Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Shadow Diagnosed

Shadow, my 10-year-old, 20-pound terrier mix, was diagnosed with AIHA 19 days ago when, after being her usual hyper self, she crashed one morning and wouldn't/couldn't get out of bed. Her pcv was 20.1. I rushed her to a vet clinic in Salt Lake City (she, the other dogs and I live 180 miles from the City). By the time we arrived, her pcv had dropped even further and she was given a transfusion of oxyglobin. Her pcv fell to 11. She received a transfusion from a donor greyhound and her pcv rose to 23.5. It stayed in the 21-23 range until Monday, when it fell to 12.3. She had a (typed and cross-matched) transfusion from a Great Dane yesterday and her pcv rose to 26. But, she is extremely lethargic - much more so than when her pcv was 12.3. She was on 20 mg of prednisone twice a day; 50 mg of cyclosporine twice a day; 25 mg of imuran once a day to treat the aiha and 1 gram of carafate and 18.75 mg of ranitidine three times a day to protect her stomach. The vet thinks that she is bleeding in her gastrointestinal tract because her stools have become tarry and her vomit (she's only vomited once - yesterday, on our way to Salt Lake) looked like used coffee grounds. Does anyone out there have experience with a dog who developed GI bleeding while being treated for aiha? What, if any, treatment was given? Shadow's vet (in whom I have great confidence, but this is one scary disease) backed her down from 40 mg/day to 10 mg/day of prednisone and increased her cyclosporing from 100 mg/day to 200 mg/day i hopes of alleviating the bleeding. He also increased her carafate from 3 to 6 grams per day. Has anyone had a similar adjustment in their dog's medication following a determination that the dog has GI bleeding? With respect to Shadow's lethargy: she was transfused with 450 ml of blood - a huge quantity for a dog her size, but that's what it took to get her pcv up. Could today's lethargy be a result of her transfusion ordeal? Any answers would be most appreciated! Shadow & Sandy

Sandy Utah

cyclosporine actually causes my dog very intense GI tract issues, constant runny stools and eventual bleeding unless she is backed way off of it. to be fair---this seems to be a rare case though as ive never read of anyone else experiencing huge problems with that drug. for whatever reason it just doesnt agree with my pups system, never has. she is still on it, but only 50mg every other day. i wish you and Shadow luck w/ this disease, you guys will make it!

josh california

What form are you giving the cyclosporine in? Many people are switching to Atopica, a veterinary formulation... I have read two separate references that indicate that the QUANTITY OF cyclosporine absorption can vary between dogs (and humans) dependant on the "vehicle" that is used to administer it. Thus the dosage can be effectively much higher or lower than intended. I have had great success with Atopica. Patrice

Patrice New York State

Thanks for your answers, Josh and Patrice. Shadow takes the veterinary formulation of cyclosporine - Atopica. I think she may be like Josh's dog and actually have a worse response to cyclosporine than prednisone. Shadow had nothing that precipitated her aiha. She hadn't ingested pennies or onions or any of the other suspect things. She was vaccinated five months before her diagnosis and had her last heartworm treatment six weeks before her diagnosis (we live in northern Utah, where mosquitos aren't present from mid-September 'til May - and heartworm is still rare). Has anyone else had sudden onset,idiopathic aiha? Thank you! Shadow & Sandy

Sandy Utah

Sandy, Sorry you and Shadow have had to join us but you came to a very supportive place. I think a large percentage of diagnosis can never be traced to an identifying factor. Yes it seems vaccines/meds play a large role but I have no idea what triggered my dogs immune system unless it was a bee sting. No shots/meds etc. other than a rabies booster 10 months prior. Better to save your energy for beating this. Keep us posted. Penny

Penny Lytle Creek Calif

Dear Sandy -- I'm sorry to hear that your dear Shadow has come down with IMHA. I second Penny's comments about what brought this on -- chances are, you'll never know. When our beagle, Wiley, was diagnosed, we ran through everything with the specialty vets, and they said that, in over 90% of cases, it is never known. So, vets focus on trying to treat the immediate problem -- stopping the immune system from destroying red blood cells so the marrow can have a chance at replenishing them. I still believe, however, that vaccinations play a huge role. My suspicion is that years of yearly vaccinations result in an immune system that is primed to go berserk, and all it takes is that last one or two shots that your dog had, or exposure to something that triggers the immune system and it goes haywire. I pray regularly that someday the vets will figure it all out and they'll develop a surefire cure for the onset of IMHA. And I regularly send a check to the Meisha's Hope Fund at the Morris Animal Foundation to do my part to make it happen. Please take care and keep us posted. The people on this website are so knowledgeable and comforting.

Brenda VA

This website and the people on it are a Godsend of information about aiha. I can't believe that it took me 19 days after Shadow's diagnosis to find it. As for the vaccination/aiha link: during her second week of treatment, Shadow's vet recommended that she never, ever have another vaccination of any kind. I thought that was telling, since it had been five months between her last vaccinations and the onset of her aiha. My non-aiha dogs, who range in age from 2 - 9 years are having titer tests for the rest of their lives . . . along with big sis, Shadow! I am just so sorry that there are so many dogs and dog lovers who need this site. Thanks to our friends in the UK at DMR for sponsoring it! Sandy

Sandy Utah

I believe it is not common for the prednisone to be lowered in severe cases like this. If you are still having these tarry stools, then there is most likely hemolysis still happening. I understand how much you trust your vet, I feel the same way. My vets were willing to take this on, but they admited that they are just general practioners and have very little experience with all these drug cocktails. What I did to help was to do all the research they had little time for. And I also contacted an expert to assist with medication selection and dosing instructions. I was advised to contact Dr. Jean Dodds at Hemopet by a good friend (search our archives for information on how to reach her.) When I called her she was willing to help me! Chance's case was very serious, non regenerative anemia and neutropenia (no white cell production). I think in your case you might want to try this out if you feel comfortable bringing information to your vet and asking them to follow it. Some vets find this very offensive. My 3 vets found it fascinating and helpful. I was very lucky. And we are very lucky. Chance has survived and after several months of high doses of prednisone and then atopica, Chance finally became regenerative. She is probably lethargic from multiple causes. The drugs are *very harsh* and the low hematocrit causes tissue hypoxia. This makes the body work harder to do everything. The transfusions don't necessarily help much more than a few days if she is still destroying her own blood cells. You may need more transfusions in the near future. The drugs will cause other side effects that can seem almost worse than the low hematocrit. This WILL GO AWAY EVENTUALLY when you finally can lower the dosages. You are in for a fight, there is no question, and I vividly remember what that was like in our house. Joanne would want you to read all of the success stories at Meisha's hope. There is great hope. My "higher power" in all of this was Dr. Dodds. When I thought I could not win, she would email me something back that would give me hope again. My best to you Patrice

Patrice New York State

Patrice: Thanks for the referral to Dr. Dodds. I sent her an email describing Shadow's symptoms (she has fluid accumulation in her abdomen as well as tarry stools; the abdominal fluid is not blood and she has no tumors visible on an ultrasound) and cocktail. Shadow's vet is very receptive to my doing internet research, saying it actually helps him because I know what it means when he says things like "autoaggluation". I'm hopeful that Dr. Dodds cn provide us with some guidance. Thank you, again! Shadow & Sandy

Sandy Utah

Sandy, Be sure to keep a file of all vet paperwork. Ask for copies of everything they do, esp the complete blood counts. Keep a notebook in the house and write down all meds you administer during the day and note anything unusual, what a poop looked like, color of gums, refusal to eat etc. All family members need to pitch in to do this round the clock care. You will like Dr. Dodds, very positive person. Patrice

Patrice New York State

Dr. Dodds is awesome. She's already responded to my email, in which I described the treatments (cocktails and transfusions) and responses that Shadow's had so far. She recommended adding one drug to help Shadow's bone marrow and included a paper on AIHA/IMHA that she's written, summarizing the studies that have been done. I forwarded that to Shadow's primary care doctor. Patrice, thanks again for referring me to Dr. Dodds. Our dogs can use all the help they can get. (And, I started a "diary" of Shadow's treatment, test results, reactions, etc., about three days after she was diagnosed. It's very good advice!)

Sandy Utah

I sometimes hesitate to recommend to contact Dr. Dodds because she is such a busy lady. I do when I see someone who is willing to do research on their own and will present the information to her in a organized fashion. She does this out of the kindess of her heart and "for the pets." Eventually I will be making a donation to Hemopet. Right now we are strapped for cash, and I know that Jean understands that of all of us. hoping you will have success this week, Patrice

Patrice New York State

When you are able to make a donation you might want to send it to her Rabies challenge fund as that will surely benefit all pet owners if she can prove to the powers that be that the laws need to be changed as to how often our pets need to be vaccinated.

Penny Lytle Creek Calif

This thread was discussed between 07/11/2007 and 08/11/2007

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