Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - How many transfusions would you do?

Our Reggie was diagnosed with AIHA eight days ago and received one blood transfusion five days ago. Our vet indicated that with every blood transfusion needed, his odds of surviving this go down. She said she's give some dogs up to 11 transfusions and they rarely make it in the end. I barely talked my husband into the one transfusion that Reggie did have, but it saved his life and gave him a chance. How many transfusions has your dog with AIHA had, and did it do the trick or end in death anyway? Reggie's gums seem pretty white to me again, and I'm worried his RBC levels are headed in the wrong direction . . .

Amy New Berlin

Hi Amy, I can't answer that question from a medical standpoint and I would think the best person by far for that is Dr. Dodd's, who started hemopet, the canine blood bank. For me it was somewhat of a personal decision. I personally would not have done any. I could not bear to see my dog die on some table somewhere. Especially when I know how much stress this sort of thing puts on them and taht they have low success rates in AIHA. Dylan was so anemic that just moving her to the vet would likely have killed her, so together we chose to ride it out on the third day of our rollercoaster ride from hell, she started to improve. She chose to stay. I am grateful for this decision and if it had not worked out, anemia is not the worst way to go! This was MY personal decision as Dylan's guardian. Others may know a lot more, but from what I have read, transfusions are only moderately successful at best. I am sure they have helped in many cases, but I can't see how 11 makes any sense at all. Dylan was and is only on prednisone. We took the minimalist approach, BUT I could see the prednisone working and her PCV returned to 39 within 2 weeks. This is NOT at all the same for you and Reggie. Dylan is doing very well, but her case seems to be very unique in a lot of ways. Her PCV was less than half of normal within 24 hours of her fist symptom and 3 days later she could not lift her head (close to 10, but not measured) and was completely freaked out when she tried and could not. Once the prednoisone stopped the disease , her recovery was quick (my vet calls her the miracle dog), but then the high prednisone too0k hold and within 3 weeks she was immobile and unable to get up, or walk. (Worry about this later, worry about AIHA now). It sounds like Reggie is still suffering the effects of AIHA. I think the advice to contact Dr. Dodd's immediately is very good advice. She can probably answer your transfusion question, as she created hemopet, the canine blood bank. She WILL know the best answers in Reggie's case. Good Luck, fingers and toes still crossed! Richard

Richard Burnaby

Amy - hi, I don't know a lot about blood transfusions b/c my dog did not drop below the low 20s so it was one thing we were fortunate to not have to deal with. However, I've been on this forum for four years and I can tell you that many people have had good luck with multiple transfusions, which bought their dog time for the meds to kick in. Of course, no two dogs are the same but I wanted to let you know that more than one transfusion is not uncommon and can lead to a good result. I am sure someone who knows more about the "logistics" of the transfusion will chime in and help you know what to look out for. But, in the meantime, just wanted to let you know that it's not that uncommon. As I mentioned in my previous post, I'd reach out to Dr. Dodds - I believe she is still in the EU so it may take her a bit longer than usual to get back to you but there may be information to help you on her website and you could always call them (they are in California and there until 5). Good luck - if Reggie holds in the 20s, hopefully another transfusion won't be necessary. Bonnie

Bonnie Chicago

Hi Amy: The purpose of the tranfusions are to increase the RBC immediatley as there would not have been enough time for the meds to stop working. I think that you decision has to be based on several options. My dog Crosby died during his second transfusion but it was because he also had itp and platlets acquired trhough trasnfusion die off very rapidly ... thus it was the loss of platlets that killed him. Based upon how many days in your vet would be best to advice ... not this web site. Also it has to be a decision made from a financial standpoint as well. I have heard of dogs whom have had several transfusions survive. I think that the vet would have made the statement from the standpoint more of how quickly the immune system is killing off cells. If your dog has risen to 20 and is holding I wouldn't think another trasnfusion would be necessary again unless they see a drop.

Elaine Ottawa

Hi Amy, Transfusing a dog buys time for the meds to start working. Every dog is individual. Our puppy, Henri, required 1 blood transfusion to stablize. Some dogs require more and some never stabilize. It would help to know what you think caused the IMHA episode. For us, the onset was caused by a vaccine, so we never vaccinated Henri again and he has done very well. There are many triggers for IMHA, if you can get an idea of what might have triggered Reggie's episode, you might know better how to proceed. Good Luck. Best, Ella and Henri

Ella Seattle

For me there'd be no question. If the money was there i'd do as many as i needed. Of course each case is different but they do generally do well with them...side effect wise. I've known of dogs that have had as many as eight transfusions and are doing great now!!! How's Reggie doing now? My thoughts and prayers are with you both. Johnny & Tessy

Johnny

Amy, There certainly is a place for transfusions in small animal medicine. It isn't widely used because transfusing dogs is more complicated than it is for humans. There are several reasons for this. Dogs can have as many as 11 different typings of blood. The first transfusion is generally "free" of reactions. But each subsequent transfusion must be carefully typed and matched to ensure that there won't be a transfusion reaction. Each subsequent transfusion brings with it antigens from the donated blood and that complicates things. Some dogs are universal donors, some dogs are universal recipients and there can be a number of other combinations. I have my dogs tested when they are young and are being neutered/spayed so I have that on record. My older girl is a universal recipient so I know she will be safe for any number of transfusions. Obtaining safe donor blood for canines has been a bit difficult in year's past. Many clinics keep a list of donor dogs for this purpose, but it's hard to keep blood stored in the same efficient manner that it is for humans. Hemopet.org has been enlarging their Greyhound donor dog clinic and are proud to be able to provide safe universal donor blood all around the world now. In some smaller clinics, the vet and staff may only do transfusions once every couple of months. It is a complex treatment that requires several hours of attention. They may have trouble getting safe blood and feel very unsure about doing the transfusion. Transfusions buy time for a treatment to work. There is no question about that. But how often can they be safely used? What is the criteria? This is called the transfusion trigger or transfusion threshold. It is extremely variable and is a decision an experienced clinician makes after weighing the hard data (blood workup and chem screen) vs the dog's clinical condition. One dog can be nearly unable to stand up with a PCV packed cell volume of 18 while another dog may seem relatively fine. It is true that less transfusions in this disease are sometimes preferable. But lets look at the reasoning about this. The bone marrow responds to a call from the body cells calling out for more oxygen (in anemia) by making more red blood cells. This is called regenerative anemia. You want to do two things in dogs with AIHA, 1. stop the destruction of red blood cells, 2. make more red blood cells pronto to replace the ones being destroyed. The drugs are doing the work to stop the destruction. The bone marrow does the job making the cells. In the early days the destruction outweighs the marrow. If you keep "topping off" the number of red blood cells in circulation too frequently with transfusions, the body stops calling for more red blood cells to be made and the bone marrow may say "ok, we've made enough for awhile, back to low maintenance." OOPS. This isn't good and can lead to a struggle for the body to get the number of red blood cells up to a normal level on its own again. So what does your vet weigh when they decide? They evaluate that hard data, the blood work and then they evaluate the patient. Is he standing, doing his business appropriately or is he unable to toilet? Eating and drinking or has been off food for several days? Attentive to her surroundings or hiding in the corner of the kennel? Happy to see family and vet staff or lurking away when approached? Is there a strong pulse, what color are the gums? What is the age, sex and general health of this dog? Will a blood transfusion buy us some time while we get these meds to work? Can I get safe blood? Do I know how to do this transfusion safely? Each transfusion should be thought about carefully AHEAD OF TIME. Don't wait until the last dreadful moment to schedule one. If you and your vet agree that another one may be needed, be prepared ahead of time. Get that donor blood in house, make sure the matching tests have been done. Schedule it for a quiet time of the day when the staff is not busy. Be relaxed and plan to spend several hours at the clinic. My dog had three transfusions, all successful and with no reactions. My vet spent the whole day preparing for the first one, reading up on what she needed to do and then staying the whole time to ensure it went well. She agreed that we needed to make him comfortable while we waited for the meds to work. my best patrice

Patrice NYS

Thanks for all the info., Patrice. Did the three transfusions buy your dog the necessary time for the meds to start working? (I'm sorry, but I am not entirely familiar with your story.)

Amy Wisconsin

Amy, Absolutely. Chance had an extremely serious condition called non regenerative anemia. The bone marrow stops working properly and doesn't make red blood cells. He also had neutropenia, the bone marrow stops making white blood cells. These two things alone were a death sentence. We believed it was an autoimmune condition and treated it as one. My vet said if this were a human we would keep giving them transfusions until we either figured out a way to help them make blood or they would pass. But it would make them more comfortable. That was fine by me. So there was no anticipation he would actually survive, it seemed like a dead end. He survived and lived another 3 years. We no longer needed any immunosuppressive drugs after the first year. He eventually put back his muscle tissue, his coat returned to normal and, though he was already 9 by then, did return to the near normal busy lifestyle of a Giant Schnauzer. He died at 12 from a heart condition. Some vets are used to hearing some clients ask "how much is this going to cost?" The vets prepare themselves and the owners to expect certain future costs and may recommend a cut off point, mostly because of costs. But more and more owners are now saying, "what can you do to save my dog?" and they don't think about the costs. There is a happy medium between these two outcomes if an owner has a local vet they trust and a specialty clinic within several hours drive. The protocol can be developed by the specialist and implemented by the local clinic. The owner can take responsibility for the intensive nursing care required at home. I have medical training, not in veterinary, but enough to understand many of the things that need to be done. I stay on this forum to help owners who need to understand medical terminology to make decisions and explain the details of treatment options and tests. I developed this skill from the wonderful relationship I had with my vets when Chance was in treatment. We worked like this together for almost a year and it was very satisfying to both of us. They admit they would never have attempted to do this on their own because it was beyond their skill set. We spent a lot of money, but not as much as some folks do. my best patrice

Patrice NYS

Amy~ A blood transfusion gave us the extra time for our Tori's meds to kick-in, but unfrtunately she is one that had an adverse reaction and they had to stop it before it was complete, but she got enough to do the job. Most likely, she will not be a candidate for another transfusion. If she relapses, we just won't have that option, but we pray we will never have to come to that place. It's because of those on this site that prayed and encouraged me when things looked to bleak that we have made it to almost the one year mark. The information is so helpful in having a good and informed visit with the vets. Asking the right questions helped get the right answers and treatment for Tori. We do not vaccinate anymore. We did titers, which will be done every three years to make sure she is still protected. Each dog is different and thus the different ways of treatment once you are in recovery. As long as there is breath, there is hope!!! Praying for you and your Reggie.

Cindi Panama City Beach

How is Reggie doing today? Sending hugs and prayers. Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Reggie is hanging in there. We found out yesterday that he IS still making red blood cells, which was good news. He started throwing up yesterday, but the boiled chicken and white rice seem to be staying down as long as I keep the portions small. He slept better than usual last night and only woke me up once to go outside. We found out last night just how wonderful our friends and neighbors are! My good friend down the street brought over nearly $700 that she had collected from friends and neighbors to help with Reggie's medical costs. We are so incredibly touched by how many complete strangers donated money to help our sweet Reggie! This neighbor friend is also Reggie's 2nd mommy (watches him when we go out of town) and her beagle is Reggie's true love :-) Last night when they stopped over Reggie actually whined at the door and jogged out to great his girlfriend - we haven't seen him do more than barely walk in a good two weeks! He was so happy to see his doggie BFF. We go in for blood work on Friday (once a week until his numbers improve) and are praying for higher numbers. His gums continue to be quite white, so I'm not feeling very hopeful. But, we continue to hope and pray for our sweet furbaby :-)

Amy Wisconsin

Madison had 3 transfusions, then the meds kicked in.. She was drug free after 9 months and is now a 2 1/2 year survivor.. the transfusions saved her life.. :o) Samantha & Madison

Samantha Perth

Samantha - how many weeks did it take for the meds to kick in? Our vet indicated tonight that if they haven't helped after two weeks, they probably wouldn't.

Amy Wisconsin

Amy, If your vet really has seen thousands of cases, I am sure she would have seen some that were slow at responding to the medications. I have only known about AIHA/IMHA and ITP for 2 1/2 years now and been on this board for the same time. i have certainly seen cases that took longer for the medications to kick in..... much longer! I can't honestly give you a time frame. But I know 2 weeks at a PCV in the low 20 is certainly no reason to think it won't happen. Just go to to the success stories on the Meisha's Hope site. Best wishes, Brigitte

Brigitte BC

Amy, You can read about Samantha's dog Madison here: http://www.cloudnet.com/~jdickson/archives24.htm Madison is the May 2010 Success Story at the Meisha's Hope Web site. Also I have seen many, many dogs who have taken many weeks or even months before they started to respond to treatment so please do hang in there. One dog on the Success Stories page had a PCV of 3, yes 3. The vet gave this dog about a 1 percent chance to surive but she did and is now doing well.

Joanne MN

Thank you so much for the encouragement. I'm so worried now that Reggie isn't wanting to eat. I did get him to take a slice of deli turkey and about 1 cup of ground beef with a little rice this morning. I just hope his throwing up/nausea doesn't continue for the duration of his treatment. The anti-nausea shots are $33/day and not something we can keep up long-term. My biggest fear is that he'll drop back down into the teens and we'll have to consider another transfusion - I just don't think I could talk my husband into the cost when we could still lose him anyway. This disease is so all-consuming - I really need to take a day off to clean my house and give more attention to our six children.

Amy Wisconsin

Hi Amy, It took a month for Madison to stabilise in the 20's.. And was up in the 30's after a few months of treatment. Joanne - I am the other Samantha in Australia. We were not the success story on your page. Thats Samantha with Millie.. Very confusing cause both our dogs were diagnosed about a week appart with similar names. And both have made it :o) Samantha & Madison

Samantha Perth

Samantha, I am sorry for the mistake. I must have been half asleep when I posted. I would love to have Madison on the Success Stories page at the MH Web site. If you are interested email me at the address on the bottom of Sucess Stories page: http://www.cloudnet.com/~jdickson/successstories.htm and we will make it happen.

Joanne MN

This thread was discussed between 17/06/2011 and 23/06/2011

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