Not producing enough red blood cells

Keymaster

Terri,
I am sorry to read about your Lhasa Apso. How is she doing?

I am more optimistic about dogs recovering from this condition. If a clinic sees a dog with these symptoms immediately, does the proper diagnostics and applies a valid and proven protocol there can be good outcomes.

Where the difficulty arises can be with the diagnostics. There are several ways that IMHA can affect a dog. The term IMHA, immune mediated hemolytic anemia, implies that there is “something or some things” mediating the destruction of red blood cells. In recent years, researchers now feel that there have always been several contributors or triggers that accelerated this condition but they weren’t as apparent to vets because they didn’t do enough diagnostics to find the cause(s.)

So there is a long list of things that can activate the immune system to not be “tolerant of self.” The more common things should be ruled out immediately. We think of insults to the immune system as stressors. So high on the list are, in no particular order: genetics (inherited immune system sensitivities), stress like over-vaccination, insults such as bee stings, venomous bites, virus and bacterial infections like tick diseases, dog flu, leptospirosis etc, exposure to certain drugs, toxic exposure to poisons. Other triggers can be things like chronic diseases or tumors.

Each of things should be ruled out, one after the other, so that anything that can be treated is checked for. For instance I see your vet has prescribed doxycycline which is the most potent and best treatment for various tick disease. The vet may or may not have tested for tick disease, which I usually recommend you ask about. But it is wise to start the treatment.

I see that they did xrays, did they comment about what they saw? They were looking for tumors and other growths that might be driving the anemia.

Unfortunately some breeds are more susceptible because of their genetics. “Dog breeds most commonly affected include Cocker spaniels, English Springer spaniels, Collies, Poodles, Old English sheepdogs, Lhasa Apsos, Shih Tzus, and Labrador retrievers, although any breed is susceptible.”

Keep in mind that it takes multiple stressors to tip the immune system in the wrong direction. So a good vet will look carefully at the history and evaluate for all these things. The other important thing is the initial emergency treatment. As Vally says, they will give prednisone immediately and, if necessary, a transfusion to buy time for the prednisone to sufficiently suppress the immune system.

After a few weeks, it is usually advisable to add a second medication to assist in suppressing certain parts of the immune system. The real goal is consistent and progressive suppression of the immune system without the difficult side effects of prednisone.

So your vet started the protocol they use and added mycophenelate (Cellcept) as an additional drug. This is a good choice. And they added stomach protection to help prevent the prednisone from causing stomach ulcers.

So once all the diagnostics have been done, a transfusion to buy time and a good drug protocol, the goal is to keep your girl as healthy as possible so she can tolerate the continuation of the protocol. Dogs on prednisone have ravenous appetites and drink tons of water, peeing all the time. But prednisone is not a good long term drug to be on because of side effects like this.

So, the big picture is, it appears your vet applied the emergency protocol properly. We want to see positive changes in the upcoming days. You might have to expect another transfusion, that would not be unusual. Dogs are very different, one from the other, with this. Some dogs are not bothered by very low PCV HCT while other dogs are more sensitive. But I have seen amazing will to live from the dogs we have helped. Your girl is very busy trying to heal herself. Stay positive for her sake and let her see you happy to be with her.

Please update us when you can,
my best, patrice

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