Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Negative coombs test

My vet thinks my 15 week old puppy may have AIHA, We did the coombs test but it is negative. We are awaiting results for the ANA test. If it is negative he wants a marrow biopsy done. I am not sure I want to do it. I am hoping that her RBC will be up on Monday. We started her on Pred on Wednesday. Her RBC on Monday 4/21 was 23. We retested Thursday and was the same. I am hoping it will be up Monday. She seems to be feeling pretty good. I believe she got this from her vaccination. I thought she was sick after the first one. It took her about 18 days to get completely better. And when i gave her the 2nd vaccination she got sick again so I took her in and this is how I got where I am now. I feel really bad for her. Anyone else out there done the bone marrow testing? I guess he wants to do it because we cant find AIHA in her blood test but I also see there are false negatives. I dont want it to be anything more serious,. Anybody else out there ever done marrow test?

Ann Ormond Beach

Ann, I am so sorry to hear that you are suddenly facing this with a brand new puppy. How very frightening for you. This is an extraordinary young age for a dog to develop AIHA. Is she a pure bred dog or Heinz 57? Dogs at this age are just beginning to develop their own immune systems after having their mother's protection from birth. If this were me I would contact the breeder to find out more information. While it's possible that the vaccination caused this reaction, did they question you about anything else? In my mind, the first thing I think of with puppies is that they will pick up and eat whatever is lying around. If your pup swallowed a coin that has zinc in it, this will cause a sudden severe anemia. This could have easily happened concurrently with the shots. A bone marrow biopsy is a test that samples the cells in the bone marrow with a kind of large needle. This is called an aspirate. It involves anesthesia and that certainly has risks. From the way the cells look under a microscope they can tell all kinds of things about how well your puppy is making red and white blood cells and also platelets. It tells them if the process is ok or not. Usually this is done when the dog presents as non-regenerative. This means that the bone marrow has stopped making baby blood cells. If a dog has anemia, the body begins to want more oxygen to go to the cells and it asks for more blood cells to be made. If the marrow isn't responding, then the anemia is termed non-regenerative. If there is anemia but the dog is also regenerative or responding by making blood cells, then usually it is assumed that the marrow is functioning properly. The Coombs test is not always accurate and sometimes has an occasional false negative or positive. A good indicator of AIHA are certain cell types that populate a blood smear. It's kind of like the difference between going to a nice pub in England and everybody is dressed nice and is very polite vs going to a biker bar in the US. There can be all kinds of odd cells in AIHA. A specialist can tell a lot from a full cbc panel. One particular cell of interest is the spherocyte. When it shows up, it's a good indicator that the spleen has been busy trying to destroy cells by biting off a chunk. We had a bone marrow biopsy done because Chance was non-regenerative. His blood work first showed that and the test would be done to find out why. He had 5 core biopsies and they all came back devoid of cells. That means he wasn't making any red or white cells. But it could not tell us why. A bone marrow biopsy doesn't necessarily tell you something you didn't already know. But in severe cases it will confirm what they suspect. In our case it told us nothing more than, "boy is this bad." It's sort of like getting out of the car to see that, indeed, I guess we have a flat tire. You knew that when you were inside the car. So ask some questions about why they want to do this test. What do they expect to find and how will that help the treatment. Will the procedure be safe? Then you can come back here, ask more questions and then decide what you want to do. I will be thinking about your little pup, patrice

Patrice NYS

I have asked the breeder and she thinks it is from the vaccination also. Yes the vet has said she has either nonregenerative or preregenerative AIHA at first. Her belly is now distended and he thinks it may be the pred so he had me give her 1/4 tab instead of 1/2 tab twice a day. Monday though and the count was at 24 instead of 23. I was going to give her back to the breeder but I think I will try a different vet. I dont know how quick the preds should start taking effect on her count. If the treatment is the same for her whether she has bone marrow or not I do not want to put her thru it. Yes she could very well have eaten a penny. Who knows? She is a pup. However she was not well after the first vaccine and then the 2nd vaccine she got really sick. We dont have good vets here and if I can't get any where I will have to give her back to the breeder. She is a full bred shar pei. SHe is adorable and I don't want to give her back but it is breaking my heart and I have a husband that had a debilitating stroke a year ago that I have to deal with at home as well.

Ann Ormond Beach

Ann, I am so sorry you are fighting this with your new puppy along with everything else you are dealing with. My dog had a negative Coombs test and all other diagnostics ruled out other suspected causes for the anemia. We did do the bone marrow biopsy and while the pathologist did not observe actual destruction on the sample, he noted there were RBC precursors that were not reaching maturation; thus, the internist we were seeing at the time diagnosed it as non-regenerative IMHA at the level of the marrow. Subsequently, I did consult with Dr. Jean Dodds (you may have seen her referenced in other threads) and she was less concerned with the biopsy diagnosis - her direction was to treat the anemia the same, irrespective of the pathologist's POV on the biopsy. I will say that it took Murray longer to "recover" from the biopsy than we were led to expect but that may be because he is an older, rescue dog. It wasn't awful but this (board certified) internist led me to think it was "no big deal" - probably not relative to other things he's seen but it was more dramatic to us. Best of luck - it's so great you are hanging in for your puppy. Bonnie

Bonnie Chicago

So what was the course of treatment that Dr. Dodd suggested? and how long has it taken for Murray to start showing improvements on the blood test? My puppy seems to act normal and it is hard to fathom that anything can be wrong with her at this time. I am taking her back for another test on Friday so I am hoping the numbers are coming up but I dont know how fast they usually start coming up?? What did you start at and how long does it take for them to come up?

Ann Ormond Beach

Ann, Dr. Dodd's reco for Murray was continuing the med protocol he was on - pred, Imuran, and cyclosporin. She wasn't too concerned with the biopsy and whether the anemia was classified as regenerative or non-regenerative; she said "you just treat it until he responds". His case started with a sudden collapse episode and as part of the workup at the ER they ran a CBC and his PCV was 33. Clearly, they weren't too concerned with that number and told me to check it again with my regular vet in a few days - then it had dropped to 30, which put us on the path of diagnosing the anemia through a specialist (ultrasounds of the abdomen and heart, tick panel, thyroid, addison's, etc.). We did the bone marrow biopsy after those diagnostics were negative. The internist gave me the option of not doing the biopsy but treating him for IMHA but I opted to try to confirm the diagnosis before putting him on such a strong medication regimen. His PCV never dropped below 21-22 so he didn't need a transfusion. We checked his CBCs weekly and didn't see an increase in PCV or reticulocytes for almost 3 months. It took another six months to get back into the normal range but (knock wood) today he is stable. Like your puppy, he was relatively normal during that time - he was interested in walks, food and displayed his typical behaviors. From my experience(and I'm not a vet and don't have a medical background), the key is giving the meds the time they need to work but at a dose and combination that they the aren't causing other problems for them while fighting the IMHA. Best of luck to you and your puppy - it has to make it even harder since she is so young. But, it is a very good sign that her behavior is relatively normal - I had many good friends on the board remind me of that when I was going through this. Take care and let us know how you are doing. Bonnie

Bonnie Chicago

The Coombs test seems to not be all that accurate. It was negative for my 4 year old golden retriever, but he most definately had AIHA. His wa brought on by a 6 month heartworm preventative injection called ProHeart6. It also damaged hsi liver. He fought hard, but couldn't over come both things and I lost 8 days fater diagnosis. BUT many dogs go into long time remission and live long lives. I hope that if your sweet puppy truly has AIHA that this happens for her. In my thoughts.

Sandra Texas

Wow! I didnt realize it took so long to see any positive results. My vet seemed to be so eager for me to get the bone marrow biopsy. I am not that eager. How often did your vet check the PCV? Did your dog ever have the distended belly from the Prednisone? I am not sure exactly what is causing it but my vet wanted me to stop the pred which I did not. I also am not doing the biopsy but I am taking her back to him tomorrow for another PCV. I just wonder how often it should be done. I have never heard of that heartworm shot but I dont think I will try it. I usually give my dogs ivermectin for heartworm as it is alot cheaper than the heartworm stuff and it is the active ingredient in heartguard. I have never had any trouble with it. Please say a prayer for Lacy and cross your fingers that her PCV goes up. I had told her breeder that if it was not up I would give her back so her vet could check her but I will also lose her for good and I dont want to do that but I would rather do that than to put her in jeopardy. My vet doesnt seem to want to work with me much except to have me go see a specialist which I dont want to do as it is quite far and very expensive.

Ann Ormond Beach

Ann, Our dog was non-regenerative (not making baby blood cells) and also had neutropenia, (not making white blood cells.) Destruction of red blood cell precursors is serious, destruction of white blood cell precursors is far more serious and if a dog is destroying or is defective making platelets, it is life threatening. It took us 5 months from diagnosis to see any change in his non-regenerative state. He was on extremely high doses of medication for AIHA. In addition he was on many other accessory drugs to reduce the risk of ulcers, protect the liver, protect him from infections and reduce the risk of inappropriate clotting. Chance had 3 transfusions in that time. Our vet said to me, "If this was a human not making blood, we would support them with transfusions and nursing care." That is all I needed to hear to keep going. It was very expensive. I have seen some folks on this forum spend over $10,000. I think we probably have spent around $6000 or so. We used our local vets almost exclusively after the initial visit with the specialist, however my vet is his colleague so they could conference on a regular basis and save us a long drive. They were more than eager to help Chance, the whole office, and came through for me on numerous occasions. If you have a somewhat conflicted relationship with your vet, this kind of long treatment could be difficult to accomplish. Sometimes the vet fears that their skills are not adequate to care for such a complicated case. I know my continued research to assist with the treatment was very welcomed by my vets. I have a medical background so it was fairly easy to transfer those skills over to studying canine hematology. But dogs are not people! So I have always had to rely on my vet's extensive clinical knowledge. They have the experience and skills that are only obtained from years of working with animals. Your own vet may not have very much experience with a severe case of AIHA. Yes, Dr. Dodds is right for the most part, and I began to feel that way as time went by, "if it looks like a broken leg and acts like a broken leg, then treat it like a broken leg." Of course, this was after I had exhausted all other causes like tick diseases, tumors etc. In the end, *for me*, I discovered that autoimmune diseases are often classified as idiopathic in their causes, especially in canines, because there just hasn't been enough research. A good example is the surgical removal of the spleen. The textbook that universities use to train specialists has a short section on this surgery with the notation that it hasn't seemed to be very effective. With the treatments for AIHA mostly the same, there wasn't a good reason for me to keep looking backwards for causes. I looked forward to see what treatment options I had. It was a pivotal time for me and one that gave me great courage to move forward with no regrets. I work with someone who has had several Shar Pei's and I asked her about your pup and the breeder. She lost her dog to cancer and commented that the breeder probably would not want to admit any wrong doing in this case as they can consider this a business deal. If a pcv is below say 22-20, I would consider a weekly pcv very important. If you see anything unusual that leads you to believe she is not doing well, then more often would be called for and you might want to plan on providing a transfusion. The prednisone will cause many undesirable side effects that will go away when it is decreased. It's a two edged sword, if you want to get the blood count up, you have to use this drug. You will also see many side effects that are very hard to watch on a long term treatment. The whole family has to be ready to help with the treatment and accept these side effects. I think of your pup often, Patrice

Patrice NYS

My puppy had her Pcv test and it went down to 22 today. The vet called an internist to see about chemotherapy type drugs but they do not want me doing that without her seeing a specialist. He did give me some med for her liver which I had xrayed and it is enlarged. Is that part of the AIHA? Also does anybody know what other type meds I should try and where I can get them? I am not taking her to a specialist and may take her back to her breeder. I need some advice here. My vet seems to think she has something bad going on and he has not really wanting to be the vet for her.

Ann Florida

Ann, I am sorry you are having such a rough time. Without the input of a specialist, it looks like this pup is not going to get the kind of specialty care that it really needs. If this were me, yes, I would contact the breeder immediately. But I would put some conditions on them. They need to help you take care of this puppy. All conscientious breeders would *want* to do that. You should not be alone in this. They have the contacts with medical professionals that you do not have. However, being harsh with them will probably push them in the opposite direction and nothing will be accomplished. Appeal to them that the pup's life is at risk and ask them for help, now. My best, patrice

Patrice NYS

I talked to her breeder and I will take her back on Sunday. She will take her to her vet and go from there. I hate to give her up but it is in her best interests. I hope she will get the treatment she needs. She has had a couple dogs with AIHA and she is better fit to take care of her than I am.

Ann Ormond Beach

Ann, I am relieved that you were able to come to an understanding with this breeder. I can imagine that this is one of the most difficult decisions you have ever made. I am so sorry this has happened to you. Getting a new puppy should be a time of happiness and excitement for the family. It is one of the greatest joys I have ever known in my life. I feel that many here on this forum would express their sorrow for your difficult decision. My best to you, patrice

Patrice NYS

Well the breeder is really a great breeder and I knew she would take her back at any time but I just hated to give her up. I know it is for the best interests of the pup as I can not give her the proper medical treatment with my vet and I think her vet can probably do better by her than I and the knowledge that my breeder has is way beyond anything that I could possibly have as she has been in this breed for over 16 years. I hope she is able to get to the root of the problem and get her back to being healthy.

Ann Ormond Beach

I took Lacy back to the breeder on Wednesday and she has a vet appt on Saturday with her vet. I am hoping she can get her on the road to recovery. I will miss the puppy and have been told she has another home for her when she is well. I knew once I gave her to the breeder i would have no hopes of having her back but that is the price I pay for trying to get help for the pup. I did it for the good of the pup and hope she has a wonderful life with someone else.

Ann Ormond Beach

Ann, Courageous act on your part. This will be the best solution for this pup. That never-the-less doesn't ease the empty feelings, I am sure. I hope you are able to fill the house with little feet again in the future. My best to you, patrice

Patrice NYS

My puppy had her vet appt on Saturday May 17th and her PCV was up to 28 from 22 when I took her about a week and a 1/2 prior. She is doing great. I know it was the vaccines and now they have gone out of her body she is coming around. She never really acted too sick except when it first began. I am going to get her back when she gets back to normal. I am hoping that should be in another couple weeks. My breeder says she is doing good and will take her back for another visit in a couple weeks so I am hoping she is normal then. Wish me good luck and Lacy will be back with me. I miss her dearly.

Ann Florida

My 19 20 wk old MaltiPoo was diagnosed with AIHA on Mon after we nearly lost him over the weekend. He was fine one day and suddenly became lazy and had swollen lymph nodes. We took him to the Vet on Fri morn and he gave him and injection of Prednisone and put him on an antibiotic. He acted somewhat normal on Sat and Sun he was lethargic and would not eat. We called our Vet and he instructed us to go to the ER which we did. When they drew Max's labs his H&H and RBC's were abnormally low. His PCV was only 18%. They gave him a bolus of fluid with Vit B12 and told us to follow up with our Vet on Mon or if he got worse to bring him back. When we got home we again called our Vet and at first he thought it could be Lymphoma and told us that it is very expensive to treat and the prognosis is still not good. So a decision had to be made. Do we want to put this poor puppy through all of this and pay all of this money only to lose him. When we took Max back to the Vet early Mon morning we really thought that we may be putting him to sleep and it was so sad for my husband and I. After the Vet examined him again and again and kept going over his lab values he said that his nodes were down significantly and that he thought it was most likely AIHA and suggested that we transfuse Max and give him a IM dose of Prednisone. We did and also started him on PO Prednisone on Tues. So far we have really not seen a big change. He goes out to "potty" and plays for short periods but usually just lays around. My husband says that it is like he went from a vibrant little puppy to an old man over night. I too would like to know how long it should take before we see some significant change. Our Vet seems to think that because of his age it is probably Genetic but he also says that no one really knows for sure. Our breeder does not want to hear anything about it being genetic and certainly has not offered to help.

Barbra Lake Mary

Hi Barbara, I just got online to see about your puppy, How is she doing now? I see you actually live in Florida. I believe the vet that my breeder took my pup that I gave back to her is in Altamonte. How close are you to there? Do you think that maybe the vaccines that you gave her may have done it? Had you recently given her some? It took my pup couple days after her 2nd vaccine to really get sick. I had noticed after the 1st vaccine that she was not right. Well it took a couple weeks and then I waited a couple more before she got her next dose and then she got really bad. Anyways my breeder is taking the pup back to the vets soon and she we believe should be fine. She is acting normal and very puppy like. No I don't think most breeders want to hear that it may be genetic. I am not saying that it may not be but I beleive in my puppys case it was vaccine related. It took my puppy about 3-4 weeks for her to get back to acting normally. She was lethargic but she always ate well. The pred will make them eat more as well as drink a lot.

Ann Ormond Beach

This thread was discussed between 25/04/2008 and 10/06/2008

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