Milo diagnosed with IMHA 9 days ago.

Kisha

Guest

Good afternoon. My 4.5 year old chow/staffs mix Milo was diagnosed with IMHA 9 days ago. Milo was a rescue that we got when he was about 4 months old. He had demodex as a puppy, but it was clear by the time we adopted him. He has always been a very healthy active dog. He received his annual vaccines and checkup in mid May and all was well. About 12 days ago I noticed he was acting off. He seemed to have some GI upset. The next morning he refused to eat. As I was leaving town for work I told my husband to keep an eye on him. He refused his walk that night and so we called the vet and got him in the next day. She ran some blood work which revealed his PCV was 9%. Our vet had us take him directly to the emergency vet as she did not have blood available to transfuse. We took him in and they did a work up including X-rays and ultrasound to check for any malignancy. All were negative (I will upload his med records when done with this). They transfused 2 units which got his PCV up to 16. They let us take him home with instructions to come back in 24 hours for PCV check. They sent him home on 60 mg prednisone daily, mycophenylate 300mg q 8 hours, omaprazole 20 mg q day, plavix 37.5 mg q day and doxycycline 300mg q day. When we took him back after 24 hours for his recheck his PCV was again 9%. They readmitted him and gave him 2 more transfusions which brought his PCV up to 18. We picked him up on Sunday with instructions to again bring him back in 24 hours for recheck. His appetite has not been good the entire time. I have cooked chicken and rice and can get him to intermittently eat (he has never been a picky eater!!). Monday PCV still 18, Wednesday was 16 at that time we added Atopica 200 mg q day. Thursday morning he threw up all of his undigested food from the night before. We took him back in this morning and his PCV was still 16. He vomited again at the vet office, but it was only what he had eaten this morning. They handed an antiemetic to his regimen and we agreed to split the dose and give him 1 pill q 12 hours. I offered chicken and rice about 2 hours after they administered the antiemetic at the vet and he ate most of what was offered and has held it down for about 3 hours now.

His energy seems a little better (he actually lifted his leg to pee!) it is heartbreaking to watch something you love just waste away and be powerless to do anything. Reading the stories here have been both encouraging and heartbreaking. Any encouraging words at this point would be so appreciated.

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Patrice

Keymaster

Kisha,
Pardon my delay in writing.

I’ve looked over your vet laboratory workup. My first impression is AMAZING. I will I could get this kind of workup for myself. You have a great clinic, vet, if perhaps a little overboard in expenses….

The good news is that everything is absolutely normal with the exception of the anemia, ie, the low number of red blood cells.

Your vet correctly notes that this appears to be IMHA. What they note seeing are spherocytes. If you follow the link to this glossary item that pops up when you hover over the word, you read that spherocytes are red blood cells that have a “bite” taken out of them and there is a picture of what this looks like. This is indicative of an autoimmune attack on red blood cells in circulation. So we can be pretty sure that the immune system is attacking these red blood cells.

He is wildly regenerative. This means his bone marrow is responding appropriately to the anemia in a big way by making a lot of reticulocytes. We like to see this and what we would really want to see is an end to the RBC destruction. Those reticulocyes will turn into RBC within a few days and it would be great if they could survive.

What is not clear is what the trigger is that is causing this to happen. Your vet has done some extensive diagnostic rule-outs and they all are showing no problems. So now we have to do some of our own detective work.

I am positive your vet asked you a lot of questions about his daily life, unusual events in the past month, could he get into things that might be dangerous like rat poison. Do you live where there are snakes, poisonous spiders, or perhaps near wilderness areas? Was there recent vaccinations, flea, tick or heartworm meds? Any chance that he had food that was “off?” Could he have eaten food with onions in it? The more unusual things you can think of the closer we can come to figuring out what might trigger this and what things we might be able to reverse.

The meds are all great, no worries there except that we will begin to look at the side effects that arise from high dose prednisone. You are going to see higher liver values, extra peeing, huge appetite, skin issues etc. It really affects the whole body negatively, but it is necessary right now to suppress the immune system.

We can help you with all these side effects as they begin to appear in the coming weeks.

Do you have any questions I can answer for you?
My best, Patrice

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