Chapter 2: AIHA

Auto-Immune Hemolytic Anemia
This page last updated June 4, 2006

Early in 2006 Rosie fell ill. The usually bouncing dog had spent most of the day snoozing with mom, who was nursing a migraine. I thought that perhaps she was just acting a little sympathetic. But when she refused her nightly cookie, I became frightened and immediately began to check her vital signs. Using the lethargy as an indicator, the first thing I did was to check the color of her gums, they were so pale they were almost white. That was all the diagnosis needed to bundle her up and rush her to emergency.

Rosie was diagnosed with AIHA. The cause of this disease is not really known, nor is there a cure. Essentially the body starts attacking its own red blood cells leaving the animal weak and fighting for oxygen. Deprived of oxygen, organs can start to shut down and the entire body suffers a long list of damage. An average of 65% of all dogs never survive the initial episode of AIHA. Those that do, often live no longer than 2-3 years further. It can be a disorder unto itself or an indicator of some deeper problem such as cancer.

Rosie spent 2 weeks in the hospital and received two blood transfusions. Her PCV (packed cell volume, red blood cell count) went down to 15 at one point. A normal dog should range 40-45. She is a tough little dog though and seemed to bounce back fairly well. Within 4 weeks her PCV was hitting marks near 40. We owe so very much to Dr. Richard Martin, specialist in Internal Medicine at Brentwood Pet Clinic. His dedicated concern an care for her was paramount to her survival. We had another dog with this disease and Rosie has done much better comparatively, so we are keeping high hopes that she will continue to be one of the lucky ones that beats the odds.

Rosie will be on theraputic doses of immuno-suppressants and steriods for a very long time, and will have to be monitored closely for the rest of her life. We have been told that certain environmental products can trigger episodes of this disease and monitoring her exposure to them will be critical. She will no longer receive yearly vaccines and her vet will excuse her from rabies vaccinations generally required by the state. Since we live in a very metropolitan area and she lives "in" the house, her chances of exposure to rabies is very slim and we will take every possible precaution to protect her from any slight chance of exposure. Becasue she was exposed to some of the suspected triggers just before she became ill, we are hopeful her episode may have been due largely to the external triggers and that she will fare better than most.

Update:

Rosie is about 4 months out now. Her PCV continues to have great numbers and her meds are being slowly reduced. On her last visit I asked that a full blood panel be run to check for several things: First, to see if the therapy was affecting her liver and spleen. Second, to see if there was any indication of other disease for which AIHA may have been symptomatic. Third, given what she has been through as a general "check up". Also, I asked for full body xrays as a visual check for underlying tumors or other abnormalities. So far, so good! Always take that extra step rather than take a chance and regret it later!

Please read the list of environmental triggers that can be dangerous to dogs and visit some of the links below to read more detailed information about AIHA. I have chosen some incredibly detailed sites that provide well researched information rather than repeat it here.

18 months out and doing great!

AIHA Risk Factors:
I have been asked to post a very simple list of "at risk" conditions here several times, here you go!

Breeds at risk:
Lahso Apsos, Dachsunds, English Sheepdogs, American Cockers, Irish Setters, Springer Spaniel, Poodle, Shih Tzus and any cross breeds.

Other factors for risk:
Any breed that has or may have cancer, or organ disease or disorder, especially liver disease.

Any breed over the age of 8. This is when the complications of old age arise and the risks above are more likely to present.

Female dogs are more likely to develope AIHA and other auto immune diseases.

Any breed that may have been exposed to things that are known to trigger AIHA. Remember that exposure is not a guarantee, it increases risk...why take the risk? Most of the triggers are things that you dog can live very happily without or there are safer alternatives, the exception being vaccinations. Do not avoid having your dog vaccinated unless your vet feels the animal is past the age where he needs some of them. If you have a dog that may be predisposed (has any above risks) for AIHA, monitor them carefully after vaccinations (for several weeks). Also, speak to your vet about eliminating uneccessary vaccines after age 6-8.

Triggers and other doggie no-no's:

Veterinary shots including rabies and general vaccines. If your dog has recently received vaccines and behaves unusually more than 24 hours afterward (effects may appear weeks later) see your vet! Lethargy, pale gums, lack of appetite, excessive panting and urination are just some of the signs that your dog is not well. Many vets no longer recommend general vaccines (except for rabies) after middle age unless your dog is kennelled regularly or visits dog parks.

Flea sprays and shampoos whose chemicals cross the skin barrier. To be safe use only Frontline and Advantage types and make sure you get the real USDA approved thing! Boric acid powder or other "fleabuster" type carpet powders are ok too. Never mix different types of flea preparations!

Yard pesticides and weed killers of any sort. Many dogs tolerate them well. But they can kill some dogs within days. My dog is more important than my flowers. I use other methods to edge and weed. A good soap solution may take more time and effort to apply for pests, but is safer for dogs, especially for a dog with AIHA.

Onions and garlic. Onions especially are toxic to dogs. For dogs with AIHA, or at risk, they can easily trigger an episode. Eaten raw or in "bites" of prepared food from the table, they can cause sickness and death. I believe there is nothing wrong with giving my dogs "people" food in small amounts, as long as I am careful that it is not seasoned or prepared with toxic additives. Don't take risks with something that your pet will never miss in his diet.

Living outside. Dogs with AIHA should be walked and exercised as tolerated....and get fresh air, but it is a good idea not to leave them alone in the yard for long periods. An insect sting or bite can trigger an episode and kill them. Treat them like family and include them in your daily life for as long as they live, it's what they want and what we owe them.

Infections, bacteria, dental health. Any infection or bacterial intruder can trigger an episode of any auto-immune disorder. A common entry point is the mouth, it connects the outside of the dog to most of the insides! Bacteria from tooth decay and gum disease can be deadly. The gentle (awake) form of cleaning might be safe for a healthy dog, but will not always clean deeply enough. Consult with your veterinary internist and weigh the benefits and costs of anesthesia-assisted cleaning for dogs with AIHA. (Cancers that start in the mouth can spread fast and be devastating, check Fido's mouth regularly for any bumps or spots and see your vet!)

No-No's:
Household hazards to avoid.

Some common sense:
Just because it is on the internet, does not make it so. Just because it is not on the internet, does not make it so. Some of the best medical information can only be found on private and pay-for-use databases.

Use critical thinking. Does the advice come from someone trying to sell you something, or do they have something personal to gain? Question it.

Risk. Is there any? What do you gain by taking the risk? What might you lose? Is it really worth it?

"A vet said so." Yes, and they said the world was flat and Woo-suk Hwang said he cloned human stem cells too. My best advice is to research and check with several vets who specialize in the particular area and who are in the forefront or research and treatment. Not all vets will agree, not all vets are qualified, not all stay current. not all care. Some have other priorities. Barring that ever elusive crystal ball, if it is a matter of avoiding something that may be harmful to your pet, avoid the risk unless you feel your pet's quality of life will suffer without the item in question.

Grape seeds are toxic to dogs. No raisins or grapes.

Chocolate can kill a dog. Don't take a chance to see if yours is one that is sensitive to it! "I gave my dog chocolate all the time and it has never made him sick before." is one of the stupidest things I ever heard the owner of a dead dog say.

Cocoa Mulch. This popular garden product is pretty and smells great. It is made from the husks of the cacao bean, it contains theobromine, like chocolate, which when ingested, in varying quantities for differently sensitive dogs, can kill within hours.

Onions and Garlic. Toxic to all dogs, cats and livestock, offending agent: thiosulphate. There are safer and more effective flea controls that will not enter the blood stream whose dosage and concentration can be better monitored. Use caution with folk remedies that have no verified dosing data and may be toxic or interactive.

Nuts. Especially macadamia and walnuts have a variety of ill effects including tremors, weakness and paralysis primarily of the hindquarters and bladder stones.

Tobacco is toxic to dogs, eaten or inhaled (and people too!)

Radiator and transmission fluid left in the drive, even a tiny puddle.

Any chemical or cleaner left to puddle that a dog might find attractive to lap up can be toxic. Many can be toxic by inhaling or from residue left from cleaning water and food bowls, kennels and bedding.The best plan is to use cleaners specially made for kennel care and rinse well. Rabbits are sensitive to any aromatic oils in cleaners.

Any medication not prescribed by the vet, even simple things like over-the-counter pain relievers such as acetaminophen and ibuprofen. Make sure you don't drop any! Make sure you use veterinary prescribed drugs exactly as prescribed and only for the animal they are prescribed for. Consult with your vet before purchasing any medications or preparations from other sources to make sure there will not be adverse reactions with existing medications or health conditions.

Snail bait..just don't! It looks like kibble!

Any kind of rodent bait or poison, even after the rodent has consumed it, even the "cardboard-box" type traps. Most baits/killers are anti-coagulants. They keep the blood from clotting and the animal bleeds to death, often by thinning the blood to a point that the veins can no longer contain it. A cat or dog that eats or nibbles on a rodent that has been killed this way can easily meet the same death. Use the old fashioned snap traps and keep them away from paws! (and the rodents they might catch, you never know what disease they might carry!)

Rawhide. There is some difference in opinion about rawhide. I only allow my dogs to have the sort that has been ground up and looks like hamburger, and only occasionally. The office manager (for 25 years) at my vet tells me that most of the surgeries they do on stomachs and intestines are to correct perforations made by rawhide and chicken bones. Both "splinter" into sharp pieces when broken and chewed.

Therefore, ditto chicken bones!

Dog toys. Choose them well. The most common reason for veterinary abdominal surgery is that the animal has swallowed a foreign object, often from his own toy. If Cuddles is a prim little gal that likes to prance about and give her squeakie a tweek now and then, you can relax and indulge in some of the softer, less expensive toys. But if Brutus loves his toys, buy only the best and toughest toys. Look for the hard rubber and canvas, no small legs and arms, no button eyes he can chew off and swallow. If he chews his toys up an swallows the squeakers, avoid the ones with the little outside squeak valves that he will get to fast and remove the toy the minute he "breaks into" it and can start swallowing the pieces. No small balls or toys. If he likes to chew your shoes, no leather toys; your socks and other such items, no sheepskin. If you have children, train them to keep any toy that Brutus might tear up and swallow pieces of, or swallow whole, where he can't get to them! No matter how appealing the bargin bin at Walmart is, use extreme caution when buying any toy, especially the cheap ones, the cost of surgery WILL out weigh any savings!

Mushrooms of any kind growing in the lawn etc.

Poinsettia, philodenrdron, many lillies, dumb cane, pothos, mistletoe and yew berries and many other plants can cause vomiting, pain , diarrhea, seizures, coma and death. Research the commonly know culprits and "dig" deeper if your dog is prone to eating the plants and other organics in your yard. Often for these dogs a nice, safe, plant-free run is best when they are without supervision. (And might reduce your headaches due to chewed plants and furniture!)

Fruit pits. Pears, apples, plums, peaches, apricots and similar fruits contain high levels of cyanogenic glyosides, (cyanide). They are dangerous to humans and other animals as well.

The leaves of rhubarb and the leaves and stems of tomatoes are toxic for similar reasons. So is broccoli in large amounts. DItto, potato peels and green potatoes. Evolution psychologists theorize that the innate knowledge of dangerous chemicals in some foods (often fruits and vegetables that we consider to be healthy) is what makes them so unappealing to children. What is in the vegetable may not be toxic to the adult, but could be to the small child...and the dog!

Insecticides. Even for a healthy animal chemicals used to kill household and garden pests (even fleas) can make your dog sick and even kill him. Consult your vet and never use different types of pesticides in the same proximity of time or space, even flea control.

Xylitol sweetener often found in sugar-free gums and candies has been reported by the ASPCA to be toxic to dogs. This new is rather new so not a lot is known as yet.

NOTHING TAKES THE PLACE OF A WELL-RESEARCHED, TRUSTED VET WHO REFERS TO A TRUSTED NETWORK OF SPECIALISTS WHEN NECESSARY!
Develop that relationship before you NEED it.

Learn WHERE your Animal Emergency is and KNOW how to get there.

Pack an emergency bag for your pets too! Leashes, meds, food, treats, bedding, bowls, water, folding kennel, first aid, bandages for feet. In an emergency or disaster, many shelters will not be prepared to house your pets.

The links below are to highly informational sites maintained by others who have had dogs with AIHA or vet info centers.

Wing-n-Wave Labradors-AIHA

Meisha's Hope-AIHA-Great Research Fund here!

Canine Inherited Disorders Database

Nuna's Story

Lilli's Legacy

AIHA Dog