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- Help and advice – Experience with Acute Respiratory Syndrom in AIHA dog
Hello everyone,
Very sorry to join you to ask for you help, but so happy to find that you guys exist. I’ll try to be brief, I need your help in this crucial and difficult time.
Our standard doxie was diagnosed with acute AIHA last Friday. His RBC was 13 then. RBC is low, but has been stable now for thelast few days, at 20. HIs reticulocytes are at 100. Here is his medication: Dexometazone 0,25mg/kg – since Saturday, Imuran – 0,25 mg/kg (I think) – since Saturday, Cyclosporine – 5 mg/kg – since Monday , Something to prevent clotting, administered morning and evening.
He had a second blood transfusion Saturday morning. He reacted well. His propects looked good. Then, late Monday evening, he had acase of acute respiratory distress syndrom. He had tubes in his nose and placed in an oxygen tent. Most likely caused by clots, but vets said cannot be sure. He still needs small tubes in his nose to breath, but has been out of the oxygen tent since Wednesday. He was on one oxygen tube for a day, but last night developped some difficulties again, and 2nd tube was put back. He is very weak, has not eaten in two days. All is meds are administered intraveneous. He vomited a bit on Wednesday. The vet said that he is stable, but she’s very concerned that he’s lethargic, dull. He only get sout of his cage to see us when we visit him. Doesn’t want to move (cannot?), eat. She said all we an do now is wait.
Our vet clinic is supposed to be one of the best, and I certainly do not doubt the vets’ dedication and judgement. It’s a big hospital, and he hasn’t been withthe same vet, a rotation of 4. He has been there for more than a week now, and while we can visit him daily, I’m sure it adds to his stress. I’m just lost right now, and wonder which information I should ask for exactly. Evasive replies do not help. After reading the forum, on the phone, I asked her a few qts about medications and RBC, and reticulocytes and I think she interpreted my questions as lack of trust – which I could understand, but was not my intent. She started saying that it was complicated to speak beyond RBC, but gave me reticulocytes.
I’ve read Bebesiosis could result from blood transfer and cause Acute respiratory syndrom, but if that’s the case, then the corticoid he already gets should treat that, right? He was tested early on, and there are no signs of cancer whatsoever.
I understand that getting the acute respiratory syndrom under control is the priority now, but which questions should I ask for? She said I should only wait, but I’m not sure what exactly I’m waiting for. Any help or advice would help here, especially is some of you have experience with ARS. We can only afford so many days in intensive care, we had some saving and have already spent over 9,500$ for his stay and medication alone (I assume that as long as he requires oxygen, he simply cannot come back home? Can he?), and I want to make sure that if he’s there, all the necessary things are being done, and that I know what to ask for. We can nurse him at home afterward, but is that even possible with ARS?
Thanks in advance, and love for you all who dedicate their lives to theirs dogs’ well-being.
Anne
Anne,
I am really sorry to read this. You must be frantic with worry. Let’s try to help you the best we can.
I believe, from prior experience with other owners, that this may be a transfusion reaction. They are not uncommon. One of the major issues with a transfusion is the amount of fluid used, a dog can simply get too much fluid in their body at one time.
Here is a pretty good discussion about this.
http://www.petmd.com/dog/conditions/cardiovascular/c_multi_blood_transfusion_reactions
I don’t have much time right now, but I will come back to you a little later in the day. Don’t worry about the Babesiosis, most blood is carefully screened. Read the article and ask any questions about it you need answered.
my best
patrice
Hi Patrice,
Thanks for your quick reply. Yes, we are frantic and desperate, mostly because now we want to see if we can “buy” our dog some time, if that’s what he needs, by finding a less expensive hospital, take him home, etc. We were hopeful because while low, his RBC seem stable now. But his repiratory distress has weakened him, and waiting for it to pass does not satisfy us right now, so we want to know what to ask for.
Anne
Anne,
Are you thinking you should move your doxy to a new hospital? I am not a vet, so anything I say should be taken with a bit of caution. This is an emergency and if this were me I would not feel comfortable moving my dog. If he is stable, as the vet says, then perhaps it is best to keep him a bit longer.
Read this:
“Transfusion related acute lung injury (TRALI) is a serious blood transfusion complication characterized by the acute onset of non-cardiogenic pulmonary edema following transfusion of blood products. TRALI is temporally related to a blood transfusion; specifically, it occurs within the first six hours following a transfusion.”
“Supportive care is the mainstay of therapy in TRALI. Oxygen supplementation is employed in all reported cases of TRALI and aggressive respiratory support is needed in 72 percent of patients. Intravenous administration of fluids, as well as vasopressors, are essential for blood pressure support. Use of diuretics, which are indicated in the management of transfusion associated circulatory overload (TACO), should be avoided in TRALI. Corticosteroids can be beneficial.”
“Transfusion reactions can be minimized (and even prevented in some instances) by crossmatching or typing animals prior to transfusion and by paying strict attention to transfusion procedures, e.g. maintaining strict aseptic techniques, infusing products slowly, not using out-of-date or discolored products, closely observing the animal during the transfusion procedure (especially in the first 15 to 30 minutes).”
“In general, treatment of transfusion reactions is symptomatic and logical. First and foremost, if a transfusion reaction develops, the transfusion should be stopped immediately (if the reaction is severe) or slowed (for milder reactions). The product should be sent for bacteriological culture (as well as a gram stain smear made from the bag to look for bacteria). ”
“The animal should be treated symptomatically, e.g. if showing signs of shock, intravenous fluid therapy at shock doses and corticosteroids should be initiated. If showing signs of an anaphylactic reaction, corticosteroids and/or antihistamines can be administered.”
I think the question that I would ask, if this were me, would be if the use of some form of anti-clotting agent, such as low-molecular-weight heparin, might help get my dog through this? You may never know, they could be doing this already.
I would also contact Dr. Dodds at Hemopet.org. Hemopet is an international canine blood bank and Dr. Dodds has over 30 years experience with canine blood transfusions. She could advise you what you should be asking and to expect.
She has a consultation page:
https://labordatenbank.com/cake/hemopet/onlineorders/hemopet_add
Send her your most recent lab work and explain what the acute emergency is. I know you will hear back within a short period of time. Many of us here have received valuable advice from her and saved our dogs’ lives.
Please let us know how he is doing right now.
my best
patrice
Hi Anne — I don’t have any experience with ARS but did have the same thought — a reaction to the transfusion, but the fact that the transfusion was Saturday and the reaction Monday — perhaps not. If the vet seems to get defensive, I think it’s okay to say “I’m not by any means challenging you or the treatment, I just need to understand what’s happening and how this is being treated. I am so very worried.” I am one of those people who needs to understand what’s happening and I have done a lot of reading on my own to understand and I believe it has helped my dog’s recovery. Also, Dr. Dodds is incredibly h elpful, and has helped so many of us find the answers to get our dogs on the road to recover. I am thinking of you and sending you and your dog much love.
tamara and ashki xoxoxo
in the fight since 4/30/2014
Anne,
I found some more specific information. It appears that what is happening may appear to be Acute Respiratory Syndrome but there is a rare chance this could be a TRALI reaction. This article says it usually lasts about 96 hours. So perhaps we will see a recovery?
my best, patrice
” Transfusion-Related Acute Lung Injury
Transfusion-related acute lung injury (TRALI) is a rare syndrome that can develop 1 to 6 hours following transfusion of a plasma-containing blood product. It is characterized by development of bilateral pulmonary edema, fever, and hypotension and is clinically indistinguishable from acute respiratory distress syndrome.
TRALI is caused by leukocyte antibodies from the donor plasma that react with the recipient’s leukocytes. TRALI should be suspected if the clinical history fits the syndrome and other causes of pulmonary edema, including cardiogenic pulmonary edema and volume overload, have been ruled out. The pulmonary fluid produced in TRALI has a high protein content, so it cannot be eliminated by diuretic therapy. In patients with TRALI, as in other cases of noncardiogenic pulmonary edema, the ratio of protein in the pulmonary fluid to that in blood is greater than 0.7. TRALI can be confirmed by documenting the presence of leukocyte antigen in donor plasma and demonstrating a positive reaction of donor plasma with recipient leukocytes via a crossmatch reaction. This level of confirmation may be impractical to routinely attain in veterinary patients.
The reaction typically lasts less than 96 hours. Therapy involves intravenous fluid and oxygen support as warranted by the severity of pulmonary dysfunction. Treatment with diuretics may be detrimental because of decreased intravascular volume and increased viscosity of the pulmonary fluid.”
Dear Anne
Welcome to the site, though I am sorry you have had to find us and so sorry to read about what has been happening with your lovely dog.
Firstly, I absolutely agree with Patrice in asking about clot-busting drugs to treat for a possible clot. It’s excellent to hear that he is on preventative medication for this, as clotting is a very serious issue for IMHA dogs. Do you know whether they have done a chest x-ray or other imaging? X-rays can sometimes help them to get a better idea of what is going on.
It can be difficult asking questions at the vet, and some vets do become a little defensive, particularly about information on the internet. They are right in this respect, as it is of course always important to find a reliable source. However, this is your precious pup and you have the right to ask anything you like. I like Tamara’s suggestion for an explanation you could use with the vet. We are not vets but we have all been through this with our pets and understand how frightening it is.
In terms of where he is physically, I’d be inclined to agree with Patrice and keep him there until his breathing has stabilised. This is an emotionally and financially draining time for you and I quite understand how difficult it can be to find the money to keep going with it all, but perhaps you could start looking at other places whilst he is still there? As for having him home, I have not heard of home oxygen for dogs and imagine it is very unlikely. It would also be a huge responsibility for you to cope with. There may well be cheaper hospitals who are able to administer oxygen therapy though.
I suspect his reasons for not wanting to eat or move are due to his low PCV and respiratory distress: he is trying to conserve all his energy for breathing, and both the anaemia and the RDS will be making him very tired at the moment.
Do you know what his most recent blood results have been? Temperature? Is he on any antibiotics? Although it’s quite early days with his immunosuppressants (the cyclosporine and Imuran), it is possible that he has picked up some sort of infection which has sparked this off. Do you have any idea what the trigger for his AIHA was?
I’m sorry for all the questions and please do not feel you have to hurry to reply, as I know you must be out of your mind with worry.
I am keeping everything crossed for you that your little Doxie soon turns a corner.
Mary & Mable x
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