Suspected IMHA for Macy and waiting on official blood work results

Keymaster

Lynette,
I really understand how hard this is. You have NO idea what to expect and you are trying to make decisions based solely on your emotional reactions.

My goal has always been to educate owners with enough information so they can make educated decisions. It is impossible, in a short time, to explain everything you need to know. So for some of this you will have to trust our experience and knowledge. I’ve read plenty of the negative stuff you are accessing. The diagnosis and treatments of these canine blood diseases is not straightforward and the opinions can vary from one vet clinic to the next. In my opinion and experience, if certain steps are taken from day one, there can be great successes. Not all vets are completely experienced with all these diseases and they can make small errors in the early days that can lead to problems.

In the early days of hemolytic anemia what you should expect is extremely variable depending on many things. From my viewpoint and experience, the most important thing you should expect is your vet to make sure that they have ruled out ALL causes for hemolytic anemia that may respond to remedial treatments.

A good example of this are tick diseases. Some tick diseases can be the cause of hematological disease. So there is a simple, in clinic, test called the SNAP 4DX+ that can perform a yes/no for 4 tick diseases and heartworm. It takes about 8 min to perform in the vet’s office and requires a tiny bit of blood. It shouldn’t cost more than $40. But yet many vet clinics do not offer this test or skip over it, not thinking it is important to consider.

There are other rule outs that I like to see done in the early days as well. Getting a look at your paperwork and test results will tell me if these were done or might need to be done.

In any dog there can be multiple triggers that lead to the development of AIHA IMHA or bone marrow failure. Sometimes it is just one trigger or more often it can be a combination of triggers that pushes the immune system to “not be tolerant of self.” An example would be a female dog that is still intact and the vet tells the owner it is time for her yearly vaccine boosters. Let’s also say that this dog has had bad allergies all of it’s life. This is a recipe for problems and after the booster shots the dog has an immediate autoimmune response that leads to hemolytic anemia.

So part of your job is to think back and develop a list of all these kinds of things and determine if any of them play a role in what is happening. The list can be extremely variable. Dr. Dodds of Hemopet.org has developed a lengthy list of these contributions and I am going to post a shortened version here.

Genetic or familial history

Pregnancy

Stress
environmental
emotional
physiological

Hormonal Irregularities

Nutritional Influences
deficiency or imbalances
trace minerals
nutrients
vitamins
chemical preservatives
toxins in feeds
chemical or drug residues
spoiled feeds

Adverse Drug Reactions

Viral Infection
parvovirus
retroviruses
cytomegalovirus
measles and distemper viruses
hepatitis viruses

Frequent or Recent Use of MLV Vaccines
parvovirus
distemper
hepatitis – Lyme (vaccines alone or in combination)
Bordetella
rabies

Underlying or Concomitant Disease
lymphoma or leukemia (retrovirus infections)
bone marrow failure (low red and white cells, platelets)
immune dysregulation
humoral – cellular (immunodeficiency )
chronic infections
bacterial
viral
parasitic
fungal

Other Autoimmune Disorders

Will she need a transfusion? We don’t know yet, it is very possible with the early treatment of immunosuppressant drugs like dexamethasone and prednisone the destruction of the red blood cells can be stopped. So how do we know?

In these early days they should be monitoring the PCV pack cell volume and the HCT hematocrit frequently, in answer to your question. There are many other things on the CBC complete blood count I would like to see as well. The PCV is a simple and quick test and really should be done every few days in the beginning. It requires a small amount of blood in a tiny tube that is held up to a chart for a visual read (and should be inexpensive!) We would like to see her PCV rise from 14% in the next week. Ideally it would be nice to see it into the mid 20’s. Then there would be less need to consider a transfusion. But, sometimes it is just necessary to do a transfusion.

If Macy has never had a previous transfusion there is no need to type and match donor blood (less $$). The first transfusion is “free of reactions.” After the first transfusion and all subsequent transfusions, they must be typed and matched to ensure she won’t have a reaction.

In theory any competent vet can perform a transfusion and some vets do have a “donor dog” they use for this purpose. Other clinics may rely solely on purchased universal donor blood. In most cases of AIHA the best blood is that which contains most of the blood elements.

If your vet seems to be struggling with what to do, they may not be the best choice for this procedure. However, if your own vet feels confident and you trust them, it can be less expensive than using an expensive emergency clinic. I paid about $300 at my own vets, these procedures take anywhere from 2-4 hours so they are very labor intensive. I considered this a bargain.

Please, set aside your grief and unhappiness. Macy can sense this and it is upsetting to her. Your job now is to help her, be cheerful and give her all of your love each day. I promise you, once she is better, you can set aside a whole day to just cry if you want, but right now it’s not giving you a clear mind. I know this is extremely hard but I have seen many owners become very disciplined and saved their dog’s life. You can do this and we will help you.
my best, patrice

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