Immune-mediated hemolytic anemia in dogs | Dr. Justine Lee, DACVECC, DABT, Board-Certified Veterinary Specialist
Immune-mediated hemolytic anemia (IMHA), often also called autoimmune mediated hemolytic anemia (AIHA), is a disease process where the body’s immune system attacks its own red blood cells (RBC). When this RBC destruction occurs, it results in severe anemia (e.g., a low RBC count) and lack of oxygen delivery to the cells in the body. As IMHA can quickly become life-threatening due to severe anemia, immediate attention by a veterinarian is imperative so we can start treatment immediately!
There are two types of IMHA: primary or secondary. Primary IMHA has no known cause – in other words, your veterinarian will have to run a lot of tests (including x-rays, ultrasound, etc.) to make sure it’s not due to SECONDARY IMHA. With secondary IMHA, underlying causes include:
- Cancer
- Toxins (like zinc, onions, garlic, certain chemicals, etc.)
- Parasite infections in the red blood cells
- Tick-born infections (like Lyme disease)
- Heritable causes (e.g., phosphofructokinase deficiency, pyruvate kinase deficiency, etc.)
- Certain drugs (like vaccines, antibiotics, etc.)
The majority of cases of IMHA are primary; however, an extensive medical work-up is typically required with IMHA to rule out these secondary causes.
IMHA is also defined as either intravascular or extravascular. This means that the RBC are destroyed either in the blood vessels or destroyed outside of the blood vessels (destroyed in the spleen or liver instead), respectively. The prognosis for intravascular hemolysis is worse as compared to extravascular.1
Breed predisposed
IMHA can occur in both dogs and cats, although it’s more common in dogs. As a veterinary specialist, I have rarely seen it in cats, but it can occur. Unfortunately, when seen in cats, it’s often due to Feline Leukemia virus. Back to dogs: Certain breeds are over-represented, meaning it’s more likely to be inherited. The following dog breeds are over-presented:1
- Cocker spaniels
- Dachshunds
- Springer spaniels
- Bichon frises
- Irish setters
- miniature poodles
Female, middle-aged dogs (ranging from approximately 3-8 years of age) are also over-represented.1
Clinical signs
Signs of IMHA are typically due to the severe anemia (and lack of oxygen to the body) and the secondary breakdown of red blood cells. Red blood cells contain an inner red to orange color in their pigment, and when the red blood cells rupture, it causes a yellow to orange hue to the skin, gums, and even urine. Signs of IMHA include:
- Lethargy/weakness
- Panting constantly
- Acting tired on walks or with exercise
- Not wanting to eat
- Acting thirstier
- Pale or jaundiced gums
- Abnormally colored urine
- A racing heart rate
- Vomiting
On physical examination, your veterinarian may identify the following additional signs:
- A heart murmur
- Jaundiced gums
- Abnormal femoral pulses (due to abnormal blood pressure)
- Elevated heart rate
- Elevated respiratory rate
- An enlarged spleen or liver
- Enlarged lymph nodes
- Hypotension
Diagnosis
How do we diagnose IMHA? It’s based on physical exam findings, blood work changes, evidence of anemia, and general history. Unfortuantely, it becomes expensive to work up a dog or cat with IMHA as we have to make sure we have appropriately diagnosed it and rule out secondary causes (e.g., such as a RBC parasite infection, cancer, etc.). The general tests necessary include:
-
- A complete blood count (CBC) to evaluate the red blood cell count and appearance (e.g., morphology) of the cells
- A packed cell volume (PCV) to determine the severity of anemia by testing for the number of red blood cells (with normal being approximately 38-48%)
- A biochemistry panel to look at the kidneys, liver, electrolytes, protein, and other bodily functions
- A urinalysis (UA) to evaluate if RBC are present in the urine. The presence of hemoglobin in the urine is typical for intravascular hemolysis.
- A rapid, in-house ELISA SNAP test to rule out tick-borne causes (such as Lyme disease, etc.) for IMHA
- A reticulocyte count to evaluate if the bone marrow is able to regenerate and make more RBC to fight off the anemia
- X-rays of the chest and abdomen to rule out the presence of metal foreign bodies (e.g., like pennies made from zinc) or cancer that can cause secondary IMHA
- An ultrasound of the abdomen to look at the architecture of the organs, to rule out IMHA secondary to cancer
- A slide agglutination (SAG) test which looks at the “stickiness” of RBC to each other, consistent with IMHA
(See picture)
- A Coombs test, which specifically tests for an inappropriate immune response. This is typically only necessary if the SAG doesn’t reveal IMHA.
A positive slide agglutation (SAG) test
Treatment
Treatment of IMHA is focused on the following:
” Life-saving care
” Immunosuppression
” Prevention of secondary complications
Life-saving care includes treatment such as blood transfusions (to increase the number of RBC and to help increase oxygen to the cells), intravenous fluids, monitoring RBC count, blood pressure monitoring, and symptomatic supportive care.
Immunosuppression, in other words, suppressing the immune system from attacking its own RBC, is primarily done with long-term corticosteroid (e.g., prednisone, prednisolone, dexamethasone) therapy. Additional immunosuppressive drugs such as azathioprine (Imuran®), cyclosporine (Atopica®), leflunomide, or mycophenolate may also be necessary, depending on the severity of symptoms and how well your pet responds to the drug therapy. Keep in mind that pets typically need to be on these medications for months at a time (e.g., 4-9 months or more),1 or another life threatening relapse can occur at any time.
Finally, treatment is also aimed at prevention of secondary complications. High dose corticosteroids, while imperative for the treatment of IMHA, can cause secondary side effects such as gastrointestinal (GI) ulceration or even a predisposition for pulmonary thromboembolism (PTE) or life-threatening blood clots. As a result, the use of GI protectants such as antacids are often necessary. Drugs such as famotidine (Pepcid®) and/or sucralfate (Carafate®) are often necessary for months at a time to prevent GI complications. The use of low-dose aspirin is also recommended to minimize the risks of PTE or blood clots. Typically, the use of corticosteroids together with non-steroidal anti-inflammatories (NSAIDs) isn’t recommended; however, with IMHA, the potential side effect of PTE can be so devastating, aspirin therapy is warranted. The dose of aspirin used with IMHA is miniscule (typically only 1/20th of a dose for pain control in dogs). Other types of anti-clotting drugs (e.g., heparin, warfarin) have fallen out of favor as compared to aspirin.
Unfortunately, the overall prognosis for IMHA is generally poor, with a mortality rate reported to be approximately 40 to 58%.2 In one study, survival to one year out from initial time of diagnosis ranged from 17-69%.3
Most importantly, with IMHA, frequent veterinary visits are imperative to monitor the PCV frequently. As drug therapy cannot be acutely discontinued (due to risks of a life threatening relapse), frequent follow-up is required at your veterinarian.
References
1. Cohn L. Acute hemolytic disorders. In Small Animal Critical Care Medicine, Eds. Silverstein DC, Hopper K. Saunders-Elsevier 2009;pp. 523-528.
2. Carr AP, Panciera DL, Kidd L. Prognostic factors for mortality and thromboembolism in canine immune-mediated hemolytic anemia: a retrospective study of 72 dogs. J Vet Intern Med 2002; 16(5): 504-509.
3. Weinkle T, Center SA, Randolph JF, et al. Evaluation of prognostic factors, survival rates, and treatment protocols for immune-mediated hemolytic anemia in dogs: 151 cases (1993-2002). J Am Vet Med Assoc 2005; 226(11): 1869-80.
WE ARE SCARED SPITLESS BY THE DIAGNOSIS AND THE TREATMENT. THE LOCAL “SPECIALISTS” CANNOT BE BOTHERED TO TALK TO US–NOR CAN THEY PRODUCE A LEGIBLE ITEMIZED STATEMEMT OF SERVICES / COSTS. PLEASE TELL US WHOM WE CAN TRUST!
My 19 month old had to be put down on August 26. Her RBC were attacking the blood transfusion so fast. She was so weak that she would never have been able to handle the meds. Hardest decision we had make. Miss her every day. We spent over $5000 and the diagnosis was IMHA. I wish she got to experience life more, but we let suffer.
I’m so, so sorry to hear this… especially when she was so young. 🙁 My heart goes out to you and your family.
My dog was just diagnosed with IMHA and my vet is familiar with
The disease letting us know survival rate and pointing out that he’s been successful in treating resulting in 80% survival rate!!! Very optimistic!
Hi Carol,
Did your dog make it? May I ask what city your vet is located. We are facing IMHA head on with our two year old dog. It’s been a tough week.
Thank you,
Tom
Not person above but took our dog to Tufts. Amazing. He was really bad. At one point given 5% chance. He is home now , still on meds. Pray daily no relapse. They performed 2 rounds if TPE ( theraputic plasma exchange ) seemed to turn it around. Local vets were of very little help. U.C Davis does TPE . Check if any local large Vet schools like Tufts in your area. This all will not be inexpensive. Its a tough one.
My 8 year old German Shepherd was diagnosed today with the same thing, if you don’t mind to tell me about the treatment your doggie is getting.. I’m just trying to see how we can help our baby
Thank you for your time
My pitbullmix is treatedin Michigan -Oakland veterinary Referral Services – it’s been a year now and she’s still alive – mstacey734@comcast.net if you want more info – Mary Stacey
OUR 13 MONTH OLD BASSET HOUND HAS JUST RECENTLY BEEN DIAGNOSED. WE ARE STUNNED BUT HOPEFUL THAT SHE WILL RECOVER BUT THE ARTICLE ABOVE DOES NOT GIVE MUCH HOPE. WE ARE DEALING WITH A SPECIALIST WHO IS WONDERFUL AND ARE CONSIDERING TAKING HER TO PENN VET HOSPITAL IN PHILADLPHIA FOR AN ADDITIONAL CONSULT.
In June 2020, my 10 yr old male neutered dachshund was diagnosed with IMHA. His PCV was initially at 22%, and within a couple days dropped to 12%. We agreed to a blood transfusion and his PCV jumped to 24% right after. Over the next few months our vet put him on varying doses of prednisone and azathioprine trying to find the right combination to raise his PCV levels. It’s a really slow climb. Finally on Jan 6, 2021, after he had been on a daily 5 mg dose of prednisone and daily 12.5 mg of azathioprine for about 10 weeks, his PCV was at 42%. We were thrilled! Our vet thinks this will likely be his long term dose of both drugs.
The noticeable side effects we’ve seen (likely from the drugs) is he seems to drink more and urinate more than he did pre-IMHA. Right now he’s also being treated with antibiotics for a UTI, also likely due to the immunosuppressant drugs.
But my biggest concern right now is he is overdue for his annual vaccinations, including rabies. Our vet is concerned that giving him the rabies vaccine would have a negative impact and undo all the improvements he’s had since last June. We have to decide if we want to risk it and have her vaccinate him. It’s completely our decision and our vet said she will go along with whatever we decide. My dog is doing well right now and I feel that thru all the hard work my vet did, he got a 2nd chance and I didn’t lose him back in June. I just don’t know if I want to take the risk of having him vaccinated.
How is your dog doing ? My
10 year old border collie went through the SAME exact thing your pup did . Minus the transfusion. She’s all better with the meds and antibiotics. I am too hesitant to give her the rabies shot . I don’t want another relapse. Did you ever get your pup vaccinated ? I’d love to hear the outcome either way .
HI Melissa: My 4 year old chihuahua “Ms. Lucy” was diagnosed with IMHA over 4 years ago. She spent 3 days in the hospital, was given two blood transfusions, prednisone and microphenalate. She gain a lot of weight being on steroids for about 4 months but we are going into our 5th year (thank God). My vet immediately made the decision to no longer vaccinate her (she says it’s too risky). Ms. Lucy is doing fine today and continues to take microphenalate daily. I’m grateful for every day I get to have her love and companionship.
My 8yr old is living with IMHA. First thing my vet told me was that he is exempt from vaccines for life.
Our 9 year old sheltie cross was diagnosed on Monday. No previous health problems. She has had three blood transfusions and last night was operated on to remove her gall bladder, which appears to be the cause of secondary IMHA. She made it through the operation and through the night. We are taking one day at a time…..
Our 7 year old Mini Schnauzer was diagnosed with this 5 years ago. She received 2 blood transfusions and a poor prognosis prior to the second transfusion. It was quite time consuming and expensive (both financially and emotionally). The initial diagnosis was quite pricey. She was in remission for 3 years. Now 12, she has AIHA again. It’s a scary disease where the imunosuppressents to keep her alive cause other issues. We went months with UTIs that were resistant to all standard medications. The best advice, trust your doctors. We are so fortunate to know that our specialist loves our dog as much as we do.
I have a mini schnauzer who was just diagnosed with this. He is only 6. We are devastated. We are just treating him with all the meds and getting food in him via a syringe in the mouth every 5 hours. VERY difficult!
Our Yorkie was diagnosed in 2019, she wasn’t even a year old. She was lethargic would not eat, weak and not behaving as herself. The vet told us she wouldn’t live past the week. In the same week we had read that dogs were getting blood transfusions, so we took her into the ER as she was getting worse not better. The ER vet told us we could get a transfusion, but they were costly and sent us home to consider our options. We were devastated. My husband had at the time been researching CBD oil and its benefits. My husband was convinced it would help. So in addition to the prednisone the vet prescribed we began giving our pup CBD oil. Within a few days she was back to herself. We stopped giving her prednisone all together. She is now two years old. The ER vet thinks she was misdiagnosed. I am not a vet, but is it possible to misdiagnose this? I can’t say for sure what happened, but using CBD is worth a try. I wanted to share if it could help another fur baby survive this disease.
Just came back from the vets,our 9 yr old beagle was diagnosed with Evans, not eating etc, his gums and tongue are so pale. He is on. Prednisone, they wanted to do more test keep him , but so expensive I’m hoping we can turn it around with meds for now. CBD ? We already have a beagle pug on it for epilepsy.. You have it along with the meds ? Comment
Our 7 year old Bichon Frise has been diagnosed with IMHA . She has had a blood transfusion & is on a high dose of steroids. She is experiencing vomiting. She has little to no energy. Once she was full of life. Our vet is doing all she can. It’s just a waiting game now. And it is a costly one.
I lost my 2 year old Shih tzu on Thursday. Went off her food Saturday, became lethargic Tuesday collapsed later that same day. Vets tried everything. Massive seizures started Thursday & I had to let her go. Still in shock how a healthy young dog with her whole life ahead of her could go in such a terrible & horrific way
Oh, I’m so sorry to hear that! 🙁 My heart goes out to you…
I thought healthcare for humans was expensive but for dogs it’s almost prohibited. It’s a shame in this country (USA). Your vets may love the animals but they also love your hard earned money. What a shame.
Hi don!t think they are any better in the uk
EIGHT years of college
7-13, depending on where you go.
Sadly, the debt to income ratio for veterinarians is unfair. We go to school for 8-13 years (e.g., internship, residency), and average $150-250,000 in student debt in US dollars. So, in life, realize this before accusing veterinarians for their “hard earned money.”
Dr. Justine Lee, DVM, DACVECC, DABT
My 12 yr old chihuahua is being treated for IMHA could u tell me if it’s painful for them?
Great question – it’s not directly painful, but it can cause lethargy, exercise intolerance, and general malaise. But not straight out pain!
I’m so sorry people are so rude! My Lab/Belgian Malinois was diagnosed IMHA & 7,000.00 survived. Worth every penny! Thank you for all you do for our fur babies! My boy is thriving 2 years later.😊
*$7,000.00 later lol
Is your dog off meds and able to be vaccinated again. My rescue was just diagnosed and its very scary disease.
The issue is that it always comes down to a “Pay us or we won’t treat, and your pet can die” type scenario. I fail to understand why vet services do not bill similar to hospitals for people. I’m sure people doctors rack up just as much student loan debt. Instead, pet owners are forced to apply for bullshit care credit or scratch, which rarely award enough to cover even half of the costs related to treating something like imha. It’s just a dog right? Refuse treatment unless 80% payment is received! I don’t think that would go to well if it was the same for humans.
Yes, but that’s because you have insurance that covers 80% of your human bill. The best safety measure is to get pet insurance for your pet or to have an emergency savings fund, as it’s part of pet owner responsibility.
You can say that about lots of jobs they don’t have the privilege to just raise their wages to meet their lifestyle and pay their bills. Poor excuse for prices. People with 20 yrs experience in a job can still be in poverty. Comment *
My dog is 13 years old…just diagnosed and don’t what to do..he also has arthritis and is so weak he can’t walk..
Needs to go to hospital but not sure if too old..any advise?!
I would discuss the prognosis, side effects of the medications, and your dog’s quality of life with your veterinarian.
If he has arthritis and can barely walk and has just been diagnosed with this awful disease. I would think that you need to think about his quality of life and may need to make a decision that you don’t want to make. I have a Bichon and I am right there with you. He lost his eye a year ago and I can tell the other eye is really hurting him. I don’t want him to be in pain. It’s really hard. My thoughts are with you….
Thank you for this information. I have an 8 year old male “something” mix breed..think between American Escimo and a Terrier that is suspected having this. Will know more this afternoon. Came on so suddenly. But got the good news this morning his red cell count went from 10% to 18% so praying it stays and/or goes up. I also hope he is part of the few that go past the 1 year mortality chances. Hope to keep you posted.
Hi Patricia – I was just reading this as my dog has IMHA too. Would you mind if I asked you how your dog is? I do hope there was good news.
My 6 month old bernerdoodle has been diagnosed with IMHA. He’s on a steroid, cyclosporine and Atopica plus various other things. He’s had 3 blood transfusions levels came up from 12 to 20 but really is not rising above. Is there hope he will improve? It’s been 3+weeks. The vet will not give a good answer.
It’s unusual in a dog that young but possible. Did you guys do x-rays to make sure your dog didn’t eat coins (e.g., zinc) that can also cause this?
I know there is a lot of doom and gloom around IMHA but I wanted to let everyone know that there is hope.
My 10 year old springer spaniel suddenly stopped eating and didn’t want to walk and within 24 hrs was in hospital having a blood transfusion. Almost 1 year on and he is still on predisolone but only a small dose and continues to have cyclosporine. He has lost some weight but is still the same dog we have loved for the 6 years we have owned him. The long term plan is to get him off the drugs but will obviously mean regular vet visits to check his PCB. Don’t give up hope
So happy to hear that! Thank you for sharing.
Thank you Ian for your encouraging message. My beloved 9-year old Shih-Tzu was just diagnosed with AIHA. The vet just called two hours ago to tell me the test results. We’ll start cortisone therapy tomorrow morning (it is now nighttime). I had never heard of this disease until now! So I started reading online about it and mainly found a lot of doom and gloom info. Your message is helping me a LOT. Thank you for it. I hope your dog is doing well.
Thank you for sharing your good news! Our furbaby (10yr old mastiff/boxer) was just diagnosed with IMHA two days ago- she has had 3 blood transfusions. Her levels were 15% and today is 24%. We are praying her levels remain steady and that she does not need a fourth transfusion. X-rays and ultrasounds have been done to rule out other issues. The doctors are doing all they can and I know she is receiving the best care- she is at Blue Pearl Emergency Specialists. She is a fighter and your story gives me hope. Thank you!
He is in great hands! 😉
Thank you. I needed the uplifting story of IMHA.
My American cocker is in remission from IMHA and now off of pred. We are looking to reduce Azathioprine at the next review. The set back has come when he was groomed and they noticed fleas. The local vet has prescribed ‘Advocate’ flea treatment. I am worried about using it. Imidacloprid and moxidectin are listed on the box. He is well now and I’m concerned about relapse. Any advice ?
I appreciate this reply is too late for you M Hinton, but for others maybe not.
Have a look at natural fles/worm treatment such as diatomaceous earth, after my dog was diagnosed with AIHA I would not allow any chemicals near her. The immune system was compromised enough and strong chemicals in flea treatments were a big no no.
Unfortunately, studies have shown that diatomaceous earth isn’t very effective.
My 8 year old Eskipoo(mini American Eskimo/mini poodle) has been fighting this disease for 1 week. I noticed dark urine on her pee pads 1 week ago at 5:30 pm after work (I’m an internist and jojo is our therapy dog). I brought her to our vet immediately and he diagnosed AIHA although at an early stage as her hematocrit was 38 which was low for her. Of note, she was vaccinated the evening prior with 6 vaccines but unfortunately I made a mental note that 4 pee pads had clear urine and one had this ghastly orange color that I “wrote off to dehydration”. Therefore I know the vaccinations did not cause this disease but surely did not help it. The next am on a Saturday I brought her back and the labs from the day prior showed her bilirubin had been slightly elevated at 1.3 and now her hematocrit was 30. She was started on Pkavix for clots and prednisone. The next morning on Sunday she was yellow in areas of her white fur ( prior her pink tummy was yellow) and her heart was fast and her gums were pale. I took her to an amazing hospital with their own blood bank and she was down to a hematocrit of 15. She was transfused one unit and went up to 36. She is now on her 3rd unit. She holds for 48 hours and slowly drops. Her red cell smear shows a regenerative anemia but she keeps agglutinating. She is on cyclosporine and Iv Dexamethasone along with Plavixand Xarelto. Mycophenolate was added today. She looks great. She is going for walks, eating and is perky. I’m taking her home tomorrow and getting daily PVCS.
The next step they say is human IV immunoglobulin VS plasmapheresis. Which would you suggest? Fortunately Jojo has excellent pet insurance so finances are not an option.
It sounds like she’s holding her own on all those meds. If she’s doing well, I don’t usually do IVIG unless they are failing to respond to all the medications. I’d manage her long term wise with an internist, but she sounds like she’s in great hands.
Comment *My sweet baby was at 18 RBC and sent home with prednisone when I ask the doctor when she would be better before I knew what this disease even was the doctor informed me a couple of days. So basically I let her lay there and die for 2 days while I was trying to put prednisone down her throat. On the second day I rushed you to a different emergency room and her our BC was down to 6. She died that night after going into cardiac arrest. This all transpired within two days and I never got to say goodbye. What I’m wondering is why that doctor didn’t treat her and give her a blood transfusion or even fluids anything to help her she was miserable I even had to carry her into the hospital. And then to tell me she should be fine in a couple of days took all of my worries away. And on her paperwork it said her our BC was low but improving…..i think this woman shouldn’t be practicing. She didn’t offer my baby ANY fighting chance at all. And I basically watched her die for two days and didn’t even realize it. Because the professional told me she’d be better in 2 days and gave her nothing but a bottle of prednisone and sent her home. I’m so happy for those that had a better outcome. I’m completely broken and not sure how fyo proceed in my life. She even went to work with me everyday every night when I close the doors Itutu cry because she’s not there I’m in a miserable existence right now. And blaming myself for taking her to that woman that obviously didn’t know what she was doing and this is a complete nightmare
My 3 Year Old Labrador is diagnosed with IMHA. And he has been treated for the same since past month. He has had six transfusions, yet he’s struggling to maintain proper hemoglobin levels. He’s on Prednisolone and cyclosporine.
My question.
I read somewhere that Thromboembolism is a possibly, and we asked our doctors to prescribe medicines for that. They took PT/PTT test which came negative for clotting, and device to not prescribe medications for the same. Is it fine or is it safe to take preventive medications?
Is there also a chance that the anemia could be non immune mediated?? Any ways to find out the same??
Any help would be really appreciated.
I’m so sorry to hear that – when in doubt, I’d make an appointment with a veterinary specialist in your area. There is a rare possibility it’s not immune mediated, but now it will be hard to test for (Coombs) as he’s already on prednisone and therapy. With thromboembolism, the PT/PTT are “normal” – meaning that medication is still necessary to prevent HYPERcoagulability (which PT/PTT do NOT test for). I generally recommend very low dose aspirin (0.5 mg/kg orally every 24 hours) – which is less than 1/4 of a BABY aspirin orally for a large 70-80 pound sized Labrador. We typically don’t use steroids (prednisone) plus an NSAID (aspirin) together, but this is a microdose and important to prevent clots. Otherwise your vet can use Plavix too. I’m assuming he’s Lyme negative?
My 8yr old pomeranian came down with IMHA and was euthanized wednesday. She was given prednisone which was not working. She had always been healthy i couldn’t stand watching her go through these treatments and I didn’t want her to suffer. This is a devastating sickness I hope someday soon a cure. Its not fair for these pets to be attacked like this. Is there some type of funds set up for the prevention?
Linda,
I am reading comments over here to heal my Pain! & my Heart! I can’t believe it from a Teddy Bear good life to Sick;(
I’m so sorry for your Loss;( your Beautiful Pom!!!
My 7year old Pomeranian was Diagnosed at 6 in a half , it’s a Silent killer started with diarrhea / loss of appetite.
Died from this Deadly Disease IMMUNE MEDITATED HEMOLYTIC ANEMIA . It was an Idiopathic case ,We were treating at Blue Pearl. The Doctors say it’s a Genetic factor and my poor little girl could no longer make it with
Therapeutic medications hospitalized for a Week and a Blood Transfusion, Destroyed and killed her all this Science did not work other things starting arising! Even more she stopped eating and was showing signs of Death and of course we have to give these innocent Souls some Dignity unfortunately, I fought so hard and strong for her so did she;(😢💔
I took her in several days later and nothing can be done for her , the body was shifting she Passed in my Arms without Lethal a part of my Heart went to Heaven with her! Such a Costly extensive treatment no cure disease even with Pet insurance. Enough to Break you and your furry Friend to Survive I’m crying and hurting daily. I wish I could have done more ;( you know when it’s time all though we are in denial of Love for them to keep them for us . Rest my Libby girl , we will see each other again … Mommy will always Love you ;( BROKEN FOR EVER!!!
God Bless to the Suffering;(
When our little Maltese was 7 yr old she was diagnosed with IMHA. This was devastating and educational for all of us. After running tons of tests and seen by numerous specialists, they identified that her bone marrow was functioning properly but her body was killing off the red blood cells as they were being produced. They did a blood transfusion and lucky for us her body accepted it and after 5 days in the hospital we were able to bring her home. She was on numerous compound meds for about a year and after gradually weaning her off all the meds and continued blood tests she was good as gold. Never had an issue with anything else other than all of her teeth were rotten to the jawbone and we had to have all of them removed. Not sure if it was an after effect from all the meds but she was good as new after that. And I’m thrilled to say that our little million dollar dog lived to be 16 yrs old! She was def worth every penny that we spent. Thankful for her doctors and the financial means to treat her properly.
Just adopted a 7yr old PomChi he is in remission and on meds. He absolutely adores me as I do him. I knew what I was getting into because he was diagnosed before the adoption. Your words have inspired me. Thank you so much for posting. What a blessing!!!
You win free awesome pet karma for adopting him with this disorder! Thank you for being an awesome pet parent!
)Hi,have just come across this page while searching for info on the subject.My 4year old whippet was diagnosed yesterday has just had a transfusion which has apparently perked her up a bit, l am devastated took her to the vet Monday she took her from me in the street due to COVID restrictions,I expected her to bring her back in a while with antibiotics instead she told me she would be transferring her to the main branch for urgent treatment.They are all doing their best and have been very kind but it’s dreadful to go through..Hope all your dogs and mine do well.
My four year old maltese was just diagnosed a week ago. What did you do to get your pup to eat. I will cook and buy anything. Just need her to eat. She has allready lost a pound.
Our 11 1/2 year lab has been diagnosed with this terrible disease. Her blood count went up by 9% last Friday. She goes back to the vet on Wednesday. I think she has declined since Friday. She is on high does of prednisone, doxycycline, and something to help her stomach. Her spleen was very large also. Our vet is talking about sending her to UGA for specialized care. We have already spent $1000. If treating it will only give us a year with her, we have made the decision to let her cross the rainbow bridge. We are both retired and on social security, but would use every last dollar to keep her if we could be sure she would survive longer than a year. This was one of the hardest decisions I have ever had to make. We are loving on her and giving her all the treats she will eat. I have cried a million tears over this decision, but she is not the same dog. She is so lethargic that she barely gets up. She is the best fur baby we have ever had. We will sure miss her, especially when we are camping.
I’m so sorry to hear this – she will be at peace and I hope the wonderful memories you had of her camping help ease your pain. Hang in there. Deepest sympathies to you guys.
Thank you so much. She really declined and today we had to return to the vet. She was 2 points away from needing a transfusion. She couldn’t get up by herself. They had to bring in a stretcher to take her back. The trip to UGA would be about 3 hrs. We didn’t and the vet didn’t think she would make it, even if he gave her a transfusion. We decided to let her cross the rainbow bridge. We stayed with her and loved on her till the end. She is being cremated so I’ll still have her with me.
We went through the exact same thing with our 11 year old Springer girl in Dec. 2018. She was the second we lost to IMHA. Like you, and considering her age and the progression of the disease, we decided to let her go. A really great vet at the emergency clinic was very sensitive in helping us come to the decision.
At least we were somewhat prepared, having been through this previously. The first one went hard, despite aggressive treatment at a vet school. We swore not to do that again.
We are in the process of adopting another adult Springer. I wish more was known about preventing this horrible disease.
My sweet Toby was diagnosed with IMHA about four months ago. At first the prednisone brought his numbers up but tonight he can hardly walk and his gums are white. He is 16 years old and has had the most wonderful life filled with love. I think I must make the hardest call tomorrow to the most wonderful Vet who loves him like we do.
I’m so sorry for your loss. I recently loss my 5 year old Shih Tzu to IMHA and I’m still trying to understand how this all happened despite him being so healthy all the years I had him. I truly believe all dogs go to heaven and your fur baby as well as mine are in a special place.
Our eight year old Brussels Griffon had an anal gland issue about three weeks ago and was given a round of penicillin. He continued to get sicker and weaker and our vet thought he still had an infection so we started a second round of antibiotics. He continued to decline so we took him to the University of Missouri Vetinary School. We arrived on a Thursday evening and were told his prognosis was less than a 50% chance of survival. By Saturday he’d had a couple of blood transfusions and the fever was down. Things were looking slightly up. The doctor felt like everything but the IMHA was under control. Sunday afternoon took a turn for the worse with a blood clot in his lung. Our Sherman died this morning. This disease is devastating.
Oh no – I am so heartbroken to hear this. The blood clot to the lung is a horrible, horrible complication. You were in excellent care with UMissouri – their internal medicine team is amazing. I’m so sorry and my heart goes out to you guys. RIP, Sherman.
I lost my beautiful Tibetan terrier called Lula two weeks ago after a four month fight and several thousandd pounds.
I would have carried on spending, her bloods came up but the med regime was just too much for her , she would not eat and just got weaker , she died in my husbands arms and the pain of losing her is so intense.
Oh, I’m so, so sorry for your loss. My heart goes out to you guys.
We lost our English Staffy, Ace, last April at only 9 to IMHA. He was an RSPCA dog who we only had as part of the family for 7 years.
I am still at a loss to understand this disease and had we done anything to bring it on like vaccinations. He was vaccinated in early April and passed on 29th April. We decided to let him go after a week at the University Vet.
He had everything money could buy to save him. Ultrasounds blood transfusion, 1 that his body accepted and 1 that his body did not. An operation to check his insides for any blockages or primary illnesses and was seen by Vets and specialists.
He also started suffering from wobbling/shaking eyeballs which created balance problems and nausea.
When he was admitted his bloodcount was around 14 and it did go up to around 29 but after this hopeful count it continued to decline.
I did find a very small tick on him whilst he was at the Vet but this was not seen to be a concern
It has been the hardest experience of my life and I dont say that lightly.
Our doggies are due for vaccinations soon and I am going to ask for a Titer test before vaccinating. I know there are many causes but this is the only thing that I can think off that Ace was exposed to.
As the saying goes ‘If love could have saved him, we would never ever part’ I miss him every hour of the day and will do for the rest of my life. It was such an unexpected situation to be faced with and now we have to face life and lifes milestones without him
I’m so sorry to hear about that. I will say that studies have shown that vaccination isn’t a definitive cause of IMHA; however, in ANY dog diagnosed with IMHA, I minimize vaccines to just rabies and those required by state/country law and any drugs if possible. My heart goes out to you.
We are still in shock after the sudden passing of our 8 year old schnauzer mix baby girl. We took her to vet because she vomited liquid yellow stuff, lethargic, not drinking water, or eating food. This all came on in one Friday. The vet thought pancreatitis and the bloodwork was all over the place. We admitted her to emergency hospital. They treated her through pain meds and thought she had developed IMHA. They thought it was secondary IMHA brought on by pancreatitis. The vet did X-ray and ultrasound. The emergency hospital again did ultrasound. But could not find any obstruction. They put her on IMHA meds. She had dropping blood counts and was not responding. We transferred her over to NC State Vet Research hospital on Monday. They did a blood transfusion on Tuesday and thought her blood counts were getting better. They wanted to do ultrasound to see whether she had acute gallbladder infection. By that time her Bilirubin had increased to 30 from 1.7 on Friday. Before they could do anything she started breathing funny and her heart stopped. I was with her at the end.
It was difficult to watch her in pain. They think her gallbladder ruptured. I am confused why she went down that quickly. She was sick on Friday and was gone on Wednesday.
Our shih tszu/Maltese/Yorkie mix who is 12 years was just diagnosed with this. She has had 2 transfusion. Her platelets have gone from 0 to 25. RBC count went up from 15 to 22. Waiting to see if they remain up overnight. This came on suddenly and is horrible. I feel so helpless right now.
Hello. Did your loved one recover? Our Husky was diagnosed 2 days ago, and just had her second transfusion. With the first transfusion her RBCs went up to 19, but then dropped to 2.6.
Please help! My 2 year old yorkiepoo was just diagnosed with this. He can barely eat or refuses water. Was given sub qutaneous fluids, doxycycline and prednisone. Will recheck in 5 days.. his hgb is 6.4.. I have 5 little ones who will be devastated if we lose him. I started a GoFundMe just to afford even 1 transfusion. Please share our link to help our family save Kingston! https://www.gofundme.com/save-kingston
My Assistance Dog Dexter has just been diagnosed with this he is a 3 year old mini Dachshund, my heart is breaking, overnight his red blood cells dropped from 30 to 15 .. he is home with me and vets again in the morning he is on prednisona and vetgastril. Something called cerinia to stop him being sick and enrofloxacino anti biotic. We live in Lanzarote Canary Islands.I am a mess he is my life without him I have no life we are so bonded. I felt something was off on Thursday and by Friday I knew something was wrong and was at the vets at 9am Friday morning yesterday this is what they said they thought it was and he has all the symptoms. He is weak but walking although has not the strength for steps. I am keeping him warm and he is taking food by spoon with some effort and drinking a lot which the vet told me to restrict so he does not drink too much in one go. I am praying so hard right now that he can be saved, he is my life and we go everywhere together.
Talk to your vet about adding him onto cyclosporine!
My cocker spaniel Teddy was diagnosed with Imha November 12 2018. He was in the hospital ICU for 5 days with no hope of him coming home. We did two blood transfusions and after the second one his levels went from 20 to 30. When it reached 35 we got to bring him home with blood tests frequently. He is on predinsone, blood thinner, and Prilosec for stomach issues. His levels now after 4 months are holding at 47. My vet cut his prednisone back a little and waiting for his next test and if his levels are holding . He is happy but just hungry all the time from the steroids. I just noticed his hair is getting really thin and wanted to know if this is normal? We feel blessed for the time we have had with him and pray each day we will have another day.
Yes, the acting hungrier, getting muscle loss, panting more, peeing more, having more dilute urine and having a thinner hair coat is from teh steroids – it sounds like he may need his steroids cut down very very slowly! There are other drugs you can add on to with less side effects (Atopica). So glad he is doing well!
I’m looking for a vet specialist in this topic in the Los Angeles area. My pom just had his second transfusion last night at our general vet’s office. He was doing well after the first transfusion on Saturday but then started bleeding from his mouth. It’s time to take this to someone who has the most experience possible. Can anyone point me to names of immune specialists in LA please?
Yes they are all over the place in LA – I would google DACVIM or DACVECC and that will help you in LA. West LA VCA, California Veterinary Specialists, etc. Best of luck with your little Pom!
My 14 -15 year old Shih Tzu (he’s a rescue so we aren’t quite sure of his age) was just diagnosed 8 days ago. We had a scheduled appointment with the vet tech for his shots, but when he started acting off, we saw the vet instead. She could not find anything wrong (temp was good, gums good, no sign of pain) so we decided to do a full senior panel, which came back with his red blood cell count at 19%. He had x-rays and ultrasound and both came back clear. Vet said suspected IMHA and started him on Prednisone, Cyclosporine and an acid reducer. Started the treatment and two days later he was worse. Brought him in and he had two transfusions and his count stayed at 35%. Brought him in daily for 3 days for and he is now at 32%.He sees the vet on Monday (its Saturday). He has little energy and doesn’t want to eat much. He is breathing a bit harder, but the vet said he is not in distress. He had diarrhea a bit so we started probiotics. This is so heartbreaking. I had never even heard of IMHA until now. I know with his age the odds are against us, but I am not giving up yet. However, I will not let his suffer and will be with him all the way.
My Maltese was a happy, healthy dog and then one day, this past Saturday, woke up lethargic and with a fever and was turning yellow. We took her to the vet and she did blood work and diagnosed her with IMHA. We then took her to the emergency vet to get a transfusion but she had reaction to it (high fever) and they were debating about doing another one. She seemed to get better on Monday and were planning to bring her home on Tuesday, but she started having difficulty breathing and was placed in an oxygen chamber. They suggested taking out her spleen, but she died before they could do it. I’m devastated. She was going to turn 6 this summer. I don’t understand how this happened. We take her to her regular checkups and if she got sick, we’d be there first thing. My family is devastated.
My sweet Pomeranian has been battling this since Nov. We discovered this issue when I decided to get CBC done after researching an anti inflammatory med she was on. She has not gotten to the point where we have needed a blood transfusion. She had been on prednisone, b12, famotidine, and sucralfate. We have tried to taper prednisone but her numbers decreased again. MCV is 33 and RBC is 3.84. Thing is she acts completely normal at this point!! Dr wants to put her on Atopcia. I hate her being on all this medicine! And I hate this disease!!! Lucy is 6 years old and is my world. Praying we can get on the other side of this terrible diagnosis.
My 6 year old Pomeranian was diagnosed with this horrific condition recently. We were alerted of this disease when I decided to get a CBC ran on her after researching an anti inflammatory she was on. She has not needed blood transfusions at this point. She is currently on prednisone, sucralfate, famotidine, and b12 shots. Recently we have tried tapering prednisone and her numbers decreased. RBC 3.84 and HCT 33.22.. ugh!!!! Dr now wants to start her on Atopica. I hate all this medicine! I hate that she can’t tell me what’s going on and how she feels. Sorry I am venting, but this is terrible. She acts normal for the most part. Makes me sad.
My sweet schnauzer almost 7 started with an upset stomach on Thursday I had her at the Vet on Friday. After a battery of tests, we got the diagnosis and despite meds and ensuring she was hydrated, she did not respond to the medications. Today, Sunday morning she couldn’t stand or walk and was in acute respiratory distress and whimpering in pain. We made the agonizing decision put her to sleep. This disease was so swift, and unexpected. They did find a mass in her abdomen upon examination, hard to know which came first. Her blood was good a few months ago. We thought she had a simple upset stomach and were shocked at the diagnosis, and are still trying to process the passing of our sweet dog today. .
I’m so sorry to hear that. 🙁 The disease is definitely swift. 🙁
I just lost my 8 year old japanese chin she was so bad when my husband go home from work took her straight to vet where she was diagnosed gave us alot of options but she was so small I was not willing to put her small body through that so I put her to sleep. Was really hard because I just lost my other dog to lymphoma She was perfectly fine that morning no warning of a problem. I now check my other dogs everyday for signs scared I don’t want to lose anymore
My mini Australian Shepherd got this awful disease about three years ago. After six blood transfusions, a week in intensive care, and a lot of blood sweat tears and of course money , She pulled through. She takes a low maintenance dose of Atopica, is not exposed to other dogs at the dog parks and does not get vaccinations now. Next week she will be 13 years old. Such a horrible disease but there is hope.
Our jack russell is 7 years old she started acting funny two weeks ago no energy not eating she just wasn’t herself. We took her to urgent vet her red blood cells were at a 10 they put her on 4 medicines we made our way back to our regular vet a week later they were up to a 20. We thought she was getting better she had more energy she was eating drinking just being herself. We had another visit yesterday and they are back down to a 13 now the vet told us she probably wouldn’t make it. We have searched all over looking for answers we don’t want to give up on our baby. Please help if anyone has any info that might help we would greatly appreciate it. Prays for you all who are dealing with this horrible disease.
My Old English Sheepdog was 5yrs old when first diagnosed with AIHA in October 2015, she was on steroids for about six months, no transfusions. The vet at them time did say that I should consider my options, (PTS) It was a scary time but regular blood tests and monitoring by the vet she made a good recovery.
Its now four years later and she has had a relapse, back on steriods last week but this morning she is not well and I am waiting to take her to the vet.
AIHA is not always doom and gloom, four extra years with my girl and if she pulls through this time, who knows…………………
Did your dog survive Lucy?. Mine had it first 4 years ago and nearly died had life saving treatment which saved her life, she then contracted it again about a year later but I had caught it early got her on prednisone and she was back to normal completely of meds after 2months. She unfortunately caught it for a 3rd time 1week ago I caught it early again but this time the pred had failed to work her blood count went from 29% to 9% in 6 days, my vet then gave me 3 options iv and antibiotics, blood transfusions and euthanasia. We decided to try our best for her and choose the iv treatment it unfortunately failed as well within a few hours. I was very distressed and confused by this point I was about to rush to Manchester vet hospital (2hrs away) for a transfusions but my vet advised me she probably would not make it there and I would cause her pain so I reluctantly decided it was best for her to be put asleep it was the worst thing I’ve ever had to do I sat with her gave her lots of love she looked so weak and tired. I rested her head on my leg and stroked her until she fell asleep then the vet euthanased her while she was unaware, I lost my best friend 21/12/20 it has turned my world upside down and broken my heart.
Our 10 year old border color was diagnosed with IMHA on Monday and passed away on Thursday. Perfectly heathy before this. Blood work was normal 6 months ago. He had vaccines one week before this diagnosis. I know it says there isn’t a relation but I can’t seem to wrap my head around this devastating disease. He had two blood transfusions and lots of tests. The white dog his eyes were hello and so were his gums. Eventually his skin became yellow too. His blood count cane up but he developed a blood clot to the lung even though he was on blood thinners. He was having trouble breathing and had absolutely no
Energy. Couldn’t stand up, walk or eat. This was the hardest thing my family had to deal with.came on so suddenly and we did everything we could. I wanted to be able to say my dog survived this horrific condition but he didn’t. I’m glad I found this page and was able to read some of your stories.
I’m thankful for this thread, trying to understand whats happening, Imelda got diagnosed today. 7.5 year old Rat Terrier Chihuahua mix little girl. SHE IS MY HEART as all of my dogs have been. She was at 12% in our regular vet’s office after a speedy yet though check to rule out everything else obvious that would cause her symptoms. Our regular vet said “ I am SO GLAD you brought her in TODAY” and had 2 vet techs on the phone to find us a 24/7 ER Vet that would prep for a blood transfusion and an open ICU room waiting for her. The ER vet did an additional test and reviewed the information our regular vet put together and confirmed it was the secondary type and immediately began steroids and the transfusion. We know ultimately there is about a 50% chance she will return to health and a 50% chance she won’t despite trying treatments. We’re trying to wrap our heads around the reality that she may be compromised, she may pass or that we may have to put her down. We’re trying everything because she deserves the best we can give her, but were afraid for her, she is so tiny and her rather large zest for life mysteriously disappeared 24 hours ago with the onset of symptoms. I’m so scared, I’m shattered, I’m unfathomably sad, and I wish more than anything she was plopped in my lap pestering me for belly rubs.
My chihuahua was the same way my vet put him on prednisone sulcrafate immuniquin doxycycline and iron supplement but my baby has gotten so big from the medicine he barely wants to move but we live in a rural area with not alot of vets so we cant play with his medicine the vet is an 1 hour drive for us.
My 2.5 year old male Brussels Griffon was just diagnosed with IMHA yesterday. They re running more tests and have sent his blood off to a lab and also to NC State (tests are for different things). Xrays show that his spleen is enlarged. His PCV is at 27%, and the internist seems to think we caught this fairly early, so we are hopeful for now.
My BMD, neutered male, 9 yrs old, doesn’t have a definite diagnoses yet, but all the symptoms. Pale, weak, no appetite. GHP reveals very low HCT, but regenerative. The Rest of the chemistry is normal. Radiography and ultrasound show nothing but a enlarged spleen. Abdomen not painful. Put him on Prednisone and HCT came up slightly. Appetite picked up some, eats small meals several times a day. How long before I see more improvement with the Prednisone? In general?
He needs chest x-rays and an ultrasound, along with a Coombs test ASAP! It generally takes 3-4 days to improve on prednisone.
Our five year old me neutered BMD has just been diagnosed with the same.Scans also only showing an enlarged spleen. He is currently at the vet awaiting blood test results to check if the red blood cells are regenerating and thr vet has suggested he may need a transfusion. What was your outcome?
Hi!
Just wondering how it worked out for your pup?
We have a 16 month BDM who was diagnosed on Monday. He is on 2 meds now- and just got a Coombs test to ensure he isn’t misdiagnosed. He was neutered a month ago which we think triggered this.
His RBC is at 18 and we want to avoid a transfusion (we lost our 8 year old 16 months ago from bloat then 2 months later cancer/ spent about $20k on that surgery – and just had twin babies – so trying to see if meds work before spending a fortune if there isn’t hope). His levels on Monday and today (wedneday) have been 18 (not declining not incling) We are devastated/ he’s an incredible boy.
Did your pup make a full recovery?
My 7 years old maltipoo also diagnosed with This Immune mediated hemalitic anemia one week Ago… he was hospitalized for 3 days and did 3 blood transfusions and doc has given up on him as he seemed to refused the last transfusions. They want me to spend time with him which means they want me to just sit home and wait him to die … it is just not acceptable to me and I wish there is something else I can do to help him… please help 🙏🙏🙏🙏
Our 4 1/2 year old Husky/Shepherd mix was diagnosed with this recently. Her initial red blood cell count was 9% so we started on Prednisone and Doxycycline. Because her platelet count began to skyrocket, the vet has me injecting Heparin twice a day to prevent a blood clots becoming loose and becoming a big problem.
Her blood count didn’t improve so she had a transfusion on Monday – she only got one unit from the vet’s donor dog. Her blood count after the transfusion went up to 20% but she doesn’t seem any better to us. We’ve also added Cyclosporine to the mix.
My question is, I absolutely dread giving her the injection of Heparin. Do you think substituting a tiny dose of baby aspirin would be ok?
Great question – we criticalists have moved AWAY from using heparin and instead recommend small doses of aspirin at 0.5 mg/kg orally once a day OR Plavix instead.
Dr. Justine Lee
So our vet wasn’t thrilled with me not giving the prescribed heparin and using aspirin instead. She is worried that our dog will develop ulcers. I’m thinking that is the least of our worries at this point, right? I’m only giving her 1/4 of a 81 mg aspiring (she weighs about 60#).
https://onlinelibrary.wiley.com/doi/10.1111/jvim.15463
My 6 year old Labrador was diagnosed almost 2 weeks ago. RBC count was 16, put on meds, dropped to 10, took her to hospital, 2 blood transfusions later we got up to 21. Diagnosed with IHMA. HAd xrays and ultrasound and test for tick, all came back normal. She has been released and is home with us. Came home with 9 meds, incl: 5 tabs 2 times day prednisone, 2 tabs daily Mycophenolate, Doxyclyclcine, Omephrazole, Clopidogrel, Metronidazole, Entyce for appetite, Carenia and Melatonin. She has been eating and was progressing. Her RBC at 37 and platelets are good. She has been reduced to taking 3 tabs daily of Prednisone, 3 tabs daily Metronidazole, Omephrazole and Entyce for appetite. She is now on day 2 of not eating again, but her blood work is looking really good, per dr. Going back to internal med dr tomorrow to see what can be done to have her start to eat and get some energy back Trying to keep her moving forward, not backward. Any suggestions, ideas that worked for you?
I never adjust the medications quickly – I typically wait 4 weeks before adjusting anything, but see what the internist says! Best of luck!
Christine, while on prednisone, do monthly full blood checks to see if liver, kidneys and in particular pancreas are all good…my 13 year old was doing fine on pred and mycophenolate, PVC holding around 40, then suddenly got diabetes, went blind instantly, but I kept her going for 6 months….imha and diabetes meds started fighting each other and it was a constant rollercoaster…..prednisone is a life save, but a killer with all the side effects….get weaned off it asap…
My 8 year old German Sheppard has relapsed and has been diagnosed with IMHA. She last had the disease back in 2014. We brought her to the emergency hospital at a 7% PCV level and 2 blood transfusion was done and she recovered and lived a great life until Friday July 17th. She was diagnosed with IMHA again and her blood count was at 24, next day went down to 23, back up to 25 in the following days. She was on 6 types of medications. The hospital discharged her on Tuesday July 21st and on July 22nd i brought her to our vet to check her PCV levels and she must’ve been super stressed because her PCV level dropped to 20. She was admitted back into the hospital and a blood transfusion was completed this morning. X-rays, ultrasound all came back clear, all her organs are healthy and her breathing and heart rate is normal. Were thinking to do another transfusion if her PCV drops again. Any advise?
Cosmo, our 5yo Golden, sweetest baby, currently at the vet’s office being worked up for a tumor underlying this god-forsaken anemia… So painful to weather the news, but I found this article very helpful and thank you.
We just lost our 4 yr old german shepherd basset hound mix to this horrific disease! Wouldn’t eat one day and by the next he was panting, lethargic and unable to get up. His PVC was 13. 5 days in the animal hospital-4 blood transfusions and 1 immune globulin transfusion along with Dexamethasone and Doxycycline and he just didn’t respond. PVC went to 26, down to 18, up to 26, down to 18 again, up to 22 and then down to 14 and they finally suggested we put him down. We are angry and devastated that he was taken so young, so abruptly and so cruelly. After reviewing the medical invoices I am also questioning the treatment because he seems to have only received 1 dose of oral Mycopheanolate…and I’m wondering if that was just not sufficient!. I am just besides myself with grief.
I’m so sorry to hear this – it’s a terrible disease. It sounds like your veterinary clinic did the right things, IMO. The first line therapy is always steroids. We usually reach for a 2nd or third line (e.g., cycylosporine, azathioprine, mycopenolate) only when there’s a failure of response. It typically takes 3 days for immunosuppression with steroids – even with intravenous administration. I’m so sorry to hear about your dog – my heart goes out to you guys.
Best,
Dr. Justine Lee
So I found this page and have been reading the comments and it has made me cry. So our story is that we went to pick out 3 dogs up from the groomer and our 9 year old corgi cross peed on the groomers concrete driveway and it looked like she peed straight blood. We had noticed she was a little off but assumed her hips were a little sore. She went to her chiropractor and didn’t feel better and started not wanting treats. Our dog is very food aggressive so when she didn’t accept treats I was concerned. So anyway we rushed to the vet from the groomer. We did a pee sample and bloodwork. The vet put her on antibiotics in case it was a pre infection. She had said that the pee didn’t look bad but she wanted to be safe. We got the call the next day (yesterday ) that Baylee has this disease and that she will need to be put on steroids and have bloodwork done regularly to find the right dose of medicine. Our vet did not make it sound like it was a scary thing at all. Nothing was mentioned to us that a blood transfusion might be needed with this disease. I honestly left thinking it wasn’t that bad until I started reading up on it. Now I’m terrified. We will get her nay treatment that she needs. Should we be more worried? The vet didn’t mention doing other tests besides blood. We had booked her a bladder ultrasound in a nearby town because originally we thought she may need one but our vet said she doesn’t need one now because she knows what the problem is. Should I be getting another vet involved?
our 9 yr old doxie was fine one day and quickly got sick with this disease. Shes a rescue who at 3 had liver surgery & survived. She’s on prednisone doxycycline & appetite stimulant. Third day in meds she’s refusing to eat & vomited. Still weak & lethargic. We’re trying pepcid now to settle tummy & giving her children’s pedialyte do she doesn’t get dehydrated. Will re-evaluate in 3-4 days at vets.
Our 9 yo mixed breed dog was diagnosed a week ago. Came on suddenly with lethargy, loss of appetite, pale gums and increased respiratory rate. We brought her to the ER at Ohio State University vet hospital. She received a blood transfusion and started on immunosuppressives and steroids. They offered a “gold standard” treatment called plasma exchange. Although very expensive, we started the first of three procedures a couple days ago. It is supposed to remove the antibodies from her blood, while giving the immunosuppressive drugs time to work. She has gradually improved but not out of the woods yet. We are praying for a recovery.
Wow – definitely the way to go based on publications out there! It’s expensive and honestly not readily available except at vet schools. Best of luck and PLEASE keep us posted!
Best,
Dr. Justine Lee
Thank you! Treatment number 3 is tomorrow.
Abby was discharged from the hospital after spending 7 days in the ICU. Follow up appointment will check her PCV to see if the immunosuppressive drugs are working.
Woo hoo! Prayers to Abby and let’s hope she does well!
Best,
Dr. Justine Lee
She was diagnosed October 24, 2020.
Unfortunately, the immunosuppressive drugs are not working. Abby is scheduled for a transfusion tonight and a splenectomy tomorrow.
My 9 year old pug was diagnosed with IMHA on tuesday after not eating for a day and very lethargic and she fell over. They started treating her right away for IMHA, they found a mass on her spleen so did surgery on wednesday to remove the spleen and the mass. When we brought her in her PCV level was at 12, yesterday she had a blood transfusion and it was a success her PCV level jumped right to 32 and today it is up to 33. However she is still not eating and lethargic but Is stable. Is it common to have act this way after the transfusion? Also, she has only seen me 2 times and I am confident she is mad at me, she has not seen my husband since tuesday could she be depressed? She has not ever left our side in 9 years and is never left alone someone is always with her so this is all new to her. Would possibly bringing her home help her get better? Thank you
My dog Sonic was diagnosed with this. I guess I should start of by saying he mixed with Pomeranian and Eskimo from moms side and I’m not sure what his daddy was. Sonic was a very handsome dog. He was black and brown and fluffy about 35-40 pounds. He just passed away a few hours ago. My family and I are devastated. We had his mother and I watched him come into this world and watched him leave out. He was 8 years old turning 9 November 24th. On Thursday my twin sister and I noticed he was laying down more and not his normal self. That night when I went to go feed the dogs (we had 4) . Sonic did not eat so that really caught our attention because sonic loves to eat. We offered him a French fry he didn’t eat that either. We watched him that night. Friday morning we woke up and started our day like any other, my mom went to go let sonic go putty outside and noticed when he was peeing it was straight blood. So we rushed him to the vet. Back in January sonic was hit by a car and by gods grace he had minor injuries nothing broken. Sonic was a fighter. Fast forward to Friday they diagnosed him with this disease. They did a number of things. They gave him a antibiotic injection, gave him steroids, and another medicine to help coat his stomach, and they did blood work. Our veteran told us he might need a blood transfusion but wanted to get his blood results back first. He would not get them back till the next day. It is now Saturday. Sonic still not eating but he was drinking water . He was very weak. The only time got up to walk was when we took him outside and he did not go far at all. When the veteran called us, he told us that sonic does have this disease. That his liver was showing sighs that it was swollen. We told him he still wasn’t eating so he proscribed another antibiotic and this thing that was in a tube. Basically it would give him the nutrients he needs since he wasn’t eating. We tied to offer cottage cheese, baby food, peanut butter but not at the same time and had no luck. When it was night time I took him outside and he used ever bit of energy. We got him back on the couch so he could rest. Soon after we decided that I was going to carry him to the basement and put him on the bed so he could be comfortable. Within 20mins he passed away. I prey that everybody has better luck with their fur babies. This really hurts. On top of this we have had major plumbing issues which looks like it is going to thousand of dollars. So we really didn’t have any money. We used our last bit to pay the 750$ from the first vet visit. We just didn’t have anything else to give. We knew the pet ER cost a lot more. On the positive side sonic went peacefully and didn’t suffer.
I’m so sorry to hear that… my heart goes out to you guys.
My 1 year old American Cocker Spaniel is currently on his 4th day of treatment at the emergency clinic in Toronto. After 2.5 bags of positive blood transfusions, blood thinners, meds to settle his stomach, steroids and immuno-suppressants, he is looking better. Our vet said the best way to describe the first 3-5 days after diagnosis is “a rollercoaster”. You want their vitals to be steady, their temp to normal and their red blood cell count to stop dropping & eventually increase on their own. Our dog has primary IMHA as they ruled out cancer via ultrasound and the other possibilities with tests/questioning. It is frustrating not to know where this originated however don’t beat yourself up about the unknown & what you cannot control.
The biggest risk in my opinion are blood clots/strokes to the brain. Remain positive for your dog and pray they will make it through. They will use all your good vibes.
Everyone out there.. I want to share a story that will give you all some hope that are currently dealing with this terrible situation. My Lexie Lou was fine one day and not the next. Very very pale, almost white gums along with lethargy and very little appetite. I took her in the next day and my vet knew what it was almost right away. He said your baby has IMHA. I had no clue what that was or what it meant. I was completely devastated. My vet is a gift from god.. He treated her with a blood transfusion along with high doses of prednisone and kept her by his side in the back while he cared for other animals. I was able to take her home with me every day since they did not have overnight caretakers. (Which was a positive in my book). But I would have to bring her back every day for about 2 weeks, then every 3 days then every other week for about 6 weeks. She needed fluids and her blood had be monitored daily. That was a year and 2 months ago. And my little angel is sitting in my lap right now as I write this message to you all. I cannot thank Patterson Veterinary Hospital in Michigan enough. Dr. Patterson saved my little girls life. I don’t know how things would have turned out if I waited another few hours to bring her in. If you suspect something is wrong, do not wait!! The treatment is not cheap.. I was lucky enough to have my local vet treat her. I’m sure it I had to go to an emergency clinic it would have cost me double. Which I would have paid to try and save her but I’m just so thankful Dr. Patterson knew this disease and was confident enough to treat her, All in all her treatment has cost around $4500 and counting. She has to have her blood drawn every 6 months..she also takes azathioprine every 3 days to keep her body from destroying her red blood cells and will have to continue to take it for the rest of her life.. Also, a dog that recovers from this can no longer get vaccines. A vaccine of any kind could trigger her immune system again. So I want everyone to know there is HOPE!! My little girl has done great and I’m just so grateful. When I went onto the sites when she was sick, all I saw were the really bad and sad stories about this disease taking the lives of our precious fur babies, I want someone out there that’s dealing with this right now to know your dog can get thru this. My little Lexie is proof of that. To anyone reading this.. there’s hope. Xoxo Lexie and her mommy..
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I am sitting at 6am with my fur baby who was euthanised at midnight with this awful disease. On Wednesday he was himself playing barking running around. But Thursday night he was a bit tired. By Friday he wasn’t eating still going for walks but not wanting to go far. Today he was just flat out not wanting to walk at all. I carried him outside thinking its just dog flu as he was sneezing a bit too. But as day went on he just was like a dead weight. Looked up on Google to look at gums and his were yellow. I guessed it was the liver. At the vets they were puzzled until they did blood tests and a chest scan of stomach. Came back as anaemic to the point the red blood cells were being attacked ay autoantibodies. They saw a tumour on his liver whichvwas the primary cause. They said withvall the treatments and liver removal of tumour he might live a year. He then said it would be kinder to put him to sleep. They put me on the spot. I’d never heard of this. I then broke down and gave them the go ahead. He was so normal looking, didn’t appear ill. But the tumour was big and I just let him go to doggy heaven. I said to him I felt guilty doing it. He kind of nodded no and gave me a kiss. They know how to communicate and I knew he was OK to leave. It just came on so quickly with no outward sign of the liver tumour until the end. Alfie who was 12 and a Yorkie was my daughters dogs son so I dontcimagine she will be happy not seeing him again. Alfie was the kind of dog you never knew what was wrong with him as he kept it quiet, didn’t want to annoy. I am sitting her cuddling him and this afternoon he will be buried in the garden so we still have him near. My grandkids will be devastated aged 4, 10, 12 when they hear this awful news. From reading up on this I can say if it’s just primary with no secondary cause like cancer the future looks bright. I hope and pray all your dogs don’t have the same prognosis as wee Alfie. Until we meet at the rainbow Bridge again…….
Reading this stories has given me much understanding and comfort. Two hours ago I gave the ok for my new baby Bella to be euthanized. She was only a 6 month old shi-poo. Friday she was so lethargic and not really eating so I took her to the vet. I was in complete shock when they told me to rush her to the ER because she needs a blood transfusion. I mean come on she just a little puppy and never heard of such a thing for a dog. A gift for my 2 sons that have been begging for a puppy. Many tests, 3 transfusions and almost 5000$ later they told me she didn’t have much chance and she would need so much more care we made the tough decision. I really feel for everyone that has had their dog for awhile because I only had Bella 3 months and I can’t stop crying for how much I miss her.
I’m so sorry for your loss. It’s very unusual to happen to a dog that young. Thinking of you.
Best,
Dr. Lee
My blue heeler (Blue) has been diagnosed at the age of 12 with IMHA. We’ve have been fighting this disease since we went in for a check up on 12-19-2020 when his CBC work showed 20% red blood cell count and 135,000 white blood cell ( a very sick dog). On 12-29-2020 he was getting his first blood transfusion at Memphis Veterinary Specialists. He steadily decreased after that transfusion but all of the tests showed no signs of a “root” cause. They started him on Azathioprine and prednisone. On 1-12-2021 he was sent down to Mississippi State for further testing. They did a bone marrow aspiration and ran multiple blood tests including tick born and infectious disease. I picked him on 1-16-2021 and they took him off Azathioprine and put him on 300mg Cyclosporine and increased his prednisone to 50mg a day and on the 19th I was taking him back to Mississippi State for his second blood transfusion with his RBC at 13%. While he was there they also did a liver and prostate aspiration from some things that had come back as unusual on previous tests. I brought him home on 1-23-2021 with an RBC of 24% and white blood cell at 12,000. He went to his regular vet on 1-25-2021 and we got great news…RBC 32% and white blood cell 6,000. Fast forward to today and he is sitting on RBC of 24% and white blood cell at 22,000. Mississippi State contacted me on 1-25-2021 and advised that they found prostate cancer through a urine test. We are retesting CBC at our local vet on 2-8-2021 and we are hoping it comes back better. He has an appt on the 15th at Mississippi State with their Oncologist but he can not to any form of chemotherapy as long as he is on prednisone. They advised they do no recommend surgery as it is very risky and easy to damage the urethra. He has lost 10lbs since all of this started on 12-19-2020. I am scared to death that I will not be able to ever get my baby back to the way he was and I am terrified of having to make the decision to say goodbye. Our family just took a huge blow and lost our 13 year old puggle, Dixie, on 12-16-2020 due to a severely enlarged heart. My husband, myself, and our 14 year old beagle/basset cannot handle another loss. We are praying for the best and a miracle but it feels like once a window opens, two doors are being shut.
Thanks for all this. We’re new to the IMHA “family”, as our Molly (pointer/greyhound mix, age 4) was just diagnosed earlier this week (3/8/2021). She was hospitalized for about 48 hours but fortunately she is responding to treatment as of now. She’s on prednisone, doxycycline and mycophenolate as RX and taking famotidine also.
Thankfully we caught it early enough that a transfusion was not necessary (yet). She had 20% PCV when admitted to the ER, and four days later tested at 25%. It’s going to be a long road ahead, but so far we’re seeing definite signs of improvement. Her appetite is back, she’s starting to play with her toys again, and she is starting to return to more “normal” behavior. We’re still hoping and praying for a “good” outcome, even if that means years of frequent vet visits and medications.
Good news so far — Molly’s PCV is up to 40%! Our vet is having us reduce the prednisone from 40 mg a day to 30 — a full tablet in the morning and a half in the evening, and retest in two weeks assuming we don’t observe any setbacks before then.
Last visit was largely unchanged — this time a CBC showed 39.1 HCT and the RBC was slightly below normal (about 5.6). We’re not changing the medications at all right now, though our vet seems to want her off the mycophenolate, and doesn’t want to reduce the pred unless he sees higher RBC and HCT. All other blood work is in the normal range, just a slightly low RBC. Our vet suggested replacing a little of her usual diet with red meat and perhaps a little bit of liver to see if that can get her a little stronger into the normal range before looking at tweaking medication. Molly seems to be stable, at least, and it could be a lot worse.
PCV 46% yesterday! Our vet is ready to start weaning off the mycophenolate, going from 250 mg twice a day to the same dosage once a day. We will recheck in a week. Hopefully we can get her off this stuff fairly soon and, if it still looks good, resume cutting the prednisone, too!
Hello Dr. Lee, I hope you are still monitoring this page for comments. I wish to tell you about my dog Ember’s experience with IMHA. In the end, I have one or two questions I hope you will answer.
My dog Ember was (note past tense) a Finnish Spitz seven weeks shy of her 13th birthday. In all respects, she was healthy with the exception that she was showing some discomfort in her right front leg. We took her to our vet on March 5 to get her leg checked and get her vaccines. She received her Rabies and Lepto vaccines during that visit. X-Rays were taken. The following Monday our vet called and said the radiologist thought she might have an autoimmune disease because of how some of the bones in her wrist showed on the X-Ray.
She began to be slightly pickier about her food. On the 20th on the way to the dog park she vomited. Other than that she seemed to enjoy herself at the dog park. By Sunday the 21st she was even pickier about her food, but she did eat by putting chicken broth on it. By Monday, she didn’t want to eat and was just not acting herself. She was normally quite vocal, for instance, while we ate dinner, but now nothing. Not active but laying around. I made an appointment for the vet and they took a blood sample to send to the lab. By Tuesday morning she was worse. She would sometimes go outside to lay in the grass, but her head would hang down. I called the vet again in desperation. He had received the results and said her RBC count was 21. He suggested we take her to Washington State University (we live two hours away). We left within the hour. Her RBC count by now was 15. They gave her a transfusion and began the treatment process you describe above. Prednisone, an anti-clotting medication, and performed ultrasounds and more blood tests.
The next day (Wednesday) her RBC was 47. She was able to go potty on her own. Thursday her number dropped to 43, but the vet didn’t think that was a concern. She was mostly concerned with possible clots. Friday her number was 37 where it pretty much stayed. She ate once during all of this. Saturday morning I received a call from the vet saying she thought Ember was having a little difficulty breathing so they were putting her in an Oxygen tent. We drove to WSU to see her, pet her, and speak with the vet. The vet again said she was concerned about clots – specifically getting in her lungs or going to the brain. She was going to add some more medications. We drove home. At about 6:30pm I received another call that she didn’t think Ember’s kidneys were working very well, so they were going to put her on a diuretic. At 9:30pm, she called back to say it wasn’t working. Ember had gained weight and was bloated but had generated no urine. Her kidneys had failed. I made the heartbreaking decision to put her to sleep. We drove back to WSU to be with her. When we got close to the tent, she was whining and obviously bloated and laying on her side. I spent 5-10 minutes petting her, telling her she was such a good dog, had helped a lot of people (she was a therapy dog), and I would never forget her. The vet put her to sleep while we were petting her. It was in the top three hardest things I’ve ever had to do because she was an absolutely beautiful, healthy dog just days before. It will take me a long, long time to move forward from this. I believe the Rabies vaccine kicked her autoimmune disease we did not know about into high gear. I have no way to prove this.
My question: I’m concerned that her whining was because she was in pain. We wanted to be with her in those final moments so she could be with people she knew (and loved I hope), and because we OWED HER THAT for all she had given to us. I’m torn about whether making a 2+ hour drive to be with her was the correct choice. I wanted to do it out of love, but if she was in pain, then we prolonged that pain by 2+ hours. This is a deep concern to me because I believe I have heard or read that blood clots are painful. If her kidneys were shutting down for that reason, were they causing her agonizing pain? That is the last thing I would ever want for my beautiful baby. The website URL is a video of Ember. Thank you in advance if you choose to respond.
Our chihuahua Flash was diagnoses with this a week ago. We started noticing he was looking very weak and walking very disoriented. We took him to the ER that night and they told us his red blood cell count was 6.They immediate did a blood transfusion on him and when we picked him up the next day he looked much better, seemed to have more energy. When we took him to the vet later that day, they ran blood test and the vet mentioned that his body was starting to fight the new blood (since it was foreign). He put him on Prednisone (liquid form) and Denamarin. One week later he seems to have a bit more energy (able to walk a bit better and drinks water here and there). We are having to syringe feed him throughout the day because he won’t on his own. My other concern is that he will pee, but he will not pass bowel movements and I am not sure if that is because his liquid diet. Regardless, it has been extremely hard for my wife and I as we see him wanting to lay down most of the day and not want to eat. I am hopeful the medicine he is on will help him, but the vet said it would be a slow process. I am just praying he gets better and does not get worse. Seeing him jaundice is heartbreaking.
Comment *I adopted a “Newfiepoo” puppy two weeks ago that was scheduled for humane euthanasia. He came into my specialty hospital completely obtunded with a PCV of 9. Since 2/9 He has had 3 blood transfusions, Radiographs, Ultrasounds, and a bone marrow aspirate. The aspirate showed that he most likely has PRCA. He is on prednisone, mycophenolate, Vit B-12, and Plavix. He acts like a normal puppy, playing and eating well. However, today his PCV is at a 15. I’m really hoping that he will start making his own RBC’s soon. This has been a really hard and expensive two weeks.
Anyone else out there experience this in such a young pup? We already ruled out Zinc toxicity…
Comment *We just lost our precious little boy toy poodle, Finn. He seemed perfectly normal on Sunday, had totally red urine on Monday, and was rushed to critical care in another city on Tuesday. After 4 blood transfusions and steroid treatment, he couldn’t even reach the point of being brought out of immediate danger. As fast as the blood was transfused, his body destroyed the RBC again. Counts went from 13-25, 15-20, 17-25, then back to 17. The final transfusion was to make him feel good long enough for us to get there in order to be with him when he was euthenized. My heart breaks for anybody with a pet family member who has this disease. I know Finn’s case severe – the vet had never seen one so bad, and most respond to the transfusions long enough to give them a fighting chance. Rest in peace, little guy. You were so loved.
Comment *My sweet Piper was recently diagnosed with this disease. We meet with our vet this week and I think she’s going to be leaning toward the IVGG. If anyone has had this done, can you please tell me the outcome, how your pup is doing, and what the cost was? I just want to have an idea of what we’re in for. Thank you.
I don’t reach for IVGG unless extremely severe – typically if they have been in the hospital with a total bilrubin that is very high, but I would check with your vet on options, pros and cons, as it’s VERY expensive.
Oliver my 5 year old Shih Tzu just lost his battle with this horrible condition yesterday. I am heartbroken. It was shocking news as he was absolutely fine 3 days prior to diagnosis. Oliver hated to be poked and prodded and was very reactive to treatment and it was so stressful for him. If I had known he would be needing oral meds after the initial treatment I probably would have avoided the hospital stay. Make sure to ask your vet what the future will hold for your dog before you proceed.
Our veterinarian told us with our dog who is autoimmune she’s been she went autoimmune when she was a year old she is now three we have had an ongoing battle in our house because our veterinarian told us that we should not be bringing our dog deliberately near other dogs such as going into dog parks or going to pet stores that have dogs walking through them all the time things of that nature that she’s not allowed to good nose to nose with another dog. The reason why our veterinarian told is that is because she doesn’t want her to get sick from another dog because she’s on immunosuppressants and there’s a likelihood that it will either work really well and she’ll get the sickness and it could hurt her or The medication will not help at all and her autoimmune will flare back up and she will die from the autoimmune itself. I want to know if I heard this right so that I can pass this information on to my daughter if I’m right If I’m wrong I want to also be able to pass that information on to her and correct myself I have absolutely no problem with being either one I just want to do the right thing. Because at this point we’re in an ongoing battle she thinks that I’m being a helicopter parent basically to the dog and preventing her from having any fun and I think that she’s being risky by bringing The dog and situations that are risky to her life by bringing her to a friend’s houses with dogs at the house and possibly even dog parks and pet stores and grooming stations and anywhere else that she feels the need to bring her that dog. Can someone make sure that I get a response to this personally so that I can for that information and not have to happen upon this website again rjaffeux@hotmail.com
A positive story to share … I wanted to share that my rescue mutt Staffordshire Terrier/Boxer mix was diagnosed in winter of 2021. She has severe upper respiratory disease so we think she was having an episode and aspirated food in her lung causing the pneumonia. They then put her on strong antibiotics (both DOENROFLOXACIN and CLAVAMOX). It was very touch and go and very scary – she would shake and was lethargic and scared. Her vet (Animal Hospital of Marion) worked with a specialist (Upstate Asheville). After many weeks of visits, one admission for blood transfusions for two days, and alot of trial and error we got Peyton through it. She only just this December stopped her mycophenalate (sp) which we had reduced to 2X a week. Peyton is a punky, happy, playful but serious girl. She is now doing very well (in this moment we have some belly issues, but w are sorting it out). But all in, we are grateful and thrilled that she pulled through. They ultimately determined she had secondary IMHA most likely triggered by one or both of the above mentioned antibiotics. Now, Peyton cannot be vaccinated (save for rabies), I use great care around other dogs that might put her at risk (so I can’t foster, or do dog parks), but she’s otherwise thriving and having a great life! She’ll turn five in April. Wanted to share a good outcome — it’s possible to pull through. Keep hope, pray, stay vigilant about any and all medicine, and there can be a happy ending. Good luck!
Sharing some hope here. Our maltipoo was diagnosed three years ago. We received our diagnosis and were on pins and needles as he stayed in the hospital for days and received a blood transfusion. He was an autoimmune suppressants for months. I am thankful to Lemonade pet insurance who made the thousands of dollars in treatment possible. He has been in remission ever since, and while we live in fear and rush him to the hospital at every sign of lethargy, he has not relapsed. There is hope.
Comment * Hi I am wondering if others have had their pet treated for IMHA and used Best Pet pet insurance, what was covered? My 9 mo whippet/hound mix is very ill, we have pet insurance but scared they won’t cover a very expensive treatment called TPE (transfer plasma exchange) which costs like 7 to 10,000 dollars. Any advice? How is your dog doing?
I agree that TPE shouldn’t typically be covered, as it’s extremely expensive and not aditionally done. That said, typically transfusions and immunosuppressives are the mainstay treatment. So sorry to hear this about your dog – wishing him the best.