Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - New diagnosis

My dog Riley was tentatively diagnosed with IMHA last night, Monday 3/1. It all started Friday - my husband noted that he was "acting out of sorts" but attributed it to my having gone out for the evening. He often acts mopey and out of sorts if I'm not home. Saturday morning he vomited the few bites of food he had eaten for breakfast. He seemed lethargic all day. Sunday was more of the same - more lethargy but he did eat a bit and not vomit. I noted that his gums looked pale and we made plans to get him to the vet on Monday. He vomited once more on Monday and was still lethargic. Monday afternoon was the soonest they could get us in. After running blood tests, it was clear he was anemic. They put some blood on a slide and autoagglutination was apparent. I keep seeing references to PCV, I don't see this on his labs, but some internet research suggests it is HCT? If so, his HCT was 18. Ultrasound was done and they did not see a tumor of any kind. He was put on prednisone yesterday. They also gave him a shot to quell the nausea and vomiting. He did eat fairly readily this morning (chicken and rice that I cooked for him) and there was no vomiting. I felt he was a bit more energetic than he was yesterday or over the weekend. We go back to the vet in one week to see if the pred is working. The vet seemed to think we would see improvement within a week if the pred is going to help. What signs should I look for at home as improvement? It is my understanding that the PCV will come up slowly and that his gums will be pale for some time to come. Is good eating and more energy signs that he is improving? I just wanted to share and become a part of this group. If anyone has any advice for me I will gladly take it.

Jennifer Michigan USA

Jennifer, I am so sorry to hear about your Riley having IMHA. I lost my pup a month and a half ago. I guess my best advice at this point is to research as much as you can. I don't mean to sound morbid but this is a very, very serious disease. When you wrote, "monday afternoon was the soonest they could get us in"....that concerns me because of the seriousness of the disease. He needs immediate attention. It can literally take an otherwise healthy dog and unfortunately have them pass away within a week. Be politely aggressive with the vets. I am surprised a transfusion wasn't done. Is Ruger on any other stomach protectants, any other medicine? It doesn't sound like your vet is an "expert" in the field. Once again, I don't mean to disrespect anyone here, just trying to help. Perhaps a second opinion will be beneficial. There are many other steroids that can be used in conjunction with pred. Cyclosporine, Azathioprine to name a few. Also, during the early stages, you should be careful for blood clotting. Aspirin and/or heparin can help for this. Best of luck and find comfort in the fact that you found the right place. The people on this forum are knowledgable, caring, and experienced. -Darren

Darren CA

Jennifer I am so sorry to hear that your dog Riley has tenatively been diagnosed with IMHA. While AIHA/IMHA is a very difficult disease dog who have been diagnosed with it CAN and DO recover and go on to live happy healthy lives. If you have not read my Web site on Canine 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 sites on AIHA/IMHA that will be very helpful to you and do read the SUCCESS Stories pages. They will show you what has worked for other dogs in terms of treatment options as well as give you a lot of HOPE. In regard to HCT, PCV you can learn more about that on the FAQ page which has some good links to provide you with more info. The normal PCV in a dog is in a range from 37-55 so while 18 is low it is not that bad. I have seen dogs with PCV's in the low single digits that have gone on to recover and do very well. It can take 5-7 days for prednisone to start to work and many times a dog's PCV will continue to drop until the pred does "kick in". Also many times pred alone will not be enough to get a dog with AIHA/IMHA into remission. If that is the case a vet can add other medications such as Azathioprine or Cyclosprine to the treatmen regimine. You can learn about those medications on the treatment page of my Web site which also has links to other sites with more info on those meds. I know this is so hard so please be assured that both you and your dear Riley are in my thoughts and prayers during these most very difficult days. PS. I would not wait a week to go back to the vet for more blood work. I personally would be doing more blood work in the next day or so.

Joanne MN

Jenifer, I don't think I would wait for an other vet check for a week. Make sure your vet has experience with IMHA. Would it be possible to get a second opinion or a consultation with a specialist? What breed is Riley, what is his weight, age and on how much prednisone is he now? There is usually a second drug added, Azathioprene or Cyclosporin. Ask your vet if that could be done. Improvement will be slow and the prednisone is very hard on a dogs body. This is why a second drug should be added. Please visit the Meisha's Hope website and learn as much as you can: http://www.cloudnet.com/~jdickson/ Stay positive and take it one day at a time, Best wishes, Brigitte

Brigitte BC Canada

Thanks all for your comments. To answer some questions - Riley is 8 years old, a German Shepherd/Lab mix. He is around 90 lbs. He is on 100mg of prednisone right now. The vet mentioned one other case of IMHA that he had treated. I got the impression that this was the only case he had ever seen. Apparently that dog is doing OK now. The vet had said he wanted to see Riley on Friday but that is not possible since my husband is having knee surgery that day (when it rains it pours!). So we pushed it to Monday. The vet plans to call us and check on him tomorrow. He will also call to check Thursday. When he calls tomorrow I will mention getting labs sooner than Monday and ask about other drugs.

Jennifer

Jennifer, so sorry to hear this bad news. You found a great sight here to get support and advise. Have the doctors ruled out any other causes or are they classing this as idiopathic (no cause known)? If you check out a reply I just did to Kapri you will see some of the things they can do. Actually.....yay for cut and paste... ~~~"Have they done ultrasounds/xrays, tick born disease tests, poisons/toxins (onions, rat poisons), recent meds (sulfatri antibiotics, estrogen, nsaids, etc), RECENT VACCINES, or any other concurrent health problems lately. If you can find a cause that would be super great. Idiopathic forms of this disease (no known cause) are sometimes harder to deal with cause we don't know what caused the disease so can't treat or prevent as easily."~~~ Better eating can be directly related to the pred! They will become little trash compacters on this drug...eating everything and anything they can sometimes. Lots of fresh water and be prepared for messes onthe floors. They can't help this remember...it's the drugs! I used to let Tessy out every couple hours even at night when she was first sick! Thank God for this site or I would have went crazy! Diagnosed LAST NIGHT!!!! Boys, I'd be really concerned with this vet and their knowledge. Waiting a whole week? I'd be wanting checks daily for the first little while till I'm sure everything is going good and then every few days and eventually weekly, etc. You're in Michigan so maybe you could contact Michigan State for help. Usually the teaching hospitals are far more cheaper and they also use state of the art technology. I've heard lots of good things about Mich. St. I don't want to overly scare you but this disease can go down hill REALLY REALLY fast. Keep a really good eye on Riley and if at all he seems to be getting worse then call the vets and insist on bringing him in to be checked. Trust me...this isn't a disease to be taken lightly. Keep him well rested and calm and avoid any stress if you can. If you have any concerns or questions just stop by here and post. There's usually always someone that'll respond fairly quickly. If not feel free to email me if you'd like. blue_majestic@hotmail.com I'll keep Riley in my thoughts and prayers. Johnny & Tessy

Johnny

Thanks all for your comments. Please know I am reading each one and taking everything under advisement! We will talk to the vet tomorrow and ask more questions. I will also be keeping an eagle eye on him. On a good note, Riley is definitely perkier and acting more like his normal self tonight. He ate dinner pretty well, begged while we were cooking our own dinner (scored a little piece of cheese), enjoyed a peanut-butter Kong (his favorite thing in the world) and asked to go outside to his backyard. While he was out there I could hear him barking at all the neighborhood dogs. So, I am hoping he is on a good path and will continue....

Jennifer

Jennifer, Sorry that you have had to join us but you can't find a better place for information and support. It is really important to have someone that is very familiar with all aspects of treatment of this awful disease. No two dogs seem to present the same way and what works for some doesn't work for others. I am happy that Riley is seeming perkier and eating well but I wouldn't go longer than 3 days without another blood read or sooner if you notice any changes in him whatsoever. Penny

Penny Lytle Creek Calif

Dear Jennifer, I am so sorry to hear of Rex's diagnosis. There is really nothing I can add to all the great advice above. I have a 12 year old dog Millie who is a 14 month IMHA survivor, it's important to stay positive and remember that dogs do survive. Keep us posted, Sam and Millie

Samantha Geelong Australia

Sorry Jennifer. I realised Rex is Kapri's dog. I should have said Riley.... Apologies for getting this mixed up!

sam geelong australia

Jennifer, Like you, this is all new to me. First of all, let me say that I think you're fortunate to have picked up on Riley's symptoms so quickly, and because you have, I would not want to see you let a week go by before taking Riley back to the vet sooner. In fact, "for peace of mind", I would want to know if Riley's PCV is higher, lower, or holding at 18. Our vet was very concerned with Rex's PCV at 20, and I was informed that it could rise or drop very quickly. We were told that should it drop to 15, which it could in a day or two, we would need to discuss blood transfusions. I'm happy to hear that Riley's energy level and appetite has picked up, but be aware that the prednisone makes them hungry and thirsty. In the first week of Rex's diagnosis, he gained 8 pounds, which at first I took as a positive sign. Now I'm concerned that his recent weight gain is harder for him to carry around being that he is still weak and tired often, and more importantly concerned about his oxygen flow. Best wishes to you and Riley! Kapri

Kapri Arizona

OK, based on all of your advice I have changed his appointment to Friday. It was a bit of a juggle due to my husband having surgery that day but I worked it out. If he weren't perking up I would push an even sooner appt. I am happy that his energy level has increased and take that as a good sign. I will keep an eagle eye on him in the meantime...and get him in ASAP if things seem to go downhill. We live not far from an animal emergency room.

Jennifer

Answering some questions - Have they done ultrasounds YES, nothing seen xrays NO tick born disease tests NO, but it is the dead of winter here poisons/toxins (onions, rat poisons) NO, but they did ask if he got into anything or if was the type of dog to get into things. He is not; he's actually pretty amazing about not getting into the trash, our food, etc. recent meds (sulfatri antibiotics, estrogen, nsaids, etc) NONE RECENT VACCINES NONE any other concurrent health problems lately NONE, other than a hot spot on his tail.

Jennifer

Jennifer, My beagle Darcy was diagnosed in July 2008 with non-regenerative anemia (IMHA). She went through the whole series of Prednisone, Azathioprine, Cyclosporine, Soloxine, anabiolic steroids, blood transfusions, etc., but wasn't getting better. She even had a bout of pancreatitis after one of her three transfusions. It was not until I changed to a holistic vet who weaned her off everything but the Prednisone and Soloxine and agreed to add in 100 mg of Doxycycline twice daily that she started regenerating red blood cells. The first vet we visited did put her on Doxycycline when she was initially diagnosed; however, she was on it for only a week. Later, I begged them to put her on it again because I had seen a slight improvement. Again, they did it but for only a week. So, months later and Darcy is not any better. In fact, her PCV had plummeted to under 8%. It was at that point that a dear lady urged me to ask the vet to put her on Doxycycline for a long period of time. Our holistic vet agreed to try it and now Darcy is back to normal. At her last check her PCV was a little over 40%. She was on 100 mg. of Doxycycline twice daily for six months. All of her tests for tick borne/flea/parasite disease turned up negative. Those tests, I now understand, are notorious for producing false negatives. I do not remember Darcy having any ticks or fleas either, but all I know is that the Doxycycline was what saved her. Now she is off all meds except for a low dose of Soloxine (thyroid medication). I feed her an organic diet and give her Standard Process supplements and herbals from the holistic vet. Blood was drawn yesterday to check her PCV levels and her thyroid levels. If thyroid levels are normal, we will discontinue the Soloxine, which initially was given to stimulate blood production, not because she had a thryoid problem. I continue to keep a supply of Doxycyline on hand just in case Darcy starts to relapse. Tick borne disease can lie dormant, so it could rear its ugly head again and I want to be ready. I don't know if Riley would benefit from Doxycycline as Darcy did, but it certainly would not hurt to give it a try. My prayers and best wishes go out to you and Riley. I'm sorry this post is so long, but I hope it will help and encourage you to get Riley the help he needs. We have to fight for our dogs, even if it means challenging the "experts." One last thing. If you haven't already done so, I would urge you to read "Jasper's Story" at the VintageGoldens website.

Karen NC

Hi Jennifer, just wondering how Riley's making out today. Hope all is going well. I'll keep Riley in my thoughts and prayers. Johnny & Tessy

Johnny

He has been holding steady for the most part. He is still not himself (obviously) but does not seem to be declining. He went on a very short walk yesterday in the warm sun and enjoyed himself sniffing around. I check his gums all the time - I think they are looking pinker but also think it depends on the lighting. In natural light they still look pale. He is being very picky about eating. I wonder if he is beginning to play me. ;) He will eat chicken in 10 seconds flat, so that's what we're feeding him for now. Any advice there? I try to add rice or potato and he just picks out the chicken and eats that. We go back to the vet today for more labs. Keep your fingers crossed that there is some improvement in his blood work. I will update later this evening.

Jennifer

Hi Jennifer Your dog has a wonderful name, Riley. Im missing my Riley who passed only a few weeks ago. I just wanted to wish you all the very best for YOUR dear Riley and I hope you can get past this and on track. As Johnny says, this is a fantastic group and everyone will do their best to help you through this - post results and make sure you get copies of everything so you can track whats going on. Is prednisone the only medication Riley is on? The medications will also have an impact and their own effects which may confuse you, so ask the vet lots of questions about what you can expect, you will be seeing of lot of him/her. Steer clear from high fat foods. Best wishes to you both. Silka

Silka Melbourne Australia

HCT was up to 21% from 18%. But the labs showed WBC were high and out of the normal range. The vet felt it might be that the red blood cells he is producing are small and being picked up by the machine as WBC. He looked at the blood under the microscope and felt that was the case. Riley is acting quite energetic tonight; I am happy to see the improvement in his demeanor. It's hard to believe he is still so anemic.

Jennifer

I am so sorry Jennifer, . I hope Riley's bloods continue to improve. I know how worrying this is for you. Sue

Sue

An elevated WBC is totally normal with AIHA/IMHA. Baby red blood cells (retics) are larger in size than healthy adult rbc's. I'd suspect that what the doctor was seeing was nucleated red blood cells. These are often mistaken for WBC's but there are ways to determine and correct the numbers. I believe some if not most analysers do this correction itself but I'm not sure on this. If the doctor is trained well enough they'll be able to tell the difference under the scope and should have mentioned this to you. Hey though....a climb from 18% to 21% is a very good improvement!!! Perhaps now you should be focusing on proper diets and making sure you are getting the proper micronutrients to the body so it can "build" new blood cells. Lots of us on here use a product called Pet Tinic. It a supplement of folic acid, B12 vitamins, adn iron...all important building blocks for blood. You may also want to consider adding milk thistle to the daily food. These drugs are incredibly hard on the body and can wreak havoc on hte liver. Milk thistle helps to protect the liver. Ask for and get results of tests. I'll be keeping Riley in my thoughts and prayers. Johnny & Tessy

Johnny

Thanks for your messages, especially about the elevated WBC's. Vet did look at the cells under the scope and said they were immature RBC's. He said the bone marrow was responding by sending out these immature RBC's. Riley's demeanor has shown a vast improvement over the past few days. He is acting like himself, eating well, and doing all his normal things. If you didn't know it, you couldn't tell he is sick. I think his gums look better. We go for more bloodwork tomorrow and am keeping my fingers crossed for a good report.

Jennifer

Thanks also for the recommendations on the supplements, I am a big believer in these things for health and healing. I will check it out right away.

Jennifer

We had a vet visit today - HCT was up to 27% from 21%! The vet is really pleased with his progress.

Jennifer

That's Pawsome news Jennifer. Keep up the good work Riley. Johnny & Tessy

Johnny

Jennifer, Whoo-hoo! onward and upward Riley!

Penny Lytle Creek Calif

Jennifer: There is hope!!! I did loss my beloved dog, Mickey, last week to IMHA. It happened so suddenly and they pumped him with steriods before they could give him a blood transfusion but it didn't help him. I had to put him to sleep. He was only (5) years old. I pray that your beloved dog will recuperate because there are dogs that do. You are in my thoughts and prayers. Kathy S. Pittsburgh, PA

Kathy S Pittsburgh

Hi, Great to hear that Riley's blood count has improved and that he is doing well. Hoping that our dog Archie can read this and start to get his pcv up a bit. Archie took ill the same time as Riley and it has been a long ride on this rollercoaster. Keep climbing up Riley

Sue Cambridgeshire UK

Hi Sue, sounds like your Archie and my Riley were diagnosed on the same day. I am keeping Archie in my thoughts and hoping that his PCV starts climbing soon! Kathy, I'm sorry to hear about your Mickey. This is a terrible disease and it's crazy how it strikes so quickly. Thank you for your thoughts and prayers, I'm sure each one is helping. Riley's gums look quite pink today and I am very happy. I took a walk today for the first time since his diagnosis and had to leave him behind, though. The vet says limit the exercise and I did not think he could make it as far as I was going. It was sad to leave him behind. My husband said he watched me leave out the window. :( Next time I will have to do a better job of sneaking out.

Jennifer

This thread was discussed between 02/03/2010 and 14/03/2010

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