Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Remy - 3 year old Boxer diagnosed 9/25/09

My baby girl Remy was diagnosed last week with AIHA and it was something I had never heard of. The original reason we took her to the vet about a month ago was a recent development of seizures. So she went on phenobarbital. I began to notice that her gums and tongue were pale, so the vet took a CBC, and her red blood cells were around 20. He immediately took her off the phenobarb and started her potassium bromide. Her RBC levels dropped to 19, and her seizures became more frequent, so we admitted her to the Michigan State University Teaching Hospital for a two night stay. They ran so many tests, including Coombs which came back negative. However, they did a bone marrow aspirate and confirmed her non regenerative anemia and then diagnosed her with AIHA. At this point (Friday the 25th) her RBC level was 18. The doctor put her on 20mg Prednisone 2x a day and Azathioprine. She went to our regular vet Monday and her RBC was down to 16. We went back today (Wednesday morning) and her RBC has stayed at 16. The vet has been honest in that this disease is truly a killer, but I just feel like she can beat this. She goes back Saturday (which will be after a full week of treatment) for another RBC test. I know these levels are low, but she functions so well despite it. Remy eats and drinks regularly, has normal stool and urine function, and still wags her tail and has bursts of her spunky self. However, she is very sleepy for much of the day, and doesn't play a whole lot. Her gums seem to fluctuate. Some days they are pinker than others, which seems so strange to me. Yesterday and this morning she was starting to look more pink, and this afternoon they look more pale again. Anyone have experience with this specific symptom? Honestly any feedback would be appreciated. I feel like this has been such an emotional rollercoater. One minute I feel like she's getting better, and the next I wonder if I'll have to bury my baby before she even turns 4. Thanks in advance for any comments. Brianne

Brianne Michigan

Hi Brianne, so sorry to hear about Remy, you have come to the right place place because there is a wealth of info here. Many dogs have been diagnosed with non-regen AIHA and are doing great. My questions are, and hopefully someone here with more non regen experience chan chime also especially with the seizures. Should she be on Azithoiprine since it suppresses the bone marrow and maybe she be on cyclosporine instead? or both? have they talked about a possible blood transfusion if her Numbers continue to decline? did they do a tick panel, thats one of the main causes of AIHA and an antibiotic doxycyclene is added if this is the case Regarding gum color, it can fluctuate, but if you see it staying pale for a length of time, get her in asap. Laurie

Laurie CA

Brianne I am so sorry to hear that your dog has been diagnosed with this disease. Please visit http://www.cloudnet.com/~jdickson/newhope.htm you will find a wealth of information there and make sure you read some of the success stories. Keep us updated on how Remy is doing. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Brianne, I am so very sorry your most beloved Remy has been diganosed with with AIHA. While AIHA is a very difficult disease, dogs who have been diagnosed with it CAN and DO survive 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. The URL is http://www.cloudnet.com/~jdickson/ Be sure to follow the links on the first page to more 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. Please know that you are in my thoughts and prayers during these most very difficult days.

Joanne MN

Brianne, I am so sorry to hear about Remy. Please describe what you call a seizure in great detail. I am suspicious that she may be having something called a syncope episode, rather than a seizure. These two can be commonly confused. The American Red Cross, in their Pet CPR program, describes the difference this way: when a dog has what appears to be a seizure, check the color of the gums and other mucous membranes. If they are still a good pink, this is probably a seizure. If the gums are very pale, then it is most likely a syncope episode. Quite simply, a syncope is a fainting spell caused by lack of blood to the brain. Our body will respond to this by making us faint and lie down. A dog may behave slightly disoriented or drunk, stumble and fall down. They may even paddle their legs and throw their neck back and vocalize. They often recover fairly quickly, get up and may even continue the activity they were engaged in, usually something like exercise. A dog that has a seizure will be more out of it, perhaps even losing consciousness. They may be out of it for a prolonged time. A known side effect of medicines used for seizures is the potential to cause bone marrow failure. This could lead to symptoms of AIHA, but more in the way of a slowly declining PCV. Since you have had a confirmed diagnosis of non regenerative anemia, I am very concerned that this is the case. In this case, since your vet seems to be unaware of this side effect of these drugs, I would suggest you contact Dr. Jean Dodds at Hemopet.org for consultation for this. She will have the information for you vet to advise him/her about this and guide the treatment. Write a concise email to hemopet @ hotmail . com. Remove spaces to send this. my best patrice

Patrice NYS

Thanks you all very much for your comments/encouragement/suggestions - very much appreciated! Laurie- Honestly, I was unaware of the side effects for azathioprine, but I will definitely look into it - thank you! She has had a tick panel, which was negative. And as far as a blood transfusion, it was brought up, and we were told that would be necessary if her levels got closer to 12. I'm still hoping that will be unneccesary, but we shall see. Joanne and Cheryl- Thank you for the suggestion of the cloudnet website - I will be looking into that! I'll be happy to read of some success stories too...it seems like all I have read about are the poor pups that lost their fight. Patrice- Your concerns on whether or not its a seizure are very valid. In fact, this debate was the cause for many of the tests she received while at MSU. To be completely honest, they still do not know whether it is a faint or a seizure, however, since we are treating her with seizure meds, that is generally what I call them...sorry for the confusion! Generally speaking her "episodes" have consisted of a fall to floor, with what appears to be a brief loss of consiousness (only a few seconds most of the time). She has had roughly 10 epidoes, and she has urinated and/or defecated in about half of them. After regaining awareness, she generally still lays there for another few seconds (5-10) before getting up. She wobbles for a second, but then resumes normal activity (going outside, eating, drinking, walking, etc.) Once she started the phenobarbital, we saw no evidence of any episodes. The confusion arises because the episodes show signs of both seizures and fainting, so we still don't officially know. After having 3 episodes in 12 hours last week, she has had none since then (that we have witnessed) so I'm thankful for that. Hope this helps, and let me know if there is anything else I should add. Again, thank you all...I truly appreciate it!

Brianne Michigan

Dear Brianne Best wishes for Remy, Im sorry I dont have a lot of advice as Im going through my own doggie's recent diagnosis, so I come here for information, advice and support. I read the success pages as well because I need to, and try to focus on the positives. Good vets are important, and gathering as much information you can, which it sounds like you are doing. Lets know how you are going. Silka

Silka Melbourne Australia

Hi Brianne, Sorry to hear about your dog getting this horrible disease. My dogs was diagnosed in Jan09 and is now totally drug free. She was extremely ill and had 2 blood transfusion within the first week. It took about 2-3 weeks for the medication to kick in and then she started improving. Miracles do happen and lots of dogs survive and live a very happy long life. Hopefully you will see the same improvement. Samantha & Madison

Samantha Perth

Brianne, I am very familiar with what this looks like and this does sound to me like a syncope episode. I have seen the defecation and urination with bad ones also. This resumption of normal activities is another clue that this is not a seizure. In this case I can not impress upon you enough that these seizure meds may very well be the cause of the non regenerative anemia (bone marrow failure). I know you want them to stop, I understand that completely, they are horrible to watch and it is frightening to you that it may be injuring Remy somehow. Because Remy is a Boxer I am going to suggest that you explore with the vet to check to see if these are caused by a heart arrhythmia and not a seizure. This is a sudden hiccup in the heart beat that can sometimes actually stop it to beat. This interrupts the flow of blood to the body, thus the dizzy behavior and the subsequent collapse. Boxers are extremely prone to heart problems and this would not be unusual to see it happen in a Boxer this young. I am on a canine heart forum for Great Danes. They often see advanced stages of DCM in very very young dogs. I am quite surprised that they have not noted this to you as of yet? Since you are seeing seizures fairly often right now, you can do a test called Holter exam where they put a harness on Remy for 24 hours to measure her heart ecg. You keep a diary and note things like activity, eating, meds and collapses. They can evaluate the heart rhythm and from there can prescribe medication to reduce or eliminate them. Many universities will have these Holter harnesses to lend to clients. You can also rent one if the waiting list is too long. I would consider this an very urgent matter, not only to stop the collapses, but to get Remy off the seizure medications as they are most likely causing this severe non regenerative anemia. Some arrhythmias are hard to diagnose because they are not regular. If this is the case, then sometimes they will prescribe medications to see if there is a positive effect. I know this sounds a little loose, but in canine cardiology diagnosing the cause of arrhythmias and successfully treating it is one of the hardest things a specialist will do in their career. Here is a link to a well written paper discussing Syncope. You may need to have an online dictionary up to understand a lot of these terms. I like www.wikidoc.org. http://www.vin.com/proceedings/Proceedings.plx?CID=WALTHAMOSU2002&PID=2992 my best patrice

Patrice NYS

There are a number of websites devoted to the Boxer and heart problems. Here are just a few. You can type Boxer heart problems into google for a better selection. http://www.workingdogs.com/vcboxer.htm http://www.geocities.com/ApexBoxers/boxerheart.html http://www.americanboxerclub.org/purina2.html

Patrice NYS

This is an interesting thread, Brianne, I'm so sorry to hear about Remy...this has potentially enlightened me to a mystery we had with Tiggs before he was dianosed. Remy, my boy Tiggs is a 5.5 year old pit mix, he's been in remission and off of all IMHA meds since May. Since this thread is about Remy, I don't want to digress, but the summer prior to his diagnosis, he did have 3 episodes which I called seizures, however, reading Patrice's description of Syncope Episode, I now believe that may be what he experienced...but, I digress. Remy's energy sounds like it is good, all things considered. Generally, the side effects from the meds will make them sleepy and depressed, which the disease also can do. But the fact that you see episodes of spunkiness is great, it means that clinically she is doing fairly well. The recovery from IMHA can be a slow process, just try to take it one day at a time, and arm yourself with as much knowledge as you possibly can, that's the key to getting through this. We're all here for you, ask as many questions as you need to! Hugs to Remy, melissa and tiggs

melissa slc

Brianne Have emailed you direct,hope you don't mind. Cheers Kathleen and Nollaig

Kathleen North Ayrshire

Brianne, Our Lhasa, Ethel, began her IMHA crisis with seizures very much like what you have described. She squealed, rolled over on her side, urinated and defecated. Her IMHA vet believes she had a reaction to a chronically low red cell count -- her PCV tested around 14 when we got her to the emergency vet about an hour after her first (and only) seizure. We still don't know if she had a "true" seizure, but in more than a year since Ethel got sick, your description here sounds the most like what happened to her of any that I have read. It took the vets several days and several tests to even decide she did have IMHA, after ruling out any internal bleeding, tumors, poisons, etc. She received doxycycline for potential tick exposure, azathioprine, prednisone and dexamethasone, with the decision to administer dexamethasone the one that really got her to the point where she could begin to recover. One day at a time.

Brian Vermont

Again, thank you all for your suggestions/comments and well wishes - truly appreciated! Silka - My heartfelt best wishes to you and your baby. We will get through this together! Samantha - So happy to hear Madison is now off her meds...what a relief for you! I hope to have the same success, even if it takes months and months! Did you have to adjust her medicines a lot, or did it just take a while to get back to normal levels? Patrice - Remy was actually tested in depth for heart issues. I will post the specific tests once I locate the paper work. Not to say it isn't heart related, however, her episodes seem to stop once she gets to a stable level on her anti-seizure meds, so naturally I am hesitant to take her off. Definitely something I will keep an eye on and discuss with the doctor though. I plan on reading through the link you posted this weekend (since it may take me a while to decipher some of it!) so thanks for the helpful information! Melissa- Thank you for sharing your story - it's nice to hear that other dogs have experienced similar episodes because they were one of the main reasons I was so concerned about potential cancer. Hearing that others have had them (and recovered!) gives me some hope and relief. Brian - How is Ethel doing now? I would love to know! As for Remy, her behavior is much the same. She seems to be a little wobbly though - back legs shift or give out. Anyone else experience these issues and how concerned should I be? Also, I think she may have picked up a viral or bacterial infection. Her nose has been runny with a greenish yellow mucous. The vet is reluctant to add an antibiotic because she is already on so many pills and because of the potential that it might be viral. Any suggestions or anyone with experience with anything like this? She goes back in to the vet tomorrow (Saturday) morning to have her red blood count tested. Depending on the results, they may up her dose of prednisone and potentially add another drug. Will post an update sometime tomorrow. Thanks again!!

Brianne Michigan

Hi Brianne, Ethel has recovered well from her IMHA. She stayed on her meds (prednisone and azathioprine) from the end of July until January 1st, and she appears fully recovered. She lost a lot of hair from the prednisone, but that has come back. We definitely had her on a full two week course of doxycycline at the beginning, as we live in an area with a lot of ticks.

Brian Vermont

This thread was discussed between 30/09/2009 and 04/10/2009

Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index

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