Not producing enough red blood cells

[Terri]

Our 12 year old Lhasa Apso mix was diagnosed with AHMA Monday. Her PCV was 13, lethargic, not eating. She had one blood transfusion. The next day the PCV came up to 24. The day after down to 22, then down to 18. It then came up to 26, and they sent her home on Thursday. We had her blood checked Saturday, and it was down to 14. They have run a full blood panel and xrays. She is producing red blood cells, but not quickly enough. I believe he said 18%. She is now having another blood transfusion. We were discouraged because the vet said that they treat around 100 cases a year and about 10 do well. He said that if she doesn’t improve after this transfusion, we should have her put down. Need advice, please. We want to do anything we can to help her.

[Terri]

I also forgot to mention that she has been on prednisone, doxycycline, mycophenelate, omeprazole for 5 days. Thank you.

[Vally]

Hi Terri, I’m so sorry to hear about your girl. Is she home with you?

The drugs take time to work, and that’s what I think you’re seeing. The blood transfusions just keep her going long enough for the drugs to start working. The blood transfusion isn’t doing anything to stop the destruction of the disease.

It’s not unusual to see a drop after a blood transfusion either, again, because the destruction of the red blood cells is still happening.

What are the doses of the drugs you’re giving and what does your dog weigh.

If you have a look at Hemopet Resourcdes, you’ll see Dr Jean Dodd’s recommendation for treatment. She’s an expert in this disease. It’s the one labeled Dr Dodds IMHA Disease and Bone Marrow Failure.
https://www.secondchanceaihadogs.com/hemopetresources

I just want to make sure the drug dosages are correct.

My boy, Bingo, didn’t respond instantly – it took about 3 or 4 weeks before he started to improve. He was put on Cyclosporine which was what turned him around and he started responding. It’s another drug which targets the actual cells doing the damage.

Have they checked her thyroid? Do you have any idea what may have triggered the disease? Had she had any shots lately? Any stings or bites? Has she been tested for tick disease. All of these are important because they could be the original cause of the problem.

Ask anything Terri. I’m in Australia, so different time zone most likely, but I do keep an eye out.

My best, Vally

[Vally]

Another thing, you could do an Owners Consultation with Dr Jean Dodds. Many of us here have done that, me included. She’s a lovely lady. If you have blood test results you can send them to her and she’ll give you an advice. Her consultation is $150 US, and once she has responded to you, you can email her back with further questions at no additional charge.

On the same page as the previous link, but it’s here again, and it’s the second item (on my screen)
https://www.secondchanceaihadogs.com/hemopetresources

[Terri]

Thank you so much, Vally. We are picking her up tonight. Her vaccinations were July 10. I do not know if they have checked her thyroid but will ask. I will look at her medicine dosages when we pick her up and message you.

[Terri]

Also, we are going to get copies of her paperwork and contact Dr. Dobbs.

[Vally]

That’s great. Do you know what her latest blood results are? You won’t go wrong in contacting Dr Jean. She’s this site’s Angel.

Vally

[Patrice]

Terri,
I am sorry to read about your Lhasa Apso. How is she doing?

I am more optimistic about dogs recovering from this condition. If a clinic sees a dog with these symptoms immediately, does the proper diagnostics and applies a valid and proven protocol there can be good outcomes.

Where the difficulty arises can be with the diagnostics. There are several ways that IMHA can affect a dog. The term IMHA, immune mediated hemolytic anemia, implies that there is “something or some things” mediating the destruction of red blood cells. In recent years, researchers now feel that there have always been several contributors or triggers that accelerated this condition but they weren’t as apparent to vets because they didn’t do enough diagnostics to find the cause(s.)

So there is a long list of things that can activate the immune system to not be “tolerant of self.” The more common things should be ruled out immediately. We think of insults to the immune system as stressors. So high on the list are, in no particular order: genetics (inherited immune system sensitivities), stress like over-vaccination, insults such as bee stings, venomous bites, virus and bacterial infections like tick diseases, dog flu, leptospirosis etc, exposure to certain drugs, toxic exposure to poisons. Other triggers can be things like chronic diseases or tumors.

Each of things should be ruled out, one after the other, so that anything that can be treated is checked for. For instance I see your vet has prescribed doxycycline which is the most potent and best treatment for various tick disease. The vet may or may not have tested for tick disease, which I usually recommend you ask about. But it is wise to start the treatment.

I see that they did xrays, did they comment about what they saw? They were looking for tumors and other growths that might be driving the anemia.

Unfortunately some breeds are more susceptible because of their genetics. “Dog breeds most commonly affected include Cocker spaniels, English Springer spaniels, Collies, Poodles, Old English sheepdogs, Lhasa Apsos, Shih Tzus, and Labrador retrievers, although any breed is susceptible.”

Keep in mind that it takes multiple stressors to tip the immune system in the wrong direction. So a good vet will look carefully at the history and evaluate for all these things. The other important thing is the initial emergency treatment. As Vally says, they will give prednisone immediately and, if necessary, a transfusion to buy time for the prednisone to sufficiently suppress the immune system.

After a few weeks, it is usually advisable to add a second medication to assist in suppressing certain parts of the immune system. The real goal is consistent and progressive suppression of the immune system without the difficult side effects of prednisone.

So your vet started the protocol they use and added mycophenelate (Cellcept) as an additional drug. This is a good choice. And they added stomach protection to help prevent the prednisone from causing stomach ulcers.

So once all the diagnostics have been done, a transfusion to buy time and a good drug protocol, the goal is to keep your girl as healthy as possible so she can tolerate the continuation of the protocol. Dogs on prednisone have ravenous appetites and drink tons of water, peeing all the time. But prednisone is not a good long term drug to be on because of side effects like this.

So, the big picture is, it appears your vet applied the emergency protocol properly. We want to see positive changes in the upcoming days. You might have to expect another transfusion, that would not be unusual. Dogs are very different, one from the other, with this. Some dogs are not bothered by very low PCV HCT while other dogs are more sensitive. But I have seen amazing will to live from the dogs we have helped. Your girl is very busy trying to heal herself. Stay positive for her sake and let her see you happy to be with her.

Please update us when you can,
my best, patrice

[Terri]

Our 12 year old Lhasa Apso mix was diagnosed with AHMA Monday. Her PCV was 13, lethargic, not eating. She had one blood transfusion. The next day the PCV came up to 24. The day after down to 22, then down to 18. It then came up to 26, and they sent her home on Thursday. We had her blood checked Saturday, and it was down to 14. They have run a full blood panel and xrays. She is producing red blood cells, but not quickly enough. I believe he said 18%. She is now having another blood transfusion. We were discouraged because the vet said that they treat around 100 cases a year and about 10 do well. He said that if she doesn’t improve after this transfusion, we should have her put down. Need advice, please. We want to do anything we can to help her.

[Terri]

I also forgot to mention that she has been on prednisone, doxycycline, mycophenelate, omeprazole for 5 days. Thank you.

[Vally]

Hi Terri, I’m so sorry to hear about your girl. Is she home with you?

The drugs take time to work, and that’s what I think you’re seeing. The blood transfusions just keep her going long enough for the drugs to start working. The blood transfusion isn’t doing anything to stop the destruction of the disease.

It’s not unusual to see a drop after a blood transfusion either, again, because the destruction of the red blood cells is still happening.

What are the doses of the drugs you’re giving and what does your dog weigh.

If you have a look at Hemopet Resourcdes, you’ll see Dr Jean Dodd’s recommendation for treatment. She’s an expert in this disease. It’s the one labeled Dr Dodds IMHA Disease and Bone Marrow Failure.
https://www.secondchanceaihadogs.com/hemopetresources

I just want to make sure the drug dosages are correct.

My boy, Bingo, didn’t respond instantly – it took about 3 or 4 weeks before he started to improve. He was put on Cyclosporine which was what turned him around and he started responding. It’s another drug which targets the actual cells doing the damage.

Have they checked her thyroid? Do you have any idea what may have triggered the disease? Had she had any shots lately? Any stings or bites? Has she been tested for tick disease. All of these are important because they could be the original cause of the problem.

Ask anything Terri. I’m in Australia, so different time zone most likely, but I do keep an eye out.

My best, Vally

[Vally]

Another thing, you could do an Owners Consultation with Dr Jean Dodds. Many of us here have done that, me included. She’s a lovely lady. If you have blood test results you can send them to her and she’ll give you an advice. Her consultation is $150 US, and once she has responded to you, you can email her back with further questions at no additional charge.

On the same page as the previous link, but it’s here again, and it’s the second item (on my screen)
https://www.secondchanceaihadogs.com/hemopetresources

[Terri]

Thank you so much, Vally. We are picking her up tonight. Her vaccinations were July 10. I do not know if they have checked her thyroid but will ask. I will look at her medicine dosages when we pick her up and message you.

[Terri]

Also, we are going to get copies of her paperwork and contact Dr. Dobbs.

[Vally]

That’s great. Do you know what her latest blood results are? You won’t go wrong in contacting Dr Jean. She’s this site’s Angel.

Vally

[Patrice]

Terri,
I am sorry to read about your Lhasa Apso. How is she doing?

I am more optimistic about dogs recovering from this condition. If a clinic sees a dog with these symptoms immediately, does the proper diagnostics and applies a valid and proven protocol there can be good outcomes.

Where the difficulty arises can be with the diagnostics. There are several ways that IMHA can affect a dog. The term IMHA, immune mediated hemolytic anemia, implies that there is “something or some things” mediating the destruction of red blood cells. In recent years, researchers now feel that there have always been several contributors or triggers that accelerated this condition but they weren’t as apparent to vets because they didn’t do enough diagnostics to find the cause(s.)

So there is a long list of things that can activate the immune system to not be “tolerant of self.” The more common things should be ruled out immediately. We think of insults to the immune system as stressors. So high on the list are, in no particular order: genetics (inherited immune system sensitivities), stress like over-vaccination, insults such as bee stings, venomous bites, virus and bacterial infections like tick diseases, dog flu, leptospirosis etc, exposure to certain drugs, toxic exposure to poisons. Other triggers can be things like chronic diseases or tumors.

Each of things should be ruled out, one after the other, so that anything that can be treated is checked for. For instance I see your vet has prescribed doxycycline which is the most potent and best treatment for various tick disease. The vet may or may not have tested for tick disease, which I usually recommend you ask about. But it is wise to start the treatment.

I see that they did xrays, did they comment about what they saw? They were looking for tumors and other growths that might be driving the anemia.

Unfortunately some breeds are more susceptible because of their genetics. “Dog breeds most commonly affected include Cocker spaniels, English Springer spaniels, Collies, Poodles, Old English sheepdogs, Lhasa Apsos, Shih Tzus, and Labrador retrievers, although any breed is susceptible.”

Keep in mind that it takes multiple stressors to tip the immune system in the wrong direction. So a good vet will look carefully at the history and evaluate for all these things. The other important thing is the initial emergency treatment. As Vally says, they will give prednisone immediately and, if necessary, a transfusion to buy time for the prednisone to sufficiently suppress the immune system.

After a few weeks, it is usually advisable to add a second medication to assist in suppressing certain parts of the immune system. The real goal is consistent and progressive suppression of the immune system without the difficult side effects of prednisone.

So your vet started the protocol they use and added mycophenelate (Cellcept) as an additional drug. This is a good choice. And they added stomach protection to help prevent the prednisone from causing stomach ulcers.

So once all the diagnostics have been done, a transfusion to buy time and a good drug protocol, the goal is to keep your girl as healthy as possible so she can tolerate the continuation of the protocol. Dogs on prednisone have ravenous appetites and drink tons of water, peeing all the time. But prednisone is not a good long term drug to be on because of side effects like this.

So, the big picture is, it appears your vet applied the emergency protocol properly. We want to see positive changes in the upcoming days. You might have to expect another transfusion, that would not be unusual. Dogs are very different, one from the other, with this. Some dogs are not bothered by very low PCV HCT while other dogs are more sensitive. But I have seen amazing will to live from the dogs we have helped. Your girl is very busy trying to heal herself. Stay positive for her sake and let her see you happy to be with her.

Please update us when you can,
my best, patrice