news is that her PCV is 21. She seems to be responsive and more energetic than yesterday. I'm starting to learn more and more about this terrible disease and to be honest it kinda scares me. I found out today that this anemia is regenerative (still in the learning process of what this means). Tessy ate a bit today and was still drinking lots of water. They were in the process of putting her on a drip today when we left. I'm hoping that this will also help. The doctor said that if things go well she may be able to come home on Monday. I'ld be glad and happy to have her back home I just don't know if it would be too early for her. At least when she is in the hospital she can be checked everyday and I know she is in good hands. I took her out for a pee when I was in there and her poop was no longer dark. It was kinda like an orange type color. Don't really know what it means but the doctor said it was a good sign. I'ld just like to ask if there are people who have been in almost the same situation as this and may be able to fill me in on what to expect from here on out. I'm really praying that she doesn't need another transfusion and that her health starts to take a turn for the better. Thanks again everyone for your thoughts and support...it helps sooooo much. Jonathan

Jonathan NS

Hi Jonathan, fellow Canadian! Thanks for the good wishes for Kahlu. He is crossing his paws for Tessy! I took Kahlu home with a PCV of 17, and it was the weekend too. Mind you my vet is only 2 minutes away and she was on call. So if Tessy can hold it above 21 she is doing good. I found this board so incredibly helpful and encouraging. Also the Success stories on Joanne's website, that has already been mentioned to you. The orange poop you mentioned is (as far as I understood) the dead red blood cells leaving the body. So that should change pretty soon. What to expect.......a lot of people called it a roller coaster ride and I can only agree. Last weekend I was down in the dumps. Monday I felt great because I found out Kahlu is not in danger of coagulating (sp?) meaning to build clumps. Then Wednesday he was so tired he could barely get up the stairs and today we have a pretty good result on the CBC. Something that is very hard is the constant going out for a pee with him. I don't think I have slept longer than 3 hours in one stretch in the last 4 weeks. So try and get some sleep before Tessy comes home. And then the paranoia of how is the poop today......It is hard to be patient, but we don't really have a choice do we? Take good care and best wishes, Brigitte

Brigitte BC Canada

Thanks Brigitte, It was a week ago today that Tessy was Diagnosed. The doctor said not to be upset if it drops again in the next few days because it could be normal while the body starts to fight it. My only concern is that maybe the Pred is not working? I don't know? I do know one thing....I have to and should try to get some sleep. I tried last night and all I did was tossed and turned. I'm going to head off to bed now and try to get some zzzzs. My thoughts and prayers are with Tessy, Kahlu, and any other unfortunate animals and owners out there who have to deal with this disease. Thanks again, Johnny

Jonathan

Jonathan, Good news about Tessy! We love to see them PCV numbers climb. We will continue to pray for complete recovery. SUE

Susie Delaware

Jonathon, It's good to hear that Tessy is considered regenerative. This is a very good sign! Dogs (and humans!) make new blood cells all the time. They are made in the bone marrow and begin as precursor cells. They stay in the bone marrow as reticulocytes or baby blood cells for about 3-4 days and then they mature, dropping their RNA, and enter into general circulation. They carry oxygen to the body cells via the hemoglobin inside the red blood cells. At about 120 days they become more fragile and, while in the spleen, they break apart. The body recycles the materials they are made of (part of this is that red coloring of the hemoglobin and thus we see brownish red coloring in feces) and either reuses or eliminates the materials. More red blood cells are made to replace the old ones every day. This is a quite complex process and is controlled by several things in the body. When there is abnormal loss of red blood cells, the body can sense the lower oxygen going to the cells and "requests" the marrow to make more reticulocytes. If there is a significant reduction in oxygen to the cells (as in serious anemia), the marrow will send out the reticulocytes early, in hopes that these new cells can help recover the oxygen capability. This is called regenerative anemia and a complete blood count will show these numbers in circulation. The body is properly responding to the need for new blood cells. You can see that any kind of loss of RBC will cause the same kind of reaction. In Tessy's case, her killer t-cells, the lymphocytes, think they have found markers on the RBC that they believe is a message to destroy them. In some cases it can be a tick disease hiding inside the RBC or perhaps there was an allergic reaction to a medication or a bee sting that caused these markers to attach to the surface. But whatever the case, the killer t-cells have gone a little crazy. They can be unstable in their jobs. Prednisone in high doses releases a flood of cortisone to the body, similar to the body's own cortisol. This suppresses the action of the white blood cells. It can very quickly suppress these t-killer cells (and all the other lines of white blood cells too.) While this is a good thing because it is reducing the number of killer t-cells, prolonged suppression of all the white blood cells leaves the body prone to all kinds of very serious infections. There are many other side effects that are also undesirable. If Tessy can stabilize and the dosage of prednisone is at the correct dosage, the damage to the rbc will stop. That is what the vet feels is happening. But then she has to make all these new rbc and mature them and put them into service. It is a big demand on the body. If the killer t-cells are not suppressed sufficiently, they can begin the destruction all over again. Thus the need for a fairly long term treatment protocol and the addition of another immunosuppressive drug (and the reduction of prednisone). So these other drugs that they add to the treatment protocol can target just these killer t-cells, reducing their numbers, while leaving the other wbc intact to perform their jobs. They don't work as quickly as prednisone so there is a need to continue the prednisone while these other drugs are introduced. I can say with some certainty that you could be looking at least at a month or two of gradually reduced suppressive treatment followed by a few months of maintenance. The body likes to be in something called homeostasis. This just means that all the systems will work hard to make sure everything becomes balanced as soon as possible. When there is such a severe and sudden attack like this on Tessy's system, appropriate and timely nursing care is very important to stabilize these systems. Once she becomes more stable, you can provide good nursing care at home if you are trained to do it. You will become very involved in her care and will be the person responsible for making sure she is properly medicated. As for the transfusion. This first transfusion introduced "not self" elements from the other dog into Tessy. The body is now examining these and setting up a little file of what these elements look like. The wbc will then prepare a "memory" of this and if it sees it again, it *may* alert and attempt to destroy. So further transfusions might need to be carefully crossmatched to avoid this possible risk or safe, universal donor blood must be obtained to make the next transfusion a safe one. If your vets are unsure of where to get this kind of safe blood, they can contact hemopet.org who provides this kind of universal canine donor blood all over the country. I advise against the use of Oxyglobin as studies have shown it to cause problems for dogs who have been in hemolysis. Many vet's donor dogs are considered "universal donors" and can be safely used for subsequent transfusions. There are 11 different types of canine blood. She may need another transfusion and while that has some risks, it has become accepted that this is a good thing for dogs who have IMHA. From your description of the last transfusion, I can sense that these folks knew what they were doing. Jonathon, there is great hope. When my dog was diagnosed in early spring of 2007, we were told that he was *not regenerative*, and that in addition, he was no longer making white blood cells either. His destruction was occurring at the precursor cell level in the bone marrow. A very serious and deadly condition. He would slowly succumb to infections and would require constant transfusions. I chose not to give up but instead researched all I could to find a way to save him. Today he is alive and well. It was very very hard. My husband and I gave medications around the clock for many months. I sense that you have it in you to give Tessy great care. Take care of yourself and put on a good face for Tessy at all times. She will be able to sense when you are sad and will respond in kind to that. my best patrice

Patrice NYS

Hello all. I was to the hospital to see Tessy again today. Another PCV was taken today at around 9:00am (approx. 26 hours after her transfusion) and the PCV has dropped to 19.7. The Doctor said that this could be normal and he will see what the numbers are Monday Morning. If they only dropped 1 or 2 points he will let her come home under our care. I was kinda hoping that the numbers would stablize first but I guess he knows what he's doing. If they drop more than 3 she will have to stay another night. I just don't know if this is too early for her to come home or not. The new concern/fear is that if she needs another transfusion she will have to be transfered to the Veterenary College in PEI to have it done because the hospital she is at now does not have the resources to crossmatch blood samples.??? PEI is almost a 6 hour drive from where I live. Don't get me wrong....if she has to go she's going even if I have to carry her there! I'm REALLY hoping it doesn't come to this. She seemed even better today than she was yesterday and she had a good appetite. We had her out for a pee and poop and it all looked good. There was a little bit of darkness to her poop but not much. Her pee was yellow. She even growled when another dog walked by her....I guess this must be a good sign eh! Just the whole thought of her numbers going down again is enough to drive the nerves through the roof again. I know that it only went down a point and a half but still. It scares the crap out of me. I asked the doctor about small doses of aspirin and he did not think it would be good for her. (any thoughts on this?) Anyhow, I've got to run a few errands around the house to prepare for if she comes home. I'll be back on here later tonight. I will keep everyone posted on any new news as it becomes available. Thanks again everyone, your prayers and thoughts are exactly what Tessy needs. Jonathan

Jonathan Nova Scotia

Hello Jonathan, somebody on this board once said, not to get to hung up on the numbers and look at how your dog IS. I think that is so important, because the numbers will fluctuate for various reasons. It looks like you are in good hands with the vet in Nova Scotia. I can totally understand that you don't want to go to PEI with all the snow and storms you have had! I will send lots of positive Energy for your girl. She sounds like a real fighter and she is eating, yea! Best wishes, Brigitte and Kahlu

Brigitte BC Canada

Thanks, maybe I should be worrying a little less about the numbers and about how she looks. I'm just so new to this that I really don't know what to think or do. It's a hard thing to do...stop worrying! Maybe I'm worrying a little more right now due to a storm coming tomorrow? Well, one can not give up hope and pray everyday and every minute for my little girl. God Bless all the little babies out there who have to deal with this disease.

Jonathan

Dear Jonathan, I'm sooo sorry & unfortunately know what you are going through. My Layla (3 year old Labradoodle) is an absolute Angel, a happy, fun loving, smart, energetic little girl who LOVES to run (20 miles an hour) behind the car in the vineyard. Unfortunately she developed IMHA around Christmas of '08, and I have been heartbroken since. Her PVC has never dropped belo the high 20's, thankfully. We took her to Ohio to a blood specialist. She's hanging in there, but has lost her sparkle. I am reaching out to anyone who has success stories of this awful disease. She’s on Prednisone (which caused a 12 pound weight gain in 1 month!), Was on Cytoxin -a chemo. drug for 4 days & now Azathioprine. The vet wants me to add Danazol, but it’s so expensive. Anyway I'm thrilled to have found this site after hours of searching. Some of the sites I found were so horrible, doom & gloom. Please, any info. will be so appreciated. Your prayers will also be welcomed. I wish you the best with Tess & will keep checking in. This is such a heart wrenching to watch. But we HAVE to stay positive, right? My best to you all, T.Rose

T.Rose Erie

Jonathan, I am sorry to hear about the lower number, but it is very early and this does happen. 19 is not high, but it isn't extremely low either. One member of our forum has a dog that has survived ok on a pcv in the mid 20's for a very long time. It's not ideal, but with care, it can be a stable place. You will know more on monday. I am feeling uncomfortable about transporting her that long distance to crossmatch the blood samples. I am not sure why they can't do some of this via overnight mail, unless they have no way to get the proper donor blood shipped back to you. Or the alternative is this, get high quality universal donor blood from Hemopet. You can have the blood delivered to your vet's office and it can be stored in case you need another transfusion. See http://www.hemopet.org/products.html "Veterinary transfusion medicine is a vibrant emerging specialty. HEMOPET established the first private non-profit animal blood bank in 1991 and has since expanded worldwide. We service over 2000 veterinary clinics nationwide and in Canada. Plans are currently underway to develop other regional centers and a coordinated national effort to maximize the efficiency and use of existing inventory. Practical, safe and affordable transfusion medicine continues to be our goal. HEMOPET is a 501(c)(3) charitable organization: Fed. ID #95-4063237." I have included some of the links and information on the website regarding their products (there are many more on the site). Your vet is welcome to call: HEMOPET 11330 Markon Drive, Garden Grove, CA 92841 Tel: 714-891-2022 or email hemopet@hotmail.com (Dr. Jean Dodds or Hemopet) to ask questions about this blood, how to order and administer etc. Here is their precaution about their packed red cell product: "A. Our blood donor dogs are negative for all recognized canine erythrocyte antigens except for DEA 4 (C), so that blood units from them should be cross-match compatible with any naive recipient. For dogs, that have received prior blood transfusions, it may be advisable to perform a routine major and minor blood crossmatch at least at 37C before transfusing packed red blood cells. However, these dogs may show some non-specific reaction in cross-match tests because of their prior exposure to leukocyte and platelet antigens" http://www.hemopet.org/files/PackedRedBloodCells.pdf http://www.hemopet.org/files/IndicationsandUseofCanine%20Universal.pdf http://www.hemopet.org/files/Blood%20screening%20in%20Hemopet%20donor%20dogs.pdf I know that Hemopet will be there when you need them. Dr. Dodds is the person responsible for saving my dog's life. Good luck patrice

Patrice NYS

I knew Patrice would have a solution! I guess you are thinking a bit more clearly that us? Shipping the blood versus taking the dog on this long trip through a snowstorm makes so much more sense. Thanks for being there for us Patrice!

Brigitte BC Canada

Hi Jonathan, I hope you and Tessy are doing better right now. I too need answers to this miserable disease. My 1yr.5mo. old shepherd Cody was just diagnosed with this Feb.17 2009 after his rabies vaccine that day...I think there is a connection between vaccines and the anemia. His lowest PCV was 18 and we hospitalized him for 2 days......didn't need a transfusion and on the pred. he slowly climbed up to 34! But now today we just came back from the Vet and he dropped to 28...not horrible but they want to put him on azathoprine now....he is acting lethargic but eats and drinks well.....My Vet said initially the pred. works good, but than not so much....This is so ridiculously scarey!!, and also really common from what I've been reading........Keep us posted.....Good Luck for now...Tammy

Tammy N.J. U.S.

This thread was discussed between 21/02/2009 and 06/03/2009

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