Autoimmune Hemolytic Anemia Frequently Asked Questions


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DISCLAIMER: This page, as well as all other pages on this site, was not written by a veterinarian. Some information on this page was obtained from the following sources: The Merck Veterinary Manual (eighth edition; 1998), Veterinary Drug Handbook, (third edition Donald C Plumb) and Baillieresís Comprehensive Veterinary Dictionary, (D.C. Blood and Virginia P. Studdert.) This page is not intended as a substitute for proper diagnosis and/or treatment of AIHA. It is meant to be used only as a means of fostering discussions between owners and their veterinarians.
Q: What is PCV, is it the same thing as hematocrit and what is the normal range for the PCV?
A: PCV stands for packed cell volume: the percentage of the volume of whole, unclotted blood occupied by the erythrocytes (red blood cells). The terms PCV, HCT and hematocrit are basically interchangeable. The normal PCV reading in the dog is 37-55.
Q: What is the normal white blood count (WBC)? What does an elevated white count indicate?
A: The normal white blood count in the dog is 6-17. An elevated white count indicates a possible infection, very common in AIHA dogs because of the suppressed immune system.
To learn more about the PCV, WBC & other elements on the CBC, check out the CBC Information page
Q: What are reticulocytes and why are they important?
A: The reticulocyte is the stage just before an immature erythrocyte (red blood cell) becomes a mature red blood cell. It is a little larger than a mature red blood cell and because it contains small fragments of DNA and other materials has a bluish-red coloration. When we evaluate anemia's we look for things like reticulocytes. If we see lots of them, it not only means that the body is releasing the cells too early to compensate for the anemia, but it is also encouraging because it means the body is ABLE to make more red blood cells. The reticulocyte count is a very essential test when dealing with AIHA.
Q: What is a Coombs test?
A: The Coombs test is the blood test that confirms the diagnosis of AIHA. It's results are either positive or negative. This test should be done at the time the dog is presented and AIHA is suspected. Some dogs with AIHA will be Coombs negative.
Q: Is there another test besides the Coombs test to confirm an AIHA diagnosis?
A: Kansas State University College of Veterinary Medicine has recently developed a new diagnostic test for AIHA/IMHA. To learn more about the test Click Here.
Q: What dosage of prednisone should my dog be on?
A: At the onset of the disease a dog should be on AT LEAST 1 mg per pound per day of prednisone divided into two doses. For example, if you have a 60 pound dog you should be giving at least 60 mg per day divided into two dosages of 30 mg each. Many vets will sometimes prescribe a higher dosage. The dosage should be decreased very slowly over a period of several months. If the dosage is reduced too quickly, relapses of the disease are very likely.
Q: When and how often should the prednisone be reduced?
A: Once the disease is in remission, the dose of prednisone can be lowered by 25% to 35% every three to four weeks until the lowest dose that keeps the disease under control is reached. It is important to do blood tests before each prednisone dosage reduction. If the dog is receiving more then one immunosuppressive drug, change the dosage or frequency of only one drug at a time.
Q: What are the side effects of prednisone?
A: Side effects from prednisone can include increased thirst and urination, increased appetite and weight gain, dull, dry haircoat, increased panting, vomiting, diarrhea, elevated liver enzymes, pancreatitis, muscle wasting and behavior changes ( depression, lethargy).
Q: The prednisone is not working, what other drugs are available for the treatment of AIHA?
A: When prednisone, alone is not effective in the treatment of AIHA, many vets add azathioprine (Imuran) to the treatment regime. Azathioprine is used in humans as an anti rejection drug after organ transplants but has been used successfully in the treatment of AIHA in dogs because, it like prednisone, suppresses the immune system. Because it takes azathioprine several weeks to start working it is used as an adjunctive therapy with prednisone. Two side effects that should be noted with azathioprine are bone marrow suppression and increased susceptibly to infections. Other drugs used in the treatment of AIHA are cyclophosphamide (Cytoxan) and cyclosproine. Two anabolic steroid's, danazol and winstrol are also some times used in the treatment of AIHA.
Q: What is the mortality rate for autoimmune hemolytic anemia ?
A: According to some sources, mortality rates range from 20% to 50%, but can be higher in fulminant (occurring with great suddenness and severity) cases.
Q: How long should I expect my dog's recovery to take?
A: Each dog diagnosed with autoimmune hemolytic anemia will have a different recovery time. Some dogs will respond to the drugs very quickly and have a rapid recovery. Other dogs will respond much more slowly and a variety of drugs may need to be tried before the right one/ones are found that will put the dog in remission. To see examples of these different recovery times view the Success Stories page.
Q: My dog is due for his vaccinations, should I give them?
A: Only healthy dogs should be given vaccinations. A dog with AIHA has a very compromised immune system and vaccinations could lead to a serious relapse. Some veterinarians recommend never vaccinating an AIHA dog again. It is important to know that many vaccines have a much longer life then we have been led to believe. To learn more about vaccinations, visit the vaccination links page. The entire subject of vaccinations should be considered very seriously and discussed with your veterinarian before proceeding with them.
Q: What can I as an individual do to help in the fight against AIHA/IMHA?
A: To learn how you can help fund humane canine AIHA/IMHA health studies at Morris Animal Foundation Click Here
To learn how you can host a garage sale to benefit the Meisha's Hope AIHA/IMHA Fund #338 at Morris Animal Foundation Click Here


Some dogs with AIHA have an underlying thyroid problem or the disease itself can damage the thyroid gland. If your dog is not responding well to the drug therapy he is being given, you might consider asking your vet to run the full thyroid panel on your dog. If the readings are low your dog can be put on thyroid medication which may prove to be beneficial to his recovery.
Discuss with your vet whether or not you should continue to give your dog heartworm prevention medication and/or use flea protection products while your dog is in a weakened state.
If your dog is having excessive thirst due to the prednisone, in addition to water, you might consider giving him crushed ice to relieve the thirst.
You might want to check your dogs urine from time to time. This can be done by putting a white paper plate underneath your dog just before he urinates. The urine should be a nice yellow color. If it is a brownish color or has any trace of blood in it, call your vet immediately.
Ask your vet about the possible side effects from all drugs he prescribes. Also do your own research on the side effects of all drugs your dog is on either on the net or with books. Two books that I have found to be of immense help are: "Veterinary Drug Handbook" third edition by Donald C. Plumb and "Bailliere's Comprehensive Veterinary Dictionary" by D.C. Blood & Virginia P. Studdert.
This page was last updated on January 9, 2013.
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