German Shepherd in critical care with IMHA

[Natalie]

Good evening,

I am not sure if this is a very active forum, but I am so very heartbroken and lost. Our 6 year old German shepherd has been transferred to a critical care vet due to IMHA and is getting his first transfusion tonight. He has been staying overnight at our general vet who was monitoring his Hematocrit levels which were initially 24 the rapidly decreased to 17 over the last 24 hours. We elected the transfer but are now at a loss of his ability to survive this mysterious illness. He was otherwise so healthy and vibrant before! For anyone who reads this, please send prayer for our beloved Kojak.

[Vally]

Hi Natalie, I’m so sorry Kojak is so unwell right now. I know the panic you’re feeling.

I’m glad he’s been transferred to the critical care vet as they will have more knowledge of how to deal with this.

The transfusion is just there to buy time for the meds to start working. They will have Kojak on medication to stop his immune system which is currently out of control for whatever reason. The meds can certainly work, my boy, Bingo, was living proof of that and there are many dogs that have survived. The important thing is to get the treatment started and working.

Ask anything at all.

You are both in my thoughts and prayers.

Vally

[Patrice]

Natalie,
One of us is always watching our emails. No worries there.

I am so sorry how lost and heartbroken you are. We know how this feels and that is why this is here, for you to get advice and friendship.

I can tell you that we have seen great successes here with hundreds of dogs, so please don’t panic right now. We try to help you understand the most critical things you need to know in the first few days. That’s when the correct protocols are critical to the survival of your dog. Years ago, those protocols weren’t really thought out well, but now most vets are more sophisticated.

The transfusion is necessary and you can expect his hematocrit to drop again after the transfusion due to the rapid destruction of red blood cells in circulation. Do not let this worry you. The vet is trying to stabilize him with a transfusion. It helps buy valuable time while he waits for the significant immunosuppressive drugs he has been given such as prednisone and possibly injected dexamethasone. I know these are scary sounding drugs but they will save his life. It’s important to get his blood pressure up to avoid hypotension and he is getting dripped fluids with this transfusion for this.

The next thing I want you to talk about with your vet is the serious side effect of DIC disseminated intravascular coagulation. This is inappropriate clotting in the first days of IMHA. It can be life threatening. Most protocols now recommend something to slow down and control the clotting. We used to recommend baby aspirin but in hospital they can give heparin or other drugs to get him past this risky time. Please ask about this as soon as you can. We want to stabilize him.

I want you to sit down and write out a timeline of anything unusual that you have noticed about him in the past few months. We have found, as most vets have, that immune mediated hemolytic anemia is a condition of a combination of triggers that suddenly tip the balance. It’s not just one thing that did this. I want to also reassure you that none of this is your fault, you have done the best thing you can, get him to a vet immediately.

So what are the triggers. Here is a short, succinct look at the main factors of autoimmune disease in dogs.

“The four main causative factors of autoimmune disease have been stated to be: genetic predisposition; hormonal influences, especially of sex hormones; infections, especially of viruses; and stress.”

So we look at the breed. Two distinct common GSD conditions come to mind. Hypothryoidism and Von Willebrand’s Disease. Both of these can be implicated in what’s happening now. A 6 year old GSD may very well have decreased thyroid values to their genetics. And Von Willebrand’s Disease can be a serious bleeding disease in some dogs. My Giant Schnauzer Chance carried a mild form of this condition, Factor VII, where severe bleeding may only occur during some kind of an emergency like surgery or a serious accident. Please ask your vet to test him for this condition. There is a protocol to treat this in these dogs.

I want to know about any tests that the vet may have done to determine if there are tumors or if the spleen in enlarged.

We want to know if there have been any tick bites, and this is easily tested right in the vet’s office with a SNAP4DX+. Certain tick diseases can lead to abnormal bleeding.

Has there been any history of gastrointestinal disease in his life? GSD tend to have very sensitive systems. It is possible he has internal colitis or even ulcers that are bleeding.

Do you live out in the country? Could he have gotten into the older types of rat poison? They would cause serious internal bleeding. The usual treatment is injected Vit K.

Write all the things you have noticed that caught your attention but you couldn’t put your finger on what they were.

I’ll contact you by email so you can send me the CBC and Chem screen tests. I can send you papers for you to read.

Do you have specific questions right now?
My best, Patrice

[Natalie]

Thank you both so much! Yes, please do email me as I can send you the lab reports and medications that have been administered so far. I also just got word that he completed his first transfusion and that his platelet count has increased to 131k per the latest labs at the specialty vet. He is in critical care now with a 1:1 nurse.

[Natalie]

Update: Kojak did well overnight. We just got the following update.

His Hct is up >22 which is an appropriate response In dogs. Vet says he looks better, he’s on dex 7.5, plavix, cyclosporine and says outlook is overall good. No plans for splenectomy or apheresis unless deconpensates. Says hemolysis is usually 5-7 days.

When is the most critical time over? The vet said at this point he expects an 85% likelihood of survival. He told us to expect a second transfusion is possible in the next 24-48 hours. And are there any resources in how to care for him once he is able to come home to us?

[Patrice]

Did you receive my emails last night? Check your email box. I sent a lot of information.

Patrice

[Natalie]

Good evening,

I am not sure if this is a very active forum, but I am so very heartbroken and lost. Our 6 year old German shepherd has been transferred to a critical care vet due to IMHA and is getting his first transfusion tonight. He has been staying overnight at our general vet who was monitoring his Hematocrit levels which were initially 24 the rapidly decreased to 17 over the last 24 hours. We elected the transfer but are now at a loss of his ability to survive this mysterious illness. He was otherwise so healthy and vibrant before! For anyone who reads this, please send prayer for our beloved Kojak.

[Vally]

Hi Natalie, I’m so sorry Kojak is so unwell right now. I know the panic you’re feeling.

I’m glad he’s been transferred to the critical care vet as they will have more knowledge of how to deal with this.

The transfusion is just there to buy time for the meds to start working. They will have Kojak on medication to stop his immune system which is currently out of control for whatever reason. The meds can certainly work, my boy, Bingo, was living proof of that and there are many dogs that have survived. The important thing is to get the treatment started and working.

Ask anything at all.

You are both in my thoughts and prayers.

Vally

[Patrice]

Natalie,
One of us is always watching our emails. No worries there.

I am so sorry how lost and heartbroken you are. We know how this feels and that is why this is here, for you to get advice and friendship.

I can tell you that we have seen great successes here with hundreds of dogs, so please don’t panic right now. We try to help you understand the most critical things you need to know in the first few days. That’s when the correct protocols are critical to the survival of your dog. Years ago, those protocols weren’t really thought out well, but now most vets are more sophisticated.

The transfusion is necessary and you can expect his hematocrit to drop again after the transfusion due to the rapid destruction of red blood cells in circulation. Do not let this worry you. The vet is trying to stabilize him with a transfusion. It helps buy valuable time while he waits for the significant immunosuppressive drugs he has been given such as prednisone and possibly injected dexamethasone. I know these are scary sounding drugs but they will save his life. It’s important to get his blood pressure up to avoid hypotension and he is getting dripped fluids with this transfusion for this.

The next thing I want you to talk about with your vet is the serious side effect of DIC disseminated intravascular coagulation. This is inappropriate clotting in the first days of IMHA. It can be life threatening. Most protocols now recommend something to slow down and control the clotting. We used to recommend baby aspirin but in hospital they can give heparin or other drugs to get him past this risky time. Please ask about this as soon as you can. We want to stabilize him.

I want you to sit down and write out a timeline of anything unusual that you have noticed about him in the past few months. We have found, as most vets have, that immune mediated hemolytic anemia is a condition of a combination of triggers that suddenly tip the balance. It’s not just one thing that did this. I want to also reassure you that none of this is your fault, you have done the best thing you can, get him to a vet immediately.

So what are the triggers. Here is a short, succinct look at the main factors of autoimmune disease in dogs.

“The four main causative factors of autoimmune disease have been stated to be: genetic predisposition; hormonal influences, especially of sex hormones; infections, especially of viruses; and stress.”

So we look at the breed. Two distinct common GSD conditions come to mind. Hypothryoidism and Von Willebrand’s Disease. Both of these can be implicated in what’s happening now. A 6 year old GSD may very well have decreased thyroid values to their genetics. And Von Willebrand’s Disease can be a serious bleeding disease in some dogs. My Giant Schnauzer Chance carried a mild form of this condition, Factor VII, where severe bleeding may only occur during some kind of an emergency like surgery or a serious accident. Please ask your vet to test him for this condition. There is a protocol to treat this in these dogs.

I want to know about any tests that the vet may have done to determine if there are tumors or if the spleen in enlarged.

We want to know if there have been any tick bites, and this is easily tested right in the vet’s office with a SNAP4DX+. Certain tick diseases can lead to abnormal bleeding.

Has there been any history of gastrointestinal disease in his life? GSD tend to have very sensitive systems. It is possible he has internal colitis or even ulcers that are bleeding.

Do you live out in the country? Could he have gotten into the older types of rat poison? They would cause serious internal bleeding. The usual treatment is injected Vit K.

Write all the things you have noticed that caught your attention but you couldn’t put your finger on what they were.

I’ll contact you by email so you can send me the CBC and Chem screen tests. I can send you papers for you to read.

Do you have specific questions right now?
My best, Patrice

[Natalie]

Thank you both so much! Yes, please do email me as I can send you the lab reports and medications that have been administered so far. I also just got word that he completed his first transfusion and that his platelet count has increased to 131k per the latest labs at the specialty vet. He is in critical care now with a 1:1 nurse.

[Natalie]

Update: Kojak did well overnight. We just got the following update.

His Hct is up >22 which is an appropriate response In dogs. Vet says he looks better, he’s on dex 7.5, plavix, cyclosporine and says outlook is overall good. No plans for splenectomy or apheresis unless deconpensates. Says hemolysis is usually 5-7 days.

When is the most critical time over? The vet said at this point he expects an 85% likelihood of survival. He told us to expect a second transfusion is possible in the next 24-48 hours. And are there any resources in how to care for him once he is able to come home to us?

[Patrice]

Did you receive my emails last night? Check your email box. I sent a lot of information.

Patrice