Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - does my dog have this awful disease?

Hello,
I am writing this fearing my Tasha Bear is dying on me. She is a 12 yr. old Shi-Tzu and has always been healthy until 2 wks. ago. She woke up two weeks ago today and could not stand up, even with help she would just lay back down. I had noticed her shying away from the group meals, I have two other dogs same breed (spoon fed Natures Recipe Lamb and Rice adult formula) for the previos two or three days. She would take two or three bites then turn away. I took her to the vet right away, and he did the feeling tests for stroke and she responded with growls so he felt fairly confident she had not had a stroke. She also had a head bob from side to side and could not drink from a bowl. He concluded after blood testing that she may have an inner ear infection although he was concerned about her liver counts: ALP >993 (0-140) Norm.:GGT 101 (0-14): ALT 381 (0-80) WBC 21.8 slightly high GRAN 18.5 high (3.5-12.0) norm.: HCT 32.6 Low from 37 norm.: HGB 10.5, & RBC low 4.96 (5.5) Norm.
He sent me home with Amoxicyllin and a supplement powder to give her (Canine Hepatic Support). She perked up the next day went outside and walked quite a distance 35 Ft. or so hobbling front legs and urinated. She ate pretty good at first as he had also given me Hills Presciption Food KD which she ate but sparingly several times a day. After the initial condition I was hopeful he was on the right treatment. She had a B.M. the next day kind of dark like blood laden and not real consistent (understandable) still I was just happy she could balance herself long enough to achieve this!
Then the day before Thanksgiving she lost interest in eating. I had been giving her the meds in rolled up small pieces of bologna (beef) and figured I had spoiled her. But on Thanksgiving day she only ate a little turkey for my daughter who was just here for the day and whom Tasha loves dearly almost as much as me lol. Anyway it has been a depressing week, she has lost interest in all food - period, I give her Ensure which I do not know is good or not, tried Turkey again and Turkey Baby food thru a hypo syringe I got from the pharmacy. She held 4-5 tsp. of Ensure down for 3 days or so and the baby food thinned with water the first couple of times but threw it up yesterday morning. She is drinking some on her own from her bowl now but I also give her some with the hypo if I don't see her drinking enough. She is losing her body fat fast, she was never overweight so her bones are noticeable where they were not before. Her legs are working better and the head bobbing is gone (mostly) unless she jerks her head up fast, and she is still asking to go out but mostly lays down, with some spurts of energy from time to time. I gave her the liquid off of an over watered bowl of instant oatmeal that she held down with honey in it, and she had a couple of tsp. of chicken broth tonight but all thru the hypo not on her own will. She takes it cause she loves me but is acting like she just wants to die. If anyone knows of anything I can do to improve her appetite please let me know. I can't really afford much more vet bills as I am retired watching my 401k disappear and now in danger of losing retirement check with the public opinion on the Big 3, and my baby at the same time. If any of these symtoms are consistent with AIHA maybe the vet will give me some Predisone or some steriod that might help, would rather find something natural herbal if possible though. Thanks for reading, help will be most appreciated Dennis

Dennis Tennessee

Dennis,
Have you had any other tests since the initial ones?
Normal HCT/PCV readings are 37-55 so the 37 is on the low side. I understand that your finances are a big worry right now but you really need to see an internal specialist to find out what is really going on. You would be suprised at how many Vets do not recognize AIHA. Here is a link to a site that may give you some more insite about the disease. It could be that Tasha has something else going on so being seen by a specialist is very important. What has made you think that she may have AIHA?
http://www.cloudnet.com/~jdickson/
Please keep us posted and know that you have come to a site where you will never be alone in your fight.
Penny

Penny Lytle Creek Calif

The first thing my vet did was check Rocco's gums. They were white. He then took some blood and it looked like red water, very thin. He wasn't himself for about 4 days before I took him to the vet, and he didn't have a bowel movement during those 4 days. He also had a fast heartbeat and tired easily, which I figured that he was just stressed out because I just moved. I took him to the vet simply on a gut feeling that something wasn't right, I never thought he would be gone 4 days later. Bottom line, if you think your dog could have this disease, take him/her to the vet NOW!! Time is of the essence.

Glenn NJ

Dennis,

for a diagnois of hemolytic anemia to be made one or more of the following three hallmarks has to be present to reach a definitive diagnosis of IMHA:

1. Marked spherocytosis.

2. True autoagglutination.

3. Positive direct Coombs’ test.

Spherocytosis

Spherocytes are spherical erythrocytes that appear microcytic with no central pallor. They result from either partial phagocytosis or lysis and are rigid and extremely fragile in the erythrocyte osmotic fragility test. Because spherocytes have lost some membrane, they do not have any reserves to expand in hypotonic solution. Large numbers of spherocytes are present in approximately two-thirds of dogs with IMHA, but small numbers may also be seen with hypophosphatemia, zinc intoxication, and microangiopathic hemolysis.

Autoagglutination

Anti-erythrocytic IgM and, in large quantities, IgG antibodies may cause direct autoagglutination. Autoagglutination may be visible to the naked eye when blood (at low hematocrit) is in an EDTA tube or placed on a glass slide (macroscopic agglutination) or may become apparent as small clumps of erythrocytes on a stained blood smear or in saline wet mount (microscopic agglutination). Autoagglutination has to be distinguished from rouleaux formation where erythrocytes stack up on top of each other. For yet unexplained reasons, canine erythrocytes have a tendency to unspecifically agglutinate in the presence of plasma at colder temperatures. Mixing one drop of blood with one drop of saline may not break up this unspecific form of agglutination. It is, therefore, important to determine whether the agglutination persists after “saline washing” which has been termed true autoagglutination. This is accomplished by adding three times physiologic saline solution to a tube of blood after repeated centrifugation and removal of supernatant including the plasma.

Direct Coombs’ Test

The direct Coombs’ test, also known as direct antiglobulin test, is used to detect antibodies and/or complement on the erythrocyte surface when the anti-erythrocyte antibody strength or concentration is too low (subagglutinating titer) to cause spontaneous autoagglutination. The so-called “incomplete” antibodies on erythrocytes, together with species-specific antiglobulins against IgG, IgM and C3b (Coombs reagents), allow antibody bridging and thereby agglutination and/or lysis of coated erythrocytes. Separate IgG, IgM and C3b, as well as polyvalent Coombs’ reagents, are available for dogs and cats. They are added at varied concentrations after washing the patient’s erythrocytes free of plasma. The mixture is generally incubated at 37°C, and then centrifuged, and supernatant and pellet are analyzed for hemolysis and agglutination, respectively. Performance of the direct Coombs’ test at colder temperatures (4°C and 20°C) is rarely indicated, because cold agglutinins and hemolysins are rarely strong enough and rarely active at near normal body temperatures (30°C) to cause disease. Cold agglutinins and hemolysins of clinical importance are generally IgM-antibodies at very high titer with thermal amplitude that reaches 30°C. Because the same erythrocyte washing procedure is used in the direct Coombs’ test as for the true autoagglutination test and the end point of the Coombs’ reaction is agglutination and lysis of erythrocytes, true autoagglutination precludes the performance of a direct Coombs’ test

source of this info

http://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00152.htm

you might want to read this whole page to learn more.

You might seriously consider getting a second opinion from a veterinary internal medicine specialist. I know you said your funds are limited but you can go to this Web site

http://www.carecredit.com/

and learn how to get a care credit card that many vets accept.

If this is indeed AIHA, at this point nothing herbal will help. With AIHA/IMHA one needs to get the red cell destruction stopped and that can only be done with proper and agressive treatment by a vet well versed in the disease.

With the high liver values going on you might want to have that looked into further as well.

Joanne MN

I meant to include this comment from the Web site I mentioned in my other post but clicked submit too soon.

"dogs with IMHA often have increased serum liver enzymes even before steroid therapy."

So it is important to find out if those increased liver enzymes are coming from a possible diagnosis of AIHA/IMHA or some other liver problem.

Joanne MN

Here is some info on Spherocytes and autoagglutination that is a bit easier to understand.

http://www.medvet.umontreal.ca/clinpath/banq-im/hematology/SpherocytesE.htm

http://www.vet.uga.edu/vpp/clerk/hiers/index.php

Joanne MN

Thanks to all for responses. Tasha is still doing the same, managed to get some chicken broth in her last night and some more mixed with beef tripe this morning. No vomiting yet, so that's encouraging along with the fact she still drinks and urinates. Her gums are not white, so I am assuming this pretty much rules out this disease at any stage. She is not the first dog I have had sick, about 5 years ago I was fighting abdominal tumors in her daughter Ladybug. They (the tumors) eventually won the battle in July 2004. I used mainly holistic products after initial diagnosis of the cancer in Nov. of 2003. She got almost 8 months of quality life after her surgery confirmed her cancer. That's what it's all about to me, is the time you can give them back, and to yourself as well. I always felt like there was more I could have done, I was still working then and could have afforded chemo but upon consulting the Vet that could provide it, decided against putting her thru that. She told me with the size of the dog chemo could potentially kill her quicker, and I appreciated her honesty considering the money she could have made from it. Tasha has had a much longer life than her offspring (double already). I still want to give her all the time I can. I will update everyone after I take her back to the vet. Thaks again. Dennis

Dennis dprice55@msn.com

This thread was discussed on 04/12/2008

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