Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Our dog was recently diagnosed with AIHA

Our 6-year-old shepherd mix, Reggie, was diagnosed with AIHA On June 9th. He was immediately hospitalized with RBC level of 12%. The meds brought it up to 14%, but when it again dropped to 12% he had a blood transfusion. He was able to come home yesterday (6/15) when his RBC count continued to slowly rise (at 26.5% when he was released). Everything I've read about this disease sounds so hopeless. The high doses of meds may save him from the illness, but the drugs also have some severe side effects. I have yet to read about a dog who came through this illness without serious problems. My main concern right now is how bloated Reggie's belly is. Does this go down on it's own, or do we need to have the fluid drained? He's breathing heavily and his belly sways from side-to-side when he walks because it's so full of fluid. Just wondering what others have experienced. The vet said it was from the IV fluids he received and the steroids. Thanks! It was great to find a forum to discuss this awful disease with others going through it. - Amy & Reggie

Amy Kuether New Berlin

Amy, I am so sorry to hear of your Reggie's AIHA diagnosis. If you have not read my Web site on Canine AIHA/IMHA as yet, I would urge you to do so. The URL is: http://www.cloudnet.com/~jdickson/ Be sure to follow the links at the bottom of the first page to many other sites on AIHA/IMHA that will be very helpful to you and do read the Success Stories pages. The main Success Stories page is on vacation for the summer but there are lots and lots of Success stories in the archives. These stories will show you what has worked for other dogs in terms of treatment options as well as give you a lot of HOPE and indeed there is hope. Many dogs, including my own Meisha have lived for years and years past their AIHA/IMHA diagnosis and have had happy healthy lives during those years. Please know that your and your dear Reggie are in my thoughts and prayers during these most very difficult days.

Joanne MN

Meisha's story was actually one of the first I came across - it was nice to read some of the success stories. Reggie's IMHA had a very slow onset, which I've read is in his favor. Do you have any recommendations for vitamins/supplements that would help Reggie's body deal with not only the illness but also the effects of the drugs? I've read a number of things that people give their dogs, but I want to make sure I don't give him something that will interfere with his body's absorption of the drugs that are trying to suppress his immune system.

Amy Kuether New Berlin

Hi Amy, Sorry to hear you had to join us here, but there are success stories and this is a place to hear about them. In my opinion, you are definetely fighting 2 battles, one against AIHA and one against predniosone and the other drugs used to treat it. Since I came to this list in March I have seen dogs succumb to both! My dog Dylan is doing great at the moment (diganosed March 19th). We are beating the AIHA and now we are beating the Prednisone. Unfortuately it is an insidious disease and the battle is NEVER over. I watch for signs of AIHA and anemia in a paranoid fashion. Despite minor brain damage from her anemia and the side effects of prednisone that took away all her muscle and left her immobile for 2 months, now she is walking and sniffing and even playing. I have to still be cautious now of her hurting herself, as her muscle strength is still very low. It is nice to see my old girl being herself again, although still weak from muscle loss (her PCV is very good). Keep the faith though and ask lots of questions and learn what you can. There are very smart people here who can help. With some effort, you CAN win the battles, even if the war is never over. Fingers crossed and all our love and support go along with you and Reggie. Richard And Dog Dylan

Richard Burnaby

Amy, I am glad you found us and that you have read some of the success stories on the Meisha's Hope site. So now you know this is a tough battle, but it is worth fighting! I believe it is very important to have a vet on board that is familiar with this disease. Our vet consulted with Dr. Dodds from hemopet in California. This was the actual turnaround for my dog. Dr. Dodds gave us a schedule on how to best reduce the prednisone and azathioprene. She recommended thyroid supplements. I hesitated to put my dog on this and wanted to test him first. Well I could have saved that money:) Dr. Dodds was right on the dot. Most dogs are either hypothyroid before the disease takes hold and for sure they will be after taking all the prednisone. The thyroid supplement helps with the blood building. She also recommended a supplement called petinic. This is not available in Canada so we gave what is in it separate. Vitamin B, iron and folic acid. Please run this by your vet, but I am convinced this would help Reggie. Also make sure that he is on at least one stomach protectant. The drugs are harsh and could cause ulcers. It would also be beneficial to put him on something to support his liver, Milkthistle and SamE are common supplements for this. Make sure you feed Reggie a high quality, lean diet. I hope this helps, best wishes, Brigitte & the poodle boys

Brigitte BC

Hi Amy, Pet Tinic can be purchased online and is available freely in the US. I got it from wwwlhealthypets.com and had it shipped to Canada, but since you are in Wisconsin that does not matter. Richard

Richard Burnaby

Amy, Sorry that Reggie has been diagnosed with this awful disease. Glad you have read some of the success story's so you do know there is hope. You will find a lot of people on here who can help you with your questions and concerns. I will be keeping you both in my thoughts and prayers. Penny

Penny Lytle Creek Calif

He seems so very lethargic since being home - worse than before we found out he had AIHA. I also just noticed that he has streaks of slimy pinkish/red blood in his stools. Is this to be expected, or a sign of something else to worry about? Any thought on the bloated abdomen? I can tell it's making him very uncomfortable and his breathing is obviously requiring more effort than it should :-(

Amy Kuether New Berlin

Amy, blood in the stool is definitely a worry. i would suspect that he has ulcers from the prednisone. Is he on any stomach protection? sucralfate, sucrate or carafate? Are you giving this an hour (or so, not to sure about the timing anymore) before the prednisone? This is VERY important. I think I would take Reggie in to get checked out, blood in the stool always concerns me. There are several reasons for his lethargy. His anemia is making it hard to get enough oxygen to his organs. This makes him very tired. Healing is tiring out his body and then of course the medications tire him out as well.The panting is a sign of the lack of oxygen and a side effect of the prednisone. So is the bloated belly. But then I have also heard of dogs that collected fluids in their bellies. Only your vet can tell what is happening. Is your vet experienced with this disease? Has he successfully treated it? Would he/she be willing to consult with a specialist? The chances of Reggie surviving depend on the knowledge of your vet, there is so much to know! of course your loving care comes into play and also Reggies will to live. What medications is Reggie on? What are his blood and chem values? How much does he weigh? Thinking of you, best wishes, Brigitte & the poodle boys

Brigitte BC

Reggie weighed about 50 lbs when admitted, but with the fluid in his belly I'm sure he weighs more right now. Below are the meds he is on: 1) Prednisolone 20mg tablets (2 1/2 tablets every 12 hours) 2) Azathioprine 50mg tablets (1 tablet every other day) 3) Metronidazole 250mg tablets (1 1/2 tablets every 12 hours) 4) Cyclosporine 100mg and 25mg (1 of each tablet every 12 hours) 5) Phenobarbital (Reggie began having seizures last Nov. and has been on Phenobarbital ever since - 1 grain tablet every 12 hours) I don't see anything in there to really protect his tummy from the harsh effects of the Predisolone . . .

Amy Kuether New Berlin

I just called the vet and she wasn't concerned about his bloated belly - she said it's normal with the meds he's on (he just seems so uncomfortable sloshing around with all that fluid). She did tell me to start giving Reggie 7.5mg of Pepcid 1 hour before his meds (but only once a day) to help sooth his stomach.

Amy Kuether New Berlin

Hi Amy, A bloated belly can easily make breathing more difficult, as it prevents the diaphram from lowering and drawing in as much air. It takes more work as a result of the bloat to do so. As Brigitte said too, on prednisone (especially the high levels used on AIHA)they will always be overheating so panting and deeper breathing are common. Other than the prednisone itself, there are other causes of bloat (many of them serious) and in my first dog (no AIHA) it was due to a tumour near her heart that was bleeding and putting pressure on the liver (please, this does not mean it is what your dog has going on). This caused yellow fluid in her belly, but it was easily diagnosed by a sample of the fluid and then subsequent tests to see why there was bile in her gut cavity. Has your vet checked the fluid? Some bloat after taking prednisone is common, but I have no idea how severe it can be. With Dylan it was, and still is minor. If it is of concern, maybe you should have it checked to see if something can be learned about it. I have no idea how much they can tell it is from the prednisone versus other causes. Other illnesses comibined with AIHA do seem to be common from what I can tell so far. I don't know a lot about triggers for AIHA yet, but one of them is thought to be cancer. Maybe someone more experienced could address that as a possibility. Taking a dog to the vet can be very stressful too, so it would really depend on the discomfort and severity level. Difficulty breathing is something to be concerend about as it is very stressful and does not allow them to rest and recover very easily. You are the expert on your dog and what you think you see matters a great deal. What you feel in your heart matters too! There are no easy choices at the moment, but whatever you decide to do, we will support you and offer help. Good luck for you both, Richard

Richard Burnaby

Amy, glad your vet is not concerned, so keep an eye on it and if it gets worse, or you feel it is a bigger problem than your vet thinks it is, ask again. Tell them of the discomfort level or any other details that concern you. For now, if it is stable, maybe you can relax about it, but continue to observe in detail for changes in his condition. Unfortunately, the intial phase of this disease is a scary rollercoaster of hope and despair, but it does get better. Your help will make a difference. Good luck, Richard

Richard Burnaby

Hi Amy: Because of the blood in the stool, I would call the vet to let them know.I would also ask if the blood work have had good plalet counts. I have rerad that many dogs can have a combination of AIHA (immune system attacking red blood cells) and ITP (immune sytem attacking platlets). Or, have one and develop the other. If the 2 illnesses are running at the same time it is called Evans Syndrome. If it were me I would want the peace of mind knowing the bleeding was from the meds and not the illness.

ELAINE Ottawa

He seems a little more perky this evening and has been following me around as usual. He has his first post-hospital blood check tomorrow and I'm SO nervous! When he was released I could see a little pink coming back to his gums . . . today they look more white to me. I don't think my husband will approve of another blood transfusion (we honestly cannot afford what has already been done), so I'm really scared his red blood cell levels have dropped. Praying, praying, praying . . . Does Reggie's med list above look normal for this stage of the illness? He's walking around like an old man and can hardly take the one little step up back into the house after going potty. So sad to see him feeling so awful when he's always been such an energetic companion, tearing around the yard with his/our six young children. We've also been trying to shop around for better pricing on the cyclosporine, but everywhere we go we find it's about $430 for one month's supply :-/

Amy Kuether New Berlin

Amy, Before you go in to do the blood test tomorrow, make a list of all the questions you want to ask the vet. I think the medications you are giving Reggie are ok, I just think he should be on a stomach protection, something like Sucralfate or Carafate. With the high doses he is on, this is VERY important. I would also make sure the vet knows about the blood you saw in the stool. Has this happened again? Ask about thyroid supplementation. Most dogs are hypothyroid at this stage. Ask about liver support and petinic. I know you have a lot to worry about and are pretty stressed out, but try to stay calm and in control for Reggie's sake. He will pick up on it if you are stressed and he does not need that. Try and keep a routine and be "business as usual" this will help him a lot. He will get his strength back, it is just a matter of time. Be patient! Please go back to the posts of the pug with AIHA. Patrice posted some information on Dr. Dodds. I think it would be good if you or your vet would contact her. Remember that Reggie is not in pain, just very tired. Hopefully his RBC is up and you can start to slowly reduce the medications soon. This will greatly improve his well being. Hang in there! Best wishes, Brigitte

Brigitte BC

Brigitte - do you think the Pepcid that the vet told me to start giving Reggie will do the same thing, or do I need to look into Sucralfate or Carafate because they are better?

Amy Wisconsin

Hi Amy, Pepcid AC protects the stomach during digestion, but does not help ulcers once they occur. Sucralfate is different and I believe helps bind to ulcers and protect them from further damage and allows healing. Richard

Richard Burnaby

Amy, another quick note on Azothiaprine and Cyclosporine. They take 2 - 3 weeks or more to kick in. At the moment the only drug helping is the prednisone. They will eventually help as well, so keep fighting :-) Richard

Richard Burnaby

I just read that a very, very high dose of Prednisolone would be 1mg per lb of body weight, divided into two daily doses. Reggie is on 100mg a day, divided into two doses (50mg morning and 50 mg. night). He's only 50 lbs . . . is his dose too high??? He's taking twice as much as what is considered a high dose.

Amy Wisconsin

Amy, While the usual dose of prednisone is 1 mg per pound of body weight divided into two doses,many vets will give a much higher dose at the onset. I have seen as much as three mg per pound given. So I personally would not worry about the dosage at this point. I am sure that once the other meds "kick in" your vet will lower the prednsione. If you are concernened about this large of a doseage of prednsione please do mention this concern to your vet and see what he/she says.

Joanne MN

Amy, that is the exact same dose Dylan was put on. It is a very high dose and I know it can also prevent recovery at some point, but the immune system needs to be stopped first. Once Reggie begins to recover (and prednisone can take up to a week to act fully from what I read initially). Hopefully you see Reggie begin to turn around and gain strength soon. I would be more concerned about the hi dose of prednisone after you saw more recovery, but again, this is likely a question for a vet since unique circumstances require unique decisions to be made. Richard

Richard Burnaby

Is Reggie eating okay? What is he eating? Richard

Richard Burnaby

Amy, Richard and Joanne answered your questions already. But I am still going to pipe in:) I do it because I think it is important to have Reggie on a stomach protectant with this high dose of prednisone! There are enough side effects that you can not do much about, the stomach ulcers you can at least try to prevent with Sucralfate. Hopefully you can start reducing the prednisone soon, but even with a lower dose the chance of getting ulcers is high. Sucralfate is a fairly cheap drug and giving it you can avoid lots of problems. Good luck at the vet today! Brigitte

Brigitte BC

Hi Amy, I was just reading a little on the Hemopet website about a condition that does impact recovery and results in a poor response to drug protocols (I did not find anything on transfusions). Again, this does not mean it is what is going on with Reggie. Reggie might just have a slow response to prednisone and maybe today is the day you see some good signs :-) This is from Dr. Dodd's Hemopet website. It is farily technical, but very informative on other related subjects too. It relates a thyroid condition to AIHA as the potential cause of this type of problem. I have never spoken, or written to Dr. Dodd's, but many have done so on this list and she has helped every one of them from what I have seen. She is a specialist in not only the blood and AIHA, but the operation of the glands involed and is the expert on thyroid conditions in dogs. The recommended dose in this condition is 2 -3 mg prednisone per day (divided into 2). Once you get a response, she recommends reducing by 1/2 every week up to a point and then maintenance, but again, this is for later. This is not necessarily what all vets will recommend, however, and remember, we have no idea if this applies to Reggie at all yet. http://www.hemopet.org/files/20100324151343591.pdf http://www.hemopet.org Richard

Richard Burnaby

First I want to thank everyone who has taken the time to weigh in on our sweet Reggie's condition. It helps SO much to chat with people who have been through this and can provide personal experiences! Honestly, Reggie seems to be a little more up-beat today - he's already taken two walks completely around the house, sniffing all the way. Yesterday he would only go out to pee and come right back inside. I also found him licking the baby's highchair seat clean and waiting under the kitchen cutting board hoping I would drop something. So, I'm hoping the white gums aren't the only thing that indicate how he's doing. Since puppyhood Reggie has eaten the generic Walmart brand of dog food (my husband is a bit cheap). This morning I actually went and bought both a multi-vitamin to add to his daily regiment and also a holistic, grain-free food for him (Earthborn brand). He did clean out his food bowl this morning and also ate some of the new food after I re-filled his bowl. Praying for a RBC number higher than 26% today!

Amy Wisconsin

Hi Amy, Great to hear he seems to be a bit better. This is likely due to prednisone effects. I did get a 24 hour swing each day where Dylan would be good and then not so good, until finally she was all good after a few days. Hopefuully that is what you were seing already and he is done with that. Prednisone will make him aggresive for food and he will likely snatch anything from hands. He will accientally hurt a child possibly. This is not being mean, but a direct effect of prednisone. Dylan now howls for her food and I have to put all my dogs away during prep, including her, so I don't have an issue develop (she would get hurt in a fight for food). She started the "snatch and grab" from me right away and I had to learn to be careful with food around her (in addition to not wanting her to eat stuff she should not). Prednisone reductions become very important, so learning as much as you can now is best. My reductions with Dylan were more aggressive than usually done, but her blood recovered quickly and I had no doubt the AIHA was under conrol. She experienced a lot of symptoms described in Iatrogenic Cushing's Disease in the link below. She became immobile after only 3 weeks. I had to use a harness and towel as a sling to take her out for a pee. She is better now though. They do recover. Dylan is walking on her own and we are back going for short walks. This is the answer to a question I see asked a lot here. "Yes" they do recover from the effects of prednisone, but love and effort are required to get through it. There are both short and long term consequences of prednisone and protecting the stomach from an ulcer if present is very important. Liver too. The link posted for me was from Patrice, http://www.kateconnick.com/library/cushingsdisease.html Diet is very important now and will make a difference in recovery, but until you see recovery I would not necessarily consider a change. Diet changes add stress to the body so consult your vet if you do consider a change. There are many opinions on what a good diet is, but doing the best you can within your own limits is probably best. This is something I recommend you talk to your vet about too! Maybe a better quality kibble, made by a more local manufacturer as they tend to produce better products. I don't know much about kibble produced for specific medical conditions like liver problems, etc. Some recommend converting to a cooked human food based diet, but this does take more effort. There is a great liver sparing diet if Reggie experiences liver problems, but it is not a kibble based diet, rather a diet based on cooked carbs and minimizing digestive workload. Others on the list know more about that. I am a rebel. I feed a raw diet of meat and bone mostly and continue to do so with Dylan. This is not something I go about recommending to others, especially if they are recently diagnosed with AIHA. Hoping things continue to improve, hope this helps, Richard

Richard Burnaby

Well, we just returned from the vet and his RBC count went from 26% at release to 21% today (two days later). The vet said she was very discouraged to see that and ordered another blood test to see if Reggie is still generating red blood cells. I did ask if she's treated many cases of AIHA and her response was, "Oh, God, thousands!" So, I trust she knows what she's doing. She also said that it may take a few weeks for his system to start cooperating with the meds - I'm just praying his RBC count doesn't drop too low in the meantime. This disease really is all-consuming.

Amy Wisconsin

Yes it is all consuming, but it can and will be better. The power of positive thinking! Drops in PCV like that in the first week seem common if you ask me. Especially if the effects of prednisone are only being observed now. Obviously you want it to come back up asap, but each dog requires a different amount of time. Get "Pet Tinic" and start using it. Your dog food will not be good enough to provide all the nutrient needed for recovery of Red Blood Cells. This will provide more iron and vitamin B to aid in the process. Sad how many dogs are treated for this disease. But they are worth the fight, if you ask me. I love my dogs and I am grateful to still have Dylan. When she pops up on the couch for a cuddle now, it is even more special than ever before. Hopefully Reggie has started producing red blood cells and his numbers get better, Richard

Richard Burnaby

Amy - hi, I'm sorry you are going through this with Reggie. You said he is on PB for seizures. If you haven't done so, I would have a full thyroid panel run through Hemopet, Dr. Dodds organization that has been mentioned here, right away. Many dogs who have seizures and IMHA are hypo-thyroid and it is a condition that can often be treated easily and inexpensively with thyroid supplementation. Dr. Dodds can help you with both conditions - she has been helping me for four years since my dog's IMHA diagnosis and now with his seizures. It's important to have a full thyroid panel run versus the typical add-on that is run by a regular vet's office (which is only one component of the panel). I can tell you that Dr. Dodds prices are very fair and reasonable and she will be of tremendous help. Please do not give up hope - my dog's PCV was in the low 20's for several months before he began to turn around. One of the most important things you can do is have a vet who is experienced with the disease and is willing to work with you. All the best - Bonnie

Bonnie Chicago

Amy, Dogs do come out of this without any lasting problems. My dog Buster is here today after suffering with IMHA. He had seizures, blood transfusions, liver numbers out the you know what, and he made it. It was a long long old road but he is now happy, healthy and no way would you think he had been through what he went through. Sometimes things don't happen the way they did for us, but, there is always the chance that it could. Don't give up! Ronda and Buster

Ronda Illinois

This thread was discussed between 16/06/2011 and 17/06/2011

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