Zhenya and immune-mediated hemolytic anemia – Page 2

Keymaster

Francesca,
I am sorry to read this about Zhenya, it can be frightening when this happens so suddenly.

In the past, many vets believed that AIHA (as it was called for years) was a primary condition, or there was no cause. They felt that the body just began “attacking self” without cause.

Now we know much more about this condition and it is referred to as IMHA, immune mediated hemolytic anemia. It means that there have been contributing triggers that “mediate” or cause something to happen to the immune sysrem. Hemolytic means destruction of a red blood cell. Anemia specifically means a condition of low hemoglobin and therefore there is less oxygen going to body cells.

Now we understand that there can be many triggers to cause IMHA. There are usually several triggers that interact and lead to a cascade of events. The main triggers that are generally recognized are genetic predisposition. This is usually breed dependant, there are breeds that have more cases of IMHA than otheres. These breeds may in general have more autoimmune conditions like allergies, gastro-intestinal conditions like frequent diarrhea, colitis, SIBO. The genetics of breeds in general can show DNA defects due to short lifespans and a faster metabolism.

So it is doubtful that this happened in just a few days. There were single triggers that went unnoticed until there was a combined tipping point. It wasn’t something you did wrong, it can be hard to see the signs.

What are some other triggers along with breed predisposition? Other big contributors are recent vaccines, tick bites, sex hormones, stress (this can be environmental such as allergies), or it can be infections, viruses. Another complex cause can be tumors. Even something like a bee sting or snake bite can lead to a tipping of the autoimmune system. Any vet facing this condition really needs to do a complete history looking for every trigger, and especially those that can be treated. For instance tick disease can be tested for and if positive, treatment is high dose Doxycycline. In this way the IMHA cause is treated.

So we need to make sure all the detective work has been done so your vet can treat anything contibuting.

So I looked over the CBC and I see he was first diagnosed with a HCT of about 17%. He was also highly regenerative (making plenty of new baby blood cells) at this time. This is a positive sign. The new baby cells are called reticulocytes. In about 3-4 days after they show up in the blood they mature and become RBC.

I see that this week he has a HCT of about 31%. This is an excellent recovery. The goal to reach that is considered the low normal value is around 36-38%. But I also see that the reticulocytes are slowing down. It would be better if this regenerative state continued until he reached normal values.

So I also see that he has had very high white blood cell counts in several lines. The monocytes are in the greatest number but there are other WBC that are abnormally high. This inflammatory state can definitely cause a condition called anemia of chronic disease. The body attempts to shut down or restrict the body’s resources that supply bacteria or viruses with nutrition and blood supply. But that also can reduce the body’s ability to make blood cells.

We see that the values of monocytes have dropped considerably from over 51 K/ul to about 33K/ul this week. So if there is an infection we would want to know what it is. But the decrease is in direct relationship to the increase in hematocrit (greater number of RBC.)

Sometimes allergic conditions can lead to an inflammatory reaction. So perhaps parasites like worms, or atopic allergies (inhaled allergens ).

You are giving 2 immuno-suppressant drugs, prednisone and the Italian version of our azathioprine in the USA. The prednisone suppresses the whole immune system. In the acute stage this is absolutely a life saver. But long-term use affects just about every body organ an system. You’ve been seeing this sad change in his body. The muscle wasting is expected, the constant drinking and peeing, the weakness, shifting fat makes his belly look dumpy. Some dogs get a wasted head, the bones become prominent.

I suspect that despite the use of antacids he may have developed a stomach ulcer, thus the poor appetite. There might even be some degree of pancreatitis, another common side effect from prednisone. So let’s put him on a drug that will heal any possible ulcers. Sucralfate is a mucous like bandaid for the esophagus and stomach. Your vet must provide you with this or a prescription. But it’s commonly used in humans and is very safe. Be sure to give it away from food or medication as it will cause them to be poorly absorbed. I like to use it on an overnight fast.

Next, ask your vet to do a specific IDEXX test for pancreatitis called cPLI, canine Pancreatic Lipase. This is extremely accurate. If the value is positive then you will need to provide a very low fat diet, and smaller more frequent meals. Attempt to feed just enough calories to get to the next meal. This will help the inflamed pancreas to rest and heal. Dogs can recover from singular episodes of pancreatitis but do much poorly when it becomes chronic. So best to treat it correctly and quickly.

I know how hard all this sounds to you right now. We truly believe here on Second Chance that excellent home care by Mom the nurse is critical to successfully treat this condition.

Keep a positive relationship with your vet, ask questions and expect to be treated as an equal part of the team that provides care.

Any of the hard stuff you don’t understand, lean on us. It’s hard to make complex decisions when you don’t know all the details. We want you to make decisions based on facts not emotions. That way you will know, at each step, that you have done the best you can.

We both have been through this and we know how sad and frightening it can be. But we have also seen hundreds of dogs survive. We know it is possible.

What other questions do you have?
My best Patrice

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