9 year old Chihuahua with benign splenic mass diagnosed with IMHA

[Taylor]

My nine year old chihuahua was diagnosed with IMHA following splenectomy surgery. He fell ill suddenly, that’s when we found he had a mass on his spleen. He was prescribed oral prednisone, however was vomiting shortly after surgery and had no appetite and noticeable lethargy. He wasn’t able to take the prednisone, so we took him back to the hospital where they gave him an injectable form and sent him home. He got worse overnight and is now back in the hospital. His kidney values are all over the place and he is very acidic. He also has a heart murmur now. They have him on IV fluids, prednisone and some meds to hopefully normalize his kidney function. This is all a shock to me — he has never had any health issues and I’m not familiar with IMHA or anything that stems from it. The vet suspects there must be a connection with all of this to his splenic mass. Any advice would be greatly appreciated. Thank you so much!

[Vally]

Hi Taylor,

I’m so sorry to hear about your boy and I know you must be incredibly worried right now. He is in the right place and hopefully his treatment will get him stabilised.

Do you have a copy of blood test results at all? If so, use the Urgent Advice to send it through. If you don’t ask for a copy.
https://www.secondchanceaihadogs.com/urgent-advice

Hoping to hear some good news from you shortly that your boy is recovering. What is his name?

Vally (Angel Bingo) and Saba

[Taylor]

Thank you so much. I don’t have a copy of his labs, but will ask for them tomorrow. His name is Harley. I will be sure to post an update once I hear from the doctor tomorrow!

[Patrice]

Hi Taylor,
I am sorry to read about Harley. You must be so worried and confused.

I’d like to know a little more about this growth on the spleen. You say he was suddenly ill and then they removed the spleen and the growth in an emergency surgery, am I correct?

There can be different growths on a spleen. Benign growths are not uncommon. Malignant growths can also be found on the spleen. The main reason for this is that the spleen is a blood filled organ and that is a nice environment for cells that want to have plenty of nutrition to grow quickly. Unfortunately rapidly growing cells on the spleen tend to be unstable as they get larger. This means that they can be more apt to rupture and bleed. Approximately 60% of splenic growths are benign while the rest are likely to be hemangiosarcomas, a malignant tumor growth common in older dogs.

It sounds like Harley’s growth ruptured suddenly, making him quite ill. They most likely removed the spleen and the growth so that he would not lose so much blood. It sounds like they appropriately sent out the growth for a cytology to determine if the growth was benign or malignant and the report was that it was benign, am I correct?

In the case of a benign growth that has ruptured, removal of it and the spleen would be an appropriate treatment. A dog can survive quite well without a spleen, though from that point on they are less able to fight off a certain tick disease called babesiosis. However in some cases, which are more complex, the removal of the spleen and the growth can lead to conditions similar to but not quite like IMHA. I would like to see several lab reports, CBC and chem screens, that were done prior to the surgery and also post surgical to be able to see what exactly is happening here.

Surgery is quite a shock to the body and this was a tough surgery on a little body. It is quite understandable that he is not feeling well at all. Prednisone is a potent drug and the side effects are very pronounced. It is quite normal for vets to use this drug as an emergency treatment for many conditions.

So the question I have is this truly a confirmed case of IMHA? Did they remove the spleen because they felt the spleen was contributing to the IMHA and then discovered the growth? Or did they remove the spleen because of the benign growth and the IMHA developed afterwards?

The kidneys are very sensitive to the load they receive when there is a destruction of many red blood cells in the body. The destroyed RBC cells release a great deal of hemoglobin, the contents of which must be processed as wastes by the liver and kidneys. This load can overwhelm the kidneys. Putting Harley on IV fluids can help flush the system. This most likely is a temporary situation.

Many dogs with anemia do express a temporary heart murmur as the heart attempts to work harder to pump more poorly oxygenated blood to the body cells. Anemia, by definition, is less oxygen being carried to the body cells. In this case it is due to a smaller number of RBC.

So the treatment needs to address the reasons for why there are less red blood cells. Transfusions can help stabilize a dog that has severe anemia. I am positive that they have already given at least one transfusion during the surgery. Subsequent transfusions will be helpful provided that the vet types and matches the transfused blood properly.

Yes, the goal is to stabilize Harley right now. The body is very resilient and dogs can be quite amazing in their ability to recover their homeostasis. When he is released to home we can help you provide some great home nursing care to him.

Help me by uploading the test results on the Urgent Advice page. Please limit the attachments to 3. We can use email to gather the rest.

What questions do you have for me?
my best, patrice

[Taylor]

Hi Patrice,

Thank you so much for your very thorough response. It gave me a lot of clarity.

Yes, Harley’s spleen was removed in an emergency surgery. However, the mass never ruptured. They believe he may have been losing blood slowly due to it as he was very anemic when we initially brought him in, but thankfully were able to remove the spleen and mass intact. It was then sent off to cytology where they confirmed it was benign. Yes, he did have a transfusion before the surgery.

The IMHA was not diagnosed until after the removal of the mass and spleen. He was transferred to internal medicine from emergency this morning, so I am heading over there shortly to meet with the doctor and learn more about his condition. He stayed the same overnight, so I’m hoping his condition improves soon. Once I have those labs, I will upload them.

Thank you again.

[Patrice]

Taylor,
These growths are fragile and can bleed and heal many times, causing a continued troublesome anemia. Rupture in these cases is a strong possibility and it’s great they caught it before that happened.

Chance, whom I named this site after, had exactly the same thing, a large benign growth on his spleen. I have gathered a great deal of information about these conditions since 2007. You can read his story under Our Stories.

Because of this information I suspect we may find a slightly different situation for Harley than the usual IMHA. Once I see the test results I will know more.
my best, patrice

[Taylor]

Patrice,

Correction: They called me before the surgery thinking Harley had IMHA due to his labs, however it wasn’t diagnosed until after.

I guess one of the main concerns I have is — the hospital has never seen a case like this before. I have been told over and over how abnormal this is in a chihuahua. They have been putting a lot of weight on the word prognosis and it has made me so worried. I was so grateful to find this forum because after lots of research I couldn’t find anything about chihuahuas and splenic masses or IMHA.

Aside from fluids, what more can they do for his kidneys? What alternatives are there for prednisone? And what questions should I be asking them? Thank you so much!

[Patrice]

Taylor,
Yes, I was expecting to actually hear this from you at some point. No, they don’t know what they are looking at and are confused. I do know what is probably going on and I need to see the lab results before I confirm this.

Don’t let them upset you. For sure I was horribly upset in the beginning and it certainly made for a lot of stress in our lives. There is a very complex but scientific explanation for what may be happening. When we have more time you and I can discuss this at length.

The most important thing for you to worry about right now is getting him stabilized and eating properly again. But right now, the diet needs to be appropriate for his struggling kidneys.

A good friend Mary Straus has a great website, Dogaware, and she covers kidney conditions and diet very well. You are going to be overwhelmed if you try to read this whole page and understand it all, just browse through and get a good idea of how the kidneys can be compromised.
http://dogaware.com/health/kidney.html

This advice on her page is very important:
“Let me start by telling you what not to do: do not put your dog on a prescription kidney diet.
A reduced phosphorus diet is not needed or beneficial until creatinine rises above 2.0 mg/dL (180 umol/L) or fasted blood phosphorus level rises above 4.5 mg/dL (1.5 mmol/L).

So we need to see your chem screen reports asap to know what the creatinine levels are.

Here is her information about diet and dogs with kidney disease. Keep in mind this may be a temporary situation, not kidney disease!
http://dogaware.com/health/kidneydiet.html

And here is Mary’s suggestions for diets for early to moderate kidney disease, understanding this may not be kidney disease but that the kidneys need to have a light load right now.
http://dogaware.com/health/kidneysamplediet.html

Right now I would use her sample diet but do not use red meats or beef liver, which could put a load on his liver, I would use eggs and egg whites plus some steamed white fish. But stick with the same basic concepts she covers. Y

You don’t need to get super concerned about grinding egg shells, crumble them with your hands or put them in a plastic bag and roll them with a pastry dough roller. For grains I recommend getting plain old sushi rice at the grocery store and let it cook in plenty of water until it is quite mushy, use the liquid in the meal also. Butter can be a vehicle to get pills down. Yogurt should be plain and that makes a great treat.

The ultimate goal is to reduce phosphorous in the diet, do you understand this part that she explains in the introduction?

Whatever help you need, let me know,
my best patrice