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Tipsi is a 5 year old spayed female Miniature Dachshund owned by Layla of Wendell, North Carolina. Tipsi was diagnosed with autoimmune hemolytic anemia on September 21, 2007.
When Layla was asked to comment on Tipsi’s symptoms prior to her AIHA diagnosis she replied, “In Tipsi’s case, it appeared the illness came on slowly. The first symptom I noticed was 2 weeks prior to the AIHA diagnosis when Tipsi vomited. Since I felt she may have eaten something that didn’t agree with her stomach, I began feeding her a bland diet. This seemed to help for a few days and then she had another episode of vomiting. After a week and a half of occasional vomiting, Tipsi began refusing food. We took her to her regular vet who did a full chemistry panel, took X-rays and did a urinalysis. The conclusion was mild anemia. Tipsi was prescribed 5 mg prednisone twice per day and sent home. Two days later Tipsi was extremely lethargic and had white gums. I called the vet and he referred us to North Carolina State Veterinary Teaching Hospital (NCSU-VTH). We rushed Tipsi there and our journey with AIHA began.
”Upon presentation at NCSU-VTH, on Friday September 21, 2007, Tipsi had a PCV of 16. She had an increased heart rate and her initial coagulation panel showed evidence that she had some clotting. Tipsi was given a blood transfusion and IV fluids and since she was at risk for developing thrombus, because of the clotting, Heparin was added to her IV fluids. Within a few hours her PCV had increased to 19 and her heart rate was within normal limits. Prednisone and Azathioprine were started and Tipsi was monitored in the ICU. The next morning she was transferred to Intermediate care in the Internal Medicine unit. Sunday morning Tipsi began vomiting and had a PCV of 15. The Azathioprine was discontinued due to pancreatitis. Chemistry and coagulation panels were re-run and they revealed the BUN, creatinine and phosphorus levels were significantly increased which indicated acute renal failure. Tipsi was moved back into ICU so she could be monitored more closely. Her coagulation panels showed she was developing disseminated intravascular coagulpathy (DIC). To help Tipsi through this process, a combination of IV Heparin and plasma was transfused and serial measurements of her coagulation factors were run. She was also switched from prednisone to Dexamethasone and started on Cyclosporine. On Monday, the chemistry panel showed even higher values of Bun, creatinine and phosphorus which meant the acute renal failure was not improving. Tipsi had also developed a heart murmur and continued to show signs of DIC. Due to the severity of the disease and the fact that other organs were affected the veterinarians gave us a poor prognosis for recovery. They warned us Tipsi may not make it through the night.
”On Tuesday I visited Tipsi in the ICU and she was able to recognize me and wag her tail. I talked with the doctors and asked them if there was absolutely no hope for Tipsi and they replied that we weren’t at that point just yet. They wanted to continue treatment for at least another day, so we carried on. The next day Tipsi’s renal values stabilized. They were still extremely high but were not increasing. Her pancreatitis resolved and her heart murmur was lessening. Thursday, September 26, was the turning point in Tipsi’s AIHA battle. That day I was elated to learn her renal values had begun to decrease. Her PCV remained stable at 15 and she was highly regenerative. Throughout the remainder of Tipsi’s two week stay in ICU she continued to improve. Her red cell blood values improved at least 1% each day during the second week peaking at 26. In addition, the clinical signs of lethargy, pale mucous membranes and increased capillary refill time were resolved. Tipsi was discharged from NCSU-VTH on October 5, 2007 on the following medications: 10 mg prednisone, twice a day; 25 mg cyclosporine, twice a day; 25 mg Doxycycline, twice a day for one week; 92.5 mg Clavamox, twice a day for one week; 2.5 mg aspirin, once a day; 5 mg Famotidine, twice a day; 0.2mL Heparin injected subcutaneously twice a day; 100mL Lactated ringers solution, injected subcutaneously for 2 days, then 50mL once a day for two days. As Tipsi’s PCV continued to rise, the medications used to treat AIHA were very slowly decreased and then discontinued.”
When Layla was asked to comment on the current state of Tipsi’s health she replied, ”Tipsi is doing remarkably well. She has loads of spunk and is as feisty as ever. At her last check up on October 28, 2008 her PCV was 52, which was her highest reading since her AIHA diagnosis. At the present time, Tipsi is taking no medications for the treatment of AIHA. She is a happy and loving doxie who is back to her normal self with loads of energy and spunk. She greatly enjoys chasing her favorite blue ball and barking at squirrels in her free time. After Tipsi’s AIHA diagnosis, it took a long time before she began doing the things she loved again. It was awesome the first time I saw her running full speed with her ears flapping in the wind. Tipsi is truly my little miracle and I am grateful for every day that I get to spend with her. I want to tell everyone who has fought, who is continuing to fight or will fight AIHA/IMHA in the future, that there is hope and that the battle can be won.”
Tipsi Update, October 2012
Layla wrote recently with the following Tipsi update.
"On June 15, 2012 my biggest fear of the past 5 years was realized. Tipsi suffered a relapse of AIHA and was rushed back to the NC State Veterinary School. We have no idea what may have triggered Tipsi's relapse because we had been very careful of her environment, surroundings and anything we gave her. Tipsi spent the next 5 days in ICU and was given 2 blood transfusions. Fortunately, she responded well and was able to come home on June 20th. She was once again taking a large amount of medications to help suppress her immune system and get her PCV back up. Tipsi seemed to be doing relatively well for the first couple of weeks and then around week 4 she became more lethargic and started not acting like her normal self.
”Since it was a weekend we went back to the Veterinary School where it was confirmed that Tipsi had a urinary tract infection. She was admitted and started on antibiotics and IV fluids. The next day an ultrasound was performed to see if there were any other signs of infection. Unfortunately, the ultrasound revealed that her bladder, gallbladder and possibly her kidneys were affected. We were told that it was possible two different infections were occurring simultaneously. The veterinarians felt that the best course of treatment was a round of very strong antibiotics combined with discontinuing the prednisone so Tipsi could fight the infections. Over the next 2 days Tipsi did not improve, but began getting worse. By Wednesday July 18th, after 3 days in the hospital, Tipsi's breathing became labored and her heart rate had increased, so she was placed in an oxygenated cage in ICU. This did provide a brief period of support, but when I went to visit her on the morning of July 19th I knew that things had gotten worse. Tipsi was really struggling to breath and any time she would so much as move slightly or try to stand, her heart rate would sky rocket. I stayed at the hospital all day and by that afternoon Tipsi's veterinarian and I had the discussion I had been dreading. There was nothing more that could be done. To keep Tipsi from suffering any longer, we made the hardest decision of my life, and that was to let her go. I, my parents, and my husband walked into the ICU for the last time to get our baby girl. She gave us the best tail wag she could manage, which took all of her energy. I picked her up and we went outside. It was a hot summer day, but there was a nice breeze blowing and Tipsi was able to feel that breeze and see the sunshine. She loved the outdoors. As I held her to my chest, we all told her how much we loved her and that everything would be okay. She then took her last breathe and peacefully went to the Rainbow Bridge. We will never forget the joy and happiness that Tipsi brought to our lives. She was the best dog anyone could have ever had. We miss her so very much."
Macie is a 7 year old spayed female Cocker Spaniel owned by Karen of Thornton, CO. Macie was diagnosed with immune-mediated hemolytic anemia on April, 14, 2006.
When Karen was asked to comment on Macie’s symptoms prior to her IMHA diagnosed she replied, “Macie’s illness appeared to come on very quickly. The day before diagnosis, she was very lethargic and not herself, but she did eat her meals. She had pale colored gums, an accelerated heart rate, and rust colored stools. I knew in the back of my mind, right away, what was wrong (having gone through this same illness with my other Cocker Spaniel, Sadie, the year before) so I immediately took her to her regular veterinarian where blood testing revealed a PCV of 10 and autoagglutination. Macie was diagnosed with IMHA and started on 20 mg prednisone twice per day; 2ml Azathioprine suspension, once per day; 50 mg Cyclosporine, once per day; 25 mg Pepcid A/C, once per day and 10 mg baby aspirin, once per day.
”The following day Macie was transferred to an emergency care clinic where she given infusions of both human immunoglobulin and Oxyglobin. After 2 days at the emergency clinic Macie was allowed to go home where she continued on prednisone, Pepcid A/C, baby aspirin and suspension Azathioprine. Since Macie could not tolerate Cyclosporine, she vomited every time she took it, that drug was discontinued a couple of days after her release from the ER clinic. The baby aspirin was stopped two months later. After one month the prednisone was reduced from 20 mg twice per day to 10 mg twice per day. Over the next few months, as Macie’s PCV increased and stabilized, we continued to reduce the prednisone. After Macie had been on 5 mg prednisone, once per day, for a few months, the prednisone and Pepcid A/C were discontinued. Macie remained on the Azathioprine suspension until June, 2007 at which time her veterinarian changed her Azathioprine dosage to 12 ½ mg (½ of a 25 mg tablet) every 3 days. At the present time Macie takes 6 1/4 mg of Azathioprine (1/4 of a 25 mg tablet) once per week. Macie will stay on Azathioprine for the rest of her life ‘just as a safety net.’ I feel very comfortable with this precaution because Macie has never had any reactions or complications from this medication. Since Macie became ill with IMHA only one month after receiving vaccinations (distemper, leptospirosis and bordetella), and my veterinarian has said that vaccinations are sometimes suspected to cause IMHA, she will never be vaccinated again.”
When Karen was asked to comment on the current state of Macie’s health she replied, “Macie's health is picture perfect, it is as if she had never been so gravely ill. Her last check up and blood work was done in October, 2008 and her PCV at that time was 49 with all other aspects of her checkup being excellent. She eats voraciously, twice daily, and comes to get me if it's a minute past meal time. Macie bounds through the house chasing her birdie toys, throwing them in the air or bringing them to me to throw for her. We take long walks together (and sometimes jog); I let her off leash in small park areas where she can romp around and do what she wants and she minds very well when I call her back to me. She's always there to greet me upon my return home and every day I look forward to our mini reunions after a long day at work. Macie is the absolute perfect dog and I can't imagine my life without her in it. Since losing my Cocker Spaniel, Sadie, to IMHA only two weeks after her IMHA diagnosis, I am so very thankful for every day that Macie is still with me. I am anticipating she will be here until she’s at least 15 years old!”
Ginger is a 9 year old spayed female Golden Retriever owned by Cheryl and Joe of Pineville, PA. Ginger was diagnosed with autoimmune hemolytic anemia on September 6, 2007.
When Cheryl was asked to comment on Ginger’s symptoms prior to her AIHA diagnosis she replied, “Ginger was treated for what was thought to have been urinary tract infections and Lyme disease for over a year prior to her AIHA diagnosis. Every few months, she would show signs of being lethargic and have loss of appetite, as well as bilirubin in her urine (as evidenced by a brownish colored urine). During this period Ginger had an ultrasound and chest x-ray with the results of both being normal.
”In January, 2007 we changed veterinarians. The new doctor ordered a thyroid test which indicated Ginger had hypothyroidism and she was put on .5 mg Soloxine twice per day. Blood work done in February, 2007 revealed a hematocrit of 28.2. Looking back on the blood work done in February, 2007, I now realize that Ginger’s veterinarian never mentioned to me that a hematocrit of 28.2 was not in the normal range. At that point in time, I had no idea what a hematocrit/PCV was or what the normal range should be. Even though I was provided with a copy of Ginger’s blood work, which stated her hematocrit was low, I never questioned the veterinarian about the low level. Ginger continued to have bouts of lethargy, lack of appetite and brownish colored urine. She was treated with antibiotics and put on dietary supplements to help control the urinary track infections. A second ultrasound was done and the results were again normal. Ginger would rebound for a few months and then the symptoms would reappear. In September, 2007 Ginger was again lethargic and had no appetite. She was seen by another veterinarian, at the same practice, who ordered complete blood work, which revealed a hematocrit of 24. Ginger was diagnosed with chronic AIHA which means her PCV falls to a low level and stays there for weeks or months. Ginger was started on 80 mg prednisone per day. After two weeks, when she showed no improvement, 50 mg of Azathioprine per day was added to the treatment regimen. About a month after the start of Azathioprine, when Ginger’s PCV rose into the low 40’s, we began to reduce the medications.
”Ginger continued to do very well over the next few months. In May, 2008 Ginger needed ear surgery to remove a hematoma. Since her regular veterinarian did not do this surgery, we made the doctor doing the surgery aware of the fact that Ginger had AIHA. He recommended that she receive her DHLPP vaccination and advised us that ‘there was no conclusive evidence that this vaccination was a cause of AIHA’, so I agreed to have her vaccinated. When 2-3 weeks later, Ginger began to have an occasional limp and seemed stiff from time to time, we attributed this to arthritis. We were not overly concerned since Ginger was still eating and playing. In July Ginger went in for blood work which revealed her PCV had dropped to 28. She was started on 60 mg of prednisone per day and 50 mg Azathioprine every other day. Her PCV remained in the 24-28 range for over two months and we again found it necessary to reduce the prednisone because of the side effects it was causing. Ginger was then put on 200 mg Cyclosporine per day and within four weeks her PCV rose to 38. At the current time Ginger takes 50 mg Cyclosporine and 50 mg Azathioprine on alternating days as well as 5 mg prednisone (for her arthritis) every 4th day. According to Ginger’s vet, she will need to be on a maintenance dose of Azathioprine for the rest of her life. Ginger also takes .5 mg Soloxine, twice per day; fish oil, Pet Tinic, Milk Thistle and SAMe, daily. Coincidently Ginger has not had a urinary track infection or been treated for Lyme disease since her AIHA diagnosis. I believe that she had been misdiagnosed many times. Our vet indicated to us that the AIHA relapse in July, 2008 may have been the result of the DHLPP vaccination, or the stress of the surgery or a combination of both. Needless to say, Ginger will not be receiving any more vaccinations.”
When Cheryl was asked to comment on the current state of Ginger’s health, she replied, “Ginger is doing very well, her PCV was 39.5 when she last had blood work done on January 29, 2009. Ginger was recently taken off prednisone for the treatment of AIHA, however a week or two later she began having trouble getting up and down the steps. When we realized that the prednisone was acting as an anti-inflammatory and helping Ginger’s arthritis we put her back on a very low dose (5 mg every 4th day) of it . I am currently working on finding a supplement that will work on Ginger’s arthritis, so she can again be taken off the prednisone. Now that we have Ginger’s arthritis under control, she is currently acting 100% like her old self. She walks 1 ½ miles twice a day with our other two Goldens and most of the time she is the leader of the pack, which is not too bad for a 9 year old Golden. On a recent vacation, she simply amazed us with her energy level and enthusiasm for hiking. At one point in her illness, we thought she would never be able to hike with us again. Ginger wakes up each morning and can’t wait to eat her breakfast and begin a new day (in that order) We are so thankful for each and every day we are allowed to spend with her. Despite all that Ginger has been through, she is such a happy dog and has brought such joy into our lives since we rescued her nearly four years ago.”
To learn more about chronic AIHA and the other basic forms of autoimmune hemolytic anemia from The Merck Veterinary Manual Click Here
Duck is a 2 ½ year old neutered male Lab/Beagle cross owned by Debbie and Greg of Nelson, BC, Canada. Duck was diagnosed with autoimmune hemolytic anemia on May 11, 2007.
When Debbie was asked to comment on Duck’s symptoms prior to his AIHA diagnosis, she replied, “The day before Duck’s AIHA diagnosis, he was uncharacteristically low in energy and slept a lot. I thought Duck’s lethargy may have been a result of the unusually hot weather. The next morning when we let Duck outside, he started to chase a cat in the driveway, stopped suddenly and collapsed. We immediately rushed Duck to our veterinarian.
”Upon admittance to the veterinary clinic Duck had a PCV of 16. Because Duck’s blood was not clotting, our vet suspected rat poisoning and administered Vitamin K. Six and a half hours later, Duck’s PCV had dropped to 9 and he was administered IV Dexamethasone. Two hours later, Duck’s PCV had dropped to 5. He was given a 350 ml whole blood transfusion that had not been cross matched. We later learned the donor blood was a perfect match. Duck was started on 40 mg prednisone twice per day and we were allowed to take him home. That night Duck exhibited signs that indicated he was passing small pulmonary embolisms. The next day he was started on 50 IU subcutaneous heparin three times per day. After the initial blood transfusion, Duck’s PCV rose to 15 and then over the next 3 days it gradually dropped. At our veterinarian’s urging we decided to take Duck to the Veterinary Teaching Hospital at Washington State University (WSU).
”Duck was admitted to WSU on May 15, 2007 where blood work revealed a PCV of 12, heart rate of 140 beats per minute and respirations of 66/minute. Shortly after admittance Duck received a packed cell transfusion. Abdominal and thoracic radiographs showed no sign of coin ingestion and the urinalysis was normal. A bone marrow aspirate showed that Duck’s bone marrow was devoid of erythroid precursors. Duck was diagnosed with Pure Red Cell Aplasia and started on the following medications: 40 mg prednisone, every 12 hours; 25 mg Azathioprine, every 24 hours; 100 mg cyclosporine, every 12 hours; 1 gram sucralfate every 12 hours, to be given at least one hour before food or medications; 10 mg famotidine, every 12 hours to be given with the sucralfate and 20 mg children’s aspirin, every other day (heparin was discontinued at this point). Duck was discharged from Washington State University on May 17th and we continued on this medication protocol until his PCV reached normal levels. We did not wait for two or three normal PCV readings before starting to decrease the prednisone because by this time Duck was experiencing almost all the symptoms of latrogenic Cushings Disease. On July 31, 2007 we started reducing the prednisone dosage and gradually, over a period of several months, we were able to significantly reduce the dosages of all medications.”
When Debbie was asked to comment on the current state of Duck’s health she relied, “Duck is the picture of health and happiness. His PCV at his last blood check on January 15, 2009 was 42.6 which is an excellent number for him. He has maintained normal PCV levels for the last 12 months and his most recent blood panel was normal on every count. Duck’s thyroid levels were tested on February 25, 2008 and they were normal as well. Duck receives no heartworm preventative since we have no incidence of heartworm in our area. We do not use any flea/tick preventative on Duck and I have decided not to give him any further vaccinations. I feed Duck smaller meals, three times a day. He eats a combination of Dr. Dodd’s liver cleansing diet and Wellness Sweet Potato and White Fish kibble. I add supplements to his mid-day meal and they are Pet-tinic, buffered Vitamin C, Vitamin E and Forti Flora (probiotic). He also gets a snack in the evening and I vary what I give him (kale, raw carrots, celery, zucchini, apple, banana). He loves them all! At the present time Duck takes 5 mg prednisone, once per day; 50 mg Cyclosporine, every other day; 25 mg Azathioprine every other day (on the days the Cyclosporine is not given); 1 gram sucralfate and 10 mg famotidine, in the mornings, one hour before the other medications. Duck is on a lot more medications than many dogs nearly two years past their AIHA diagnosis but after consulting our local veterinarian and the specialist at WSU, we have opted not to make further reductions in an attempt to avoid a relapse although, we realize that there are no guarantees of that. The long term use of these medications may shorten his life but, in the end, we decided that quality of life was the first priority. Duck has regained his original energy and love of life. He has a passion for aqua fetch and would play all day if we were willing. Duck also loves to play, go for walks and nap with our other two dogs, Teddy and Panna and he gives Greg a welcome fit for royalty when Greg comes home from work each day. Duck continues to steal the hearts of all those who meet him with his calm and gentle personality and we treasure each and every day that we have with him.”
Duck Update, October 2010
I recently received the following Duck update from Debbie.
”At the beginning of this summer Duck became quieter than normal so I took him in for blood work. The tests showed that his liver enzymes were slightly elevated in comparison to previous tests in which his liver counts had been normal. He also had developed cloudiness on both corneas. After conferring with the specialist at Washington State University, we decided that Duck was no long tolerating the medications he was on and we decided to start reducing his prednisone. He was taking 5 mg prednisone per day at that point.
”We followed a very slow prednisone reduction schedule going down to as low as 2 ½ mg every 7th day before the prednisone was totally discontinued. I am so happy to be able to tell you that Duck has now been off prednisone for two weeks and his PCV has remained stable all the way through the prednisone reduction process. I am noticing an increase in his energy level and a slight decrease in the amount of water he is drinking and urinating. In general, Duck seems happier and even more alert. I've also been able to eliminate the ‘tummy coaters’ (sucralfate and Pepcid) and Duck is truly happy about that. He never liked getting these medications, even though he tolerated them like a good sport.
”We were able to get Duck in to see an eye specialist and her diagnosis was ‘corneal dystrophy’. She said that this is a genetic condition and Duck would have developed it even if he had never been on medications to treat AIHA. She predicted that it would spread out over the cornea and then go clear in the middle; somewhat like a doughnut. It has done just that and doesn't impair Duck's vision in the least.”
Agatha Tallulah is a nearly 6 year old spayed female Standard Poodle owned by Roberta of Valley Village, CA. Agatha was diagnosed with autoimmune hemolytic anemia in early February, 2007.
When Roberta was asked to comment on Agatha’s symptoms prior to her AIHA diagnosis she replied, “Agatha’s illness appeared to come on very suddenly. She lost the glimmer in her eyes and all of her playfulness. In addition she was very tired, panted, lost weight, vomited, had diarrhea, and became heavy footed when we walked. When she stopped eating, I cooked everything I could think of for her including lamb shank, chicken and brown rice. She would eat none of it and finally ended up on veal baby food.
”Prior to Agatha’s AIHA diagnosis, she was seen at a veterinary emergency clinic, a well known veterinary specialty hospital and a neighborhood veterinarian. The neighborhood veterinarian ran a number of tests including a test for Addison’s (negative), chest x-rays (negative), Giardia (negative), complete fecal analysis, coagulation profile, and Coombs test (negative). I was prescribed amoxicillin, doxycycline and Pepcid AC for Agatha, but was given no clear diagnosis of her illness. Because the Coombs test was negative not one of the three veterinarians who had seen Agatha suspected AIHA/IMHA. I find it very interesting that one of these veterinarians has a dog with IMHA yet was not able to diagnose Agatha’s case. At this point in time, I really thought I would wake up one day and Agatha would be gone. I told everyone to come and see her if they wanted to see her alive.
”I work as a Private Chef and House Manager and at the time of Agatha’s illness I was working for a high profile celebrity, who also happens to be a dog lover, in Malibu, CA. I came to work in tears one morning and my boss asked me what was wrong. I simply said ‘Agatha is dying’. She stopped what she was doing and told me to immediately call Dr. Lisa at Malibu Coast Animal Hospital and ask for an appointment. Had I not been working in Malibu, which is 35 miles from my home, I would never have known about Dr. Lisa Newell and I think this story would not have had the same ending. I was certain I wouldn’t get an appointment right away, but when I called and said I believed Agatha was dying and begged to bring her in the next day before work, I was given an appointment. When I met with Dr. Lisa, she listened to my stories about having seen 3 veterinarians and none of them being able to diagnose Agatha’s illness. She also read through all the notes and lab results from the other veterinarians Agatha had seen. One of the things Dr. Lisa immediately did, was look at Agatha’s gums which were very pale. Blood testing was done and when the blood tests were complete, I was informed Agatha’s PVC was very low (21) and that we were dealing with autoimmune hemolytic anemia. Agatha was given a prednisone injection, started on prednisone and Cyclosporine and hospitalized for two nights. Two weeks after Agatha’s discharge from the veterinary hospital, the Cyclosporine was discontinued. As Agatha’s PCV rose and stabilized, we slowly weaned her off the prednisone.”
When Roberta was asked to comment of the current state of Agatha’s health she replied, “Agatha’s health is great. When she last had blood work done in early February 2009 she had a PCV of 56 and all other readings were in the normal range. Agatha currently takes no prescription medications for the treatment of AIHA although I do supplement her diet with UDO Choice Pet Essentials for Dogs and an Omega 3 tablet each day. She also gets filtered water. Because every veterinarian I have spoken with has advised me to never vaccinate Agatha again, she no longer receives vaccinations. Agatha receives no heartworm or flea/tick preventatives. Agatha is not permitted to go to the park since dog parks can be a breeding grounds for disease, so her play dates are always with friends and in a clean environment. I continue to monitor Agatha very carefully, checking her gums for color, watching her eating habits and noting her energy level which at the current time is high. Agatha and I walk 3 to 4 times a day and she will chase anything furry, especially squirrels or cats, that she sees. She has many friends, both human and doggie that she can’t wait to see each time we go out. Agatha is a very sweet dog who is an absolute pleasure to be with. She is the light of my life and I so very thankful for each day I am able to spend with her.”
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