# Sudden anemia??



## Brittanyy08 (Jun 22, 2008)

Hi all, my 7.5 year old girl Ruby has suddenly become anemic.
For the most part shes been extremely healthy (minus allergies etc. but nothing life threatening) up until about last week. She had been on Rimadyl quite a bit, as it was given to us by the vet and we were unaware of its terrible possibility of side effects (she will NEVER be going back on it, I promise you that!) but things have progressively gotten quite scary lately.

Last Monday - we started noticing that she was not eating, very lethargic and just completely not herself.

Last Tuesday - first day we took her in. they informed us that her blood cell count was quite low and they wanted to run blood tests etc. Then scheduled an ultrasound for Friday so we could rule out internal bleeding/cancer etc. and also one last check-up on Thursday.

Last Thursday - she needed to be carried out of the car by two nurses, because she was unable to get out herself. I then had to rush her to the other side of the city for an ultrasound, which came back clean. Although they said her spleen was enlarged, which could be because her body is destroying her blood cells at a rapid rate. She was then brought back to our vet, and given a blood transfusion, and about 3 different kinds of meds to take home with us. She was like a brand new dog, and we were all jumping for joy.

Last Friday - told that her RBC count was still sitting around 22.5%. things were looking great

Last Saturday - told that it had gone down a little, but she was stable so we didn't need to worry.

Monday - informed that it was continuing to drop, but again that she was stable and would be in on Wednesday. that night we noticed that her back legs were swelling.

Tuesday - take her in regarding her legs. they told us it could either be a drug side effect, or immobility. Told to massage her legs 3 times a day, acting as a circulatory system.

Wednesday - I brought her in expecting the routine "shes stable, everything is fine. see you Friday!" but instead was told that her RBC count will not budge off 18% (normal is at least 35%) and that the vets are starting to worry that she could start to deteriorate suddenly. 

She goes in for another ultrasound tomorrow, and this time we're seeing a specialist. I'm sorry this is so long, but I was just wondering if anyone has dealt with this before in their dog?
She still has literally no energy. She went from a dog who was basically insane with energy, to one who barely gets up to look at me when I walk in a room. Massaging her legs does nothing, and all of this is taking its toll on her. Shes about 100lbs (not over-weight, just a really big girl) and I had to walk over to the couch moments ago and lift her onto it, because she was unable to do it herself. She barely even stands up now unless I help her/pick her up.

Anyone have any ideas what I should be preparing myself for? or has dealt with this in the past?


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## Elaine (Sep 10, 2006)

My first thought is she's bleeding from somewhere, whether that's into her belly or she's got a GI bleed, I don't know. If she's as weak as you say, I'm wondering why she's not at the vet?


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## Cassidy's Mom (Mar 30, 2003)

I hope it's not this: Autoimmune Hemolytic Anemia (AIHA) in Dogs

How are her platelets?


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## Brittanyy08 (Jun 22, 2008)

I've been wondering the same thing myself. Believe me, its not us. We're probably around 3 grand deep in tests etc. we've done since last Monday.
They keep sending her home with us, and just having us bring her in every 2nd day. 
They're absolutely stumped as to whats wrong, but her heart etc. is fine, so they say shes alright to have at home.
The only thing they've noticed is that her body is destroying her red blood cells, and seems to not be working hard enough to make new ones.

As I said though, she does go back for another ultrasound/spleen inspection tomorrow with a specialist.


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## Brittanyy08 (Jun 22, 2008)

Cassidy's Mom said:


> I hope it's not this: Autoimmune Hemolytic Anemia (AIHA) in Dogs
> 
> How are her platelets?


Wow, that actually sounds quite like what shes going through. Although I've yet to see her urine change from its normal yellow, and theres been no blood in her stool or out her nose.

She did have a transfusion last Thursday, and has been on Prednisone (the drug talked about in the article) and still no change. They've even given her a second drug to stop the immune system from fighting to kill the RBC's, but her count just will not improve from 18%.


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## BowWowMeow (May 7, 2007)

I'm very sorry your dog is having these problems. Immune-mediated hemolytic anemia can be caused by rimadyl. 

Are you near Guelph or another teaching hospital? I would be going to a specialist immediately.


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## LisaT (Feb 7, 2005)

Ehrlichia/anaplasmosa, get her on doxycycline immediately, 10 mg/kg TWice a day (roughly 5 mg/lb). There are places where it's known to be in Canada, and also places in Canada where it is, but the vets will tell you that is not the case. Just ran into one of those late last year. 

Do a search on this site for Enya and the thread "my dear friend"


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## LisaT (Feb 7, 2005)

Can't edit my post, but it could also be other tick diseases, such as babesia or others. Start with the doxy and note response. 

Idiopathic thrombocytopenia in dogs - Pet forum for dogs cats and humans - Pets.ca


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## Brittanyy08 (Jun 22, 2008)

BowWowMeow said:


> I'm very sorry your dog is having these problems. Immune-mediated hemolytic anemia can be caused by rimadyl.
> 
> Are you near Guelph or another teaching hospital? I would be going to a specialist immediately.


Thats what my parents are thinking. Because it came on so quickly, and out of nowhere really. She was doing fine up until that point.

I'm in Winnipeg, and we're trying to see as many specialists here as we can. Guelph is, correct me if I'm wrong, about a 22-hour drive from us, so that long of a travel is out of the question for us


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## Brittanyy08 (Jun 22, 2008)

LisaT said:


> Ehrlichia/anaplasmosa, get her on doxycycline immediately, 10 mg/kg TWice a day (roughly 5 mg/lb). There are places where it's known to be in Canada, and also places in Canada where it is, but the vets will tell you that is not the case. Just ran into one of those late last year.
> 
> Do a search on this site for Enya and the thread "my dear friend"


I whole-heartedly appreciate the input, but I'm not sure if a tick related disease is possible?
We have not one blade of grass in our backyard, or her dog run, and everything here has been covered a few feet in snow since about December. I didn't think ticks could survive those conditions?


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## LisaT (Feb 7, 2005)

If she has serious bloodwork abnormalities, this is a disease process that has likely been occurring for a long time, could be 2-5 years. There is an acute, sub-clinical, and chronic stage. These numbers are indicative of the chronic stage.


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## EchoGSD (Mar 12, 2010)

That enlarged spleen would bother me....are they absolutely sure there is not a mass on the spleen that is pulling her needed blood cells away, or (worse) bleeding out? Even a large mass can be hard to detect sometimes, but if/when they rupture it is an immediate crisis. I'd rule that out ASAP; sometimes an exploratory surgery is necessary to really see what's going on there. Is her blood clotting? Have they done clotting factor testing? Just a few thoughts...hang in there!!


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## Brittanyy08 (Jun 22, 2008)

LisaT said:


> If she has serious bloodwork abnormalities, this is a disease process that has likely been occurring for a long time, could be 2-5 years. There is an acute, sub-clinical, and chronic stage. These numbers are indicative of the chronic stage.


Oh wow, I had no idea. Thank you for the heads up.
And I checked over her meds this morning to see which ones she'd already been on, and Doxycyline is actually in the group of the first pills she received last Tuesday.


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## JeanKBBMMMAAN (May 11, 2005)

I would make a list and ask the things that others have asked/mentioned, and Lee Ann's questions are ones I would particularly hone in on. 

I had a dog with a diffuse GI lymphoma which is difficult to diagnose. Her bloodwork was not like that though. 

Take care.


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## LisaT (Feb 7, 2005)

The enlarged spleen will go hand in hand with low platelets and is often seen in tick diseases. Tick disease *completely fits*, though certainly it could be other things. 

I'm glad to see that she was on doxy - sounds like the vets are already thinking in this direction. The aggressive dose is 5 mg/lb, twice a day, though some dogs can't tolerate that, and if the liver enzymes are up, additional liver support is needed. If steroids are also given at the same time as the doxy, the doxy isn't making a lot of headway on killing any possible infection, but mostly keeping it status quo. 

Babesia is a tick disease with a similar profile, but it doesn't respond to doxy.


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## LisaT (Feb 7, 2005)

One thing I did recently learn is that a severe case of giardia, worms, stomach worms, and coccidia can present similarly.


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## LisaT (Feb 7, 2005)

Wish I could edit with my phone...

Tick tests may not show anything because of the drugs already given. Ultrasound should show if there is a mass. When my boy's spleen enlarged, u/s showed only a "generous spleen", which resolves while on doxy.


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## 1sttimeforgsd (Jul 29, 2010)

I hope that it is not IMHA (immune mediated hemolytic anemia) that your dear pet has. I just last year lost my dear Jackie to IMHA. Like you , I did not notice any symptoms untill she would not eat and was also lethargic the only sign was she had lost a little weight. She had not been on Rimadyl since she was a pup and she had only been on it for 1 perscription.

When we first took her to the vet, they did the blood work and made the diagnosis. The vet told us to take her home for 3 days and crate her and to not let her do anything except go out and potty. We did this and when we went back for blood work it was even worse. She told us that they could do the transfusion thing and remove her spleen and that she would have a 30% chance maybe. And that she would have to be crated and restricted for the rest of her life.

Jackie was very active up untill this time and we did not think that would be a lifestyle she would be happy with, she was just 5yrs old. Even though we did not want to lose her we decided to let her go to the bridge and run happy and be free. I loved my girl so much and I still cry for her sometimes at night. I am able to cope with her loss a little better but the pain is still there.

I will be praying for your pup that she will respond better than my Jackie did, or that it could be something less serious. Best wishes and good luck.


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## wyominggrandma (Jan 2, 2011)

had a shepherd with AIHA... It hard to deal with, can be treated and they can survive, but the vets have to get on top of it immediately and she will need treatment for months and months and months of high doses of steriods and antibiotics. 
never knew what caused my shepherd to get this, it just happened one day.
If you need any advice or help or words of encouragement, you can PM me and I will give you my personal email and we can talk


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## wyominggrandma (Jan 2, 2011)

What is her hematacrit? (HCT) My shepherd got down to 14%. She was on 100mg of steriods a day,(weighed 58 lbs) plus doxy twice a day, plus famotide for her stomach, This went on for over 5 months. She was only 5 months old,it usually happens to older dogs. They can't say what causes AIHA, can be vaccines, can be ticks, can be anything that starts the body killing off the red blood cells. As far as being at the vets, I kept my girl at home, although I do work for the vets. She was taken back daily at first for blood tests, then every other day, then weekly, etc.
If your vet has not dealt with AIHA then you need to get her to a specialist immediately. Every day she is not given the correct dosages of steriods and such is one day less of helping her body try to fight. The masses doses of steriods will kill her immune system, but that will stop her body from killing the red blood cells that her body thinks are bad, which is why they are killing them off as her body produces them. There will be side effects, but once the steriods can start being taken less and less, the side effects will go away. But, she needs to be on the massive doses for months, not days or weeks. Some vets only put them on the doses for days and this will not stop the problem, just makes it seem to go away and there will be setbacks.
Please, get her to a vet immediately who has dealt with and "cured" dogs with this problem. Some dogs will recover and be okay without meds, some will stay on meds the rest of their lives, although low dosages of it.
My girl never had red urine, never had one sign of AIHA except her gums were WHITe and that is what caught my eye, plus she was lethargic and puppies are not lethargic. When I took her in on Christmas day, she was white and her first blood sample was like water draining out of her it was so anemic.
Please, please do not wait another day. Get her to a vet who has dealt with AIHA. I will bet my life this is what your girl has and a doctor who says they don't know what it is except her red blood cells are being killed off is not knowledgable enough to treat your girl.
If she does not get correct treatment immediately, she will not make it.AIHA is very very hard to beat, but can be done.


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## wyominggrandma (Jan 2, 2011)

Oh, if it is AIHA, the bloodwork does show abnormalties. BUT, this is not an illness that has been going on a long time, one day the dog is normal, the next her body is trying to kill off her good red blood cells. It is autoimmune disease and can kill very quickly.
Not trying to scare you, just stating how devastating this is and that she has to receive the proper treatment immediately.


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## LisaT (Feb 7, 2005)

When was she last vaccinated?

What's your current plan?


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## Kris10 (Aug 26, 2010)

Hope she is doing okay--


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## wyominggrandma (Jan 2, 2011)

Any updates on this girl?


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## Brittanyy08 (Jun 22, 2008)

Thank you so much for the support/ideas, but I am incredibly saddened to say that we had to put our beautiful baby girl to sleep tonight. 
Her body was just starting to completely give up. She refused to eat, had that look in her eyes as though she'd already checked out, and couldn't lie down without being unable to breathe. It was as though we were already watching her slip away in front of us.
Our vet showed up after hours, and both my parents and I were giving her love and affection as she left us. Although it was truly rough, I take comfort in the fact that I was there giving her forehead kisses and lots of pets in her last moments. She'll be deeply missed everyday of my life.

Once again, I thank you all so much for your support. It truly means a lot, and I wish the best for every one of you and your pups <3


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## wyominggrandma (Jan 2, 2011)

I am so sorry for your loss. What a very tramatic thing to go through.

I suspect it was AIHA and it can attack so quickly and is so deadly. The actual percentages of death with AIHA is almost 70%, so don't feel as if you did not do enough to help her. Sounds as if she would not have been able to go on much more, even with a specialist's help. It is very common for older dogs to have sudden onset AIHA and relapses are very very common with this disease. Sometimes blood transfusions can help, other times they seem to trigger the body to react and go after the new blood also. Usually if the HCT(hemecrit) gets below 18% the vets like to transfuse. My girl got below 14% and after my vet and I confered with his specialist, we decided to not transfuse and see if the meds kicked in. They did and things started going up and stayed up.
My girl was a puppy so don't know if it was because she was so young and strong before the attack or what, but she did live. 
Please to anyone who reads this, be aware of how quickly AIHA can attack your dog. If you see your dog happy, carefree and acting normal one day, then lethargic, not eating, etc the next, check gum color and if they are white or pale, take note of this and get your dog to a vet.
One other comment on this disease, my boss's wife(the vet I work for) was not feeling good one day. Had been taking ibrofen for aches and a headache, and got weak and sick. They took her to the hospital and she was diagnosed with AIHA. Not sure if the ibrofen did it, if something else triggered it or what, but she had three blood tranfusions and was in the hospital for months, finally had to have her spleen removed and is doing good now. Same type of symptoms and same disease.


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## Brittanyy08 (Jun 22, 2008)

wyominggrandma said:


> I am so sorry for your loss. What a very tramatic thing to go through.
> 
> I suspect it was AIHA and it can attack so quickly and is so deadly. The actual percentages of death with AIHA is almost 70%, so don't feel as if you did not do enough to help her. Sounds as if she would not have been able to go on much more, even with a specialist's help. It is very common for older dogs to have sudden onset AIHA and relapses are very very common with this disease. Sometimes blood transfusions can help, other times they seem to trigger the body to react and go after the new blood also. Usually if the HCT(hemecrit) gets below 18% the vets like to transfuse. My girl got below 14% and after my vet and I confered with his specialist, we decided to not transfuse and see if the meds kicked in. They did and things started going up and stayed up.
> My girl was a puppy so don't know if it was because she was so young and strong before the attack or what, but she did live.
> ...


Thank you. It is incredibly heartbreaking. 
We did absolutely every single thing the vets told us to do, but nothing seemed to work. It hasn't fully hit me yet, and I still expect her to be lying at the top of our stairs just having a rest. It just hit so quickly, that while I was still getting used to the fact that she may not recover, shes now gone. It was so quick that my mind, and heart, are having a great deal of trouble trying to process it.


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## Kris10 (Aug 26, 2010)

I am so sorry for your loss.


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## arycrest (Feb 28, 2006)

:hugs::hugs::hugs::hugs::hugs:

I'm so sorry for your loss!
:hugs::hugs::hugs::hugs::hugs:


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## BowWowMeow (May 7, 2007)

I am so sorry for your loss. How heartbreaking for you and your family. :hugs:


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## Brittanyy08 (Jun 22, 2008)

Thank you so much everyone.
At least the timing was alright with it being the weekend. My family and I can relax, and just hang around the house and support each other. All my friends have also been very kind, constantly letting me know that we gave her an absolutely fantastic life for the 7.5 years she was with us, and offering to take me out whenever I feel up to it.
It'll be a slow process, but I'll be alright eventually. I mean, I'll miss her every day, but it definitely gets manageable after some months.


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## LisaT (Feb 7, 2005)

I'm so very sorry to hear this


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## JakodaCD OA (May 14, 2000)

I am so very very sorry for your loss


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## Miss Molly May (Feb 19, 2010)

Oh my!! I am so sorry for your loss My heart truly goes out to you and your family!


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## 1sttimeforgsd (Jul 29, 2010)

So sorry for your loss, I know the pain that you are feeling. We can only get comfort in the knowing that they are at the bridge waiting for us to join them some day running free. :angel:


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## Cassidy's Mom (Mar 30, 2003)

I am so sorry.  When you described her symptoms I had a really bad feeling that it might be AIHA, but really hoped I was wrong. Dena went through that too, but when she died 3 weeks later after herculean efforts to save her we discovered she had lymphoma, so nothing we could have done would probably had made a difference. Even with just AIHA the prognosis tends to be very poor, and as wyominggrandma said, early diagnosis and aggressive treatment by an experienced doctor is key. Still, most will not make it. :hugs:


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## Brittanyy08 (Jun 22, 2008)

Thank you all so much <3 you've been absolutely wonderful through this.

I also have had my doubts these past 2 weeks, just after watching her body not respond to any of the treatments. I'm thinking the meds she was on just kept her alive the past weeks. Her RBC count had stayed at 18% the whole time, no more no less, but because the Prednisone kept her hungry and thirsty, she continued to get some sort of nutrients etc.
I don't know, that could just be me. But it seemed so weird that she coasted on 18, until her body finally had no fight left.


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## wyominggrandma (Jan 2, 2011)

I imagine if she had not been on the dose of Pred she was on, her blood level would have been very very low. Obviously the Pred let her body fight some and kept up the level, probably one or even two days of no Pred and she would have had no red blood cells at all.
You did the best you could do with this horrific disease. Sometimes the treatment works and the dogs do well for months, then all of a sudden have a second attack and die quickly. Even the best specialist and quicketst treatment does not work on all dogs and it seems the older they are the fast their bodies just can't take it and the organs quit working.
The main thing is do not blame yourself. This disease is quick to kill and alot of the time by the time you do realize your dog is sick, it has done so much damage already. One day they are fine, the next day they are a bit "off" and the next day they can be dying.
You did what your sweet girl asked, instead of dragging on treatment, you let her decide it was time to go and let her be out of pain. Alot of people will drag on treatment hoping that their dog will be the one to make it, and months of drugs, side effects and pain and they still don't make it.If the blood tests tell you things are improving, then there is hope, but even that doesn't help sometimes. Your sweet one was not improving in reality, just the Pred making it seem better.
My prayers are with you. You fought a battle that is almost guaranteed to be a losing one. You gave your sweet girl a run, but in the end you gave her peace.


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## LisaT (Feb 7, 2005)

wyominggrandma said:


> I imagine if she had not been on the dose of Pred she was on, her blood level would have been very very low. Obviously the Pred let her body fight some and kept up the level, probably one or even two days of no Pred and she would have had no red blood cells at all.
> You did the best you could do with this horrific disease. Sometimes the treatment works and the dogs do well for months, then all of a sudden have a second attack and die quickly...


I agree with this. However, for anyone reading this in a similar condition, let me add, that often when the standard treatment of Pred is not sufficient, sometimes this disease is caused by infection - several infections can cause this: ehrlichias, anaplasmosa, lepto, babesia, lyme nephritis, bartonella, and I'm sure that the list goes on.

If the anemia is caused by infection, steroids will initially help the anemia, but some time after, they will be less effective, since the infection hasn't been addressed. 

Whether this is infection induced, or pure autoimmune, it's a terrible disease process, and difficult odds when fighting it. 

Brittanyy08, again, I am so sorry for your loss. These mystery diseases have taken way too many dogs.


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