BrandiW

My sweet five year old lab mix passed away on fathers day this year from what the vet assumed was AIHA. Within 48 hours of first showing signs we had to put him to sleep as he was laboring to breath and could no longer eat without vomiting and urinating blood. Upon first illness signs we brought him to the er vet and they suspected AIHA. He was kept overnight then sent our regular vet for further testing the next day. All test were normal as far as no disease present but ozzy kept declining despite iv fluids and steriods. We got the call Sunday morning that he was much worse. We went into see him and decided he shouldn't suffer. I cant stop questioning myself as to if I should have held out another day. I was just so scared he would die of suffication as he was laboring to breathe. What upsets me the most is that i contacted my vet a few days after talk to him about the AIHA diagnosis and also questioned if the leptosporosis panel i asked to be run came back. The answer i got was that they truly felt it was AIHA and did not do a lepto test due to his anemia. What if it was Lepto could he have gotten better with more or different treatment? I am struggling not knowing. We rescued him 5 years ago and he was the love of our life i feel like i could have and should have done more. Im so confused.
Brandi Wery
Quote 0 0
rosee
Brandi,

I am so very sorry for your loss. I think losses can be even more difficult if we are not sure if the vet made the best decisions.

One of the things I've discovered since losing my cat seven weeks ago, is that  many of us use hindsight to feel guilty or angry with our vet or our self. It is a way to try to hang on to our pet, even though not consciously so.

This is a place where you can come and communicate with others who are  going through similar events, so you are not alone.

My most sincere condolences to you.
Quote 0 0
Blitz
Any one lost a dog to AIHA caused from a bee sting? My American Eskimo, Blitz, whom I shared a bond with like no other,  the love of my life, had this happen.  He was stung on June 14, 2013. Next morning would not eat. Took him to Vet on June 15. had l04.7 fever, lymp node swollen in upper thigh left back leg, same side where stung in foot. Was given antiobiotics. told is not better in 2 days. still not eating, just laying around. Back to vet on June l7, gave steroids to calm his stomach, thought antiobiotics upsetting  him and shot to calm inflamation down..as he was biting his foot,  told bring back if not eating in couple days.  Back to bet on June l9.  ran CBC blood panel. Findings AIHA.  Red blood cell count 17.9   Told could try transfusion, but odds against..could attack new blood, plus Blitz was 10...try predisone, or put down. I chose to try predisone.  I force feed him for 6 days...just small amounts. He layed around, breathing hard, then began to vomit, gums white. I hope I didnt make wrong decision.  I feel so guilty...maybe one more day would have made a difference...ANY ONE had similar experience??  I need some closer or answers.   I CANT SLEEP, IT GOES OVER& OVER IN MY HEAD.   email: doggieresortb@roadrunner.comi
Janice Heintz
Quote 0 0
Blitz
SO SORRY FOR YOUR LOSS OF YOUR BABY TO AIHA. 
Janice Heintz
Quote 0 0
heartsick

 

 

I am so very sorry for the loss of your  sweet precious Lab mix baby.

Grief is awful and there is nothing else like this pain.

I am divorced - when I was married I buried my son- at that time I became a Certified Grief Counselor- I used the same graveside service for my Bear as I did for my son.

Bear is my first furbaby  and the soulpuppy of my life.

Please know that when we lose someone we love we don't stop loving them -

 LOVE NEVER DIES.

The soul bound connection that is between our babies and ourselves is forever.

Nothing - not death- tears -grief - or sadness will ever break the ties between us for those ties are made of LOVE so strong that NOTHING will ever sever those connections.

LOVE NEVER DIES.

When we grieve for those we love it is because we do not quite know how to live without them. We breathe because we have no choice but the living part takes a huge amount of learning and time.

Grief is not something we get over but something that we learn -slowly- over time- to incorporate into our lives until it becomes a part of us like our bones and our breath.

Please know that we all understand here and we are all here for you.

We are all in this together and all walking the same roller coaster path of grief together -

some a bit ahead of you, some by your side, and some will come behind for you to help along.

Grief takes time. It usually takes the whole first year of “firsts” without them to take a true deep breath again. Be kind to yourself. None of this is easy.

I am here for you.

We are all here for you and we care about you and we understand.

You Are In My Thoughts.                                      

Susan(heartsick)

 

 

Quote 0 0
heartsick
This is what I have ...

 I have not heard of a bee sting causing AIHA but all animals are different as are all people. My Bear was stung and his face swelled to twice the size - I was lucky I had Benedryl in the house and quickly gave him a dose and then sat up all night dosing him every four hours as per my vet by phone - as soon as they opened we were there the next morning and she checked him over. He was getting better and the selling was resolving so she changed the dose to every 6 hours. From that day to this I ALWAYS keep  Benedryl on hand and know the doses to give to each one of my babies should an emergency arise.

 

  

 

 

 

  
   
       
 


   

What Is Auto Immune Hemolytic Anemia?

Information for Patients and Veterinarians

What is AIHA?

Autoimmune hemolytic anemia (AIHA) is a disease in which the body attacks its own red blood cells (RBC). A pet suffering with AIHA will have a lower-than-normal number of red blood cells within the blood. This is termed anemia. The normal range for the packed cell volume (PCV) or hematocrit is 37-55% (the ratio of the volume of packed red cells to the whole blood).

AIHA is classified as a “primary” immune disease. No underlying cause of the immune destruction can be found after an exhaustive clinical and laboratory evaluation. A “secondary” disease is called immune-mediated hemolytic anemia (IMHA). IMHA refers to all anemias that occur when the immune system inadvertently destroys its own blood cells secondary to an immune attack directed against an underlying condition such as cancer, endocarditis, heartworm or by unidentifiable causes as in AIHA.

 

What are the Symptoms of AIHA?

When a large percentage of red blood cells (RBC) are affected, and they are removed faster then they can be replaced, the animal shows external signs of the disease.

The clinical signs of AIHA are usually gradual and progressive, but occasionally an apparently healthy pet suddenly collapses in an acute hemolytic crisis. The signs are usually related to lack of oxygen supply. The hemoglobin in RBC is the primary carrier of oxygen in the blood. Signs include weakness, lethargy, anorexia, and an increase in the heart rate and respiration. Heart murmurs, pale mucous membranes (gums, eyelids, etc.), and discoloration in the urine and/or stool may also be present. More severe cases also have a fever and icterus (jaundice), which is a yellow discoloration of the gums, eyes, and skin. This is due to a buildup of bilirubin, one of the breakdown products of hemoglobin.

The diagnosis of AIHA/IMHA is usually made on these clinical signs as well as a complete blood count (CBC). The CBC usually shows a regenerative anemia with spherocytes. Spherocytes are a special type of red blood cell that develops in IMHA. The blood samples may auto-agglutinate (clump). A Coombs test may be done to support the diagnosis.

Why My Pet?

Unfortunately no one knows why an individual pet develops AIHA/IMHA. Certain breeds such as cocker spaniels and poodles are at a higher risk than other breeds. Middle-aged female dogs are also at a higher risk. However immune-mediated hemolytic anemia may occur in any breed at anytime.

Typically, the veterinary medical field has not discovered why an individual dog gets AIHA/IMHA. However, evidence suggests that recent vaccinations (DHLPP) may be associated with a higher incidence of IMHA and so has the administration of certain medications like sulfa-trimethoprim antibiotics. Dogs with serious infections or cancers in their body may also develop IMHA. The thought for the underlying cause is that something (i.e., vaccine, cancer cells) triggers the immune system to react and to create antibodies.

Accidentally the antibodies also destroy the red blood cells and sometimes also the platelets (idiopathic thrombocytopenic purpura); and therefore, the first sign of illness may be the anemia.

Is There a Cure?

AIHA is better thought of as a disease that is controlled rather than cured. Medications are used to decrease the hyperactivity of the immune system and suppress the abnormal immune response directed against RBC.

Treatments may need to be given indefinitely, but at least for several months. Most dogs are on medications for at least 4-6 months, some much longer. Dogs that have had AIHA once are more likely to get it again, particularly if they are weaned off medicines very rapidly (less than 2 months).

What are the Treatments?

The initial drugs used are cortisone medication (prednisone, dexamethasone). Prednisone takes approximately 5-7 days to become effective, during which time the animal’s disease may worsen. Other cytotoxic drugs such as imuran (azathioprine), cytoxan (cyclophosphamide), and danazol shut down the immune cells (lymphocytes) producing antibodies and/or stop cells of the immune system that destroy the RBC (macrophages). Other immunosuppressive therapies such as cyclosporine administration and a host of other experimental treatments are or have been used by various clinicians.

Most pets with AIHA/IMHA are presented for weakness and lethargy; i.e., the effects of anemia. The pet may require a transfusion to improve its clinical state while immunosuppressive treatments have time to work. The clinician may elect to give whole blood, or more commonly packed red blood cells or synthetic hemoglobin (Oxyglobinc).

Pulmonary thromboembolism (blood clots in the lungs) results when abnormal clotting arises from an activation of the clotting system due to inflammation and RBC destruction. In pets with AIHA/IMHA, several factors, including the presence of hemolysis (RBC destruction), IV catheters, prednisone administration, and vascular stasis contribute to the increased clotting tendency of the blood in dogs with IMHA/AIHA. If thromboembolism is suspected, the pet will be given doses of heparin (100-200 iu/kg of body weight 4x per day) and possibly oxygen to reduce the labored breathing.

Side Effects from the Drugs

Prednisone and other cortisone medications are catabolic substances; pets lose muscle mass and strength. Additionally, these drugs cause increased thirst and urinations (PD/PU) by affecting kidney concentrating ability. These drugs are potentially irritating (ulcerogenic) to the gastrointestinal (GI) tract and can cause vomiting with or without GI bleeding. Pancreatitis is another potential complication associated with cortisone and aziothioprine administration.

In some instances, the cytotoxic drugs can cause bone marrow failure. As these drugs kill rapidly dividing cells, the development of decreased production of white blood cells can arise and open the pet up to life threatening infections.

When to Decrease Medications?

Typically about every 3-6 weeks, medications should be decreased by 25-50%. Factors that are important in deciding treatment adjustments include trends in the hematocrit and resolution of clinical signs in the dog compared to prior examination. Cocker spaniels tend to be weaned a little slower, and large pets may tend to be weaned over longer time periods because of the higher level of medications they were on. Most pets should be off medications by one year and then be checked 3-4 times per year for the first year, and then yearly after that.

SUMMARY

AIHA/IMHA is a life threatening immune disease that can cause damage to vital organs through the lack of oxygen supply associated with the resultant anemia. Owners of pets with AIHA/IMHA face a guarded to poor prognosis for the pet at the time of diagnosis. If an underlying disease such as cancer is discovered the prognosis becomes complicated by the limitations associated with the underlying cause as well.

Additionally, the destruction of RBC can result in development of blood clotting disorders and a systemic inflammation syndrome that looks like a severe infection clinically—the aftereffects of these can also cause organ damage to kidneys, lungs and other organs resulting in death or prolonged hospitalization.

This brochure was written with the wonderful help and support from Dr. Robert Murtaugh of Dove Lewis Emergency Animal Hospital and Dr. Elizabeth Rozanski from Tufts University School of Veterinary Medicine. The material in this brochure was written to use as an aide for others to learn about this terrible disease and its effect on their pet.

Reference:

Dr. Robert J. Murtaugh, DACVIM, DACVECC is a graduate of the University of Minnesota, College of Veterinary Medicine. Dr. Murtaugh was formerly on the faculty at Tufts University School of Veterinary Medicine and is currently the Director of Critical Care at the Dove Lewis Emergency Animal Hospital in Portland, Oregon. Dr. Murtaugh chaired the organizing committee to establish the American College of Veterinary Emergency and Critical Care (ACVECC). He is a past-president (1994-1996) of the Veterinary Emergency and Critical Care Society and currently President-elect of ACVECC.

Dr. Elizabeth Rozanski, DACVIM, DACVECC is a graduate of the University of Illinois. She completed a residency in Emergency and Critical Care medicine at the University of Pennsylvania and is currently an Assistant Professor at Tufts University School of Veterinary Medicine.

Publications:

Immune-Mediated Hemolytic Anemia and Immune-Mediated Thrombocytopenia, Textbook of Veterinary Internal Medicine—Client Information Series, Carol Norris, DVM, DACVIM. Copyright 2000 by W.B. Saunders Company


 
   

 

 

 

Quote 0 0
Meekey_mom1
Meekey, a Papillon/Japanese Chin mix, at only 3 years and 10 months old...had a rough start to life.  Due to a false health certificate, she survived adult hookworms AND parvo at 9 weeks old, 1 week after we adopted her.  She was a miracle!; and I do not regret a single moment we had together, it is and always will be cherished forever.  Being so close to death at that age, I think made her perfect, not just for my heart, but for helping care for the broken hearts in my office as a therapy assistant in private practice mental health.  

Meekey seemed to suddenly develop weakness which was later found to be Pure Red Blood Cell Anemia (PRCA).  Bone marrow test found it was "aplastic" and non-regenerative. Then she got a pulmonary embolism...she became transfusion AND oxygen chamber dependent...I was undone!  I heard what the UF vets said, but I didn't process it.  I told her vet to go ahead & give her the experimental treatment dose that morning...In total denial while deep down I knew I had to let her go that afternoon...I almost escaped with her from the office after she received the tranquilizer shot, but she couldn't breathe outside of the oxygen chamber and that would have been very selfish of me.  I lost her 5 days ago and I am undone! I do grief therapy for loss of loved ones, human or pet, but have been sheltered myself.  I teach that the suffering and pain means one can truly feel, everything, including joy, again one day. I never thought I would be here this soon.  I do not want to know why...I just want to know where she needed to be in such a hurry.
Beth Maharaj
Quote 0 0