Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Just Diagnosed Today

Hello, My 10 y.o. beagle Daisy was just diagnosed today with AIHA. I also found out last month that she has hypothyroidism and is on Soloxine for it. She also has to take phenobarbital and potassium brommide for seizures. Can these two be linked? She is staying over night at our Pet E/R for steroid treatment. Her PCV's are very low. She started showing signs last night; lethargy and very pale gums. I have read most the posts from others; it seems like a waiting game. I wish eveyone all the luck and my heart goes out to those who weren't as lucky.

Lisa ALASKA

Lisa, I am so very sorry to hear that your most beloved Daisy has been diagnosed with AIHA. If you have not read my Web site on AIHA/IMHA as yet, you might want to do so when you can. The URL is: http://www.cloudnet.com/~jdickson/ Be sure to follow the links on the first page to many other AIHA/IMHA sites that will be very helpful to you and do read the SUCCESS STORIES pages. They will show you that dogs with AIHA/IMHA CAN and DO recover and go on to live happy healthy lives. They will also show you what treatment options have worked for other dogs. I have seen many dogs with AIHA/IMHA who have had hypothyroidism before their AIHA/IMHA diagnosis and The Textbook of Veterinary Internal Medicine says when speaking of IMHA: “The association of IMHA with other immune disorders, including hypothyroidism and immune-mediated thrombocytopenia (ITP), lends support to the hypothesis of a general immune disturbance.” End of quote. I truly do know how hard this is so please be assured you and your dear Daisy are in my thoughts and prayers during these most difficult days.

Joanne MN

Lisa, Do you know how low her PCV is? The weekend before our Holly was diagnosed she had about 5 seizures and then to the hospital on Monday morning and her PCV was 8. Lack of oxygen to the brain. Yes, it is a waiting game, and a long and expensive roller coaster. If they have the will to fight they will. Just don't give up on her, fight with her. Linda

Linda Sapphire

Lisa, My 4 yr old Lhasa Apso Ernie was diagnosed with AIHA on 1st October, Like your Daisy he was on phenobarbital for seizures. To cut a very long story short it was eventually realised that the phenobarbital was what had actually CAUSED his AIHA. It's a rare reaction and not even my vet considered it until I found a couple of articles about it from veterinary publications. As soon as Ernie was taken off the phenobarb he started to improve and he has now been med free and perfectly healthy for nearly 3 months. This may not be anything to do with Daisys case but my first question would be how long has she been on phenobarb? The articles I found suggested that this reaction will happen within the first couple of months if it's going to happen at all. In Ernies case it was 6 weeks after starting phenobarb that he became ill. If any of this sounds relevant please post again, if it will help I'll mail you the articles I found and Ernies full history to show your vet. Sue

Sue Northants UK

Sue, Very interesting that you found this literature. Good research effort on your part. Your vet must love you! I have a little snippet from my boat anchor textbook for you to add to your information. Most of it will sound like "blah blah blah." Patrice "Schalm's Veterinary Hematology" Chapter 32 Nutritional Deficiency Anemias Folate and Cobalamin-Deficiency Anemias: snip> " However, the possible development of megaloblastic anemia during some drug treatments should be considered. Long-term treatment with anticonvulsant (phenobarbitone, phenytoin, and primidone) sometimes causes folate-deficiency anemia in people, perhaps when dietary folate is marginal. Chronic therapy with phenytoin in dogs produced no evidence of folate deficiency, although suggestive hematologic changes have been seen in earlier studies. Folate-deficiency anemia was suspected in one dog given primidone for 6 months; folate was not measured but blood and bone marrow changes were suggestive and treatment response to folic acid was excellent despite continuation with phenytoin." Next paragraph also contains some interesting information about changes caused by the use of cytoxic agents such as azathioprine, which is sometimes used to treat AIHA in canines.: snip> "Folate-deficiency anemia also occurs in some people given drugs that act by impairing folate metabolism, such as methotrexate, pyrimethamine, suflasalazine, and trimethoprim. In addition, *various cytoxic agents* can cause megaloblastic anemia, including *azathioprine,* cytarabine, 5-fluorouracil, and hyroxyurea. The absence of reports of anemias induced by therapy with these drugs in veterinary patients suggests such effects are rare or nonexistent. If anemia does occur, the blood film may not show the typical changes found in people. It has been suggested that folate and cobalamin deficiencies more likely produce normocytic normochromic anemias in dogs and cats, although there may be some circulating macrocytes and megaloblastic bone marrow changes. Other date generally support that view, but some uncertainty remains." This chapter goes on to describe how Giant Schnauzers are the one breed that can inherit a cobalamin malabsorption condition and they describe the type of anemia that develops from that. While I can't say whether Chance actually inherited this genetic problem, I had him tested for cobalamin (B12) levels just prior to his developing severe non-regenerative anemia and he was found to be totally lacking in this essential nutrient. Matter of fact, last Monday I asked the vet to run another blood test with the lab to see what his level is at now. B12 is essential to the production of blood and is the one nutrient you cannot supplement orally if it is deficient, it is absorbed through the action of bacteria in our small intestine walls. As we age, we lose the ability to absorb it well in our intestines, thus you hear about seniors going for B12 shots. Well, I gave Chance shots for a period of time last year. I may have to begin giving them again depending on the results of the test.

Patrice New York State

I had to take Daisy back to Pet E/R last night. She is urinatined nothing but blood. They checked her pcv levels again and she is stable. I was told that the blood in her urine is the bilirubin flushing out, which is part of the disease an that this will pass. I freaks me out but I have been assured this is okay.This is her third day of steroids. SHe is eating well and drinking alot of water, but very tired. She get to see her regular vet this wednesday and take another blood and thryoid test. Thank you all for your responses. XXOOO's

Lisa ALASKA

Dear Lisa -- I am sorry to hear that your dear beagle, Daisy, has been diagnosed with IMHA. This is such a horrible disease, and you probably are still in shock about it since most of us have never heard of it until it strikes our dogs. I am glad you have found the forum, because there are many people here who can help you as you work with the vets to help Daisy fight the disease. These beagles work their ways into our hearts and we can't do enough for them! It is interesting to hear that your girl was recently diagnosed with hypothyroidism. We lost our 10.5 year old beagle, Wiley, to IMHA on 19 May 2005 after she fought for a week. Wiley had been hypothyroid since spring 2003 and was on soloxine. She also was diagnosed with Addison's Disease in April 2004. My Wiley also had epilepsy, and had been on phenobarbitol since May 2001, so I am interested to hear about this research that links phenobarbitol to the onset of IMHA. The vets could not tell us what brought on Wiley's hypothyroidism -- she had had her rabies vaccine a month before and was due for a Lyme shot the month after she died. It sounds like Daisy is responding to the treatment, and I hope this is the case. Some dogs do respond and get better, which suggests that there was something they ingested that may have provoked IMHA. I hope she continues to respond and will keep both of you in my thoughts and prayers.

Brenda VA

Dear Brenda, Thank you for your support. She has hardly moved at all today. This is her actual first day home. She did not touch any food for the rest of the day or want to. She is drinking water; however, she is too tired to get up on her own so I bring it to her. It's hard to get her meds down if she doesn't want to eat. Our challenge tonight is to get her to go out and potty. I noticed ealier she stil has blood in her urine I was hoping that would reside; guess not. I do not want to leave her alone tomorrow but I have to go to work. Fortunately my husband can come home for lunch and check on her. She will see her regular vet on Wednesday for blood work and I have tons of questions for him. I also have printed alot of literature as well. I'm happy to have found this site it has helped me understand a lot. I'm very sorry to hear about your Wiley. I bet he was an awesome companion. I guess this is a day to day battle, were keeping our fingers crossed for her. I hate that I have to give her all these meds. Pheno, potassium bromide for the seizures, soloxine, prednisdone, azathiopine and pepcid ac so her intestines do not become ulcerative. Her pcv level was at 21 on late Saturday night. This puts her at the Evan's Syndrome level is what I was told and about 40%-60% have poor prognosis. I can't even imagine the people who have this disease and what they go through daily. Will keep everyone informed. Thank You. XXXOOO's

Lisa ALASKA

Dear Lisa, Welcome to the list, i am so sorry you have found yourself here but it is a great place to find information and support. Before our mini-schnauz Kent was diagnosed with AIHA, he developed seizures - petit mal. He was vaccinated beginning of december, then in February started having seizures. Slowly at first, and we didnt understand what had caused it. He was neutered 2 weeks after his vaccinations in December and never really himself again - very blah, just sitting. Then the seizures. He was put on phenobarbitol, and became even more blah. Out of it. Then he had diarrhea, and i rushed him to the vet - AIHA. He was taken off phenobarbitol, given a transfusion etc. and was in hospital for 3 days,and when he came home he was much more 'normal' and he was taking then only pred. He has never had seizures again. Its important to have a tick panel done to rule out a tick disease, its also important that when they go on pred to give liver support as early as possible - supplements like denamarin, milk thistle, diet such as wellness sweet potato - also sucralfate to help coat the stomach. Kent never had blood in his urine but that sounds like a UTI which likely needs antibiotic treatment - kent has had UTIs off and on over the course of the last year. Kent had a relapse in november, with immune mediated thrombocytopenia - Evans syndrome. Please read about Angelo, a Evans syndrome survivor on Joanne's website Meisha's Hope. Kent is on the road to recovery, though we have had some setbacks, all of them secondary effects from longterm steroid and imuran use. When kent first had seizures our vet thought he might have inherited distemper, but I now believe that the seizures were lack of oxygen to the brain from lack of RBCs. What are your Daisy's numbers? RBC, HMT, WBC, Platelets, urine tests? Welcome, i look forward to hearing all about Daisy's recovery! Christine and Kent

Christine Florida

lisa, MY Bella also had hyprothyroid and was on Phenobarbitrol for seizures it is so weird to hear of all the dogs that have the same things going on .MY Bella was diagonosed with AIHA on jan 13th we treated her for 1 month w/ 2 transfusions.and 15 pills per day .I had so much trouble giving her all her pills when she didnt eat it was so hard . I so feel for you right now it was so hard for me too. MY prayers are with you you i know how hard this is try to stay strong Love Kathy Bellas Ma Ma....

Kathy pacifica

This thread was discussed between 16/03/2008 and 19/03/2008

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