Newly diagnosed AIHA looking for advice and help

Keymaster

Angela,
Welcome to Second Chance. I am sorry to read about Maude. This is indeed a very sudden event.

A severe reaction like this to a sting or bite is unfortunately common enough to be part of the known triggers for autoimmune hemolytic anemia in dogs. In this case we could call it IMHA or immune mediated hemolytic anemia because we know that this was “mediated” by a known trigger. These triggers can be numerous and variable. Many breeds have a genetic predisposition to autoimmune diseases and the immune system will react when enough of the triggers are present. So it is often a whole group of triggers, not just one, that leads to IMHA. It’s quite possible that once she was stung her immune system became alert to many other things like medications etc. For example we might see an older female, perhaps a breed like a Cocker Spaniel, in heat (lots of hormones), who may be overweight (inflammatory influences) and the vet suggests that she”get that yearly booster shot to protect her.” This can and often leads to the expression of IMHA.

The term AIHA is considered being more of a primary cause for autoimmune hemolytic anemia. The immune system is triggered by an unknown trigger. And there are plenty of times where owners and vets never really can pinpoint exactly what triggered the condition.

Luckily, the acute care is usually the same, high dose immunosuppressive drugs such as prednisone. This suppresses the over activity of the immune system in an attempt to stop it from attacking and destroying red blood cells. But you are probably guessing that longer term use of this drug has some serious side effects. What is long term? We should hope for almost immediate responses but some dogs need longer periods of time to stop hemolysis. They may need one or more transfusions to give the drugs time to work.

What is critical during this period of time is for the vet to begin looking for other triggers that may be contributing to the condition. If there are other treatable causes then it will be very helpful to start treatments. For instance tick diseases are a frequent trigger and treating the dog with doxycycline immediately kills the tick disease and the immune system reduces the attack. In young dogs they often put everything in their mouths so we look for ingested coins or older style rat poisons. Older dogs can have tumors that can be a trigger. Vaccines are part of these triggers. Dogs that have had previous autoimmune conditions such as developing atopic dermatitis (canine inhaled allergies) at a young age will be prone to developing AIHA IMHA. Digestive disorders seem to be very complicit in the development of autoimmune conditions. The inflammatory conditions that develop in the intestine contribute. The pancreas, as you mentioned, can also contribute indirectly and we might see this as more of a non-regenerative anemia due to poor nutrition absorption.

Severe acute cases can be a difficult balancing act because the homeostasis of the circulatory system becomes compromised. Red blood cells being destroyed in circulation create a large load of intravascular debris and organs such as the liver and kidneys have a hard time processing it. You may see jaundice for instance as unprocessed waste builds up in the blood. Since you are a nutritionist, you will understand that we want to reduce the wastes that these organs are trying to process by, for instance, avoiding red meats in the diet that add even more red blood cell wastes. The liver is already being compromised by processing the prednisone (you will see the liver enzymes rise during treatment) and so we often recommend the liver sparing diet. See this page for the diet, click on the picture for Liver Sparing Diet and it will open a window, you can then click on the upper right hand arrow to open it in a full tab where you can save or print it.
https://www.secondchanceaihadogs.com/nutrition-resources

Another unfortunate condition of acute hemolysis is a breakdown of the normal clotting process in the blood (called the clotting cascade.) We often have small injuries in the blood vessels and the body is very good at quickly clotting these. But with the instability of hemolysis comes a greater risk of inappropriate clotting. The medical term for this is DIC disseminated intravascular coagulation. The body begins to sense that there seems to be injuries everywhere in the blood vessels and it begins to try to fix everything all at once. Fibrin strands begin to form in many places and clots develop. Thus we almost always recommend an immediate discussion with the vet about the use of low dose aspirin or other clinical drugs like heparin (dosed carefully for dogs.) In the early acute days clotting can be a difficult condition to manage.

Transfusions are helpful and you may experience a rise in the PCV HCT but then the next day see it fall. This is expected. But the important things about the transfusion are the additional elements of the blood such as serum, this helps reduce hypovolemia, which is low fluid volume. Transfusions improve homeostasis. Each transfusion after the first must be matched and typed. Transfusions must be done slowly to avoid transfusion reactions! After a few weeks, transfusion triggers should be carefully evaluated by an expert to determine if the need for another one is called for.

So in general you are asking “what should I be doing?” First, remember that you want to be included as part of the team that helps Maude. Be polite and calm at all times. Request nicely but firmly that you want to be included in all clinic activities with her, excluding of course xrays. You want copies of all her lab and blood work (which you can upload to me on the Urgent Advice page.) Your vets know you are upset and worried, so your job is to be focused on helping get Maude better, not expressing your out of control feelings. Maude will sense your panic and fear and then feel she has done something wrong. Be cheerful and happy around her.

Read everything you can on this website. We have put up a ton of information for you to study. Ask me questions about anything you aren’t sure about. Read Our Stories to get a feel for how this condition can be so variable from one dog to the next.

Most of all, we want you to make decisions based on your knowledge, not on your emotional feelings. Since you are limited in time, you can’t possibly understand everything you need to do that right now! Trust us to guide you with the decision making processes. Vally and I both had dogs that were seriously ill and we understand how you feel right now. Panic and fear.

Vally will hopefully pop in later and advise you about some supplements that should be added to Maude’s protocol. She can even make up a chart to help you dose everything properly!

What questions do you have for me?
my best, patrice

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