Staffie X Tiger Diagnosed with AIHA

Adam

Guest

Hi Everyone, I found your website through my continuous googling online for more information about this terrible disease that has struck my 5 year old staffie x “Tiger”.

He is a beautiful boy who has spent the better part of every day under my desk (I work from home). He is truly my best friend in this world.

Last week Sunday, we noticed he was running a high fever and a bit lethargic. We took him to a local vet because our regular vet was closed, this vet diagnosed him with “Doggie Flu” and injected him with Carprofen. Gave me 5 x 50mg tablets to take home and give one per day.

By Tuesday morning, Tiger was not getting any better, I took him to our regular vet who upon seeing Tiger’s gums immediately suspected that he had gotten into rat poison. She started him on some vitamin K and immunosuppressant drugs (I don’t know which ones). She also sent off for a full blood panel.

Tiger remained at the vet, and I was confident her diagnosis of rat poison may have been correct, I asked all the neighbours and walked around the property boundary but couldn’t find any pellets or bait anywhere. I suspected he may have eaten a rat that had been poisoned in the night.

The next day, I was given the blood results with a suspicion of AIHA and a PCV of 15%. The vet had started doing the test in house and said his PCV had increased to 17% but if it dropped below 10% we would need to take him to a specialist hospital for a transfusion.

Later that day, one of the overnight nursing staff at our local vet called and said his result had dropped and that I needed to come and take him asap. I rushed over both confused and alarmed as Tiger seemed fine, but all signs pointed to this disease being a terrible and very difficult to treat condition.

The vet had given me the PCV test rods to take over to the specialist, with the latest one showing, and I am trying to remember here the words of the specialist (“blood cells being destroyed in the bloodstream, not in the spleen any longer”). He said that the prognosis was not good and that Tiger had a 50:50 chance of survival as his immune system was now destroying blood in his veins directly (rather than waiting for his spleen to remove them).

They admitted him, and he was given a transfusion overnight. He responded well to the transfusion and the PCV taken the next morning was 22. The specialist said that this was to be expected from the infusion of new blood, and what we needed to see now was how long Tiger could hold onto this blood whilst the new meds took effect.

(I was later told, that this test was incorrect, and that the nurse who drew this blood had mechanically damaged the blood cells causing the incorrect diagnosis).

I have been devastated for days, calling every few hours, visiting daily to see him. He is lively and is fully alert. Yesterday we went for a walk around the block and he was happy/not tired.

His PCV results have been stable around 22-24. With two tests taken daily one at 9am and 9pm. We did have one outlier result of 30 taken yesterday (my heart skipped a beat and I was jumping for joy) but the next morning the result had dropped back down to 23.

This has been such an emotional roller coaster ride to date, what I want to know is. How long before we can start to see a gradual increase in PCV and is there anything I should be doing\preparing for Tiger’s return tomorrow from the Vet. (He has been at the vets for 5 nights now).

Thank you so much, I feel relieved to get this off my chest.

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admin

Keymaster

Oh Adam – you are having a rotten time. So glad you’ve found us in the end. Lets start with all the good stuff – if Tiger is more active & happy, that is the best news& actually very positive at this early stage of treatment. It is not unusual for the PCV to drop after transfusions in these early stages because the drugs haven’t had a chance to suppress the immune system properly yet. Give them time. I totally understand you are worried sick – the vets have done a good job and so have you – getting Tiger to the hospital so quickly has made a big difference. Are the vets still saying this is definitely rat poisoning? Blood tests again would help a diagnosis. Rat poison is very nasty stuff & should be used with more care to stop animals being able to accidentally ingest it – poor you having the worry of that.

You can read about reticulocytes here https://www.secondchanceaihadogs.com/AIHA_Terms/reticulocytes/
and reticulocytosis here
https://www.secondchanceaihadogs.com/AIHA_Terms/reticulocytosis/

Basically, reticulocytes are baby red cells that have just come out of the bone marrow – they are immature & will develop into nice red blood cells in normal circumstances. If Tiger is producing lots of reticulocytes, that means she is making lots of new red blood cells – exactly what should be happening – to replace the ones her body has “accidentally” destroyed. This is called regenerative. A blood test will show this. If for some reason Tiger is NOT producing reticulocytes it is called non-regenerative & means that for some reason the bone marrow has been affected. Do not panic if this is the case – my Worzel had a rare form of the disease which meant he had no reticulocytes getting into his bloodstream whatsoever. I was as scared as you are, believe me. He was given immuno-suppressant treatment (prednisone & longer acting azathioprine) & treatment of the cause or trigger of the disease (antibiotics for ehrlichiosis), plus stomach protectors to prevent the drugs damaging the GI tract. Slowly he recovered- he is in remission now, over 2 years after the diagnosis. It was a horrible time. Bone marrow failure is much more rare & can take various forms. Let’s not worry about that until we know about the reticulocyte levels on Tiger’s blood tests. It is more likely to be destruction of cells in the blood stream – this is called intravascular haemolysis. Does that help explain things a bit?

If you would like us to look at any tests & help you with the results, you can scan & send them as attachments on the Urgent Advice page:
https://www.secondchanceaihadogs.com/urgent-advice/

It would help us to help you if you can give us exact details of what drugs Tiger is on. With this disease, there is often a risk of abnormal clotting when intravascular haemolysis takes place. Anti-clotting medication is needed when any of the following are present:
1. Large scale hemolysis
2. Spherocytes seen on blood smear
3. Very high platelet count – over 1,000,000
4. Auto-agglutination
5. Transfusion

Obviously if anticoagulent rat poison IS the cause, the initial worry is bleeding & I see Vit K has been given.
I imagine your vets have already investigated these things – they sound very good indeed, but it is vitally important to be aware of clotting risks.
You can read more about this here: https://www.secondchanceaihadogs.com/AIHA_Terms/abnormal-clotting/
You are more than welcome to print anything you want to from the site glossary & take it to the vets with you if that helps.

Whe you get Tiger home – let’s hope that will be very soon as he is making progress on the PCV front – you will need tummy protectors – famotidine & sucralfate are excellent for this. Again, this is important as you don’t want the drugs to irritate or ulcerate the GI tract.

Anything else you’d like to ask?

Sending you & Tiger all my very best wishes – give him a gentle hug from me when you visit. This disease can be beaten with the right treatment & you must keep focused on all the positives, even though it’s hard when you see them so poorly.

You will get wonderful support from everyone on here – we have ridden that roller coaster too. The rarity of this disease means we all need to lean on each other. Please let us know how Tiger is whenever you can.

Sheena, Worzel & Ollie xxxxx

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admin

Keymaster

Hi Adam

I am so sorry to hear about what you and Tiger are going through, although I am glad you have found us. All of us have been through this and completely understand how shocking and devastating it is. As you can see above, there is hope for many animals with the right treatment, and I am so pleased to read that Tiger is seeing a specialist and holding his own. It’s great news that he appears well in himself too. That’s so important.

If you could get us a list of medications, and if possible Tiger’s blood results, that would be really helpful. As has been said, there are other medications which are used alongside the immunosuppressants which are really important to counteract the side effects of the drugs and the effects of the disease (e.g. abnormal clotting). From what your vet has said, it sounds as though Tiger may have intravascular haemolysis, although I am not certain on this. Sheena has explained reticulocytes, and that is also important and something to ask the vet about. This will help you to find out whether Tiger has regenerative or non-regenerative IMHA.

I understand your frustration waiting for his PCV to rise. It is so hard waiting and waiting, but hang in there. These drugs do take time to work and hopefully Tiger’s transfusion has stabilised him so that he is able to maintain his PCV whilst the drugs take effect. The length of time it takes for response varies according to the drug used, and also to the individual dog. You are doing an amazing job getting him the right treatment.

In answer to your question about getting ready to bring him home – well, I’m the only cat owner here, so I am sure the dog owners will have some handy hints here for you, but I would suggest you get in plenty of food, both for you and for Tiger. If he is on prednisolone, which is likely, he will probably become very hungry. I think the others can help with advice on what to feed him. He will also drink and pee a lot with the prednisolone, and some dogs have “accidents” so perhaps just make sure you are prepared for that with some clean towels etc. I would also suggest making him up somewhere cosy to sleep which is near to his food and water, so that he doesn’t have to use too much energy to get up. He is likely to feel pretty tired for a while.Perhaps consider whether you will want to sleep near to him too. Some people do, some don’t, and either way is fine, but if you are likely to want to stay close to him, you might want to make yourself up somewhere to sleep too!
As much as you can, try to stay positive around him too. This is devastating for you, but Tiger will pick up on your emotions and it will help him if you are positive and things at home are as normal as possible.

One more important point – don’t forget to look after yourself. You need to stay strong for Tiger, so eat well, sleep well and make sure to ask for help from others if you need it.

Keeping everything crossed that Tiger is soon home with you and feeling much better.

All best wishes,

Mary and Mable x

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Patrice

Keymaster

Adam,
I am sorry you have had such a scare with Tiger. There seem to have been some missteps during the diagnosis and initial treatments that have alarmed you.

Lets look at canine influenza. This can be a very serious illness. There can be either one, two or both components to this disease, viral and bacterial. Unfortunately in some areas of the United States it has become quite a potent disease, leading to the death of some dogs. Currently in the US these areas have the most serious forms: New York, southern Florida, and northern Colorado/southern Wyoming. It’s interesting to note that the origins of this disease were in your country, Australia, in 2007 where it was passed from equine to dog. What is the status of canine influenza in your country today?

Usually the most difficult part of the disease for some dogs is the development of pneumonia with high fever and this can lead to hemorrhaging and vasculitis which would then lead to anemia. Can we be safe in saying that there was never any nasal drip or indication of pneumonia? I feel this is unlikely as I read through your post. It was unfortunate that they diagnosed this as a certainty so quickly and sent him home considering how serious this can be.

Some vets that have been in the business for a long time will think immediately of rat poison as the cause. I’ve been studying canine hematologic conditions for over 7 years now and I am less likely to think of this as a cause of IMHA. (And remember, there are certain values on any CBC that helps you know if this is IMHA or rat poison!) Dogs that live in good homes like yours are not apt to go prowling around at night looking for goodies such as dead rats. Or do you live in an area in Australia that is prone to problems with vermin? Is rat poison is sold prolifically at the local hardware stores? Most countries have discontinued the sale of the type of rat poison that can lead to this kind of bleeding disease.

What is true about AIHA and IMHA is that the attack by the immune system on red blood cells has become much more commonly seen in dogs around the world. If you have time please watch these two short introductory videos about AIHA IMHA:
https://www.secondchanceaihadogs.com/aiha-video-library/aiha-introductory-videos/

You can see that there can be a genetic component to this condition that is triggered by the environment where the dog lives. Stress could be considered one of the most common triggers. But it’s not the kind of stress you and I get when we are in a traffic jam!

In dogs stress comes from things like exposure to vaccines, hormones, certain medications or ingesting human meds, chemicals or heavy metals, stings and bites, or even something as common as allergies.

I know for sure that many of our survivors on this forum have had dogs that had allergies all their lives, or perhaps had serious digestive problems such as diarrhea or colitis. My dog Chance was one of these, he had serious allergies starting at the age of 1.5.

Diet can also play a significant role. Many dogs seem to have had continuing problems with diarrhea or colitis. Dog foods can contain impurities such as mold or bacteria that can stimulate the immune system.

What is important to consider is that in many cases we will never know the actual trigger, we don’t get the exact cause of this written down on the vet’s notepad and handed to us. What we do know is that appropriate treatment relies on an excellent history, a careful examination plus good diagnostic testing. These put together tell a “story” if you will, that leads us to a better understanding of what has happened. That needs to be followed up with immediate and appropriate treatment. Combine all these elements and you have a great chance for recovery.

As you talk with your vet, have a list of specific questions that you want answered or at least discussed. Be polite and thankful to them always, but do have them respond to you in a way that you understand. You need to be determined sometimes to get those answers. Always ask for copies of all your tests, especially the CBC and the chem screen. We would like to help you read them and understand them. Within those tests we can help you understand where Tiger was and where he is now. You are paying for the tests, they belong to you, you can say they are for your records.

Common laboratory artifacts caused by inappropriate sample collection and transport can and do cause significant errors in the test results and indeed this “jostling” of delicate red blood cells can and will cause the PCV HCT, among other values, to vary widely. It is an unfortunate part of veterinary treatment. The difficult part with our special dogs is that their lives depend on the subsequent medications and dosages that they receive. If the tests are wrong, so too can the medications be wrong.

How do you control this? After a bit of time you will begin to figure out which techs are really good at what they do and seem to keep Tiger the calmest. Be polite and say anything you can to make sure that tech is the person that handles your dog for testing. “Tiger likes Sue so much, can she be our tech today?” “What days and times is Sue here? We like her so much, she makes us feel at ease.”

We can help you read your own tests so you can recognize when something doesn’t seem right. Try to stay with your dog if you can. Explain that you want to learn everything you can and it helps to watch. Avoid getting nervous or asking too many questions. A polite owner who appears to be interested in being a partner in care will be appreciated by the staff. In general, most people who got into the field of veterinary care did so because they love working with animals. Appeal to that love of the job.

If you are at the vets and need us to answer a question or explain something while you are there, just send us an Urgent Advice email. This site is mobile friendly. We’ll get your answer to you before you leave the vet’s office.
https://www.secondchanceaihadogs.com/urgent-advice/

I think the best thing now is for Tiger to come home. Remember stress? He is without you for most of the day in a very strange place full of other noisy dogs and that is extremely stressful. A little over a week ago I spent nearly 20 hours with my dog in a kennel after knee surgery. It was so noisy and I could tell it bothered him. You can’t imagine how loud a ceiling hose is being yanked over to the next kennel to be hosed down!

I knew the one thing I needed to have happen was to get him home as soon as possible. Once home where it was quiet I was able to make him special food and let him rest in peace. I know that is good for him. It is your loving presence and home nursing care that will be the most important part of his treatment while the drugs are working.

I am absolutely positive that Tiger will survive this. His PCV is currently in the 20’s and that is a good sign. Very sick dogs with PCV’s of 9% have survived with excellent owner care.
my best
patrice

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