AIHA or IMHA

 Hi Poppalacious,

Poppalicious

Is there a difference between Tick Fever and IMHA, if so what (from what I’ve read it sounds like IMHA is the name of the condition, with Tick Fever being one of the possible causes)?  

 

I am not a doctor so please double check everything I say.  In fact.. even if I was a doctor I would tell you the same thing.  I have found that no two doctors have agreed on much when it comes to this.

Here is a quote from a medical website:

 Canine babesiosis (Tick Fever) is an emerging infectious disease. Babesiosis is caused by protozoal parasites that infect mammalian red blood cells (RBCs). The signs of babesiosis are indistinguishable from those of immune-mediated hemolytic anemia (IMHA), immune-mediated thrombocytopenia (ITP), and Evan’s syndrome (concurrent IMHA and ITP). 

Many dogs with IMHA have gotten IMHA due to a tick bite.  It seems that the difference is that while most cases of IMHA remain a mystery of how it got started, Tick Fever is IMHA that is known to be started by parasites passed on from a Tick bite.  Unless someone tells you otherwise I would treat what is happening as IMHA and treat it as such. 

Poppalicious

We noticed on Friday that our normally inquisitive, independent and spunky 2 1/2 year old female mini schnauzer (Poppy) was ‘suddenly’ lethargic, not interested in food or play (which she loves), more attached than normal (always wanting to be in my lap/arms), hotter than usual, and was being 'obedient' outdoors (normally she likes to run away when we try to leash her, as she prefers to follow us home from walks – but now she’ll let me catch her.)

 

Poppy is of a breed that gets IMHA more often than many other breeds of dogs. That combined with the heartguard shot is a pretty good indicator she has IMHA.  They may not be finding any parasites because the IMHA may have been triggered by the Hearguard.   Also the survival rate is lower for Schnauzers than many larger breeds.  I say this because its very important that you treat this agressively and without delay.  Its not impossible for your Schauzer to recover.  User Callie on this board also has a breed that usually does not recover from this and her dog is a long term survivor.  

Poppalicious

  

 So he sent us home with some vitamins, anti-inflammatory pills and antibiotics, with instructions to come back in a week for a check up/more tests or to come back ASAP if things got worse. 

 

Your dog's appetite is probably getting better because of the Prednisone that your doctor prescribed.  Don't mistake this for your dog getting better.  My dog's appetite also improved but yet she almost died the next day.  

Do you know what Poppy's PCV was when they did the blood test?  You want to keep track of that number as its a better indicator what direction Poppy is heading than her appetite is.  

Be sure you have a plan to get Poppy a blood transfusion.  If the clinic you are going to now does not have that ability then find one that does. Ask specificly if they can "type and cross match" your dog's blood and find a compatible donor.  You can use a Universal Donor ONE TIME if you have to.  

Poppalicious

 

 If Poppy has IMHA, will she be on drugs for the rest of her life?

Poppy will be on drugs for a long time, my vet said my dog will be on drugs the remainder of her life.  That dosen't mean she can't live a happy life but it does mean that it costs a lot of money.  

Poppalicious

  

 Is IMHA passable to humans/dogs from day-to-day contact (e.g. touching, handling food bowls etc)? 

 

IMHA cannot be passed to another dog or to a human.  Neither you nor anyone else or any other dog is in any danger.

Poppalicious

  

 Is there anything else we should be doing for Poppy?

 

If you can find a teaching hospital that is experienced with IMHA I would do that.  If  you can find someone who can do a blood transfusion in case it gets to that point I would do that.  I would seriously consider asking your doctor if you should start her on immunosupressive drugs.  The doctors here say there is nothing better than Cyclosporine.  I can't argue it since my dog is still alive.  But can you afford it?  I would ask about Azathiaprine. - regardless which of those 2 drugs you choose it takes 2-3 weeks for it to do any good whatsoever because it takes time to build up concentration in the blood.

Start thinking about things like how far are you willing to go with this.  Your dog is not in any pain just extremely weak and tired.  Thats what makes these decisions hard.   Maybe things there in Hong Kong are not as bad as they are in the US as far as prices of drugs go. 

Keep on top of this because this thing can take a turn for the worse in a second.  I would get a CBC at least once every other day or consider hospitalizing your dog at a teaching hospital where they will monitor her very closely. 

I know what I've said is very bleak and this whole thing is very overwhelming.  I am sure I will think of other things too.  Please read what I've said a few times and feel free to post more questions.  I'll check back later in the day.  

Poppalicious -- I will try ON MY LUNCH to answer this but I"m racing out to work right now.

1.  Watch CAREFULLY -- did the vet DIAGNOSE tick disease before starting antibiotics for it?  The doxy cycline was actually what WORSENED Billy's IMHA -- doxy is an antibiotic that boosts the immune system and in the case of IMHA it can make the immune system attack the body even worse -- BUT it's also the drug of choice to *treat* tick disease.

2.  It IS better to have a known cause for the IMHA than not to -- if it was truly idiopathic (no known cause) then it has higher chances of recurring.

Will answer more later -- glad you are here!!

 Callie

From what Poppalicious said (the way I interpretted it) - his vet made the diagnosis of "Tick Fever" because it has all the same symptoms as IMHA. No tick was found on the dog and no sign of tick infection found in the blood.  I think a lot of these vets do the antibiotics as a prophalactic.  

What struck me the most was the Heartguard 6.

I'm glad you saw this post - I knew you'd think of things I left out.

Best thoughts for Poppy.

 See that's kinda what concerned ME -- there was a LONG time between the last tick seen and onset of the "disease" (altho it can be really tricky to know that).  In Billy's case his body actually had addressed the tick disease and formed antibodies to it - so when we tested him it was a FAINT positive.  Meaning the antibodies were new and they showed as a faint positive rather than the NEGATIVE it really was.  We had started him on prednisone and he WAS responding (his packed cell went from 20 to 29 in just a couple of days)

It's possible that he did have a mild case of IMHA or maybe the body had JUST dealt with the tick disease so the antibodies were 'new' and his body was still a little anemic.  But in any event, the doxycycline likely caused the immune system to react even more strongly.

The body was still dealing with this -- and when they added doxycycline to this mix, Billy's body sent the immune system into mega overdrive.  He crashed and his packed cell went from 29 on Wednesday to EIGHT on Friday night. 

So be VERY VERY careful -- watch this dog EVER so closely. 

Any sign whatsoever of weakness, nausea, unsteady walking, pale gums (even just a little more pale), nausea, ANYTHING UNUSUAL -- go to the vet **NOW**.  Don't wait.  Don't wait even a day.

And honestly, gratefuldawg's advice to go to your nearest vet school is a GOOD ONE.

IMHA is extremely difficult to deal with because it happens SO FAST.  IT changes in a heartbeat.  Vets typically will try to save the owner some money -- they tend NOT to react fast.  You call them today, they give you an appt tomorrow or "later this week" and frankly, with IMHA the dog can be GONE by then.

2 1/2 years later my head is STILL spinning from how fast Billy 'crashed' after the addition of the antibiotic.  We DID a tick test -- the standard protocol is to start PREDNISONE, not antibiotics necessarily. 

Why?  Because any antibiotic has to be approached with extreme caution because they CAN adversely affect IMHA.  REalize that not all tick disease results IN the IMHA.  So essentially you treat the IMHA **first** and then if you verify there is tick disease they usually treat later. 

ANY chemical, ANY stress can trigger auto-immune disease.  So you tend not to hit it with a ton of things at once at first.  At least that's MY experience. 

In honesty, *I* am the one who encouraged my vet to give Billy the doxycycline.  I did NOT want it to be IMHA.  noooooooooooooooo -- I knew people who had lost dogs to it and it scared me.  I **wanted** it to be tick disease because that was treatable.  Drugs for a long time?  yes -- but it was treatable and not often fatal.  IMHA is a killer. 

BUT in encouraging my vet to give me antibiotics it was a mistake and Billy paid the price.  We DID ultimately get it under control -- SIX TRANSFUSIONS LATER. 

How long will the dog need to be on drugs?  Completely unknown.

Billy is *not* on steroids.  Hasn't been in almost 18 months.  Some dogs can get totally off them (and we use Traditional Chinese Veterinary Medicine **in addition** to regular traditional medicine and that did help enormously). 

Much depends on whether or not you can nail down what "caused" the IMHA.  If the cause was a toxin (like a tick bite, chemicals like vaccines, flea/tick preparations, pesticides, chemicals sprayed around your home or neighborhood, etc.) then the prognosis for getting the dog off the drugs is BETTER than if the IMHA is truly spontaneous.

Normal 0 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Grateful Dawg & Callie - thanks so much to the both of you for the detailed, prompt responses and the rich insights!  They have given my husband and me much food for thought.

Grateful Dawg – you are correct in that the vet listened to us describe her symptoms, told us it was likely to be Tick Fever but wanted to do blood tests to confirm, then called us in to say the results from the blood tests so far supported his theory but he wanted to have a closer look at her sample and to get a second opinion from his colleague.  Finally he called us back in to say he could not find anything to conclude she did have Tick Fever (this all happened within the one appointment.)  Additionally I’ve started looking into your great advice; there are no vet schools in Hong Kong (!) but there seems to be a local expat community who have experience with Tick Fever and/or IHMA which I have also reached out to in case we need to go down the path of a blood infusion etc.

Callie - Thanks for your extremely valuable point about the antibiotics and the impact on IHMA.  I am not currently working so can monitor Poppy’s progress closely (she is lying in her bed next to me as I type) and no questions about it, will be taking her to the vet ASAP upon any signs of worsening.  It’s great to hear

So it's been under 48 hours since we've seen the vet, Poppy has perked up somewhat - she is eating her two meals a day (although does not finish every thing like before), is showing interest in snacks and when I call her, has initiated games of 'rope' (which we play gently), has gone back to being a little guard dog, growling at the door when someone goes pass our apartment – and best of all, I saw her tail wag today.  Despite these improvements we will continue to remain vigilant during this time.  IMHA is such a dreadful disease and I am glad to have found this forum.

THANKS again for your concern – we’ll be in touch with her progress.

In the meantime, all the best to you, your dogs and your families!

 Can you find out what Poppy's hematocrit was on her last test?  Just based on what you're telling me it doesn't sound like she needs a transfusion.  But be sure you have a place that can do it in case it comes to that.  I know it sounds like a drastic measure but a blood transfusion can give time for the medicine to stop her immune system from attacking.  If she refuses food especially a treat, get her to the vet immediately.  My dog turned down a McDonalds Cheeseburger and Fries.  When that happened I knew she was in trouble.  Not that I feed her that but I was desperate to try to get her to eat something. 

I am assuming she is on Prednisone/Prednisolone?  That may end up being all you need.  Some dogs seem to do well on Pred alone.  But I would ask your vet about Azathiaprine, if he thinks your dog should get started on that.  If it were me I would because it takes 2-3 weeks to kick in.  The worst that can happen is that it ends up being unnecessary and then they can discontinue it.  My dog had to have 2 blood transfusions in order to buy enough time for the Azathiaprine to kick in, as my dog didn't respond to the Prednisone the way the vet wanted her to.

Sounds like you're keeping a good eye on Poppy.  We'll be thinking of her.  Remember, you have to ask your vet many questions and if you think something isn't right get a 2nd opinion.  Keep watching your dogs lips/gums for color, keep watching the appetite and energy level.  I'd let your dog rest as much as possible right now.  Also at this point its ok to spoil Poppy with her favorite foods.  Its ok if Poppy puts on a little weight.

Have you heard of a group of Hospitals in Hong Kong called "Pets Central" ?  It seems like they have many locations.  Some people online seem to think its a good place.  Website:  http://www.pets-central.com/ - it seems like a place where they'd be able to handle the typing and matching of blood anyway. 

Glad you updated -- and glad the vet is being cautious.  Simply because it can be tough to figure out what TO start doing, and as I said the wrong thing can make it worse sooo fast. 

IF your vet needs to, I can give you some emails of vets that may be able to help your vet over there.  at the top of my post on the other side from my name you'll see a button "Contact" -- that gives you a drop-down list and an email to me will allow me to get back to you with some email addreses.  Vets tend to be really good about sharing information like that.

A HEARTGARD SHOT WAS MENTIONED.;  I HAVE NEVER HEARD OF IT IN INJECTION FORM, ONLY PILLS  THE ONLY INJECTION I KNOW OF FOR HEARTWORMS IS PROHEART6  AND THAT IS WHAT CAUSED THE AIHA AND DEATH OF  MY JUST TURNED 4 YEAR OLD GOLDEN RETRIEVER, HUNTER, OCT. 16, 2003.  IT WAS PULLED FROM THE MARKET SEPT. 3, 2004 BECAUSE SO MANY DOGS HAD HAD SEVERE ADVERSE REACTIONS, SO MANY HAD DIED....MANY OF AIHA.  IT WAS ALLOWED BACK ON THE MARKET THIS PAST SUMMER, BUT WAS SAID TO BE REFORMULATED WITH THE RESIDEUE THAT CAUSED ALL THE REACTIONS/DEATHS THE FIRST TIME REMOVED.  HOWEVER, IT WAS LOADED WITH WARNINGS ON THE LABEL AND THE VETS EVEN HAD TO TAKE CLASSES VIA WEB BEFOR THEY COULD PURCHASE IT FROM THE MAKER.  WAS IT PROHEART6 YOU LITLE ONE GOT, AND IF SO, HOW LONG BEFORE THE SYMTPOMS WERE NOTICED.

 Sandra,

I was thinking the same thing you were.  I'm glad you asked if it was Proheart 6.  I thought that is what she meant - but you're right we should make sure its the same thing.

Cyclops' biopsy came back.  She has a condition called Calcinosis Cutis.  I'm trying to research and find out what to do next.  It usually takes a month to resolve no matter what.  So I am going to try a month of cyclosporine at normal levels and see if its due to the high dose she was on.  The main thing I have to do is watch for infection.  A lot of people have had success with a couple different Rx shampoos one of them is called Etiderm and one is KetoChlor.  I think I will get more anti-biotics also just in case.  

I am going to call OSU and let them know about the biopsy and see what they want to do.  

Normally this condition is caused by too much Prednisone, but she's been off that for over a month now.  I am speaking with some people on VetNet who have had this happen while on Azathiaprine/Pred but so far no one else has had this diagnosis while on Cyclosporine.  The other reasons this happens is either due to Cushings or tumors, but I don't think that is the case with Cyclops.  I am going to go with changing the Cyclosporine dose and then if that does not work I will try switching to the non-modified version to check if its a reaction to the carrier.  If neither of those make a difference then I will have to consider (again) switching her to Azathiaprine.  

OSU wants us to run a ACTH test to check for Cushings.  That is a major cause of Calcinosis Cutis. 

I am going to have them rerun the CBC and this time get the Full Panel to test Liver, Kidney and Iron.  I hope they get it right this time.  

I need all your best thoughts for Cyclops.. we don't need Cushings or any tumors on top of IMHA thats for sure.

GratefulDawg

I need all your best thoughts for Cyclops..

You got it!  I haven't posted here lately, but I check it every day and am always sending healing thoughts and prayers your way.  Hang in there.

GratefulDawg

I am going to have them rerun the CBC and this time get the Full Panel to test Liver, Kidney and Iron.  I hope they get it right this time.  

I need all your best thoughts for Cyclops.. we don't need Cushings or any tumors on top of IMHA thats for sure.

You absolutely have them -- I have so been there done it ... I feel exactly in MY gut what you feel. 

While Billy was on Cyclosporine he had THREE tests for Cushings -- no ... two while he was ON cyclosporine and one later on (remember I told you it takes FOREVER to get it out of the body?)

I SOOOO doubt it's Cushings.  And frankly, I doubt this is that rare with cyclosporine -- we're talking about ALL steroids or steroid like drugs -- all very similar in the damage they do -- I'm not blowing you off.  Trust me -- I can SOO emphathize with this -- Billy's skin was sooo freaking bad and yeah -- they don't want them inflamed or infected ... and you feel like tearing your hair out and screaming *WHAT MORE can I do???"

Why don't they have records?  Because cyclosporine is so freaking expensive that no one is going to the extra expense of a biopsy while the dog is on it (because you had one vet jump in with this mega nasty "cancer" scare -- she did you NO favors that day). 

The test for Cushings is tricky -- they have to stay there the whole day.  You have to fast them for 12 hours before the test and then they take blood and then feed them and draw blood again (it's similar to the procedure for the bile acids test).  It's not tricky for you -- but it needs to be done right.

I doubt it's Cushings '' she's pretty asymptomatic (not showing symptoms) for Cushings!  Yes, it's a risk but ... you may have to rule it out but I truly doubt it.

Did you get to speak to YOUR vet at OK?  or was that the response of someone else on the team?

 You have my thoughts and prayers too. I agree with Callie that it's probably the cyclosporine causing this.