New to this disease

Keymaster

Hi Cindy and Darlene,
I am so sorry both of you are here because of these sudden events. I know you mus t be very frightened and worried. We can help you with this. There is so much to learn but neither of you have the time. We can help you make some important decisions with facts and information. If you can, please upload your latest two CBC and chemical screens on the Urgent Advice page.

I am sure Vally will nod her head when I say that we seem to see a huge increase in reports of AIHA IMHA diagnoses in the spring, well at least here in the US. (It is fall where Vally is.)

Why is this? Dogs that have sensitive immune systems in general tend to react more frequently with autoimmune conditions in the seasons where they are exposed to pollens (canine atopic dermatitis) and tick diseases.

Vaccines are also another trigger as are hormones and stress, plus certain breeds seem to be more prone as well. So a common patient might be a female of a certain breed and age, who may have been in heat recently, was vaccinated with boosters she didn’t need and has experienced certain allergic symptoms like itchy skin, paws and ears and may even have always had certain digestive issues.

So it is a condition that more often than not is triggered by multiple things. Vets now use the term IMHA more often, because it more accurately describes how the condition is triggered. I stands for immune, M is mediated, H is for hemoytic (destruction of red blood cells in circulation) and A for anemia ( a shortage of oxygen being carried to the body cells by red blood cells.)

This condition is considered secondary, or mediated by outside triggers. Our hope is always that those triggers are identified immediately by your vet and that the bulk of the triggers are treatable in some way. So for tick diseases, which should be one of the first things a vet should check for, the treatment is immediate doxycycline.

Primary IMHA has no known triggers, it just happens. Most veterinarians now think along the lines that they haven’t figured out the trigger, but there must be something causing the condition. Vets should be doing all kinds of testing looking for triggers when they suspect IMHA.

The first treatment in almost every case is high dose immunosuppressive prednisone (2-3mg/lb/day in two doses 12 hours apart.) It is an absolute necessary treatment because it works quickly to suppress the immune system, which is critical so the destruction of RBC can be stopped.

Vets (and we too) don’t like to treat for a really long time with prednisone because of multiple negative side effects. So secondary drugs are added to take over some of the suppression in a more targeted way. Two that are used a lot are cyclosporine (Atopica) (10mg/kg for 5 days, rest 2 days and cycle as long as needed) and azathioprine (Imuran) 1mg/lb/day for 7-10 day and downward tapering over several weeks. All three of these drugs can be used concurrently while we are looking for the rapid immunosuppression to start working. We want to stabilize the ongoing immune destructive process. The dosages should be adjusted to maintain the absolute lymphocyte count at about 1/3 of the normal range. (750-1500/ul.)

Transfusions are commonly used for patients with critically low PCV HCT levels. Sometimes a dog may need a second transfusion to buy more time for the meds to work. This is a bit more tricky than a first transfusion and so a vet should be experienced in administering this second one. For safer transfusions vets can used universal donor blood. Hemopet.org provides this blood donor product in most places around the world and they are safe to use for this treatment.

There are other less used treatments and they should be applied judiciously depending on the situation.

But still, it is critical to find the treatable triggers asap. Getting those cleared up can keep a dog healthy enough to tolerate the drugs they are taking. So some of the causes can also be variable depending on the sex and age of a dog. Older dogs tend to have other conditions like tumors, kidney disease, liver disease, pancreatitis, some forms of serious gastrointestinal disease. Younger dogs tend towards inappropriate ingestion of something like coins, rat poisons, lead paint or contaminated water, onions, tick diseases, inherited autoimmune tendencies like allergies.

There is also a list of breeds that are over-represented with these conditions because it is a genetic trait. Cocker Spaniels, Poodles. Irish Setters and Old English Sheepdogs are at the top of the list of these breeds.

On this page click on the the article titled The Canine Immune System and Disease Resistance.
https://www.secondchanceaihadogs.com/canine-disease-resources

Dr. Dodds has outlined the autoimmune conditions in this article. The list of triggers towards the bottom are extensive. Close to the top however she points to the big 4:
“The four main causative factors of autoimmune disease have been stated to be: genetic predisposition; hormonal influences, especially of sex hormones; infections, especially of viruses; and stress.”

I’ve made two short videos about IMHA you can see here, unfortunately they are in Flash and may not play on your computer well.
https://www.secondchanceaihadogs.com/aiha-video-library/aiha-introductory-videos

Do you have any questions for us?
my best, Patrice

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