Immune-Mediated Hemolytic Anemia: Annie’s Lost Battle with IMHA

What makes immune-mediated diseases so horrible is that the immune system, which should protect your dog from disease, turns on them.

Thank you to Alison Kaylor for sharing Annie’s Immune-Mediated Hemolytic Anemia story.

Immune-Mediated Hemolytic Anemia: Annie's Lost Battle with IMHA

Annie’s story

My little Maltipoo of 11 years and 11 months,  Annie (Snanniebug) was my biggest joy. She was a healthy little pup, had a great appetite and was full of spunk … until one morning …

I noticed she had no interest in her breakfast, and a few of her morning antics were not present. 

That made me nervous, knowing that Annie loved to eat! Trying not to be too alarmed, I went off to work and came home at lunch with some El Pollo Loco chicken thinking this will wet her appetite.

Annie’s brain was interested in the chicken but she couldn’t stomach it. She took only a small bite.

Pale gums

Her gums were pale too. I thought she was dehydrated. It was evident that Annie needed to be checked by her vet so I took her in that evening.

Annie's Lost Battle with IMHA

Initial diagnosis

The vet suggested Annie could be dehydrated which can cause a lack of appetite. In my opinion, her behavior was a little odd as well, which I conveyed to the doctor.  He offered to run some blood work and after talking with him further, he made me feel comfortable enough to take her home to see how she does through the night with the fluids he gave Annie as that could be the solution.

The next morning I woke up to see Annie had wet my bed but the wet spot had a tinge of red.  

Emergency visit

I immediately rushed Annie into the vet closest to my home (VCA Saddleback Veterinary Hospital, Lake Forest, CA).  Dr. Heathcock examined her while I went to work and bad news prevailed when I received a call from the doctor in the early afternoon.

The diagnosis

She informed that Annie had IMHA and tried to explain the disease and its complications.  

I still didn’t fully understand the severity of this disease.  She told me she would start Annie on steroids that I would continue to give Annie once I picked her up the same evening.

When I arrived at the vet I was called into the exam room so Dr. Heathcock could talk with me in private.

She brought Annie out and it was so obvious my poor baby was so tired and lethargic!  

Dr. Heathcock was very sincere and advised I euthanize Annie due to the progression of this disease which had taken a toll on her in such a short time.

I was devastated! I couldn’t fathom giving up and was in complete shock. As an alternative, the vet suggested taking Annie into the Southern California Veterinary Specialty Hospital in Irvine, CA.  She called the specialty hospital giving them notice I was on my way there with Annie and updated them on Annie’s condition.

The intake veterinarian made me comfortable giving me a great deal of hope by informing that their specialty center had a very high recovery rate with IMHA patients – 90% by which she then disclosed, however, there are those 10% of their patients that don’t survive.


Annie was admitted on a Wednesday evening.  

The staff advised me to visit Annie as much as possible and bring some food each time in an attempt to persuade her into eating. The SCVSH had started blood transfusions for Annie as well as immunosuppressants.  Her Pack Cell Volume was extremely low  – “12”. Blood transfusion bumped it up to 15.

Annie continued getting blood transfusions.  

Annie’s highest PCV number while hospitalized was “18” I believe on day 3.

Fighting for life

It was so sad to see this sweet little dog fighting for her life. 

Each day Annie seemed to feel and look worse, with jaundice very evident throughout her body. I continued to ask the doctors for their support and advice as to how much time I should give this disease to turn around the chances of that happening.

The lead Critical Care doctor (Dr. Tracey Rossi) informed that it takes a minimum of 3 days to see any results from immunosuppressants before they catch up to Annie’s immune system, thereby suppressing the antibodies attacking Annie’s healthy red blood cells.

Initially, when I visited Annie, she cried when I was leaving.  After the 3rd night during her hospitalization, she didn’t respond.

I feel I should have listened to Dr. Heathcock at VCA Saddleback.

Annie’s 5th night at the specialty hospital was the night Annie was clinging for life and I was literally clinging for hope on a very thin thread. I wanted my Annie’s health back and Annie wanted to live!

The ultimate decision

After seeing Annie that evening,  I told the doctor on duty I will not let my dog continue to suffer. 

She said to go through the night and then make a decision in the morning.

I went home, and at 12:30 a.m. (Tuesday) morning, I received a call from the veterinarian on duty telling me Annie’s condition had declined and she was having difficulty breathing. I told the doctor to immediately euthanize Annie. She then asked if I would like to come down to the hospital to visit Annie for the last time (which was approx. 20 – 25 minutes from my home with no traffic). I didn’t want Annie to suffer a minute longer and explained to her that I already said my goodbyes to my precious little girl earlier that evening.

I had to ask myself if putting Annie through so much misery was the humble thing to do despite the 42% survival rate – a long term more like 20%.

Finding out about Annie’s condition I was so caught off guard.

I had very little time to research the disease. Had I known what Annie was going to have to go through, I would have made a different judgment call prior to Day 5 (1/2 hr into Day 6) of Annie’s ordeal.

I hope more awareness is raised and more published stories are available as well as studies on this horrific disease (IMHA) to educate everyone who owns a fur baby.

Dog’s lives are much shorter than humans; their quality of life needs to be top consideration (even for 1 week).

Related articles:
IMHA Is Not To Be Taken Lightly: Know The Symptoms

Further reading:
Immune-Mediated Hemolytic Anemia (IMHA) in Dogs

Categories: ConditionsImmune Mediated Hemolytic Anemia (IMHA)Real-life Stories

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Jana Rade

I am a graphic designer, dog health advocate, writer, and author. Jasmine, the Rottweiler of my life, was the largest female from her litter. We thought we were getting a healthy dog. Getting a puppy from a backyard breeder was our first mistake. Countless veterinary visits without a diagnosis or useful treatment later, I realized that I had to take Jasmine's health care in my own hands. I learned the hard way that merely seeing a vet is not always enough. There is more to finding a good vet than finding the closest clinic down the street. And, sadly, there is more to advocating for your dog's health than visiting a veterinarian. It should be enough, but it often is not. With Jasmine, it took five years to get a diagnosis. Unfortunately, other problems had snowballed for that in the meantime. Jasmine's health challenges became a crash course in understanding dog health issues and how to go about getting a proper diagnosis and treatment. I had to learn, and I had to learn fast. Helping others through my challenges and experience has become my mission and Jasmine's legacy. I now try to help people how to recognize and understand signs of illness in their dogs, how to work with their veterinarian, and when to seek a second opinion. My goal is to save others the steep curve of having to learn things the hard way as I did. That is the mission behind my blog and behind my writing. That is why I wrote Symptoms to Watch for in Your Dog, which has turned out being an award-winning guide to dog owners. What I'm trying to share encompasses 20 years of experience.

  1. First of all, you’re probably here because your best friend has been diagnosed IMHA and for that I want to say that I am so sorry.
    I don’t normally post to reddit or other places, I usually am one of the people searching for the information. So this is really my first post ever in attempt to help people with our story. When she was diagnosed with IMHA I spent hours searching for any information. When I tell you I was desperate there is really no way to describe how deeply I was in it. I can say with confidence this will be the first story you see like it. Perhaps that’s why I am so set on sharing this with the people seeking answers the way I was. I wish I had seen a post like this and I hope I am able to bring you any sense of peace even though this is going to be so hard to hear.
    Willow’s story:
    I got Willow Marie when she was just 6 weeks old along with her dear sister Lila May, two tiny papillon/long hair chihuahua mixes that looked like neither breed. They were my first dogs just on my own. I have taken better care of them than myself the last almost 7 years. They taught me so much about forgiveness because I fucked up with them sometimes. Twenty somethings are a trip. However I learned from them and with them, they gave me unconditional love something I had not experienced yet. We drove each other crazy sometimes but it was all in the name of love. I have loved these dogs with every fiber and molecule in my body. Willow took care of us all is the real truth to it. She cleaned her sister, and always made sure I was taking care of us all. She was vivacious, she made everyone laugh, and anyone that met her fell in love and she became part of them too. She was incredibly unique and she was truly everyone’s dog. We often called her Eeyore, because if she didn’t get exactly what she needed she would put on quite the sad act but I promise she always got what she wanted. Willow would get up every day when the sun came up whether I got up with her or not and demanded to start her day. She would greet the house with her gentle soul, and greet the birds… not so gently. So, when one random day she woke up at noon that was my first raised eye brow.
    As the week went on I noticed she seemed a little more down than usual but we were experiencing wildfires and the smoke was terrible so I was making her stay inside. Then my next concern was that she rode to one of her favorite places in the back seat curled up into herself. Then during the stay she just kind of stuck near us and didn’t really play. I kept it on my radar and told my partner that if she didn’t start acting better I would take her in because she seemed off. I tried taking her for a walk to see if that brightened her spirits and she was behind the pack. I watched her feeling it in my gut something was off. She would sit outside and still eat a bit so I wasn’t worried, but then she started to get worse. I thought I would give her one of her anxiety pills to see if that helped her at all and as I was giving it to her I noticed her gums were a little pale. My heart sank but I read that it could be from pain as well. I remembered a couple years before this girl had me in emergency and costing me $500.00 for a trapped fart and she had to be on pain meds. Makes sense right? Not really eating, tucking under herself, and pain. I went to our friends and she did really well with the new friends we were meeting. She wasn’t 100% herself but still had a good time. When we got home she chased a bunny 4 houses down and I thought jeez, she’s fine. I gave her little pats on her little slow buns with my foot all the way home and felt a lot of peace. She even ate when she went inside and all was well.
    Then I woke up a few hours later to her throwing up violently all the food she had eaten. She was weak and feeling so fragile. I put her in her spot and when I woke up she was looking even paler in the gums and just so tired. I rushed her to the emergency vet. I thought, I know my damn dog and I’m not waiting something is WRONG. I handed her off to the vet hoping she would make it to top priority because I couldn’t wait and neither could she. She made it to top priority and they began working on her and running a blood panel and a blood smear because. 1 hour later sitting in my car and shaking with anticipation for my best friend I got the call. I answered and she asked me about our recent activity, if she had gotten into anything, and there was no way. She was picky and didn’t eat anything that wasn’t delicious. After all of this she said “Willow is severely anemic and will need a blood transfusion as soon as possible, she has IMHA an autoimmune disease…” My whole entire world felt like it was paused.
    Now, I know that maybe you’ve heard and read stories like the ones above but this is where our story is unique to the other stories and threads. I don’t have 4,000 dollars, we couldn’t do the blood transfusion. I wanted to die right there on the phone with my partner, my dog was dying. I accused her of not being willing to try when she said we didn’t have the money, I immediately started beating myself to a pulp not having the money to save her. I told the vet that I was so sorry but I couldn’t do it and that I needed the next option. Those options were prednisone and azathioprine. We started the prednisone immediately, and then attempted to find azathioprine. It was hell, no one had it. We found a competent vet and went to her the following Monday for a second opinion who was confident at what we were looking at was IMHA. She told me that we weren’t at euthanasia yet, and to go get that second med and come back in a week. I was devastated for my sweet girl. She was miserable and I could see it but there was hope. I drove over two hours there and back to pick up the azathioprine because it had to be made for her. I was told its incredibly toxic and I had to handle with care. I thought, Jesus what is this going to do to my dog. All I cared about was getting her better. I went straight home and gave it to her.
    She hated her meds, and it was twice a day. The azathioprine was given at night and she would lick for hours after I gave it to her. She had constant diarrhea, she only ate bland meats and rice, and then spent the day hiding under our bed. I couldn’t get her to hang out with us, and days into it I noticed her tiny legs would shake holding herself up while giving kisses. I cried every day for her. I felt her muscle mass slipping away more and more every day and eventually when people would hold her or pick her up she would wheeze and she would struggle to breathe. Her breathing was fast and she even developed a heart murmur, I could quite literally see it beating in her chest. I spent hours of research. I even found that PROBIOTICS could send her into a relapse or create infection in a dog with IMHA, and I gave them daily probiotics. I got rid of everything that could hurt her. I carried her every where and tried my best to make her comfortable. I was ready to put her in a bubble and the vet said that if she ever reached remission she would have to be in one. Anything could trigger a relapse. She could never be vaccinated again, and never be around dogs that weren’t vaccinated or sick.
    So there we were. My sweet angel dog who would hike, kayak, run the fields for hours, take care of all of us, jump, howl, and run the whole dog park was withering away right in front of me. My desperation grew even though my loved ones tried to get through to me. I looked up meals good for anemia, I planned, I learned I did it all. I was giving her baby food with perfect ingredients, and gave her pedialyte and calorie replacements. I just wanted to get to our appointment and blood draw. Maybe just MAYBE they were wrong, and MAYBE this med would work, and and and. I lost sleep, my hips were bruised from laying on the floor watching her breathing. I looked for answers, looked for people and things to blamed. I remembered she took vaccines harder than her sister and swore them off (don’t do that). I was chained to an emotional roller coaster and then I just realized. Every time I saw her she was looking at me with desperate whale eyes. She was having anxiety. She was hiding all the time to protect herself because she was vulnerable. Willow Marie with the endless personality was slipping into a instinct only role. Her own sister would try and be near and willow would back off as if she was a threat. I had already lost my sweet girl.
    I couldn’t deal with it, and I kept going. I went to wal mart and I was obsessively checking labels and ingredients and it suddenly hit me. “What am I doing?” I asked myself for the first time. My dog is suffering. Her body is shutting down and its giving her anxiety. I was giving her anxiety. The pills, the food, the pedialyte. It was too much. I held her and I cried for the next few days. I talked to my friends and family and we cried together. I started seeking help in making the decision to end this awful ride for all of us. Willow has always hated pain, and she was in it. If I almost stepped on her she would scream.I was asking her to fight something that was her worst nightmare. Weekly blood draws, toxic medication, and just the physical pain already occurring. I couldn’t ask her to do this. I felt guilt just thinking about it. Nothing major had happened yet. No collapsing, nothing was turning yellow. She wasn’t “there” but you guys… she was. She told me she was with her eyes full of anxiety and not even I could comfort her. When your dog doesn’t even want your comfort anymore, something isn’t right.
    Since I had them and since I knew it was an option I always said I would do it at home if I had the opportunity. I started half heartedly searching for one and found Lindsey Mccalister from Heart in Home Vet in Vancouver, WA. I emailed her and I told her our story, she immediately said she was sorry. We talked quite a bit and we even spoke on the phone. I told her I didn’t know what to do and that I was so scared of doing the wrong thing. However, I couldn’t bare my girl or myself going though a blood clot, a organ completely failing, seizures, collapsing, the risk list goes on. She told me that the only way to ensure a peaceful passing and not have a crisis is giving her the chance to go in peace sooner than later while she still has dignity and it isn’t in a cold room on a metal table (please if you do it this way, its your choice, this is just my interpretation and what I believe my dog wanted, willow HATED the vet.) Lindsey knew my heart was broken and never pressured me into anything, but did agree that this was the kindest thing I could do.
    So I decided I loved my best friend too much to let her continue to suffer. I am crying right now just typing this. It was absolutely the hardest thing I have ever had to do, but like many of you I would do anything for my dogs. I canceled the blood draw for that Monday and had Lindsey come instead. I couldn’t imagine this life for a pup who loved life, the outdoors, and hated needles and vets. Living in a bubble and enduring the next year of toxic meds, and maybe forever was just not it. The day before we sat in the sun, she marked her siblings pee and let them know she’s still a baddie and runs the coop. We had snacks and for dinner that little thing ate 1/2lb cheese burger which left her a little gassy which doesn’t normally. Her body was telling all of us that is was working so hard. It was a long last night, she was up and down. And she next day she was so shaky, but still giving me kisses. I let her do what she wanted and helped her around until Lindsey came. We went over the paperwork and process. I let Willow get some water and go potty, and then I picked up my baby and took her outside and put her on the bed we laid out in the sun and the shade. I hugged and kissed her and Lindsey gave her the sedative. She screamed, I won’t lie and it killed me. But I then got down with her and within 15 seconds she was surrounded by her favorite people and was getting all the snacks. For a moment her sweet eyes looked at me and I saw my happy little girl again before she drifted off to sleep in my hands. Once she was out Lindsey came to administer the second shot. She was so gentle to all of us. Willow let go easily and quietly, and I believe that was a sign in itself.
    It’s been just a couple days and I have cried my way through most of them. I have gone through guilt, denial, panic that I did the wrong thing, acceptance, and then back through it all again. I was really hurting last night, we made the bed and I didn’t have to prep her spot because she slept on my head every night. I got in bed and started looking though pictures and videos. I was quickly reminded who my girl was. A tiny but mighty loud little gremlin that never slowed down for anyone or anything. Until IMHA showed up in our lives.
    I am writing this partly for the release and in honor of my sweet Willow Marie, but mostly because I have a different story than everyone I read about. I didn’t spend 4k-20k on blood transfusions only to lose her anyway. She never spent a week in the hospital missing me. She never had to have strangers poke her and hurt her even if it supposed to help. She didn’t have to go through anymore pain and suffering than she was in. It was genuinely the hardest thing I have ever done, but I was able to do it because I loved her. I never truly understood loving someone so much you’re willing to let go until now. IMHA is not something deeply understood. Unless there is another issue causing it, you aren’t even going to be able to know what it was. I asked myself so many questions, was it the vaccines, the tick when she was 2, was it environment, the flea treatment, was it me, did she eat something, was it the probiotics. I will never know. However, I do know that I did the right thing for Willow. And I am struggling every minute, but she isn’t going through this anymore. She’s free, like she was before IMHA.
    I’m not telling you what to do here, I just wish I had something like this to read when I was feeling desperate and unsure. The truth is, you know your best friend. You know what they want and don’t want. If you aren’t sure, they will tell you. If you think they aren’t, you’re just not listening. So put down the phone and close the computer. Be with them, they are terrified, and they’re body is trying to kill them. They need you to be present and they need your help whatever that looks like for them, not you. You need to ask them and yourself what the next step is. If it feels like it’s impossible, then it’s probably the right answer. Trying to save her was easy for me and harder on her and I would have done it for the rest of her life. But I loved her too much. She never let me suffer a day in my life, why would I let her suffer.
    Again, I want to say that I’m sorry. I also want you to know it’s not your fault no matter how you got here. I know you’re losing your best friend but this doesn’t mean anything for the time you have spent together. You still have all of those times. If they are hiding from you, it’t not you, they still love you and you are still they’re best friend and that’s why they are hiding. To protect you, and themselves. I know it’s hard to make the decision, and I know it’s hard to realize that sometimes our help hurt’s. But, we have to hear it.
    Love them, hold them, never forget them, and please god if you can help it do not leave their side as they move on. I was there for every minute of it and I would regret otherwise.
    Willow, it was truly in honor in life and death my dearest friend.

  2. Went through this in 2017 with a beloved Rottweiler I had adopted (foster failure). Only two months after I adopted him. It was devastating. He spent a week in ER and just got progressively worse and I had to let him go. He was only 6 years old. A very hard loss that can still bring me to tears. Not to mention the $11k ER Bill I am still paying on.

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