Help and advice needed: New to AIHA

Candice Sarah

Guest

Hi
I’m hoping to get some guidance and advice for my dog. I apologize for how long this is. Only having first hearing of the dreadful aiha in the last two weeks, I find myself a bit overwhelmed, helpless, and generally confused. I also have a bit of pstd with this kind of stuff as Luna, my dog, a 9 1/2 catahoula mix was diagnosed with Addison’s about 4 1/2 years ago. And it was traumatic, As several vets could not figure it out.

In the last month I have noticed changes that I thought of as age related. Luna seemed more tired then normal. On March 6, she was very lethargic and wouldn’t eat. Thinking it had something to do with her Addison’s we rushed her to the emergency vet. We were told that she likely had AIHA as she was very anemic. She had to get a blood transfusion and was at the vet for two nights before they let her go ho,e.Her liver panel was normal and before treatment (although running a fever) her wbc was normal. Her ultrasound did reveal an enlarged liver and spleen but nothing obvious conclusive in regards to cancer. They didn’t seem too interested in doing a tick/infectious disease panel as it seemed that nothing in the blood concluded that. The critical care vet is now releasing her to the internist. Who we will be seeing on Wednesday. From everything I’ve read it does seem like something triggers or cause this, so I’ve been doing a lot of thinking to come up with a timeline, but the current vet did not seem interested.

When she came home from the vet on March 9, the following morning she threw up a thick baby wipe which we matched to others in the bathroom trash. We were pretty alarmed because it meant that she got in the bathroom trash which had all kinds of stuff from both me and my partner having the flu, besides the fact that wipe was in her stomach for that long ( also I had no clue those are made from plastic), but the vet seemed unimpressed.

I’m hoping when I go to the new vet I can have some clarity.

In House Tests on March 6
RBC…..2.6 m/ul. (Ref 5.65-8.87) Low
HCT….18.2 %. (Ref 37.3-61.7) Low
HGB… 6.2 g/dL. (Ref 13.1-20.5) Low
PLT…. 60 K/ul. (Ref 148-484) Low
In Normal Range: MCV, MCH, MCHC, RDW)
WBC was normal though monocytes were high.

After the blood transfusion per HCT/PCV went up to 30% on 3/7 to 32% on 3/8.
She was immediately started on Doxy, Dexa, Cyclosporine, and metro.
When she went home she was continued on Doxy, Prednisone (40mg/day), Metro, Atopica 100mg 2x/day, and sucralfate.

Her official blood smear came back (this is the report is from March 7):
WBC… 16.4 (Ref 4-15.5) High
RBC … 3 (Ref 4.8-9.3) Low
HGB… 7.6 (Ref 12.1-20.3) Low
HCT… 25 (Ref 36-60) Low
MCV… 83 (Ref 58-79) High
MCH… 25.4 (Ref 19-28)
MCHC… 31 ( Ref 30-38)
Anisocytosis- Moderate
Polychromatic- Slight
NRBC…1 (Ref 0-1)
Blood Parasites-None Seen
Platelet Count….75 (Ref 170-400) Low
Few small clumps observed

Neutrophils… 14596 (Ref 2060-10600) High
Bands, Lymphocytrs, Monocytes, Eosinophils, Basophils-All Normal
Reticulocyte Count:
Total…. 5 (Ref 0-1) High
Absolute…. 15000 (Ref <60000)High

Pathologists notes:
The slide review is consistent with a moderate anemia exhibiting marked regeneration. No Spherocytes are noted. A mild neutrophilia is present, and no degenerative changes are noted. In my opinion the platelet numbers are adequate with mild platelet clumping.

After the results, the Critical Care vet wanted to retest and send out a new smear a week later. I have the initial results, but haven’t been able to get the pathologists notes. The vet finally labeled it as regenerative and said its time to see either our primary vet or specialist.

Those results are from March 13
WBC… 24.6 (Ref 4-15.5) High
RBC … 4.6 (Ref 4.8-9.3) Low
HGB… 12.1 (Ref 12.1-20.3) Normal
HCT… 38 (Ref 36-60) Normal
MCV… 83 (Ref 58-79) High
MCH… 26.1 (Ref 19-28)
MCHC… 32 ( Ref 30-38)
Anisocytosis- Moderate
Polychromatic- Slight
NRBC… 2(Ref 0-1) High
Blood Parasites-None Seen
Platelet Count….220 (Ref 170-400) Normal

Neutrophils… 17958 (Ref 2060-10600) High
Monocytes…3936 (Ref 0-840) High
Bands, Lymphocytrs, Eosinophils, Basophils-All Normal
Reticulocyte Count:
Total…. 5 (Ref 0-1) High
Absolute…. 15000 (Ref <60000)High

There is a note that the Reticulocyte count increased but I don’t have the final report yet from the pathologist.

To be honest I find this disease so scary and confusing. And everything that I read seems to say even if there is no obvious triggers there is almost always a trigger, but hat doctors just can’t figure out.

Things that have come up that are worrying me are:
-We switched her food food a little over a month ago because there is a class action suit going on in California that had specifically listed her food as being high in lead and aresenic (Blue Buffalo) I couldn’t find anything conclusive and she had only had 2 bags worth but am over that company.

-she was stung by a bee about a month ago (or what we thing, there was no scab or bite mark, her was was very swollen but was normal in 24 hr after getting benedryl)

-she has had access to onions/garlic in the past though I don’t believe recently. It would have been about a year ago, she kept getting into the garden and pulling up green onions and garlic. I feel horrible because I had no clue they could do more than just an upset stomach. I never had heard of it until dealing with this.

-of course there is the baby wipe. It was a pretty thick baby wipe. It has a few ingredients in that don’t mix well with stomach acid, but again the vet said it had nothing to do with this. The trash bag it would have been in, it is possible there were benzocaine lozenges also which concerns me.

Again all of the above was discounted by the vet since no Heinz bodies were observed and the initial liver panel was normal. I am interested in getting a tick panel. The vet wasn’t concerned because where we are in California but we are actually from Florida where we dealt with ticks all the time.

Any guidance or suggestions would be greatly appreciated.

Candice and Luna

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