19 September 2018

The Silent Killer Dog Owners Should Know About: IMHA

This cutie is 'Zoey'. Our troubles with her began a couple of days before Halloween 2016. Zoey was extremely lethargic and had no appetite. All she wanted to do is stay in her bed and sleep. This was very unusual behaviour from the dog who usually couldn't wait to eat breakfast and dinner. After we ascertained that she had not sustained any injuries, her belly was soft (so, internal bleeding was not high on our list of potential culprits), and she wasn't running a fever, we checked her gums. They were stark white. As we rushed her off to the nearest emergency vet, my husband and I couldn't help but flashback to the many times our late epi-warriors, Lana and Darren required emergency medical treatment for their canine epilepsy. We feared for Zoey's life. After several days of inpatient treatment at the veterinary hospital, the diagnosis was IMHA or Immune-Mediated Hemolytic Anemia. 

Simply put, Zoey's immune system was destroying its own oxygen-carrying red blood cells.  Her bone marrow still produced trace amounts of red blood cells to replace the destroyed ones. However, once they were released into circulation, her immune system mistakenly recognized them as foreign bodies, such as a virus or bacteria, and eliminated them. I'm the first to admit that my husband and I aren't novice dog parents. Instead, we are, what some might categorize as helicopter pet parents, highly-informed and hyper-aware of our dogs. So, any deviation from Zoey's 'normal' is immediately scrutinized in great detail for possible causes and potential results. IMHA is an autoimmune disease, and is, unfortunately, often fatal because either the initial symptoms go unrecognized, relapse, or complications such as pulmonary thromboembolism (PTE - a blood clot that can travel to the lungs). Based on a cursory search, breeds that seem prone to this illness, are Cocker Spaniels, Springer Spaniels, Finnish Spitz, Poodles, Basenji, Bichon Frise, West Highland White Terriers, Old English Sheepdogs, and Irish Setters, but any dog can be affected. Zoey is a Rhodesian Ridgeback. 

What causes IMHA?

In most pets, the underlying cause of the disease is never identified. Some experts believe IMHA may be caused, in part or because of:

- Blood loss
- Decreased production of red blood cells
- Toxins
- Drugs used for the treatment of another condition. Implicated drugs include antibiotics (penicillin, trimethoprim-sulfa), methimazole and acetaminophen
- Cancer
- Insect bites/stings
- Spot-on flea and tick preventatives
- Vaccinations/over-vaccinating is suspected to be a culprit, although the jury is still out on this. However, core vaccines play an essential role in controlling the spread of diseases like Parvovirus and distemper, so it is never a good idea to stop administering them altogether.
- Infection

The Symptoms

Symptoms include, but are not limited to: 

- Weakness/lethargy
- Dark orange or brown urine
- Yellowing (jaundice) of mouth and/or eyes
- Labored (heavy) breathing
- Refusing to eat
- Pale/white gums
  Note: If your dog has black gums, you can also check their eye  
  membranes. Just pull the eyelids gently up or down and look underneath. 
- Seems a little “off”

Note: Not all dogs will experience these symptoms or all at once.

The Diagnosis

If your beloved furry companion shows any signs of the above, time is of the essence. Get your dog to a veterinarian immediately. He/she will need a full medical history. Be prepared for questions about the symptoms you've observed and how long they have been present, any medications your dog may have taken, when the most recent immunizations were given, and questions about your dog's urine and stool. The vet will want to run several of the following tests to determine the underlying cause for the anemia, such as:

- A complete physical examination.
- A complete blood count (CBC) to identify if your dog is anemic.
- A packed cell volume (PCV) to test for the number of red blood cells present.
- A reticulocyte count allows the veterinarian to determine if new red cells are being made in appropriate quantities. 
- A blood film to look for parasites and blood cell characteristics.
- Chemistry tests to evaluate liver, kidney, and pancreatic functions, along with sugar levels.
- Electrolyte tests to ensure your dog isn’t dehydrated or suffering from an electrolyte imbalance
- Urine tests to screen for a UTI, other diseases, and to evaluate the ability of the kidneys to concentrate urine.
- Fecal analysis to look for intestinal parasites.
- Screening for vector-borne disease.
- Radiographs, ultrasound examinations, or blood tests for potential underlying infectious diseases or internal injuries.

The Treatment

Dogs can and do survive despite a diagnosis of IMHA. It is not an automatic death sentence. It can be costly, and it is a disease that also requires the pet parents to be diligent, especially where the aftercare is concerned. Treatment isn’t easy, and it is ongoing, and it may include, but is not limited to:

- Hospitalization
- Intravenous fluids
- Blood transfusions
- Immune system suppression (immunosuppression) with corticosteroids or stronger immune suppressive drugs when necessary 
- Repeat vet visits and close monitoring

Treatment of IMHA is one battle, and the side effects of those medications can wreak havoc on your beloved pet's already compromised systems. 

The Costs

Like most life-threating diseases, IMHA treatment is expensive! Zoey's overnight stay with intensive care for four days at the emergency vet cost us nearly $5000. Medications ran about $250/month for an additional six months. Not to mention the cost of each follow-up vet visit and blood tests. Treatment costs will vary from vet to vet, and the price for the medication can significantly differ from pharmacy to pharmacy. It's always a good idea to shop around for a budget-friendly drugstore, and it also doesn't hurt to get an estimate from your veterinarian before you agree to any treatment options.

The Prognosis

I am not one of those pet-parents who believes every so-called fact or statistic she reads online. The published survival rate runs the gamut, but dogs can beat this disease. Zoey is living proof. IMHA is not an automatic death sentence. Patients with IMAH require close monitoring. Red blood cell counts must be rechecked every two to three weeks, and the medication regimen and further treatments will fluctuate depending on blood work results. After stabilization, a basic blood panel and urinalysis should be performed every four to six months. Also, keep in mind that it's not recommended to have your dog routinely vaccinated after an IMHA diagnosis since you just don't know what will cause your dog's body to go through another bout of anemia. 

Thankfully, Zoey is still with us, and we are grateful to have this spunky girl in our lives. Miraculously, her red blood cell count stabilized in the normal range after nearly four months of treatment, and she's been in remission for over a year. But, I still check her gums at least twice a day for any change in colour from their usual pink, healthy shade to anything that even slightly resembles a pale to white-ish tint. Our favourite colour is now pink! While this illness cannot be cured, it can be managed. There are great resources and online forums available to lend you some much needed emotional support and provide you with information. You are definitely not alone. 

Disclaimer: I am not a veterinarian, just an experienced, well-read, and hyper-observant pet parent. This article is not meant to diagnose or treat any canine illness, nor does it replace professional veterinary care. Always talk to your vet about your dog’s health as health care is an individual matter. 

Resources and further reading:


petMD: https://www.petmd.com/dog/conditions/cardiovascular/c_dg_anemia_immune_mediated

Pet Health Network:

Piper is the author of several non-fiction books, and recently added two historical fiction novels to her ever-expanding collection of published writings, In the Shadow of Her Majesty and The Country Girl Empress. When she isn't busy typing away on her computer, she can be found chasing after her furry children or holding on tightly to a good cup of coffee. Follow her on LinkedInFacebookGoodreads and Google+.

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