Recently found out my baby has AIHA. I’m lost in my fears and confusion.

[Rica]

Apologies in advance for a foggy understanding of my dog’s condition – I have no idea what, if anything triggered this in my boy and have very little medical knowledge.

 

Twelve days ago my nearly-two-year-old male, neutered border collie Vincent seemed extremely lethargic and wouldn’t touch food. He’s always been a weird eater, and while playful he never seemed to fit the hyperactive standard the breed has set. I wasn’t too worried until later in the day I noticed his gums were super pale. I called the vet, and the soonest we could get in was the morning, so he slept in my bed and I watched him pant all night as though he was struggling to breathe, could hear his heart beating very quickly. He could hardly sleep.
The next day when I took him in the vet ran a number of tests and was able to determine that he had no parasites or worms. A blood test determined that he was severely, severely anemic and that his red blood cell count could not be much lower. Forgive me, though the blood work is in front of me, I hardly understand what I’m looking at. All I know is that his initial PCV was 19 . She told me about Autoimmune Hemolytic Anemia.

The vet looked grim, and I broke down. It was clear to me that my beloved dog’s life is in the balance. She warned me first and foremost that there are many treatments, but no guarantee any of them will work. The process of trying to figure out what will could be very costly and slow-moving. I told her I would do whatever I can to save him.

The initial thing she wanted to try was immunosuppressive therapy – drugs to shut down him immune system and to give his bone marrow a chance to create new blood cells. If this didn’t work, there could be an issue with his bone marrow, and a blood transfusion could be necessary. She told me blood transfusions are expensive and complicated, that it often takes multiples, and sometimes they can be dangerous in their own right.

So, per vet’s orders, Vincent was boarded at the vet for ten days and given prednisone. She wanted to have him near to monitor his food intake and blood levels, and of course in case of any emergency. The first four days were terrifying. He had almost no response to the medication, was continuing not to eat, and seemed to be barely holding on. The vet introduced cyclosporine into his pill regime. Finally, day 5, we saw some improvement. His PCV was at 28! I was over the moon for some half decent news. This meant that his anemia is regenerative – that his bone marrow is functioning. He began to eat a little more and regain his color. Monday, yesterday, we finally were able to have him home once his PCV ran up to 30.

Obviously, we’re not out of the woods yet and probably won’t be for some time. My dog is still not as energetic as he was, but his mood has noticeably improved. He gets exhausted easily. I am grappling with hope as well as worry – my dog has lost a significant amount of weight. I can sense he is a great deal weaker (cannot jump up give me “hugs” like he would before :( ) He feels like skin and bones. He needs to pee constantly. Also, his medication regime is intense, and must have complicated timing to be effective. I’m scared of the side effects and hope they’re minimal. He must take:

1 gm Sucralfate, 2x a day, to protect his gastrointestinal organs from ulcers resulting from all the medication.

1 ml Cyclosporin, 2x a day, an immunosuppressive drug.

20 mg Prednisone, 2x a day, another immunosuppressive drug.

10 mg Famotidine, 2x a day, to reduce stomach acid.

3 tablets Vitamin K 1, in case he has any anticoagulation poisoning (like rat poisoning) though both myself and the vet agree it doesn’t seem like the most likely trigger

The vet says this regime will be necessary for at least 3 months, probably longer.
I’m keeping him closely watched at all times – he stays with my dad while I am at work. I gotta be honest, I’m worried to death. I’ve been crying at least once a day since he got sick. I try to be soothing and upbeat around him (he’s sensitive to this stuff), but it can be a challenge. I just want so badly for him to be healthy, playful, and comfortable again. He clings to me desperately when I’m here, and leaving for work or other things is horrible every time. I’m so scared of exposing him to anything dangerous while his immune system is so suppressed – I know he can’t be on flea/worm meds while on this stuff, and the vet has expressed to me that he can never have vaccinations again. He could have a similarly scary immune reaction to them (his last vaccinations were in June, btw, so vaccines do not seem to be the trigger this time).

It’s not clear to me what the long-term implications of this. I know there’s a chance that even if he fully recovers, he could relapse again. I know that he might have to be on expensive, awful medications for a very long time – maybe forever. I do know that it’s worth it to me. I just hope he gains some of his strength back soon, despite all the side effects.

Any guidance or advice would be appreciated. Is there anything else I can do for my dog – supplements or foods that would help him feel better? Non-drug ways to protect him from fleas, etc?

Thanks if you read all that. I love my boy so much. I’ll do anything for him. There’s a lot of information on the web, but much of it is either very technical or discouraging. I could really do with some positive support right now.

[admin]

Hi Rica, and welcome.

I’m really sorry you had to find us and that beautiful Vincent has been diagnosed with this horrible disease. We have all been through it with our pets and totally understand how confusing and frightening it is. Is your vet certain that Vincent has AIHA? There are certain tests which are used to diagnose the disease.

It sounds as though Vincent is responding well to the medication which is wonderful news. You are right that some animals relapse, but for now I would focus on his improvement. Often, though not always, animals relapse because medications are reduced too quickly. Hopefully you have avoided the need for transfusion. You are right that transfusions have certain risks, although in some cases they are lifesaving whilst the drugs have time to take effect.

I’m not too au fait with dosing (others can help on that as they are very knowledgeable) but on the whole, his drug regime looks pretty good. The one thing that jumps out at me is the Vitamin K. I could be wrong but I thought Vitamin K was used to promote blood clotting. This is something we need to be very wary of, because one of the most serious consequences of AIHA is abnormal clotting. Most dogs need anti-clotting medication alongside the immunosuppressants. The lasts thing I want to do is scare you, but clots kill more AIHA dogs than AIHA itself, so that is definitely something to talk to your vet about. It may be that he/she has a very good reason for giving it. I agree that Vincent should not be treated for parasites at present and vaccination could be dangerous for him. Does your vet have any idea what triggered his AIHA? If possible, it is important to find the trigger so that it can be avoided in future.

Secondly, it might be worth adding in some liver protection, and I know that others here can make recommendations on what to use. The lifesaving drugs can have some harsh effects on the body so several supplements and medications can be used to reduce these. I think you are already seeing some of the side effects of the prednisolone – panting, drinking, urinating and muscle wastage. Dogs will often feel very hot whilst on it, and may also be very hungry. Vincent probably lost a lot of weight too when he was very poorly so he will be feeling weak and tired, but a PCV of 30 is not too bad. Keep him calm and quiet and try to limit his movement, by placing his food and water nearby etc. When is his next PCV check? (PCV = packed cell volume. It is measured as a percentage. Check out the glossary for more information on what these terms mean). I’m the only cat owner here, but I am sure that when the others read your post they will recommend foods to try to support Vincent’s recovery.

Is Vincent under the care of an internal medicine specialist? I would certainly recommend this as AIHA is rare and many vets are not familiar with it. You could also consider contacting Dr Dodds, who is a renowned specialist (see “Hemopet resources” tab for further information).

AIHA is a serious disease and it is expensive to treat, especially at the beginning. But, the most important thing is that there IS hope. There are many success stories on this site and I hope that will give you some encouragement. I totally, utterly understand how scared and upset you are feeling. Every one of us does. As much as you can, try to stay positive around Vincent as it will help him to feel normal and stay strong.

I’m glad you found us. I remember trawling the web reading and reading and trying to find the answers. None of us are vets but we are all with you every step of the way. If you want to, you can upload his blood results on the urgent advice tab, and some of the members will be happy to have a look to see if anything jumps out.

Hang in there and keep us posted. Fingers and toes crossed that Vincent is going to beat this.

Mary & Mable x

[admin]

Hi there Rica

Oh, I’m so sorry this has happened your lovely Vincent – you must so worried. Thank goodness you noticed him becoming pale & did exactly the right thing quickly.

You have come to the right place or help – we will all do our utmost to try & support you through this scary & confusing time. Vincent is a really handsome lad & I know you are very concerned about him – believe me, we have all been frantic about our pets when they were diagnosed & completely understand how horrible this is for you. I knew virtually nothing about AIHA when it happened to us and it is a very steep learning curve. Remember that most dogs do get better with the right treatment.

I am so pleased to see his PCV has gone up so much – that’s GREAT – & he is termed as regenerative – this is positive & cheerful news – some of us would have paid a lot of money to hear that news so early on during treatment. He certainly doesn’t need a transfusion now – lovely to hear that he’s got past that stage. It’s good that you keep completely positive in front of him – they really do know what we are thinking!

The drug regime looks pretty good to me, but like Mary, I am also concerned about the Vitamin K aspect – this would normally be administered when something like rat poison (an anti-coagulent such as warfarin) was suspected, low vitamin K levels are found in the blood, irregular clotting time (INR) or possibly a very low platelet count – and it would be evident from the blood tests & symptoms. Do you know if Vincent’s platelets are very low or did they mention anything else? It would really help if you could let us know more about these blood tests, actually – you can scan & send them on the urgent advice page, or just type them on here. I need to do some more homework on this subject too!

You need to be aware that the biggest risk with a definite diagnosis of AIHA is clotting – you can read about this in out glossary of terms:
https://www.secondchanceaihadogs.com/AIHA_Terms/abnormal-clotting/

I am wondering (& hoping) if this could just be a really nasty case of anaemia, (rather than an auto-immune problem). The reason I say this is that he has responded so quickly & so well – the prednisone seems to have kicked in nicely. You are still looking at a very slow reduction in medications either way & you certainly can’t even consider reducing anything until he’s been in the normal range & stable for a while. Unfortunately, the drugs have side effects, but they are life-saving & necessary.

It would be useful if your vet could determine the cause of the problem, although sometimes, we never do find out!

Mary mentioned liver protection – most of us use Denamarin which is tried & trusted & is a pure product. It is an excellent way of preventing raised liver enzymes during the use of these strong ( but necessary) drugs.

I hope you’ll look through the AIHA Video Library – there’s a really good explanation of what is happening with AIHA. You can also look up information in the AIHA Terms, for example prednisone https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/
It’s in alpahabetical order & we’ve tried to include as much as possible.
If you would rather ask us questions on here, that is no problem at all – whatever makes it easier for you.

Rica, please don’t worry too much – Vincent is doing well, but please discuss the clotting risks with your vet straight away. I am the site “pest” about clotting, so you know what to expect – it’s only because I care about all our babies getting the right treatment.

If there is anything else we can do or something you need to ask, please do. Some of us are in different time zones, so forgive us if we don’t get back to you immediately, but there’s usually someone around.

Sending hugs & moral support to you & Vincent
Sheena, Worzel (diagnosed Dec 2012 – you can read about him in “Our Stories” on here) & Ollie xxx

[admin]

Hi again Rica

About the vitamin K, take a look at this:
https://www.secondchanceaihadogs.com/AIHA_Terms/anticoagulant-rodenticides/

From what you have said, this is the reason your vet has prescribed vit K. I would definitely agree with Sheena about talking to your vet about the clotting risk if they are certain that Vincent has AIHA and not anaemia from another cause.

All best wishes,

Mary and Mable x

[Vally]

Hi Rica, I’m sorry too you’ve had to look for answers, but I’m glad you’ve found us. Everyone here is really really nice and we all love our mutts to bits so we totally understand you. Vincent is a really gorgeous boy.

First of all if you have blood test results, please send them through by attaching to the Urgent Advice bit at the top, or just type them up in a post here. Mary and Sheena, and others, are very clever in understanding them (I’m not though).

What does Vincent weigh?

First of all, you were brilliant at recognising Vincent’s pale gums. I don’t honestly think I would have noticed, well I didn’t. Bingo just didn’t seem well and vets were looking for answers before they gave up and referred me to a specialist, who worked it out quickly.

You’re seeing a lot of the side effects of the high dose prednisone. Lethargy, weight loss, muscle loss, drinking, peeing. They’ll be there for a while whilst Vincent is on the high dose, but when the prednisone can be reduced, the side effects all start to go away. Bingo is 10 years old (at least – he’s a rescue). He was diagnosed in November 2011 and whilst he’s still on a small dose of pred now, he’s doing great. So don’t lose hope. The fact that Vincent’s PCV has jumped right back up is the best news.

As the others have said, get the Vitamin K sorted out. That’s very important right now.

If blood tests show the liver is starting to suffer from the drugs, then yes, as others have said, you should start to use Denamarin (or Denosyl here). It works magic in helping the liver to recover and in fact worked very quickly to bring Bingo’s ultra high liver enzymes right back down to close to normal.

I understand you’re feeling lost and scared, but Vincent seems to have already turned the corner. Relapses do happen (happened twice with my boy), but it’s usually a result of a too quick reduction in drugs. We’ve all learned that and we all say, do the drug reductions slowly. Never two at once, and never more than 25% prednisone reduction at a time. Many vets recommend a much quicker reduction and in fact when on high dose, I think it can be done, but unless there’s a real reason to do it, stick to a slow reduction.

Ask anything. We all want to help.

My very best
Vally & Bingo

[Rica]

First of all, I want to thank all of you for your quick and well thought out responses. I’m sorry we all have this experience in our lives, but am so grateful I was able to find such obviously dedicated and empathetic individuals. You guys have given me hope.

I’d like to point out that I’m quite unhappy with my vet, though I am grateful that Vincent is showing improvement. We’ve gone to her for over a decade, and I know she is competent as she saved my childhood golden retriever from a car wreck and later my brother’s miniature pinscher from being poisoned (on purpose – sociopathic roommate) with rat poison.

The problem with her is communication. You guys have asked if my vet has confirmed if this is, indeed, AIHA, and I honestly she has not. She says we can do more testing in the future but honestly she has not been very communicative nor co-oporative with me. Maybe it’s the time of the year, but I’ve barely been able to get the woman to say more than a few jumbled medical-jargon-y sentences to me. All conversations were cut off because she has “plenty of other dogs to deal with besides Vincent”.

In fact, upon my first visit, she seemed convinced I was wasting my time and money trying to save him. Needless to say, now that he is home, I’m already looking into a new vet to run further tests and monitor his improvement.

I am worried about the vitamin K. I truly don’t know how he could get ahold of rat poison, living in a fenced yard with two people that have had dogs their whole lives. Neither one of us would ever purchase it. I don’t want to jump the gun in taking him off of it, but I am extremely skeptical now. I’m calling the vet immediately tomorrow and praying that she’ll give me the time of day to explain why he’s on it.

Thank you, Vally, for turning me on to Denamarin. Such an intense medication schedule is freaking me out and it is comforting to know there is a treatment if his liver starts acting up.

This website has been a lifesaver in a very scary time. When we first went to the vet I thought he was dying! For the next 10 days I wondered if I’d ever see him home again! So grateful for every improvement I see.

I uploaded his latest blood work to Urgent Advice. Thank you, thank you, thank you everyone.

[Patrice]

Hello Rica,
I just looked over your most recent lab tests that you have sent along.

I am pleased to say that things look very good. What you are looking at is a CBC, complete blood count. I made a little movie about this if you want to understand it a bit better. See here for the CBC:
https://www.secondchanceaihadogs.com/aiha-video-library/aiha-introductory-videos/

The RBC (red blood cell count in millions), HCT (hematocrit, the percentage of red blood cells in the blood) and HGB (hemoglobin, the protein molecule inside the RBC that carries oxygen to the body cells) are all a bit below normal. But not by much.

The RBC is 4.3 million while low normal is 5.5 million. That is very close to normal.

The HCT is 30.4% while the low normal is 37%. This is very close to normal and is not a dangerous level.

The HGB is 11% while the low normal is 12%, again this is really close to normal and means that plenty of oxygen is getting to the body cells.

The new RBC being made are a little larger than normal right now, that is ok, but that is why you see a high RDW. Don’t worry about it.

The RETIC is reticulocyte value as absolute (taking certain things into account), which indicates a very high regenerative response by the bone marrow. This response was driven by the kidneys who monitor the blood for oxygen and “ask” the bone marrow to make more red blood cells. This number will begin to get lower in the next few days and you will see the number of RBC rising. His body is turning baby blood cells into mature red blood cells. This is absolutely normal. Eventually when the HCT reaches about 37% the RETIC value will be about 60,000 or so and remains that way when we are healthy.

The white blood cells, the lymphocytes, are low. This is normal and a good response to the prednisone suppressing the immune system. These rogue WBC, the T-Cells, are responsible for the autoimmune attack on the red blood cells. Right now it is necessary to suppress them to keep them from destroying more RBC. You will eventually gradually reduce the prednisone, over a long time, so that they stay suppressed during recovery.

I would be interested to also see the chemical screen, this tells us about the health of the body organs and other things like electrolytes. From this I could tell if the liver has been impacted yet. However, to me it already looks like a healthy dog that had some kind of sudden autoimmune reaction to some event. If you have this test, send it along too.

These events can be variable and sometimes hard to pin down. But in general things like recent vaccinations, exposure to certain drugs, hormonal changes, bites or stings from snakes, spiders or bees, certain foods etc can lead to an autoimmune attack. Do we always find out? No, sadly many owners never really know what caused the initial attack.

Do we blame ourselves? Sure we all did, but it is important that you NOT blame yourself for things that are out of your control. You would not be here if you weren’t a wonderful caring owner. There are plenty of steps going forward that you can take to make sure there isn’t a relapse and we will help you with those things.

Rica, you are an excellent owner who took action immediately and saved Vincent’s life. Good job.
my best
patrice

[admin]

Hi Rica,
I am so sorry you had to find this site, but glad you did! You already got a lot of very valuable information and I will try not to repeat too much. While Sheena is the “pest” for clotting, I am the one for stomach protection:) I am always very pleased when I see a vet putting these dogs on Sucralfate, glad we have that covered with Vincent. Make sure you give the sucralfate away from all other medications and food, this way it can do its job and coat the intestines. Prednisone should be given WITH food because it is harsh on the stomach. I am sorry but I am not 100% sure but I think cyclosporin should also be given without food. It can make Vincent feel nausious so a little bit of food should not hurt. Talk to your vet about this.
What are you feeding Vincent? I think it would be great if you could cook for him. Any lean meat, especially chicken would work. You can also cook beef but be sure to scoop away as much of the fat as possible. Of course you should not give cooked bones at all. Add sweet potatoes, kale, beans, carrotes and Vincent would benefit from real healthy food. Here is a receipe from Dr. Dodds with fish that is also very good:
http://canineliverdiseasefoundation.org/wp-content/uploads/2009/01/dr20dodd27s20liver20diet.pdf
You could substitute the fish with chicken, turkey or beef. One thing that these dogs are susceptible to is pancratitis. they can get it from fatty foods, so please keep it as lean as possible.
I know you are worried about Vincents weight but since the prednisone seems to be working, he will be having a ravenous appetite soon and gain weight. Please always have lots of clean water available for him. All the peeing you see is very normal and once the drugs can be reduced it will get better.
Of course I don’t know exactly how you feel, but I have a pretty good idea. These first few weeks are awful and all you do is worry about your dog. There is nothing else you can think or talk about. Everybody on this forum understands this! it is very difficult to find out what triggered this disease, what ever it was, please don’t blame yourself. Also try and treat Vincent like a “normal” dog, not one that is very sick. Stress has a big influence in AIHA, some even say it could be a trigger. If you are always sad and stressed out, that is not good for Vincent. Tell him he is doing just fine and that you will beat this. he needs to know you got this, your job is to look after him (not an easy job) and be confident you can do this. His job is to get better. And he will!!! I think that a jump in his PCV to 28 is a VERY good sign that he is on the way to get healthy again. Ifyou get discouraged there is a website, Meisha’s Hope that has many success stories of dogs that got better and had a happy and healthy life after this disease:
http://users.cloudnet.com/jdickson/successstories.htm
Please focus on these positive stories and not the negative that you hear or read!
Best wishes,
Brigitte