Rhodesian Ridgeback – Some Questions on Diagnosis of IMHA

[Lucy Thomson]

Hi my pet Shaka is a Rhodesian Ridgeback 5 years old. A week ago today I took him to the Emergency Animal Hospital after he had been peeing dark brown urine, was lethargic, and entirely not himself for two days. He got a blood test and urine/fecal samples at my vet on the day this started two days before I took him to the ER. His blood count was at 31%. It was all very sudden and I felt sure it must be a UTI or something he had eaten. At the ER with his count down to 21% and some more tests/checking everything it could possibly be including zinc poisoning, garlic/onions, parasites, leptospirosis, etc they told me it was IMHA. I was in shock and hadn’t heard of this before. Over the next 5 days he stayed there in the ER. Last Saturday he hovered to as low as 11% but held off on a blood transfusion which we thought might be Saturday night. Sunday he read around 13 & 12%. Monday it was around 12-14%. Tuesday it was 14-18%, Wednesday am it was hovering around 14-18% again so he came home. Monday a radiologist said there was no signs of cancer. At home Wednesday he was exhausted, very hard to feed anything. Thursday he was really hungry, thirsty and wanted to walk in our neighborhood. No vomiting no diarrhea so far only some tremors etc from the Prednisone (30 mg twice a day). He is also on Oxycyclin and Omeprazole plus Pitagril. Today he is doing well, eating/drinking, still tired, lost about 15 pounds since last week so we are going slow. But his reading shows red blood cells at 28%, platelets normal and some indication of new red blood cells, white blood cells still quite high. His gums are pink/red again.
I have no idea why this happened. He is a very active dog, no illnesses, was on Bravecto and Interceptor Plus, no recent vaacines but was on an antibiotic last September for an anal gland infection. He has some allergies and gets itchy paws and yeast infections. We live near the mountains and he is exposed to all sorts outside. I do wonder if toxins could have been the cause. I have no idea what to expect moving forward and I thought I would throw it out there as a question since this healthy fit youngish active dog should not have gotten sick like this.

[Vally]

Hi Lucy and Shaka. I’m so sorry to hear about what you two have been through.

Good news though he seems to be improving and you did great in getting emergency care quickly.

Keep Shaka quiet as while his red blood count is low, oxygen is not circulating as usual, so I would keep him quiet and maybe reduce his walks for now until he’s better.

Pink/red gums are the best. Don’t look at his gums while he’s resting, because they’ll always be pale. It’s best to check them while he’s up and about.

Red blood cells at 28% is out of the danger zone, so that’s really good.

Prednisone has a lot of side effects, panting, increased appetite, increased drinking, and so increased weeing.

Did they check for tick disease? It’s possible he has

Ask anything Shaka, happy to help.

Regards, Vally

[Lucy Thomson]

Hi thanks for replying so quickly. I checked all the tests and we did do a 4dx test in the ER on June 14 which was negative. Last week we did do the annual heartworm AG elisa test which was negative. He was due for a Bravecto (every 3 months – gave him that on March 9) and Interceptor Plus (last one on May 7) the day he got sick so I never gave him these and I was supposed to be taking his fecal sample to vet for annual check on heartworm. His fecal Thursday June 11 showed Fecal DX Prof with Giradia Hookworm Whipworm Roundworm negative. The Idexx CBC-Select test on Thursday June 11 did show T4 at 0.6 which my vet was concerned about cos of indicator of hypothyroidism. Apart a little bit of being tired in last year after walks, he has no weight put on, and no other symptoms as far as I can tell. His liver and kidnies appear to have been functioning well in all tests. He has had a few accidents of peeing in the night earlier this year but it was winter and he kinda didn’t want to go out into the cold night usually as far as I can tell no uti issue. Sorry just brainstorming to try and find a cause. He is tired today but still eating and drinking- solid stools. Thanks Lucy

[Vally]

Sorry a bit slow. Was out all yesterday.

The weeing is most likely the prednisone. It makes them drink a lot and so it’s not unusual to hear that accidents happen when they’re on high doses. It may happen a few times still, but it’s not a forever thing. As the prednisone can be safely dropped, you’ll see a lot of the side effects go.

For heartworm medication, we, on this site prefer Interceptor as recommended by Dr Jean Dodds. I’m quoting this from another post. “It can be used for very ill dogs in 45 day dosing cycles, but there is NO WIGGLE ROOM if you dose this way. It must be exactly 45 days. The label says 30 days because owners can forget to give it and probably remember sometime in the window of 30-45 days”.

I personally don’t like 3 monthly anythings after my last dog started having seizures after the yearly heartworm injection. I only use monthly heartworm but dose every 6 weeks and note it on the calendar and send myself a note on the phone so I don’t miss it. I don’t use anything else on my girl now.

I know there are no answers, many times we never find out the cause however hypothyroidism is a very big possibility. In fact you can ask for testing to be done through Dr Jean Dodds. She is a specialist in this and in fact runs very specific thyroid testing, based on breed, rather than just on the normal “dog” results.

In fact Jean Dodd’s protocol for treating AIHA is to dose with thyroxine even if a dog is NOT hypothyroid. Have a look at the Second Chance Resources relating to Hemopet. https://www.secondchanceaihadogs.com/hemopetresources
Item 5 shows a dose of 0.1mg/10lb giving twice daily. It helps to stimulate bone marrow and enhances platelet function.

Regards, Vally

[Lucy Thomson]

Hi Vally Thanks so much for your reply and help. I really appreciate it. Just fyi when I said he was peeing in the night that was over the winter way before all this ever happened and i was just wondering if this might have been a symptom of something coming. But now of course he is peeing a lot due to all the water he is drinking so he is a little put out by having to sleep in his crate and has got some pads. Thanks to all the people who have posted so many useful ideas.
We got fully discharged on Friday from the ER and I am calling my vet tomorrow to update him and book our first follow up in two weeks and I will definitely mention the thyroid test with Dr Dodds. I have been reading all her articles. My breeder is looking for some home-cooked meal recipes for me. He is doing well very tired still and looks very thin and has lost pounds. I am feeding him 6 smaller meals spread across the day and perks up with these. The meds are definitely working on him right now and I started on a couple of teaspoons organic thistle milk powder today. I learnt of two other dogs in the area who also have similar issues plus it sounds like there is a specialist here in Boise, Idaho who has dealt with some other cases. Thanks for all the support. Lucy

[Lucy Thomson]

Hi Shaka got some blood work done yesterday with our vet and overall he is doing better.
Hematology outcome:
WBC 20.74
LYM 1.96
MON 1.02
NEU 17.72
EOS 0.03
BAS 0.02
LYM%,9.4
MON% 4.9
NEU% 85.4
EOS% 0.1
BAS%,0.1
RBC 4.07
HGB 10.9
HCT 34.1
MCV 84.0
MCH 26.8
MCHC 31.9
RDWc 17.5
RDWs 56.2
PLT 488
MPV 12.8
PCT 0.62
PDWc 41.4
PDWs 20.9

Also CDP Outcome
The ones which were alerts on the test to summarize were
ALP 896
ALT 193
TBIL 0.7

Thyroxine T4 Test
T4 <0.4

Plan is to taper prednisone every 2 weeks by 20 mg as long as stable and improving. Clopidogrel will be discontinued in a couple of weeks. Continue with Omeprazole 20 mg twice daily two hours after other meds (do I do one two hours after morning Prednisone and one two hours after evening Prednisone?). Finish Doxycycline on Sat June 27 (will have been 400 mg daily for 14 days).

So my calculations following your advice are: July 1 vet wants him to do 40 mg per day reduced from 60 mg per day. This is 33% and not 25% but in some of your notes you said 25-33%. Maybe that is because of dividing pills etc. It will be 1 tablet of 20 mg 2x daily instead of 1 .5 tablets (30mg) 2 x daily.

His HCT is not yet 38% which you say is minimum to start reducing Prednisone but yesterday it was 34% and hopefully next Wednesday July 1 it will be 38%. What if it is a little below? Should I ask my vet to hold on?

Unfortunately i realized on the paperwork yesterday that there is no reticulocyte or retic reading which we had at the Dog ER and which you say is important.

Thanks for your input.
Lucy and Shaka

[Vally]

Hi Lucy, I’m thrilled to hear that Shaka has improved.

You’re starting the reduction at 33% and that should be okay. Don’t rush the reductions. I’d probably go a bit slower than every 2 weeks. Can you stretch it to 3 or 4 weeks. Makes sure Shaka’s PCV is checked first. A slight reduction is okay. You don’t want to see a continual reduction.

The percentage can vary by about 5% up or down, without concern, although I HATED any drops. They terrified me. The percentage varies also by how much fluid they’ve had, so if they drink a lot of water, the PCV will go down and if they are dehydrated, the PCV will go up. That’s why slight changes are not a problem.

If the PCV is 34 or thereabouts, I think you’re safe to start reducing. Just keep an eye on Shaka, which I know you’re doing.

With the Omeprazole, the 2 hours after is fine, but you can also do say 1 hour before food and drug, if that’s easier for your scheduling.

Regards, Vally

[Lucy Thomson]

Hi Vally I just wanted to say thank you for all your help and advice. It is such a good feeling that there are people supporting me and Shaka during this time. I just wanted to let you know that his HCT was at 38% on Wednesday – yesterday- so that was great. I started the Pred reduction last night and today. He was a little slow and quiet today but woke up and was quite lively each time it was meal time. I am feeding him smaller meals more often but to be honest he was a handsome 89-90 lb Ridgeback and he is at 74 lb now so i am feeding him way more than I would usually. I will give update next week. Still trying to decide about thyroid medication. Thanks Lucy