Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Non-Regenerative Anemia

My little Beagle Darcy has been diagnosed with nonregenerative anemia. After blood testing that determined the type of anemia, she was put on Doxycyline to take care of possible parasites/worms that had not shown up in the stool or blood samples. She was also given Baytril for a urinary tract infection. In addition, I started giving her Pet Tinic, an iron/vitamin supplement. After one week, her PCV had gone from 25 to 20. I scheduled an appointment with a veterinary specialists group in the area. Two weeks later (this Monday) Darcy went in for an ultrasound and extensive blood work. The cost was $845, but I would do anything to help my little girl. The ultrasound looked good, only a little mottling on her liver which the vet said was an againg thing (Darcy will be 9 in October). I received the results of her blood work today and broke down and cried when the vet said her PCV was 13. She talked about a course of action which would include a transfusion followed by bone marrow testing. She did say that the blood test to determine if there is a tick related blood disease would not be available until tomorrow. She couldn't make any promises about what a bone marrow test would reveal if anything at all, but said it could possibly show an immune system problem which they would treat with prednisone. I decided to take Darcy in for the transfusion today and start her on prednisone. I want to see how this works out and also see what the additonal blood test report shows. I will pick her up this evening. Her appetite is still good when it comes to organic chicken and brown rice and an occasional egg and Frsoty Paw, but she seldom touches her Newman's Organics kibble. I was just devastated today over the blood results and knew I had to make some important decisions. I hope I've done the right thing, opting for the transfusion and the prednisone. Has anyone else had a similar experience or can anyone offer suggestions?

Karen North Carolina

Karen. I am sorry that you have had to join us but you have come to the right place. If you haven't found your way to Joanne site yet here is a link http://www.cloudnet.com/~jdickson/ It will answer a lot of questions that you have as well as help you know what the Doctors are talking about. I am concerned that your Vets have not been more aggressive in treatment or maybe I am misreading your post. Time is of the essence when treating this. If you have any questions know that people on this board are very helpful while sharing their experiences and we have all been in your shoes. Best to you and Darcy. Penny

Penny Lytle Creek Calif

Penny, Thank you for your kind words and the link. You say that you are concerned that the vets may not be treating this agressively. Can you elaborate more on this? Darcy's tests haven't shown any blood in stool or urine and she hasn't been throwing up. Her gums, tongue, and inside of ears are pale and that's what prompted the initial blood tests at the local vet. She also sleeps a lot and seems tired. She has gained three pounds since the initial diagnosis of non-regenerative anemia, which is probably because I've been feeding her organic chicken breast, brown rice, organic low-fat hamburger, eggs, and she will east a little Newman's Organic dry dog food. She drinks water, goes to the bathroom, etc. Her bone marrow is not producing the baby red cells, hence her packed cell count of 13 and the need for the transfusion. She's still at the specialists and I will pick her up this evening and then start her on the prednisone. I'll have to call the vet in the morning to get her blood levels and, hopefully, the results of the tick blood test. Is there something more that you think I should do or ask the vet to do? Thanks, Karen & Darcy

Karen North Carolina

karen- some dogs begin to re-generate right away, others do not and it takes weeks or months. my dog took 6 months before she even showed any re-generation at all. just hang in there and keep learning about what needs to be done to better darcy's chances. this is the right place to be, most people here have a dog going thru one form of AIHA or another,

josh california

Thanks, Josh. Your words are a great encouragement to me. I'm glad your dog had a good response. I'm so fortunate to have discovered this site. Karen

Karen North Carolina

Sorry that you have joined us here, but this is a great place to be for information & support. As I'm sure you have been reading, there are additional drugs besides prednisone that can be used: Imuran and cyclosporine seem the to be the most common, though other substances are sometimes brought in when those aren't effective. Be sure to ask your vet about them if the only thing they are offering is prednisone. With low PCV levels, lethargy and tiredness will happen. It's a survival mechanism, there is not as much oxygen getting to the tissues. Joanne's site that Penny listed above is great. It's full of information and wonderful success stories. Best wishes and prayers for Darcy.

Ronda So Cal

Karen, I am so very sorry to hear about Darcy. In many ways this is the exact same scenario as we went through with Chance last year. The main difference is that he had his spleen and a large mass removed in March 07 and seemed fine until about 1.5 months later. It is very good news that your vet did an ultrasound to check the internal organs and that you are testing for tick diseases. Those are diagnostics that some vets skip over. Non regenerative anemia is very serious, I will not deny that. We went to a specialist who is highly recognized for his expertise and he was stumped as to the exact cause. He did do a bone marrow biopsy and the results were that he COULD NOT FIND ANY MARROW CELLS even doing 5 different taps. So in our case, the bone marrow biopsy only confirmed what we already knew: he was not making blood and in addition he was not making white blood cells either. He sent us home with a very high dose of prednisone and antibiotics to protect from infections and I am sure thought he would be dead within a few weeks. I asked Dr. Dodds to come on board to help with a treatment plan for Chance a little over a month later. We had done a couple of transfusions at this point but there had been no sign of regeneration. She was overly excited to help me and developed a treatment protocol just for Chance that included adding cyclosporine in the veterinary form of Atopica, slowly reducing the prednisone, continuing the antibiotics and adding a number of complementary drugs to protect the stomach and liver. The most important thing that she told me was that AUTOIMMUNE DESTRUCTION CAN BEGIN AT THE MARROW PRECURSOR CELL STAGE. It's a critical thing to understand and many vets do not understand that kind of advanced autoimmune disease in detail. Since the marrow makes red and white blood cells, along with platelets, any suppression of the marrow by drugs, tick disease, heavy metals, etc or *the immune system* is devastating. Thus when the bone marrow biopsy was done, there were no cells to be found. I think the specialist was satisfied he did the procedure, but really it did not tell us much about why it was happening. In essence it was a step we could have skipped. I always say it's like when you think you have a flat tire and you get out of the car to look and see that, indeed, you actually do have a flat tire. You probably didn't need to get out to figure it out and it didn't get you any closer to fixing the problem. Chance was very sick for a very long time. I will not deny that this can be a long complicated process that will be nearly round the clock. However, after about 2-3 weeks on the cyclosporine, Chance did begin to become regenerative and by late fall we knew he was not only going to live but would return to good health. In addition to the difficulty for the family in terms of the amount of care it takes all day and night long, this can be a very expensive treatment. I'd estimate that we spent close to $6,000 if you include his surgery to remove the spleen in March. I do know that others on this board have spent a great deal more than that. I have a medical background and I began studying veterinary hematology so I could be right on top of everything in the treatment plan. I learned where I could save money on tests and where I really should put the money. I felt early on that my local vets were fully capable of doing 90% of the treatments required. They were extremely capable and glad to treat Chance with the assistance of Dr. Dodds guiding the protocol by email. The three of them went well above the call of duty to learn everything they could to help him. We were lucky that the vet's donor dog was a good match for transfusions for Chance and doing them in the local clinic made it easier for Chance and cost us less than an emergency clinic. I scheduled them ahead of time so they could be done at a quiet time in the afternoon. I paid great attention to his nutrition during this time. I have always made his food and I modified everything I did to ensure that it was safe, digestible and nutritious. What I am trying to say to you is that you have cause to be somewhat optimistic that you can bring Darcy back to good health. In some ways, this very slow reduction of the pcv in Chance was far less dangerous than the sudden massive hemolytic events that some dogs suffer. In your case, the pcv was slowly declining but for some reason, your vet's actions to do something about it were slow. My vet said to me "Patrice, when a human stops making blood, we give them transfusions to help them until we can figure out how to help them make blood again. We can also do that for Chance." That stuck in my head and I went home and studied everything I could about transfusions. I was no longer as worried about the cause of the non regenerative state as I had been. Instead I looked forward to find the best treatments for him. One thing that is very helpful is to keep a notebook in the kitchen and write down everything of interest: meds, foods, body temp, activity level, results of blood tests etc. Learn how to read a CBC complete blood count so you can look at the results (which you need to have copies of at home) and understand what they mean. In the meantime have a family conference and sort out how you feel right now about what is happening. Everyone at home needs to help for this to be successful. If there is a family member who might be resentful about the time or money spent, well that needs to be addressed now. Whatever you decide to do is the right thing. There is no right or wrong with this. You clearly love Darcy and will do what you can for her. If you are successful, that will be wonderful. If you decide she has suffered too much that too will be something you have decided out of love for her. I can tell you that I was and continue to be glad that I put forth the effort to save Chance. I can also say that I was exhausted afterwards. Please be sure to post the results of your blood tests here as soon as you get them. my thoughts are with you in this very difficult time patrice

Patrice NYS

Hi Karen, I'm so sorry that you have had to join us here, but you have come to a great place for resources and support. Everyone on here has been through or is currently going through what you are currently dealing with. I too live in NC and am curious what part of the state you are in. In my past experience, I learned it was critical to have someone with extensive AIHA experience to treat my dog Tipsi. She was treated by the internal medicine specialists at the NC State Vet School. If you are anywhere close to the Teachning Hospital I would highly recommend you taking Darcy there. How much does Darcy weigh? I am asking because she needs to be on a dosage in (mg) of prednisone that is at a minimum the same amount as her weight. For example if she weighs 15 pounds then she should be on 15 mg a day split into 2 doses. And in some severe cases this dosage should be even higher. My Tipsi weighed 14 pounds and was on 20mg a day because her case was so severe. In addition to the prednisone I would ask about including an additional immunosuppressant. Typically Imuran or cyclosporine would be good options, although it may take a while for these drugs to begin working. Also, talk to your vet about starting Darcy on something to protect her stomach from the prednisone. Pepcid or aka (Famotadine) would be a good option. And don't be alarmed if you have to give Darcy several blood transfusions to buy her time until her bone marrow starts regenerating. This isn't uncommon and many people on here have been through that. I'm not sure if the vet has mentioned this to you or not but many AIHA dogs are at a high risk for developing blood clots that can become disloged in their system and move to vital organs. Tipsi was initially given shots of heparin to help combat this and was then later switched to baby aspirin. The most important thing is that you learn as much as possible about this disease so you can work closely with your vet. It will definatley be a roller coaster ride so you have to be prepared mentally as well as financially. But just know you have support here if you have any questions or concerns. I wish you and Darcy the best!! You'll be in my thoughts and prayers, Layla & Tipsi

Layla Raleigh

Karen -- I'm sorry to hear your dear beagle girl, Darcy, has come down with IMHA. Patrice and others have given you good advice. Someone on the forum recently posted Dr. Dodds' protocol for treating IMHA, so maybe you can pull that up too and share with your vet. I am glad you are doing the transfusion and getting Darcy on prednisone, because the tranfusion will help buy time so the pred and other drugs can kick in. I will keep you and Darcy in my thoughts and prayers, and I hope that hers is a case where the immune system responds to the drugs and the bone marrow can make new red blood cells. My husband and I lost our dear beagle to this disease three years ago, and it is so hard. I so hope you and Darcy will be winners this time. Please take care.

Brenda VA

Thanks Ronda, Patrice, and Layla for all of your comments. We just brought Darcy home from her transfusion and she seems very tired and very thirsty, and will not eat at all. She is also a bit constipated. I was able to get her prednisone down her by wrapping it in peanut butter. She weighs 26 pounds and is on 30 mg. once a day. The latest blood work came back negative for tick disease. I take her back next week to have her blood levels tested. I will not know until tomorrow, when I call the vet, what her level was after the transfusion. When I call, I will ask about some of the other meds that all of you mentioned. I have been giving Darcy the Pet Tinic (iron/vit. supplement), but none of the vets seem to think I should continue with it since it hasn't helped so far. I was reading on the internet about a supplement called BioPreparation that has produced good results. Has anyone heard of it? Layla, it's interesting that you mentioned the Pepcid. Our regular vet has always told me to give one half Pepcid a day whenever Darcy's been on meds. I mentioned this to the specialist, Dr. Purnell, and she said that she never recommends that unless a problem develops. I'm a bit confused over this, but I do recall reading something about Pepcid not helping unless an ulcer had formed. Also, Layla, I live in the High Point area and the specialists I take Darcy to are in Greensboro. Thanks for all the advice and especially the prayers. Karen & Darcy

Karen North Carolina

Brenda, Thanks for sharing and for caring. I'm so sorry about your beagle. Pets are such sweet little gifts from God. They offer so much unconditional love and it really hurts when we don't know how to help them. I'm sure you did all that you could for your little one and that is what I want to do for Darcy. I did find Dr. Dodds' protocol and am printing it out to share with my vet tomorrow. Thanks, Karen

Karen North Carolina

Darcy's story is pretty much identical to my Emma's. Emma became severely anemic back in March, and blood tests found the anemia to be non-regenerative. Her stool sample came back negative for worms. She took Doxycycline while they waited for the results of the tick test, but that too came back negative. She also was on an iron supplement and antibiotics for a UTI. She ended up getting a blood transfusion and was put on Prednisone. After about two weeks on the Pred, her PCV count was not going up. I opted to go ahead and do the bone marrow biopsy test. From this test, they were able to tell me that Emma did not have leukemia. They also were able to tell me that Emma was producing red blood cells in her bone marrow at that point, but was missing some of the precursors which affected the releasing of the cells. The doctor told me that he was fairly confident that she would begin to release them soon with the Prednisone treatment. Within a month, her PCV was back up to 43. Emma would have survived without the bone marrow biopsy, but it was great peace of mind in our case. There are a few drawbacks though. I think I paid around $500 for the test, and Emma was sore and on some pain meds for a couple days after. Also, as your vet and Patrice said, there is always a chance it won't provide you with any new or useful information. It is something that might be worth looking into if the pred doesn't seem to be helping regeneration.

Michelle IA

Karen, It might not hurt to print out some of the information on Joanne's page to talk over with the Vet. A large number of dogs on this board have had gastric problems when no pepcid type drug was administered with the high doses of steroids. I also am curious as to the once a day dosage of the Pred. I definately would not wait a week to have her PCV checked. A transfusion will raise it up but usually only for a little while and it takes days for the Pred to kick in. One thing that you can take comfort in is the disease itself is not painful. A lot of Vets look at this diagnosis as a death sentence so make sure you have a Vet who is willing to fight the fight. If you didn't read them when you were at Joanne's site check out the success stories. Keep us posted. Penny

Penny Lytle Creek Calif

Karen, It had always been my understanding from Tipsi's vets that they wanted her on Pepcid (Famotadine) as a precautionary thing. It's suppose to help protect their gastrointestinal tracks while on such high doses of prednisone in hopes to deter any ulcerations. I think it would be easier to try and prevent them as you go versus treating them once they have already formed. Does anyone else have any advice on this that they could share with Karen?

Layla Raleigh

Darcy and I had a rough night after her blood transfusion. She was extremely thirsty, but wouldn't eat a thing. I was able to give her the 30mg. of prednisone in peanut butter. She had diarrhea and a rumbling tummy off and on during the night. At five o'clock this morning, she ate some chicken and rice. The diarrhea has calmed down. She drank water this morning, but she hasn't eaten and is just lying around looking sad. Her gums and ears are pink again! This morning I made a call to the hospital and the tech said that yesterday, after the transfusion, Darcy's blood count was at 36% (up from 13). I know that's the high end of the mild range for anemia, but I'm still hopeful that the prednisone will bring her level up even more. The tech said that it will take a couple of days for the prednisone to kick in. Layla, I did push the Pepcid issue and the vet agreed that I should give her half a Pepcid each day. I'm also to give her only bland foods like plain pumpkin, chicken and rice, etc. until her tummy is straightened out. Penny, I've checked out Joanne's page and also Dr. Dodd's protocol, which I plan to take with me to the vet next week. I notice that Dr. Dodd mentions chemical or toxic exposure as triggers for this problem. I spoke with our state's Dept. of Agriculture and they are going to test Darcy's food (Nutro Ultra Holistic Weight Loss Management dry formula)to see if it is tainted. It is not on the tainted recall pet food list, but I decided to withhold it when her problems started. Anyone have comments on how tainted dog food might attribute to anemia? Michelle, your story about Emma has made me very hopeful as well. Her case sounds just like Darcy's. I pray Darcy will have a good outcome like Emma. Will keep you posted. Thanks to all, Karen

Karen North Carolina

also when speaking of chemical or toxic exposure... did you just recently treat her with a new flea product? or etc... some flea products consistently have been thought to have caused these issues in our dogs, ask around and there are a handful of people that point to them as the potential reason

josh california

to add to Josh's comments - recent vaccination? (if you haven't already considered it). Pink is a wonderful color! Thinking good thoughts for Darcy that she stays pink!

Ronda So Cal

Thanks Ronda and Josh. I have always used Frontline on Darcy, but not every month because I just hate putting that stuff on her. However, I do use it every two or three months and always check her for fleas and ticks. It had been at least three months since her last application when the anemia problem started. When the possibility of flea/tick/parasites contributing to the anemia problem came up, that alerted me that it was time for another Frontline application. So, yes, I did apply it but it was after the anemia diagnosis. I'm not aware of Frontline causing problems for Darcy, but now I wonder. Her last set of booster vaccinations was in February. I have been reading that adult dogs shouldn't have any vaccinations except for rabies, so I did question the vet about this. Darcy was also on Rimadyl back in April/May for back problems. I alerted the vets to this also. They said that none of those things should have caused the problem, but I'm not convinced. I've had another crazy thought. Darcy has always had this thing about licking my husband's face. I've told him not to let her do it, but he thinks it's cute. He wears aftershave and I'm wondering if that could have contributed to the problem. Maybe I'm just grasping at straws here, but I'll see that she doesn't do it anymore. Also, has anyone thought about pet feeding dishes? Most of them are made in China. Remember what happened with toys and the lead based paint that was used to manufacture them in China? Karen

Karen North Carolina

My Great Dane, Athena has had anemia for several weeks and my vet has been stumped because her Coombs test was negative and her ACTH also came back negative. Her PCV is 18 and we have her on 120 mg of Prednisone a day. SHe was 150 lbs and now is 131 lbs. Her appetite increased with the Prednisone but she is still lethargic and sad. We did exploratory surgery because her pcv went down to 14 and the emergency vet thought she might have a tumor but all was clear. After some pepsid and a blood transfusion her pcv went up to 27 but not has fallen again to 18. I am at my wits end and cannot get any answers. My vet has consulted with Virginia Tech vet school but we have not done the bone marrow test which will come next. If anyone out there can help Athena God bless you! Please let me know what we are missing here. Thanks! Irene

Irene North Carolina

Irene, Where are you located in NC and has your vet referred you to a specialist? My dog was also diagnosed with non-regenerative anemia, which is different from the AIHA that most of the people who post here are talking about. In the non-regenerative anemia, the bone marrow doesn't produce the baby red blood cells. In the regenerative anemia, the bone marrow produces the red blood cells, but for some reason the body kills them off. I'm not an expert, but that's my understanding of the two conditions. My dog's PCV went down to 19% a week after her transfusion and the vet added the drug azapriothine in addition to the 30mg. of prednisone. We go back on Thursday for a recheck of the blood and I'm praying that her levels will have improved and she won't have to have another transfusion. I have not opted to do the bone marrow test yet because I don't want to put her through that. I understand that it doesn't always give answers, but, there again, I'm no expert. The prednisone has given her an appetite, but it causes her to drink lots of water and she pants a great deal at night and sometimes seems anxious. With the azapriothine there can be side effects and the vet said that she'll have to have her liver monitored while on it. Hope you can get some help for Athena and that she'll soon be back to her old self.

Karen NC

To those of you who are newer to this board you can access consultation with Dr. Dodds in Santa Monica, CA if you go to the Hemopet website. She is a veterinary hemotologist with extensive experience and can interact with you and/or your vet by phone and/or email. You can also access blood products through her canine blood bank which can save you money if your regular vet can do your dog's transfusions. Mine cost a third of what they had been at the Emergency Veterinary Hospital, permitting me to provide transfusions for a longer period of time to my dog to allow time for the medications to begin working. And remember...some of the meds take at least six weeks to begin to demonstrate their effectiveness so you may need those transfusions during this time to keep your dog going. I can't wait until there is no longer a need for this board. If any of you can afford to contribute even small amounts of money to the Morris Animal Foundation/Meisha's Hope that is conducting research for a cure for this disease PLEASE do so. Small amounts add up to large amounts and our precious pets need all of the help we can give them. Hopeful blessings to all, Cheryl (and always Barkley)

Cheryl Medford

This thread was discussed between 20/08/2008 and 03/09/2008

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