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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Surgery and IMHA
| Hi Folks, I had a quick question regarding surgery in dogs with IMHA. Are there any special precautions? Henri having come down with IMHA at 5-months old, is not neutered yet. We would like to neuter him in a couple months, is that realistic? The internist said he would have to be on less than 0.5mg/kg/day of prednisone for it to be safe. ______________________ He is currently on: 5mg/day prednisone (new dose today, down from 7.5mg/day) 25mg/day Cyclosporine 12.5mg/every other day AZT Pepcid ______________________ The internist said typically the cyclosporine would be his next drug reduction but if surgery is desired, we would work on lower the prednisone first. Thank you, Ella Henri, West Highland White Terrier, 7-months, 14-lbs, diagnosed 02/25/09 with vaccine-induced IMHA. Bella, West Highland White Terrier, 3-yo, 14.8-lbs, diagnosed with Primary Addison's Disease on 04/28/09, last DOCP injection was 0.38ml on 04/01/09, maintained on 0.33mg/day prednisone. |
| Ella Seattle |
| Ella, This is a tough question to answer. I personally would not want to do elective surgery on any dog that is not perfectly healthy. That said, if there was a necessary surgery that was needed, for instance the removal of the spleen if it had a mass and was grossly enlarged, I would probably do it. If you want to proceed with this in a few months I would suggest that you have a number of tests run to determine Henri's overall health. The minimum would be a full CBC and a full chem screen. These can have a lot of information. I would want to see mostly normal numbers across the board. In addition, because of the potential for bleeding issues (as evidenced by the history of IMHA) I, myself, would probably want to do a clotting profile that would determine if there are any hereditary clotting factor deficiencies. These can be minor but become problematic during a surgery where there may be great blood loss. Your vet is very familiar with this kind of approach to surgery and can help you decide what to do. A neuter is a more simple surgery than a spay, but still requires anesthesia and at least 10 days of recovery (stitches). my best patrice |
| Patrice NYS |
| I would definitely wait to have this done. Ginger had a ear hematoma removed last spring along with a vaccination and shortly after that she had a relapse, not sure if it was due to the surgery and the vaccination or the combination of both. Glad to hear Heni is doing better. Cheryl & Ginger |
| Cheryl & Ginger Pineville PA |
| Patrice, Thank you for your guidance. I didn't understand your statement about bleeding issues. Henri never had bleeding problems. His IMHA was vaccine-induced. How does a history of IMHA cause bleeding problems? Per your statement and Cheryl's, surgery sounds risky. We will try to wait as long as possible. Maybe wait until his pred is very low and he is off the cyclosporine. Thank you, Ella and The Westie Pack |
| Ella Seattle |
| Ella, Clotting factors assist the body to repair itself. This can occur when you have a little cut, a big cut, intestinal bleeding or injury to the inside of a blood vessel. Those people who are missing enough of the proper clotting factors are called hemophiliacs. They are always at danger of out of control bleeding even from the smallest injury. Certain dog breeds can have this same inheritable condition called von Willebrand's disease where they are deficient in clotting factors. There are basically three types of von W and they range from very severe to very mild depending on the factors that are missing from their blood. For instance Giant Schnauzers can be deficient in one factor but it isn't as severe as other types. Why is this important? Well, a dog that has severe von W will probably begin to have trouble right from the start while a dog that has a milder form may not express this clotting disorder until they are put into a situation, most often hit by a car or a surgery like a neuter, where the lack of a clotting factor begins to compromise their ability to properly stop bleeding. This can also lead to a sudden and serious problem with clotting called DIC disseminated intravascular coagulation. This website has a good explanation of this disease, the breeds that generally inherit it. One particular paragraph addresses how this disease can cause problems during a surgery. http://www.marvistavet.com/html/body_von_willebrand_s_disease.html "One would expect a congenital disease like von Willebrand's disease to manifest in puppyhood and in fact this is usually so. Von Willebrand's disease is usually detected when there is unexpected hemorrhage during a spay or neuter or when screening tests are done in anticipation of surgery on a member of a von Willebrand's breed. Borderline dogs often show signs of bleeding later on. For example, sometimes a dog with borderline von Willebrand's factor will show a slight drop in platelet function and will experience inappropriate bruising or bleeding transiently. This is something that might be seen later in life." This isn't something that everyone needs to worry about. Most dog breeds don't have this condition. But in my breed, there is a risk, however minor. Some folks who own Giants and want to have a spay done will have their dog's clotting factors tested. Luckily there is a type of drug that can be administered prior to surgery that makes this less of a problem. my best patrice |
| Patrice NYS |
This thread was discussed between 23/04/2009 and 24/04/2009
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