Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Mini Daschund - Crashing - Help??

4 year old female miniature daschund, monday rush to vet (orange pee, weak, white gums) crit test was 9, rushed out of town to where she could get tranfusion, recieved transfusion Monday late afternoon, crit tested at 15, Tuesday crit drops to 9 by late day, by evening drops to 7, this morning back to 9, noon today drops to 6, transfused again, currently at 15 again. They have also been giving her drug treatments (steroids, I think?). My concern/questions - my vet told us dogs cannot be transfused mroe than once, it was not until she called a collegaue in the USA (I am in Canada)that she was told to try. I have also read on other sites that splenectomy has been performed in other animals or that an underlying cancer perhaps should be treated versus IMHA. When they ran her intial blood tests Monday they said that all the values in other categories looked good - leading them to beleive it was not cancer but, IMHA. I am also worried that her dropping to 6 has perhaps compromised other organs. I vistied her after the transfusion and she actually seems stromger than last night or two days ago. I feel like it is just an "artifical" good sign and simply because she has transued blood in her. Are we prolonging the inevitable? The fact that they did not think she would make it through the night but went up from 7 to 9 - is that a good sign? does that mean she actually produced new red blood cells? Help - any help or advice would be so much appreciated. I feel like we accepted that she would pass through the night and now my daughter is back on the roller coaster high of thinking she might make it. I don't want to give her false hope :-( Are there different options for treatment in the USA versus Canada?

Catherine Canada

I'm not knowledgeable enough to give any type of medical info to you, but wanted you to know I am thinking of you and your pup. Others on this site can offer more info. Take care and try to remain calm. Read through this site and obtain information from what others have been through

Mardi Northern Calif

Catherine, I believe that a blood transfusion "without matching blood types" can only be done once, after that the blood types need to match. My girl had two. I would also suggest an ultrasound to rule out some other cause if IMHA is not confirmed. Blood tests do not reveal cancer, as I learned. I was told it would have to be a VERY amazing vet to determine cancer from blood tests. Toqua had low RBC, low platelets, and slightly elevated WBC. Everything else read "normal". Her anemic episode was a result of cancer, not IMHA as initially expected. The prednisone (steroids) kept her uplifted, but the end result was surgery. 10 weeks later she is thriving, and back mostly back to her normal self. Stay strong, you are doing everything you can for your girl right now. There are so many people here who can provide info and support. In our thoughts and prayers, Jessi & Toqua

Jessi BC

Catherine, so sorry to hear your pup came down with this terrible disease. Obviously your vet isn't the smartest there is to think a dog can only have one transfusion. In a way they are kinda right but to tell you they can only have one is wrong! I've known dogs that have had several transfusions and even one that has had up to six! The first transfusion is what we call a freebie...meaning it doesn't have to be typed and matched whereas the second and thereafter has to be. Can you give us a little more info? Weight, meds (and dosages), triggers? etc. Do you know the trigger? What have they done as far as testing? Xrays? Ultrasounds? Tick panels? Thyroid panel? Poisoning (rat poison/zink poisoning/edtc)? I see you are in New Brunswick. If you want to know what your best bet would be it would be to go straight to the University of PEI. The veterinary college there is great and you'd get cutting edge technology not to mention up to date protocols. I took my dog there for treatment. To me it sounds like either the meds haven't quite kicked in yet or the dosages may be wrong ...which is why I asked the weight, meds, and doses. You could always ask them to administer a shot of dexamethasone or prednisone. This would work much faster. You could also ask about the use of cyclosporine (atopica). Is she home now? Keep her as calm as possible and let her have lots of rest. Make sure she DOES NOT miss a scheduled med. Plenty of fresh clean water is a must cause I'd assume they have her on pred and this drug is known to cause excessive drinking. Keep her stress free and be ready to let her out frequently for pees. You should get a copy of the tests tomorrow and post them her for us as well as the other info I was asking. Sending some healing vibes her way and I'll keep her in my thoughts and prayers. Johnny & Tessy

Johnny

Catherine, I am so sorry you and your dog have to deal with this awful disease. It is certainly a serious diagnosis, but many dogs have survived it!!! please go to Joanne Dickson's site to get more information and please read the success stories: http://www.cloudnet.com/~jdickson/index.html You find the most up to date info on this site. The success stories have given many of us hope at the darkest moments. As to your question if treatments in Canada are different then the USA, they are not. There are dog owners from The USA, Great Britain, Scotland, Australia and Canada on this forum and treatments are all very similar. The expert in this disease is Dr. Dodds, you will hear many of us praise her. She runs a clinic and lab in California but is originally form Canada. If you are too far from PEI it would be wise to get Dr. Dodds involved for blood testing and treatments. I remember Johnny drove with his Tessi from Nova Scotia to PEI in a snowstorm! She was very critical but over a year later she is still happily enjoying a sinful ice cream here and there! So please don't give up hope. (But don't feed your pup ice cream either) Dr. Dodds told me once, where there is life there is hope! Also remember, your dog is not in pain, just very tired. I will be thinking of you and your pup (what is his name?) Best wishes, Brigitte

Brigitte BC Canada

Please know that I am keeping your daschund in my prayers. If you can keep us updated on how she is doing and be prepared to be her voice in regards to her treatment, gather all the information you can about this disease and get test results for your records and don't be afraid to voice your opinion. Cheryl & Ginger

Cheryl & Ginger Pinevile Pa

Catherine, please let us know how your girl is doing today, Best wishes, Brigitte

Brigitte BC Canada

Hi Catherine, I too, send my best wishes to you and your puppy. My standard poodle, Mercedes, is also currently battling IMHA. She was diagnosed 2 months ago. This is a great site with lots of knowlegeable people who will offer you "good" advice and guidance. They (and Jean Dodds) have helped me immensely over the last couple of months. Please stay connected with all of us. We know what you are going through right now and will support you however we can. My thoughts and prayers are with you this evening. Sending lots of positive vibes to you and your dachsy!!! Warm Regards, Maureen and Mercedes

Maureen B.C. Canada

Hi Catherine, So sorry to hear that your dog is poorly. Archie collapsed on 1st March and was diagnosed with IMHA two days later, he had an oxyglobin transfusion at the time as his pcv was so low, it has been as low as 10 but now 3 months later is 38%. At times it has been worrying mainly because we didn't know much about it but the people on this site do so ask questions and they will put you on the right track. Good luck and our prayers are with you. Sue and Archie

Sue Cambs UK

Catherine -- Dogs can only have one non-matching blood transfusion; after that, it must be matched. Dr. Jean Dodds, one of the most preeminent experts on IMHA and blood disorders, has an organization called Hemopet, that is a blood bank. It can be reached at www.hemopet.org. Hemopet provides blood to veterinarians in the US and Canada. Please go to the website and encourage your vet to take advantage of this wonderful resource. Some dog owners on this forum who have ordered it directly and had the blood shipped to their veterinarian. You also should contact Dr. Dodds. I don't have her e-mail, but others here do. She has done dozens of consults for people on this forum. She is not available on Saturdays, and I don't know of her availability this weekend. But others on this forum can advise of how they contacted her and the information she needed to work with their vets. Some vets have reacted negatively to clients who have contacted Dr. Dodds, while others have embraced collaboration with an expert on blood disorders. My best to you and your little dachsund. They are a tough breed, so I hope your little sweetheart can hang in there and turn the corner. You've got to be positive when you're with her. Everyone says that's key.

Brenda VA

Dear Catherine, You have so many good questions and such an immediate emergency. Sometimes it takes a lot of studying to answer all the questions an owner has and that unfortunately takes a lot of time. There are many people here who can help you get through this emergency. Your first concern, transfusions, is warranted. As others have pointed out, dogs get one "free" transfusion, or a transfusion that does not lead to a transfusion reaction. But there are 11 different blood "types" for canines (vs the 4 that humans have), so subsequent transfusions are not straightforward. There are dogs that are considered universal donors and their blood can often be used safely. Dr. Dodds has a clinic full of Greyhounds, a breed whose blood is often considered a universal donor type. She ships this safe donor blood around the world. But in many cases, a vet clinic will have a donor dog (with a universal blood type) that they are able to use in emergencies. Remember that most small local clinics only need transfusions for things like car accidents and that most dogs are receiving their first donation when this happens. You are looking at multiple transfusions and they must be done carefully to avoid transfusion reactions. What is a transfusion reaction? All body elements, including red blood cells, have proteins attached to them that help the body identify what belongs to *that body* and what is foreign. When you introduce something foreign into the body, it looks to see if it is acceptable or not. If it thinks it doesn't belong, it will immediately react by trying to eliminate that foreign thing with the help of the immune system. This can be as mild as springtime allergies (dripping nose, runny eyes) or a full blown autoimmune reaction that is very life threatening. Right now, your girl's immune system is attacking her own red blood cells. Thus it is called autoimmune hemolytic anemia. The autoimmune is the part where it is mistakenly identifying its own red blood cells as foreign. The hemolytic part is where the immune system sends special white blood cells to attach to the red blood cells and destroy them by rupturing them. The anemia part is a sign or a symptom this this is happening and is shown on blood tests by very low numbers of red blood cells, very low packed cell volume (or hematocrit) and a severe lack of available hemoglobin to carry oxygen to the body cells. Anemia in-and-of itself is not a disease, it is caused by some condition. What your vet is trying to figure out is "what is causing the anemia?" They are thinking, "Is this a straightforward case of AIHA or is there an underlying cause like cancer?" They are reviewing their textbooks trying to see what all the other causes could be. They have seen the section that talks about removing the spleen. They have also seen that this is not often successful. I would advise you to question any move on their part to subject your very very ill dog to a serious surgery like this right now. So you can see if you introduce new red blood cells from a donor, the body is also going to investigate these cells to see if they belong! Dogs are very lucky that they generally don't have a problem with that first transfusion. However, in the state your girl is in, it is very likely that many of the transfused RBC would be destroyed by the body because that is what it is busy doing right now. When you add this first foreign blood type into the body, it leaves little messages that identify itself to the immune system and the body never forgets these. It develops antigens to these elements and if it sees them again, the immune system will now be primed to attack. Will it? That is why the second and subsequent transfusions are more tricky. Can it be done safely? Yes, unequivocally. Is this something your vet does every week, every month? NO. Can they learn how to do it safely? Yes. My vet spent a whole afternoon learning how to do this and administered a second transfusion on July 3, 2007 that was successful using universal donor blood. It took her the better part of the day. You most likely will need a third and maybe even a fourth transfusion. If you are lucky your local vet will have a donor dog available. Can you use this dog's blood? Yes and no, it must be first matched to your dog at this point. A lab must have samples of both dog's blood and must perform special tests to make sure this will be safe. I was lucky that my vet did have a donor dog, we did the tests and from that point on subsequent transfusions were done that were safe. So this type of transfusion, whole red blood, is very acceptable when done safely. The advantage is that it contains many important elements that are vital. But there is nothing wrong with using carefully prepared emergency blood products. I would mention that the usage of Oxyglobin in dogs that are undergoing a hemoytic crisis has been shown not to have a good track record. It does help get the level of blood O2 up, but may not last very long. Most likely one of the reasons that she feels better is that the transfusion is administered with an IV fluid. These together help raise the blood volume level up to nearer normal levels and that is very important. So combining immediate immunosuppressive drugs at the proper doses with excellent emergency nursing care and appropriate transfusions can be a very successful approach. If this were me, I would continue to allow these treatments some time before making any rash decisions. Finding a good internist who is experienced in this treatment protocol would help a lot if you are able to find one and can afford it. my best patrice

Patrice NYS

Hello Catherine, I am sure I am not the only one wondering how you and your little girl are doing. Please give us an update, no matter if good or bad,if you have a minute. Best wishes, Brigitte

Brigitte BC Canada

This thread was discussed between 27/05/2010 and 31/05/2010

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