Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Questions for Lilly

It has taken me almost three months to be able to type this. Our Lilly was diagnosed with AIHA on 1-27-09. We lost her on 2-11-09. If someone could please interpret her labs for me I would really appreciate it. There are just so many unanswered questions... 9-25-06 Lilly is having back dicomfort when she jumps from the bed. Diagnosis-arthritis (she was 2)-rimadyl 12-4-06 still having problems - more rimadyl 12-8-06 coming out of a heat cycle, temp is now 103.2. Now she's not eating. different vet seen she runs battery of tests. WBC 53.3 MCV 65.8 LYM 6% MCH 22.4 MON 6% MCHC 34 seg. neut 62% band. neut. 25% neuc. rbc 2/100WBC RBC 3.99 PLT 175,000-300,000 RCDW 16 HGB 8.9 HCT 26.2 neg for lepto,coombs, RMSF exposed to lyme Ehrlichia equi(anaplasma)1:512 (we were only told ehrlichia - not what strain) treated with Doxy -numbers improved but it took a month for them to come back. 8-15-07 ehrlichis recheck - neg they tested for e. canis NOT e. equi (is there a difference?) 9-14-07 approx 2 mo. after heat cycle elevated temp 104.3 lyme C6 <10 ehrlichia canis - neg HCT 27.3 HGB 10.3 MCHC 37.9 WBC 18.31 neut. 12.85 PLT 149 retics 34.3 RBC 3.92 MCV 69.6 MCH 26.39 was given Baytril & Doxy (in case) took abt. another month for #'s to come back 8-2008- we were assured Lilly was healthy & there would be NO effects from the Lyme or the Ehrlicha. She was bred. 10-15-2008 abscess developed on her back & was drained. 10-29-2008 gave birth to 9 healthy pups & 1 stillborn. We kept three of her beautiful babies. 11-14-08 eleated temp 103 may be the start of mastitis. given cephalexin - much improved. 1-09 about a week after treatment ended, Lilly's abdomen enlarged. She became slightly lethargic -not so much that we really noticed. Took her in to be checked in case...Her HCT was 29. Tired to tap her abdomen to see what was going on. Couldn't get a clear draw. Saw some bacteria. It was deemed to be fluid in her abdomen but not sure where it was coming from. 1-27-09 went for an ultrasound and more blood work. we were told nothing was abnormal - later found out that her kidneys were enlarged. She was tested for E. equi this time & it was <1:16 WBC 28.4 RBC 3.9 HGB 9.3 HCT 29 MCV 75 MCH 24.1 MCHC 32 bands 1704 neut. 19596 lymph. 4544 mono 2272 eos. 284 plat. 267 coombs neg but autoagglutinated put on 20mg Pred 2x/day, finish doxy but was given no more - we asked for it but were told it wasn't necessary even tho she responded to it in the past... While on doxy she seemed to be responding well... 2-3-09 still abdominal distention - they wouldn't srain it for fear of infection. Lilly id finished with the doxy & antibiotics from before. RBC 3.04 Hemogl. 8.3 HCT 24 MCV 78.9 MCH 27.2 MCHC 34.5 RCDW 20.7 WBC 26.5 seg.n. 57% band n. 29% lymph 7% mono 7% polychromatophilia 1+ nucleated RBC 2/100WBC platelets are clumped but appear to be 175-450 Pred. is now 50mg 2x/day 2-11-09 RBC 2.5 HB 6.6 HCT 20.2 WBC 49.6 MCV 80.9 NRBC 5 Lilly has begun throwing up they finally give us a script for her stomach & have added azathiaprine. Lilly never recovered. We took her in to another vet later that night & they didn't think she would make it even with a transfusion. They were also VERY concerned about the distention of her abdomen. We made the hardest decision we've ever made and said 'Goodbye'. The puppies are all doing GREAT!! They are wonderful, big running field dogs. Two of them are going to their first show next week! I'm sorry for this being so long... any interpretation would be appreciated. As I sit here in tears now - I know I should have fought harder for her to stay on the antibiotics & doxy. What would it have hurt?? I'll never know, but if someone runs into this in the future they will & can fight for their dog.

Ann

I'm so sorry to hear of yor loss x The hardest thing is letting them go, I know, I was in that terrible situation a little over a year ago. But you know, I told myself, I loved her enough to set her free. I'm sure you did all you possibly could for Lily, as we all have. But there comes a time when we can to do no more. Lily will live on through her pups x

Tricia UK

Hi Ann, I am no help with the labs, but I am so sorry for the loss of Lily, my heart aches for you. You will be in our thoughts. melissa and tiggs

melissa slc

Melissa & Tricia, Thanks for your support. I have been reading the posts since the end of Jan. & follow everyone's ups and downs. I just want Lilly's death to help someone who's dog might have some of the symptoms she had and to hopefully find some answers for me to help deal with this. Thoughts and prayers to all of you!!

Ann

Hi Ann, sorry for your loss. Anyone who has put up the fight against this disease is an inspiration. Her pups must be getting pretty big by now. I'm not that educated yet with regards to interpreting numbers but to me it sounded like it was anemia even though the coombs test came back negative. It also sounds as though there might have been an underlying problem with this as well. How old was Lilly? Since she's been having low HCT's since 2006 with the numbers fluctuating the way they were perhaps her arthritis or the meds might have been having an affect or cause. I'm not overly sure as to the roles of Lyme disease with anemia but that also sounds like it may have been a contributing factor from the get go. I'm not a doctor so I can't tell you for certain. Lilly's doctor should have been keeping a close eye on her since 06 when her numbers were going so low. Perhaps the fluctuating WBC's showed signs of a recurring inflamation or infection. Did they put her on any meds for clotting? If it were me I would have sought out a specialist. I don't agree with any doctors that say there's no hope or chance. The same thing was said about my Tessy. I was told that she probably wouldn't make it after her PCV dropped to below 10. I rushed her to the nearest animal hospital where she had a transfusion. This bought her the time she needed for the meds to start working. I want you to know that you did what you thought was best for Lilly. Nowone can change the fact you loved her very much and had her best interest in mind. I would however question the doctor. With a HCT of 20 I would have went through with the transfusion. I'ld try to stop the earth from spinning if I thought it would benifit Tessy. I find that sometimes doctors just don't understand or are educated enough on some diseases. Just my thoughts on this. I say this because a lot of people out there rely on their doctors to make decisions for them. They're educated and that's why we pay them what we do. I've found that with my dealings with some vets...some just don't seem to put enough effort or caring into their patients. I'm hoping that Lilly's doctor was not one of these. I hope you find the answers you need. Give your pups a hug from Tessy and I. Johnny & Tessy

Johnny

Johnny, Thanks!! No one seemed to put two and two together about her anemia until after she had been diagnosed with AIHA & I found this board. That's when I got the records and started reading. We are thinking it was from the Ehrlichia that she had all of the problems. We were told she was clear when in fact they had been testing her for two different strains. She was <1:16 in the end but did the heat cycles & definitely the pregnancy cause relapses?? We would have had her spayed fro the get go had we known... Lilly would have been 5 on 4-20. I'm not sure she even had arthirtis, I'm thinking that instead of looking for TBD, the vet assumed that it was. Needless to say we are no longer at that vet. In answer to your other question, she wasn't on anything for clotting although I asked for that as well... Now I know - DON'T GIVE UP UNITL YOU'RE SATISFIED WITH THE ANSWERS YOU'RE GETTING!! We just thought that we're not vets, they are & should know... The pups are doing GREAT!! We spent the afternoon yesterday with our three & three others. They had a BLAST!!

Ann

Ann, I am glad you posted your story. You never know who it might help. I can't help you with any of the readings perhaps Patrice can answer some of your questions. When my dog Salome relapsed a month into treatment her swelling started in her hind leg and within 3 days in the ER it had spread throughout her entire body most notably in the abdomen area. Ultra sounds did not show any masses it just seem to be a major build up of fluids. We did have an autopsy done but it did not shed any light on what was going on. Unfortunately instead of a full blown autopsy like they do on people this was just more of a pathology report of certain organs. It will be 3 years in June and I still miss her every single day. I am glad you have the puppies! Penny

Penny Lytle Creek Calif

Ann, I am so sorry you have not been able to find a definitive answer to the cause of Lilly's death. Looking over the history leads me to wonder if the tick disease was just not treated aggressively enough. While not a firm answer, tick diseases if not treated aggressively while they are first active in the blood, will tend to invade body tissues over time. Once in the tissues, it sometimes takes very large doses and lengthy treatment to see any improvement. There is no guarantee that this treatment will eradicate it either. I have known of folks on the Tick-L list finding that their dogs improved with continuous treatment and would relapse if they tried to remove the doxy. I just don't know enough myself to say for sure. And I don't think the experts are in agreement either. Ascites, fluid in the abdomen, can be a sign of kidney problems as they can no longer process body wastes. There is a condition called Lyme nephritis that begins to shut down the kidneys as the spirochetes attack the kidney cells. There doesn't seem to be any adequate treatment for this and once the kidneys begin to fail, it is very difficult to recover from this. Again, I know of this, but am not an expert in this. You don't post what area of the country you live in. However, going forward, you can be proactive against tick diseases. Read all you can, talk to your vet. If you find your vet doesn't have the same interest in helping you with tick diseases, find a vet that will help you. When I see people I know when we are out walking I sometimes bend their ear about tick diseases. My vet is very proactive about advising her clients. She keeps brochures in the waiting room and has little wallet sized tick identification cards. I am so sorry you lost Lilly. I think that you did all you could in your power. You trusted your health care providers to help you. I think that stories like this are why some of us become so over the top about getting the word out about tick diseases. I am hoping for long and healthy lives for all of Lilly's brood! my best patrice

Patrice NYS

Penny, Thanks for your response. You're right , each day it gets a little easier. There are days when I swaer the female we kept is Lilly. Some of the things she does... Patrice, After joining the Tick-L, I was wondering about the same thing (lyme nephritis). The vet said that her kidney levels weren't anything to be alarmed about though. They only retested for the Ehrlichia, not the Lyme. You can bet I am the biggest advocate against ticks and AIHA that there ever was now!! Everyone I come across knows about it. Because of our experience, we have been able to save at least 5 dogs lives. I think there is just so much that is unknown that we (the vets & us) are still learning. I have now found a vet that will listen to what I have to say. I know that he is not God, but at least I think he's in my corner. I also have some more info thanks to you and everyone here to fall back on if the need arises. Thank you!!

Ann Wi

This thread was discussed between 26/04/2009 and 28/04/2009

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