Reader IMHA Stories: Immune-Mediated Hemolytic Anemia

Anemia is a deficiency in red blood cells (RBCs), resulting in a decreased oxygen-carrying capacity of the blood.

Potential causes of anemia include blood loss, insufficient red blood cell production, or increased destruction (hemolysis).

In immune-mediated hemolytic anemia (IMHA), the dog’s immune system attacks the red blood cells.

IMHA is a life-threatening disease that strikes fast and hard. Acting fast when you suspect IMHA is your dog’s best chance for survival.

Red flags include

pale gums
yellow-tinged gums or whites of the eyes
dark or dark yellow urine
weakness
lethargy
loss of appetite
rapid breathing

Many readers shared their stories in the comments.

Reader IMHA Stories: Immune-Mediated Hemolytic Anemia

Reader stories

One-and-a-half-year-old Rottweiler

I had never heard of IMHA until it happened to my dog. I found my one and half-year-old Rotti with white gums and very lethargic when coming home from work.

We immediately called the vet and rushed him in. They did blood work. His RBC was 2.10 and PLT 22. They sent us to the ER, which could take care of him in his critical state. They ran several blood tests and placed a central line and IV fluids. Three days later, they allowed me to take him home.

He was doing better, but not his playful self. He was eating and drinking fine, and his urine was still clear.

The doctors have informed me that the tick titer and other labs have all returned negative. So we still didn’t know the underlying cause. Sometimes, the underlying cause remains elusive.

Thirteen-months-old Golder Retriever

I also had never heard of IMHA until my 13-month-old golden was diagnosed with the disease.

One night we were going to bed. I was petting him on his stomach, and his groin area felt like he was on fire. I took him to the local animal emergency center, where he got his diagnosis. He received an IV and immunosuppressive meds.

On Thursday, he needed his first transfusion.

He came home on Saturday, and he seemed to be doing better. On Monday, he was again very lethargic, and the vet said he was very bad. I thought that I had lost him.

On Tuesday morning, he had two more transfusions and a splenectomy.

After three days, he got to come home again. His vet said that he was holding his own. His blood values were going up slightly every time they were tested. With Murphy being just a puppy, it is so hard for me to watch him just lay around. Unlike my Murphy, who would run and jump and play with me. I know that his recovery will be a long road, so I take one day at a time. If you have a dog with these symptoms, get them to the vet as soon as possible.

Eight-and-a-half years old Chihuahua

On Saturday, I lost my beautiful soul mate – Ricky, my 8.5-year-old Chihuahua, to this awful disease.

It came out of nowhere.

The week before, I noticed he was 20% not himself, but I thought maybe it was some sort of cold. Then, on Monday, he didn’t want to eat anything. On Tuesday, he also didn’t’ want to eat anything – and I noticed that his urine was a dark orange(brown).

I made a quick appt for my husband to take him to the vet. All the blood work was done, but unfortunately, we had to wait 24 hours for blood work results. The next day I called my vet, and it seemed like Ricky’s red blood count level was way off. So the vet asked that I rush him to the vet. I left work and immediately took Ricky to the vet with my husband.

The vet told us that Ricky was diagnosed with IMHA.

She asked that we leave him in the animal hospital for intensive treatment. Steroids, IV, and some sort of antibiotic since he was running a slight fever of 40c.

On Wed, his red blood cells were in the 30s. However, on Thursday, since she was giving him an IV, they dropped down to 18. But she expected that since she was flushing his body out with IVs. She said that the steroids wouldn’t’ start working for a couple of days. However, Ricky is stable and had a great outcome. Ricky was lethargic. He didn’t’ want to eat or drink, but he was fully alert and soo happy to see us.

We went and visited him for 2 hours on Thursday afternoon/evening.

Little did I know that would be the last day I saw my precious angel.

We cuddled and held him as he was hooked up to his IV. He was so happy to see us as he was panting and giving us small kisses. Then, he just wanted to sleep with us.

After 2 hours, I kissed him goodbye and said, “see you in the morning.” He had these beautiful brown eyes and was like, “mommy, where are you going, don’t’ leave me.”

On Saturday morning, my husband and I started getting ready to visit my sweet baby. But, instead, we got that awful call.

The vet said, “I have some terrible news. Ricky passed at night time. He probably had thromboembolism (blood clot) which is a considerable risk during IMHA. Apparently, when the vet came in the morning, he had his blanket still on top of him. At least he died peacefully in his sleep.

I have so many “What ifs,” such as :

What if I took him to a 24-hour hospital where they had night care? Could they have saved him? My vet says “probably No” Because a blood clot is impossible to cure when it happens.
What if I have done something wrong?
What if we got a blood transfusion. The vet thought Ricky was stable and didn’t’ require it at the time.

Ten-year-old Rat Terrier

Our 10-year-old rat terrier Ralph was diagnosed with IMHA last December.

He was not acting like himself for a couple of days, then he stopped eating and was very warm.

We took him to the vet the following day. They suspected IMHA and started him on prednisone while we waited for the labs to come back. Finally, the labs confirmed the IMHA, and we admitted him to a hospital with an autoimmune specialist. After six days in the hospital, three blood transfusions, daily acupuncture, and daily cocktails of prednisone, cyclosporine, and leflunomide, they were able to get the IMHA under control and released him.

It has been almost four months. He has been off medication for seven weeks now and is back to his spunky, playful self.

There were so many times during the treatment that we thought we would lose him. We wondered if it was best for him to continue treatment. But, we are so grateful we hung in there and give the medications a chance to work.

Eleven-year-old Yorkie Mix

On April 7th, 2011, my 11-year-old Yorkie/Maltese, Bridgette, woke up sick.

She had been fine the night before, running around with her two sisters. It was 7:30 in the morning, and I had taken them out. Upon coming in, she didn’t want to eat. She just sat and looked dazed.

Then she collapsed and cried, at which point I rushed to the vet.

My vet was not in. Another vet checked her and said that when he listened to her lungs, it sounded like she had a little fluid on them and a heart murmur that she hadn’t had before.

He told me we should wait until the following Tuesday and gave us some fluids pills.

He also said that if she had another episode to bring her back.

When I got her home, she slept for a while and then almost seemed like she was having a seizure.

I returned to the vet, at which time he took a chest x-ray. Again we returned home. Bridgette slept for a while and then started throwing up. It was now late Saturday afternoon, and I had to call the vet as they were closed. He said he’d meet me there.

It was 4:30 PM the day before Easter. I kissed my sweet precious Bridgette goodbye.

They wanted to keep her and watch her.

They called later that night that they thought it was IMHA.

Bridgette was given large doses of prednisone and a transfusion. They said that she was holding her own on Easter, but her red blood cell count was very low.

Easter Monday morning, I was hurrying to get ready to go to the clinic to see her. Instead, I received a call that Bridgette had passed away.

It was the worst day of my life. I hope no one has to go through it. I wasn’t even aware that IMHA even existed.

Australian Shepherd

We lost our Australian Shepherd, Bonnie, to IMHA complications.

Like everyone else here, we never heard of the disease until April 28th. Bonnie survived the initial event and was put on prednisone and immunosuppressants but died from a horrible internal fungal infection.

The infection wasn’t diagnosed until it spread to her spinal cord, and she couldn’t walk.

We had to let her go when it moved into her lungs.

Ten-year-old Terrier Mix

My beautiful 10 yr old terrier mix, Sadie, was very vibrant and full of life.

She was a rescue who entered our home over 9 yrs ago. She declared that she was the alpha female in our little family of dogs and cats. Except for needing thyroid meds, she was healthy for her age.

On Mon, 9/10/12, at 4 PM, she collapsed.

We took her to the vet immediately, and after blood tests, she was diagnosed with IMHA.

First time I had heard of it.

Our vet started meds and was optimistic. I was tired but had a good night. I went back to the vet for a blood test, and slightly worse, but still ok. The next day was weaker, they started new meds, but alert lost appetite late in the day. That night she would only lay still and watch us or sleep. Then very late, breathing became labored, and we knew she was leaving us.

We called a vet who met us at the animal hospital, but she died before we got there.

Three days is all it took for this horrible illness to take our baby.

Five-year-old Rat Terrier

It is so comforting to read other stories.

And yet I still don’t know if I did the right thing for my baby girl.

Her name was Tinkerbell, 5years old rat terrier. She was so fun and sweet, and she loved me as much as I will always love her.

She was fine one day – playing, chasing her tail – and the next, not eating, sleeping constantly, her gums were white. I knew this wasn’t good.

I took her to the vet the next day. Her counts were at 25. She was put on prednisone. The next day she was worse (15). They doubled her meds and gave her an IV, and were to bring her back in the morning.

By then, her counts had dropped down to 10, and they said she needed a blood transfusion.

I was not going to make her suffer anymore. She couldn’t even hold her head up, and her eyes were just glazed. I couldn’t put her through that.

I will always love her and miss her.

Chihuahua

My Chihuahua too has IMHA. I have never heard of this awful disease before and have had pets all my life.

When I went to work, all was well. However, when I got home, Hayley did not act like herself. I do not know why but I picked her up to look at her gums, which were very pale…

Off to the vet, where we were told of this awful disease.

Hayley was sent to the critical care animal hospital. She received a transfusion and IV, and they put her on her meds. She has done very well from the get-go.

After the 4 hours of the transfusion, Hayley wanted to eat and drink.

She started wasting from the prednisone… so I cut the dose, and she is more like herself now. Her count went up from 8 to 24 after the transfusion, and the next day it was 25.

Now, after four weeks, it is 40. Next, we will send her to physical therapy with a laser so she can regain her muscle.

We are not out of the woods.

Many things can happen with IMHA. It is terrifying, and we feel it was her shots. She had such a bad reaction she had a waver on all shots.

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