Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Please Help Angel!!!

My dog Angel, a White German Shepard, just turned eight yesterday. She has IMHA. Angel had a MCT(mass cell tumor) removed from her hind leg on Tuesday, she was recovering at first, but then her condition rapidly deteriorated. We brought her to the vet on Friday. After running multiple tests ruling out additional tumors pneumonia and infection, we were told that it was IMHA. Her PCV was 19 on friday. The vet gave Angel a blood transfusion on Friday night and her PCV was then 27, she was also put on IV fluids, dexamethasone, azathioprine, and prednisone among other meds. Saturday Angel's PCV dropped to 22, then to 17. Saturday night she was given a second transfusion and her PCV only went up to 22 this time. I just wanted input from anyone who has any experience with this type of situation or any information that could help please. Thank you in advance.

megan illinois

Dear Meagan, I am so sorry you got this diagnosis for Angel. It is a serious disease, but there is hope. Please go to Joanne's "Meisha's Hope" website and learn as much as you can: http://www.cloudnet.com/~jdickson/newhope.htm When you read the success stories, you will see, that there are so many dogs that recovered from this. It sounds that Angel is in good hands with your vet. A PCV drop after the blood transfusion is pretty common. The destruction is still going on and the medications have not kicked in yet. It could also be that because of the IV fluids that the numbers seem lower than they actually are. Once the meds take effect, you will see the numbers climb. This will not happen over night, you will have to be very patient. Hopefully there will be an improvement soon, so you can take Angel home. Make sure to write up all the medications, doses and times to be given. Have a day planer ready. Let us know how things develop. We will keep Angel in our thoughts and send lots of positive energy your way. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Thank you for responding Brigitte, i am looking into that website now. I Just spoke with the doctor and she said that not only did Angel's temperature spike during the second transfusion(which luckily has returned to normal) but also her blood pressure rose and has not come down yet, the doctor said she may need to put her on a medication for that as well if it doesn't come down this afternoon. Angel definitely had a much harder time with the second transfusion, she also urinated on herself during it and apparently since then too, even though they said she is still going outside. The doctor said there was some blood in her urine, she is looking more jaundice today and that she is a little more lethargic today. The doctor also increased her prednisone. The way Angel reacted to the second transfusion and for how much less her PCV went up on the second one is so concerning if she ends up needing another one, and Angel's PCV dropped so fast from the first one. Her meds do not seem to be kicking in at all yet, i wish i knew how long it would take for them to start working or if they were going to. The doctor said she would be much slower to recommend a third transfusion due to possible bad reaction, so they would wait longer this time and that she usually never recommends more than 3 as they do not go well. I am going to read more on "Meisha's Hope" now, everything else I have read so far about IMHA and the mortality rate is just so completely horrifying. This is so hard, it just hit her so fast and I just don't want her to suffer. She is such a great dog. Once again anyboby that sees this that may know anymore about this type of situation please respond.

megan illinois

Megan, I am sorry there has not been an improvement for Angel yet. There are a lot of similarities, but also every dog reacts to medications and transfusions differently. I think I would ask your vet if she could consult with Dr. Dodds at hemopet. Dr. Dodds is THE expert in blood diseases AIHA/IMHA. Our vet had some experience, but started to feel overwhelmed and needed some guidance. She called Dr. Dodds who gave us some very valuable information and advice. If your vet does not see any value in this you could write to her yourself. You would need all the test results and write them down for Dr. Dodds as clearly as possible. Hemopet also has a bloodbank and does testing. Don't let the statistics posted on so many sites get you down! As you see on Meisha's hope, there are so many that live after multiple blood transfusions and even relapses. Where there is life there is hope. Also, remember that Angel is not in pain. She is very tired and probably feels nauseous, but there is no pain with this disease. The peeing on herself might be a reaction to the prednisone. Dogs who are on high doses of this medication loose muscle and it is hard for them to control urination. This could be a sign the pred has kicked in! Take care, try to get some rest. Best wishes and good luck, Brigitte & the poodle boys PS: Dr. Dodds contacts (714) 891-2022 e mail: hemopet @ hotmail.com (remove spaces) She is not available Saturdays, but I go an answer one time on a Sunday. She usually answers very promptly if she is at the lab.

Brigitte BC Canada

I am sorry to read that your Angel has been diagnosed with AIHA. You have found a great forum and many have gone through what you are going through now. It often takes a few days or maybe even a week or two for the medicine to really begin working so the transfusions often buy needed time. Hopefully Angel can hold steady or not drop into single digits she may not need another one. Sometime cyclosporine is also used, you might want to ask your vet about that. The prednisone makes them urinate and often they just control it while being on a high dose of the pred. How many mg's is Angel on of the pred and the azathioprine and how much does Angel weigh? Is Angel eating anything? Ginger and many other dogs on this forum have had blood in their urine, so that is not uncommon. I know it is so hard right now for you but you just have to take it day by day and sometime hour by hour and give the med's a chance to kick in. Please know that I am praying for Angel. Keep us updated on how she is doing. Cheryl & Ginger

Cheryl & Ginger Pinevile Pa

hello megan,dont give up hope.listen to the experience of the people on this site, they have all been through it.my dog amy was diagnosed 4 weeks ago,she went in for a lumpectomy and didnt pick up.her pcv went down to 10,and needed a transfusion,which took it to 20 then she had a burst ulcer from the meds and it dropped again.but with persverence.its now 40 and dropping back on the meds.so keep faith,and help angel fight this terrible disease,it can be beaten. best wishes,john & amy.

john teesside uk

I am so sorry to hear about your dog, mine was recently diagnosed with Evans syndrome same illness but it also affected his platelet count as well. Ekim my 7 year boxer is my best friend I am frantic with worry we didn't start the chemo drug yet because his counts came up a little with the steroids and he wasn't eating so the vet wanted to wait until his appetite improved a little.So I guess we will start them tomorrow and we also have an appointment with Cornell University. It has been only a week but this is killing me so I feel for you. Someone told me that it is harder to treat larger dogs and the prognosis was poor for big breed dogs, Thank God I found this site it shows that some large breed dogs did well. Please keep in touch and I will pray for your baby.

LUANN PA

Megan, I am so sorry your Angel has been diagnosed with this awful disease. The important thing is to have a Vet that is well versed in treating it. When you go to Joanne's site be sure to read the success stories too. It is a good thing to have proof of success when you are also reading all the dire statistics. It is a tough disease but it can be beaten. Keeping you and Angel in my thoughts and prayers. Penny

Penny Lytle Creek Calif

Luann, I don't think that it is harder to fight this disease for a large dog. In a way it is easier to dose the medications than for a smaller dog. Especially when it comes to the reductions. With larger dogs, I think there is more room to reduce slow. How do you split an already split pill? so don't let anybody tell you it is harder for Ekim! I am glad you will go to Cornell, (hopefully soon) he will be in good hands there. What "chemo drug" were they talking about? Stay positive, concentrate on Ekim getting better and he will! Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Megan, I'm so sorry to hear Angel has this terrible disease. You'e got some great advise above. I'm wondering what's up with the blood myself. Did the vet look at it under a slide (microscope)? Here's what you should call and ask... 1)Are there spherocytes seen under the scope? Was a coombs test done? The coombs would have to be sent out. FOR SURE THOUGH ask for them to look for spherocytes. 2)Ask them if they can give her an injectable form of the dexamethasone or prednisone. These will work much quicker than the oral forms which is what is needed now. I wouldn't go no more than 2-3 injections over time though. 3)Given the time for these meds to start working...Pred up to a week, azathioprine up to 10 days and the dexamethasone actually I'm not sure but I'd assume it would be within a week due to it's strength......I'd ask to have Angel put on Cyclosporine (Atopica) because this targets the part of the immune system that actually needs to be suppressed. Cyclosporine works much quicker than the other drugs and rapid suppression can be seen in as little as 48 hrs!!! I also wouldn't worry about having to have multiples of trasnfusions done. I've heard of dogs that have had up to SIX transfusions and are still alive today!!! Just gotta make sure the blood is a good match. Someone above mentioned Dr. Dodds and that is a VERY good idea!!! Contact her tonight if you can. Everything you are describing is normal with what you are going through. Hang in there and be strong. Try to relax and be calm if you can that way Angel doesn't pick up on any negative energy. Dogs can pick up on anything! ALSO...tell us her weight and teh amounts of each drug she is taking. My thoughts and prayers are with you both during this tough time. Johnny & Tessy

Johnny

Thank you all so much for responding, it definitely helps. I just got back from a visit with Angel a little while ago and she is shockingly yellow today. The great news is that her afternoon PCV test was 24, it was 22 after last nights transfusion, so hopefully tonight's PCV holds or at least doesn't go down too much. That test will be very critical, but we are now hoping the meds have started working. We really need that to be the case. I have also heard of many dogs getting multiple transfusions, from what I've read online, but we're not sure Angel would fair so well through another one. The latest bad news is that her bilirubin count is at 44.3 and the vet said it should be 1 or less, they said this was caused from the transfusion. So now we need the PCV to go up and the Bilirubin's to go down. She had started to eat yesterday for the first time in a while, but she vomitted today. Sometimes it seems like one step forward two steps back. My sister and I did leave Dr. Dodds a message before we left and we're going to email her as well now that were back, thank you so much for the info. Angel's blood pressure did eventually come down to normal without needing medication for it, so that was really was good. We took her outside the vet, with her sling a few times and she went pee twice while we were there, when we had her lay down on the blanket we brought for in the room, some more leaked out a couple times like they told us. Angel weighs 81 lbs unless she has dropped more since Friday, which is likely. I asked about the dosage of the Pred. and they said they were doing 3mg per kg, which they said was 55mg twice a day. I think they were giving her 40-45mg twice a day before they upped it. The Azathioprine, the doctor said was 2mg per kg she believed but did not have the paperwork in front of her. As for the coombs test, the vet told us on Friday they were going to do one, but come Friday night they said it was no longer going to be necessary. The Doctor said she could see all the red blood cells clumping together, that it was severe, and they knew then she had IMHA, so there was no need for it. They said it no longer mattered about type or cross matching the blood because they then were going to be using a universal donor, and that her body would destroy any foreign red blood cells just as her own were being destroyed. This was just supposed too tide her over till the medications start working, also they needed to start the transfusion immediately. Angel did receive dexamethasone intravenously, but on Saturday, they switched to prednisone orally. I read about Cyclosporine a little bit before and some other meds too, Angel is on so many meds, including stomach coating ones, it's so hard to know the best route to go, always feel like i'm playing catch up trying to research the latest issues and meds and things they've told us about so we can make somewhat of informed decisions about everything. I will ask the doctor about the Cyclosporine, thanks for the tip. Not sure about the Spherocytes so I will check with the doctor. Also they checked a couple other liver enzymes because the bilirubins were so high and said her ALT was normal but her ALP was 1200 and should only be a couple hundred, haven't had a chance to read about that yet but will be shortly. Thank you all again

megan illinois

We just spoke with the vet and received Angel's latest PCV count which was 21,(Sunday night)...the doctor said that number was ok because it did not drop drastically. Hopefully it stays the same or goes up! Also next Bilirubin test tomorrow(Monday) at some point so hopefully that gets better. Dr Dodds already responded to our email:-) and said she would review Angel's case report and lab values, so our vet will be sending that over in the morning.

megan illinois

Megan, A PCV of 21 is indeed not bad under the circumstances. I am so glad you have Dr. Dodds on board. I can guarantee you, you will not regret having made contact with her. Not only does she know her stuff, she also has a heart of gold. Try and get some rest, tomorrow will bring good news and a new start with lots of advice from Dr. Dodds. Take care, thinking of you and Angel, Brigitte & the poodle boys

Brigitte BC Canada

hi megan.the alp at 1200 is not realy alarming,it can go much higher with the pred. amy's went strieght to 2000,so dont despair, it falls of as the pred is reduced. keep your chin up.amy sends hugs to angel. best wishes.john&amy.

john teesside uk

Got back from visiting Angel a while ago, her PCV was 20 with this mornings(Monday) test, but this afternoon it went up to 24. She vomited again this morning, so the doctor switched the Pred. back to Dexamethasone but said they will be putting her back on the Prednisone tonight. They can't keep up with her urinating, (bathing her and changing her bedding) so they put a catheter in today, also they don't want her surgery leg(incision) to keep laying in her urine. Angel's white fur in the back is all stained yellow now from her urine, even though they wash it, it stays that way. She was even more yellow all over today(skin, mouth, eyes, ears) than yesterday and Angel's Bilirubin went up to 50.9. I guess it's good that it went up more slowly, but we really need it to go down, it's just so high. We finally got the pathology report back from last Tuesdays surgery and apparently it was not a mast cell tumor like they thought. It was a Nerve Sheath Tumor. They believe we caught it in an early enough stage. Sometimes they otherwise have to amputate if not caught soon enough but the vet said it was completely excised with good margins. Just spoke with the vet and tonight's(Monday) PCV was 22, guess it can fluctuate a couple, also depending on who's looking at it we were told. When we talked to the doctor today she still seemed hopeful but Angel's nurse today really made it seem like she wasn't going to make it. It is so difficult when you get totally conflicting opinions like that. We spoke with another doctor though, the one that was on Angel's case most of the weekend and she said she was still hopeful too. I hope all of your dogs are doing well. Sincerely, Megan

megan illinois

Hi I'm Megan's sister... Does anyone know anyway to help the bilirubin to go down? We would try ANYTHING!!! Thank You

Amber Illinois

Hi Megan, Can you tell us whether the vet classifies Angel's anemia as 'regenerative' or 'non-regenerative'? Dexamethasone is a lot stronger immune suppressant than prednisone - I think I read somewhere 5-7 times stronger, so you don't want Angel on this long term I wouldn't think.... Have you had any feedback from Doctor Dodds? Please don't give up hope - remember a lot of vets/vet nurses have not seen many cases of IMHA. I remember my local vet telling me when they first diagnosed Millie at PCV 14, that if she hadn't responded to the Dexamethasone injection and the Prednisone OVERNIGHT, we might have to put her down! They must have done some reading after they told me that, because then they suggested a blood transfusion instead.... We are telling you - there is HOPE. I have a 15 month survivor. Angel's PCV is good, hang in there. Thinking of you, Sam & Millie.

Samantha Geelong

Please know that Angel is in my prayers. You sound like you are doing everything you possibly can do at this point. Is she on Azathiporine or Cyclosporine often these drugs are used in conjunction with the prednisone, has your vet mentioned at least starting the Azathioprine (Imuran). Have they checked Angel's thyroid level as often dogs with AIHA are put on a thyroid drug too, check with Dr Dodds and ask you vet if they would check it. Does Angel have an appetite? Hoping and Praying for Angel. Cheryl & Ginger

Cheryl & Ginger Pinevile Pa

Hi Megan, I am so sorry to read this thread, you must be at your wits end. I don't have the knowledge the others have but have experienced your fear, just praying that Angels gets the strength to overcome the next few days without any more hurdles. Sue and Archie

Sue Cambridgeshire UK

Megan / Ashley - I'm so sorry to read about Angel. I was just wondering where in IL you are - I am in Chicago and my dog was diagnosed with the less common form of IMHA. As you know, it's a very tricky disease to treat and just wanted to offer my help with any dr. recommendations if that would be helpful to you - sometimes a second opinion offers a different perspective that's the "missing link". I also reached out to Dr. Dodds and she has been so extremely helpful so I hope you are able to get some answers/ideas from her as well. Take care - Bonnie

Bonnie Chicago

Megan, the fact that the PCV is not dropping means that Angel is starting to fight. I've no doubt that with such HIGH? doses of meds the immune system has to be suppressed. Don't worry about the bilirubin, you should see this start to go down within the next week or so...I'd assume. What *I* would be concerned with is two very important numbers...REticulocytes and Spherocytes. You should really get these numbers. These will tell the story for you. In fact, you should get copies of *ALL* tests done. Post them here if you'd like. Myself, if there were no spherocytes seen then I would want to lower the drugs some. These dosages are likely making Angel nauseated or giving her an upset stomach. It could be the high liver values also. Often times the liver toxins will shunt to the brain and *make* them feel sick to the stomach...which could be causing the puking. Could also be ulcers. WHAT would I do for this....first you should add milk thistle to the daily food. This will help the liver if htis is the problem. Second, you could add another stomach coater...here's a recipe for a Slippery Elm Cocktail which is natural and would work really well. SLIPPERY ELM COCKTAIL 1) half cup of boiling water. 2) add 1 rounded tsp. of ground slippery elm 3) let cool totally 4) add 1/8 c. + 2 tablespoons of aloe juice 5) add 10 drops of chlorophyll 6) Add 2-3 capsules (open the caps) of acidolpholus Mix it up and whip it smooth. It will keep in the fridge for 3-4 days (after that the acidopholous dies). Use a baby medicine syringe and load it FULL. Give about half an hour before a meal. Just put the tip of the syringe behind the canine tooth and hold the mouth loosely closed. Squirt slowly so they can work their tongue to swallow. If she is still at the vets then likely they won't want to use this. They're usually more pharmaceutical than natural in most cases. Good to hear you have Dr. Dodds on board. If you haven't sent blood to her yet then you should do this soon. I'd also add a hematinic of some sort to aid in the blood building process. Many of us here use Pet Tinic. Dr. Dodds recommends this and it helps greatly. If not you can add separate iron, folic acid, and B vitamin supplements to the daily regiment. ALL VERY IMPORTANT!!! Have they considered adding ultra low dose aspirin? This helps to thin the blood and prevent clotting.... a leading cause of death in dogs with AIHA. Keep us posted on how she's doing. I'll keep her in my thoughts and prayers. Johnny & Tessy

Johnny

Megan I was just wondering how Angel is doing today. We are keeping her in our prayers. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Sorry I didn't update yesterday...had to work and visit Angel a couple times....was gonna do it last night but I was so tired. We're waiting for the doctor to call us back this morning with the latest test results, probably will be soon. Yesterday(Tuesday), the 1st time we saw Angel she seemed a little better, more alert, she had an appetite and was eating. When we went back later she wasn't feeling so good because they had just given her 2 antibiotics orally at the same time. While we were there she was so nauseous and vomited up one of those pills and the food she had finally started eating. We were pretty upset because she was making progress. We've told them multiple times how sensitive her stomach is and they didn't listen...they were like i guess we should have spaced those out, now they will be given through her IV, because she vomited again last night after a little bit of water. Obviously they were not feeding her anymore either. Her bilirubin did go down to 44 yesterday so that was very encouraging. Her PCV fluctuated a lot, last at 20. I have to go to work now but will update and respond better later tonight when i get home.

megan illinois

Make sure they have Angel on a stomach protector prilosec or pepcid. You have to be Angel's voice right now and make sure you let them know all your concerns, just suggest in a very nice way at first. So glad you did see some improvement. Thanks for the update Cheryl & Ginger

Cheryl & Ginger

=Any up dates on Angel? Keeoing her in my prayers Cheryl & Ginger

Cheryl & Ginger P[ineville PA

I'm also wondering how Angel is doing. Thoughts and prayers are with her. Johnny & Tessy

Johnny

This thread was discussed between 11/04/2010 and 18/04/2010

Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index

This thread is from the Vetnet archive. The live Vetnet forum is active now.