Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - German Shephard

My 8 year old German Shepherd (weighs 123 lbs), Jack, got sick May 29, 2009. We brought to vet and he had a 105 fever and loss of appetite. His HCT level was 28, low red blood cells, elevated white blood cells. However, his body was making baby red blood cells. They prescribed 600 mg of Doxycycline and 100 mg of predisone. They tested for lyme, tick infection, zinc poisoning negative. He has had two ultrasounds of his abdomen. No signs of tumors. His numbers stablized HCT 35 and then around July 14th, he numbers have been dropping. The vet added Imuran on 7/14/09 50 mg daily. He has been having weakness in the back legs so they reduced his prednisone to 60 mg daily. We are taking him to a specialist in NYC. His last blood work indicated cells called sindercytes. So, they did a bone marrow biopsy on Monday (waiting for result and should have on 8/24/09), his numbers continue to decrease HCT 26. Now, his body seems to have stopped making baby red blood cells. The drugs don't seem to be helping???? I have getting so sick watching my baby get sicker and sicker and no one seems to have any answers. Does anyone have any suggests for me??? I feel helpless and will do anything to help my boy.

Robin New York

Hi I am sorry to hear about your pets diagnosis. Please ask your vet about cyclosporine, it helped my dog when nothing else seemed to work. It did take about 4 weeks for her after starting it to really show any improvement. Please read the sucess stories and the treatment protocol on the Meisha's Hope website http://www.cloudnet.com/~jdickson/successstories.htm You might want to read Ginger's success storey which is dated March 2009. I hope your pet is feeling better soon. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Robin, I am sorry that Jack is having such problems. If you haven't found your way to Joanne's site please take a look. http://www.cloudnet.com/~jdickson/ You say you are seeing specialists? We have a number of people here in the NY area who will probably check in with the best Vets/Hospitals. I do not know what you mean by sindercites? It is not uncommon for muscle weakness to appear because of the drugs but because of his weight his pred dosage should be higher. Penny

Penny Lytle Creek Calif

We are bringing him to a blood specialist, Dr. Hohenhaus, at Animal Medical Center in NYC. It is located off the FDR and 62nd Street. It is a 2 hour commute for me but well worth it. She explained the sidercytes as abnormal red blood cells similar to a abnormal pap smear. However, she doesn't think it is cancer. He had a great appetite up until today. More CBC tests tomorrow and bone marrow report on Monday. Is it just me or do other people free so helpless. I don't have any children and Jack is our baby.

Robin New York

Robin, Everyone here has felt that helplessness. It is such a shock to have a healthy dog one day and have one at deaths door the next. The best thing you can do is read as much as you can and write down every thing your Doctor tells you. It is hard to absorb things when you are an emotional wreck. Anything you question you can post here and know that there will be someone who has gone through the same thing and will be quick to post how they got throught it. Penny

Penny Lytle Creek calif

The cells are called sidercytes. i apologize

Robin NY

Robin, I am so sorry Jack is so very ill. It sounds like he is in good hands. I totally understand for your feeling helpless. I think the only thing that made me feel empowered was getting as much information as i could. It really helps when you know better what is going on with your dog and you can also ask specific questions at your vet. Joanne's website http://www.cloudnet.com/~jdickson/ is very informative and the success stories give lots of hope. i agree with Penny, that the prednisone dose seems to be very low for your big boy. It was lowered so quickly maybe that could be the reason he got worse? I have never heard of sidercytes and i am not really sure if Jack has an autoimmune blood disease? We will be thinking of you, best wishes, Brigitte & Kahlu

Brigitte BC Canada

Bridget, I do think the doctors know what he has!!! These cells just started to show up now. She thinks this is why his baby red blood cells were not becoming the adult cells. But now he stopped making the baby cells.

Robin NY

Robin, the baby cells you are talking about are the reticulocites. You have to be patient, these things don't happen over night. I think what you are calling sidercytes might be the spherocites? http://www.medvet.umontreal.ca/clinpath/banq-im/hematology/SpherocytesE.htm When you see the specialist next time ask if they could check Jacks thyroid. It is an easy blood test. A lot of our dogs have hypothyridism and if put on thyroid medication their blood becomes more regenerative. it would be worth bringing it up. Also make sure Jack's stomach is protected from the strong medications with carafate and pepcid. If he is eating fine, that is great. Make sure you don't give him any fatty foods or he will be prone to pancriatitis. I hope I have not scared you with all of this. This is a serious condition, but dogs can recover and have a normal life after it!! Best wishes, Brigitte & Kahlu

Brigitte BC Canada

Robin There are cells called siderocytes,abnormal red blood cells that have iron granules that are not part of the hemoglobin,could that be what Jack had,if you just google them if you want more info. Hope you get some answers off the professionals soon, and that they can get Jack on the road to recovery. Best wishes Kathleen and Nollaig

Kathleen North Ayrshire

A siderocyte is a red blood cell (erythrocyte) which contains iron granules. These are seen in various anaemias as per vet. Jack was not on any stomach protection for at least a month until I mentioned it to the vet. He is on Prilosec 20 mg daily.

Robin NY

I believe that is why they did the bone marrow biopsy on Monday because they don't believe it has anything to do with cancer. I believe they are seeing if he might have myelodsyplastic syndrome. She believes it is an auto immune diease and is treated the same as AIHA. Or it could just be AIHA!!!

Robin NY

Robin, I am so sorry to hear about what is happening with Jack. I have to say that I was pleased to read the steps your vet has taken to diagnose him. You are lucky to have a vet like that. The siderocytes are simply red blood cells that are normally not seen in circulation, but during hemolytic anemia (when there is a large number of reticulocytes (baby blood cells) being pushed out into circulation early) they can be seen in circulation. The cell contains a little "packet" of iron that is not inside the hemoglobin of the cell. This is usually removed in the marrow before the red blood cell is sent out to circulation. The spleen also has the ability to remove this iron, called pitting, and in a dog that doesn't have a spleen, these cells would be seen more frequently. So this may just be a sign that there was a period of hemolysis (destruction of red blood cells). If you attempt to read the information below, from Cornell's teaching modules, you see that they can be associated with "abnormalities in heme synthesis." This really means that these cells are often associated with a problem the bone marrow is having making new baby blood cells. Do you understand this? They mention that this can be caused by exposure to certain drugs, lead poisoning, Vit B6 deficiency and dyserythropoiesis. Big word. It just means there is a problem with making blood cells in the marrow. I am going to take a guess that this might simply be a B vitamin deficiency causing the bone marrow to have problems making red blood cells. Ask your vet if they will do a simple Cobalamin (B12)and folate blood test. Add in the ferritin (iron) test if you can. If it does show a deficiency these can be administered via simple shots. The most common cause of these deficiencies is a malabsorption in the small intestine. This can be caused by digestive disease. Has Jack had problems with his food? Diarrhea, lots of gas, sometimes the food seems not digested well? Stools that look large and fluffy, sometimes covered with mucous? I hope it is this simple. It is an uncommon but viable cause for non regenerative anemia. I know this because one breed, the Giant Schnauzer, can actually inherit a condition that causes a B12 deficiency. Supplementation with B12 (via syringe) resolves the issue nicely. B12 is ESSENTIAL in the making of blood. A complex process is involved in the absorption of this nutrient in the small intestine. So giving B12 orally may not be effective. As humans age, we begin to lose the ability to process the B12 this way and it shows up as chronic anemia (Grandpa is tired all the time). So you may hear older adults say they are going to get a B12 shot from their doctor. The other causes are less common, but certainly worth checking into. Lead poisoning can happen in many places, esp older homes or homes that border highways (lead from older gas engines drifts into the dirt surrounding the homes). You have heard about the constant worry about lead in children, well this is one of the illnesses that they get from it: anemia. And is there any chance that Jack could have gotten into any drugs in your home? Maybe you go to visit your parents and they might have left something out? Although, this would tend to diminish over time as the drug was metabolized and eliminated from the body. And finally, this could be related to a particular form of myelodysplastic syndrome that is like a form of leukemia. My father had this type of anemia. What is the "rule out" for this form of leukemia? A simple B12 and folate blood test. If the test shows a deficiency, then it is not leukemia. I know there is a lot of information here for you to absorb and it's not easy to understand. I always write a lot of detail and try to explain it the best way I can. If you don't understand it all, that's fine. But do talk over the B12 and folate test with your vet. It won't be too expensive, probably around $50-80 dollars. i will be thinking of Jack today my best patrice this webpage has pictures of this type of cell. http://diaglab.vet.cornell.edu/clinpath/modules/rbcmorph/sidero.htm Siderocytes are (anucleate) erythrocytes with iron-containing (siderotic) cytoplasmic inclusions (also called Pappenheimer bodies). A nucleated erythoid cell with the same inclusions is termed a sideroblast. In animal species, low numbers of siderocytes are often seen in the context of hemolytic anemias, where they are the result of increased iron turnover that occurs. In this setting, they are of no pathologic significance. Increased numbers may also be seen in connection with abnormalities of heme synthesis. Heme synthesis can be abnormal in drug intoxication (e.g. chloramphenicol), lead poisoning, vitamin B6 deficiency (in pigs; B6 is required for heme synthesis) and in dyserythropoiesis associated with neoplastic transformation (MDS/AML in cats). Idiopathic sideroblastic anemia has been reported in a dog. In human beings, the most common cause of sideroblastic anemia is alcoholism.

Patrice NYS

Patrice - Are you saying the myelodysplastic syndrome is a form of leukemia or that it is like leukemia but not cancer. Robin

robin ny

MDS is a type of "cell" that gradually replaces the normal cells in the bone marrow. Sometimes referred to as "smoldering leukemia, subacute leukemia, or preleukemia." It is a disease of the white blood cells that can affect the manufacture of all bone marrow cell types (red, white and platelets). So yes, it is a form of leukemia. It behaves similar to a cancer. I honestly don't know how common this is in canines. I know that cats can get this form of leukemia, I have certainly known plenty of cats that went to Cornell to get treatment for it. This is called feline leukemia. But I think this is a side track right now for Jack. How do I know this? Because when Chance was diagnosed in early 2007 with non regenerative anemia, I researched all of this stuff. It wasn't until I talked with Dr. Dodds that I understood that more and more dogs are being diagnosed with non regenerative anemia (bone marrow failure) and most often the cause is autoimmune. The dog's immune system destroys the precursor cells in the bone marrow. Thus, the red blood cells are not being made or they are being made but are destroyed in the marrow before they can mature. In Chance's case, he was also destroying his white blood cells as well. In some very serious cases there can be destruction of the platelets as well. These are the clotting agents in the blood. When they are destroyed, it is very serious because there can be unchecked internal bleeding. I have seen a number of dog owners come to this board with the same symptoms and the end result was that the immune system was responsible for this destruction. Treating with a cytotoxic drug like cyclosporine or azathioprine in addition to prednisone has, in many cases, saved the dog's life. I hope other owners here who have had this happen will speak up here. But doing a well rounded diagnostic panel is an excellent approach by your vet. I wish that had been the case when Chance was diagnosed 2 years ago. Just don't get too hung up on exotic causes right now. The most important treatment is to make sure that Jack is comfortable and has proper nutrition. This is good nursing care. If his hematocrit or PCV drops too low, then a or multiple transfusions may have to be done. There can be dreadful side effects from the prednisone (as you are finding) and that dose should be lowered *after* another immunosuppressive drug like cyclosporine has been added. Your vet probably has this right on his shelf now in the veterinary formula Atopica. It is a highly bioavailable from of cyclosporine in weight dosed capsules. You can search this forum for many references that I have made to this drug. Email me privately and I will send you the protocol I used. You can share this with your vet, if they are agreeable to looking it over. my best patrice

Patrice NYS

oops, just saw that your vet did add imuran a few days ago. Dr. Dodds would do this reversed: add cyclosporine first and then add imuran. But this may be effective. I like your vet.

Patrice NYS

Yes, Imuran was added on july 14th with no response. He is getting worse not better. Can the Imuran cause his body to stop producing red blood cells altogether or supress his marrow???

Robin NYS

Patrice - I emailed you directly

Robin NYS

I am so sorry for what you and your pup are going through. I, at this point, can't offer any advice as my dog is going through AIHA/PRCA and we are still trying to figure out what road to go down. His last blood count was: reticuloytes were down to 45,000 and PCV is still hovering at 14, which is good because that has somewhat stabilized over the last 3 weeks. His reticulocytes were 80,000 3 weeks ago. He is on 50 mg of pred 2 x day and 50 mg of azathioprine 1x daily. Also taking meds for his stomach(due to possibility of upsets because of all the meds.) He is maintaining healthy/normal eating and drinking and bodily functions. He goes for a transfusion tomorrow to allow more time for meds to kick in, if indeed they will and to make him a little more chipper, although he has seemed in pretty good spirits throughout this ordeal. My point with all of this is, thanks to the kind words of others on this site, remain optimistic, this disease can be a very long battle. Take all the information you receieve from all these wonderful people and share with your vet. As Patrice told me, you have to be your own advocate as a lot of vets don't know alot about this disease. I am truly a novice at this and this site has taken me from the brink of despair to optimism and hope. I will be thinking of you, stay strong and stay healthy yourself. Keep up posted and share any developments. We are here for you.

Mardi Northern Cali

Do you know what is sad? Jack is so lame and tired these days but tonight he used all his strength to get up, walked across the floor and bought me his ball. What do I do... burst out crying??? He looked at me like Mommy what is wrong. They were tears of joy. I want my old goofy boy back. The one who use to drive me crazy with the ball, wake me up at 2 in the morning because of T-storms and follow me around like a shadow. I get my strength from this site and all of you kind people and words. Support is soooo important with this disease.

robin NYS

Robin, My brother had Myelodysplasia (Myelodsyplastic Syndrome) and had to take Epogen shots. There's probably an equivalent drug for animals. His bone marrow was not producing the red blood cells and the Epogen helped with the production and gave him energy. Myelodysplasia is pre-leukemia, but my brother's never developed into that and that doesn't mean that Jack's will either. He started out having to take two or three injections of Epogen a week, then it was lowered to one a week. He lived many active, happy years despite the ailment, but, sadly, passed away from a totally unrelated illness. I share this with you because it might help to ask the blood specialist in NYC about the Epogen treatment. It sounds like Jack is in good hands and hopefully things will take a positive turn once they've got all of the test results and determine the best path of treatment.

Karen NC

Dear Robin, I'm so glad that you came to this site (after seeing your post on the Facebook Group for AIHA). I am certainly not an expert at this disease, but my little girl is a 7 month survivor. In the early days, I felt helpless and sad as I watched her struggling to breathe, lethargic, panting, inactive and generally miserable. I was nervous before every PCV test and I took every negative sign as fear that she was relapsing. Now I see her chasing and playing with her two puppy friends, loving her walks again and just being her lovable self. Jack bringing his ball to you is a good sign. He wants to pull through and he hasn't forgotten what he loves. Good luck and please keep us updated. Samantha & Millie. PS - some have mentioned the Pred dose is too low, and I agree.... Millie had significant muscle wasting and weak back legs, but we didn't reduce the Prednisone dosage until her PCV was stable.

Samantha Geelong

Robin, i am sorry, I guess i was way off with my thought of sidercytes being spherocites. Good thing Patrice is keeping an eye on things! She really knows her stuff and we are all so very lucky she still spends the time to help everybody on this site. I know the feeling having your healthy dog deteriorating in only a few days. But i am confident that Jack will pull through in time. It is not a sprint, it is a marathon. One of the many things I have learned during the last few months when my dog Kahlu got ill, is being patient. Don't forget to look after yourself! Don't treat Jack like a sick dog, keep a routine and keep it happy. It was Patrice who once posted, that it is good to just take the leash every day and walk the dog as far as he wants, even if it is only down the driveway. Try and stay positive, I know it is not easy. We will be thinking of you, Brigitte & Kahlu

Brigitte BC Canada

Jack is having another CBC done this afternoon. He is very sad this morning. I hope we find some sort of answer soon.

Robin NYS

Robin, Good luck today. You and Jack are in our thoughts and prayers. Chris & Alex

Chris Pa

I hope I am doing the right thing. I spoke to a woman today who agrees that Jack's predisone level was too low. Jack is 125 lbs and is only taking 100 mg daily (they had dropped him to 60 mgs). Her dog is 75 pounds and was taking 160 mg daily for 5 days and then depending on results then lowered. Very similiar to Dr. Dodd advise. Soooo.....I made an appointment with the woman's vet tomorrow. Jack is currently getting another CBC test done right now at my vet's office. Reminder..my vet is away and we are only seeing his partner tonight. My current vet doesn't think Atopica is a good idea where as every other vet and person seems to think it works. My vet and the specialist say there is no scientific proof that it works. My opinion is if nothing else is working then we need to try something else and not just wait. What are your thoughts!!!!

Robin NYS

Please please please robin - try to get a vet to give you Atopica (cyclosporine) I swear this is what has turned Phoebe's AIHA around - although she has underlying problems (blood clot) her pcv is 34 after about 3 months of patient waiting - her bone marrow cells are just beginning to show signs of regeneration - listen to Patrice - she is right - it takes time and lots and lots of patience to get to this stage - lots of tears, lots of tiny moments of joy such as you had with Jack and his ball - two weeks ago Phoebe went to her toys (something she has not done for about 3 mnths - picked up her favourite sqeaky and brought it to me to play - you would have thought I had won the lottery and I phoned and sent texts to all my family!!) such a small thing but in the general scheme of things a huge leap forward. And that is what you have to have Robin when facing this adversity - a huge leap of faith - listen to the experience of the information given on this forum - those who can give medical advice do so out of the kindness of their hearts and those who cannot, well they just give the kindness of their hearts!! Take care - will be thinking about you and jack and praying for you both Kind regards gill & Phoebe

gill uk

This thread was discussed between 19/08/2009 and 24/08/2009

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