Thursday, September 16, 2010

Dr. Jekyll And Mr. Hyde: Razzle's Immune Mediated Hemolytic Anemia (IMHA)

Who doesn't know the story of Dr. Jekyll And Mr. Hyde? How does the story relate to autoimmune disease?

Your dog's body was designed to maintain health and it has an amazing guard against disease—the immune system. His immune system protects your dog against disease by identifying and killing invaders foreign (infections) and domestic (tumor cells).

There are few things as amazing as the immune system.

An important part of the immune system's function is to be able to distinguish between native and invading cells. When it fails to tell the difference, it can turn against body's own cells and bad things start happening.

The body's guard and protector becomes its enemy.

Autoimmune disease is a fairly self-explanatory term. The very system that is meant to protect your dog from disease is now causing it instead. Autoimmune disease can affect a single organ or it can be systemic.

Immune mediated hemolytic anemia (IMHA) is a condition in which the dog's immune system attacks his own red blood cells.

What causes the immune system to turn into Mr. Hyde? This doesn't seem to have been conclusively determined, but it is believed that both genetic and environmental factors are in play. IMHA can be triggered by infections, medications or vaccines, but often no clear cause can be established.

Of course just because we don't know the cause, it doesn't mean there isn't one.

Some breeds are more susceptible to the disease, such as Cocker Spaniel, Springer Spaniel, Miniature Poodle, Finnish Spitz, Irish Setter, Dachshund, Bichon Frise and Old English Sheepdog. (source:

IMHA is a life-threatening disease and it strikes fast and hard.

Red blood cells play several important roles in your dog's body. Without sufficient red blood cells your dog cannot survive!

Symptoms of IMHA include
  • pale or yellow tinged gums
  • rapid breathing
  • weakness
  • lethargy
  • dark urine
  • loss of appetite
  • vomiting
  • rapid breathing
Conventional treatment consists of immune suppression and supportive care, such as blood transfusion.

Razzle's Story

Razzle's story is shared with us by my dear client and friend, Ben Moomaw of Leader Source SGA.

Razzle is a 5-year-old neutered male Cavalier King Charles Spaniel, loved by his family.

Last summer Razzle underwent a battle with Immune Mediated Hemolytic Anemia (IMHA). 

On a Friday afternoon, we noticed that Razzle was a bit listless. We didn’t think much of it, as we didn’t want to overreact.  But through the weekend, he got more and more so, and seemed to be getting very weak.

By Monday morning, he was barely able to stand, and he was turning yellowish (eyes, inside of mouth, skin color). 

We realized something serious was going on, so we took him to our vet.

The vet diagnosed IMHA, a blood disorder where the body’s white blood cells start attacking and destroying the red blood cells. It is most common in middle aged dogs, generally more often in females, and spaniel breeds are more susceptible than others.

He was very weak, and the vet immediately put him on steroids in an attempt to stop the immune system reaction.  Razzle got a blood transfusion as well, to replenish his red blood cells.  We went on a regular “watch” of monitoring his red cell count a couple of times a day.

It was nip and tuck for about five days.  

His blood count appeared to be headed in the right direction, but then took a dive a couple of days later and we had to go through the transfusion again.

Apparently, about a third of dogs who get this do not survive the initial situation, a third survive but it recurs later, and a third survive and it never happens again. So we were very disappointed when things didn’t seem to be working after the first transfusion.

At the vet’s guidance, we decided that we would try one more transfusion. We were literally at the point where if the next blood test showed the counts dropping again, we would have no choice other than to put Razzle down.

It was a very difficult situation for our 14-year-old daughter to whom Razzle belongs.

Fortunately, the second transfusion and continued use of steroids for a period solved the problem. Razzle pretty quickly regained his strength and color, and within about a month he was back to normal.
We are not sure what caused this. We’d never heard of IMHA before Razzle’s experience.

It is unclear in general what triggers this in dogs.  Sometimes it can be a reaction to another infection – say a tick-borne illness or some other illness –  experts aren’t really sure. But it is a rapidly life-threatening disease.

We didn’t act quickly enough when we noticed the first symptoms, and three days later, Razzle was almost dead!  

If you see symptoms in a dog, don’t “wait over the weekend” to have it checked… Symptoms are pale gums, yellow tinged gums or whites of the eyes,  dark or dark yellow urine, tiring easily, weakness, lethargy, loss of appetite, vomiting, tachypnea (rapid breathing).

We realized that we saw all of these in Razzle, once we knew what we were looking at.

The lethargy and loss of appetite was first. We didn’t know to look at the inside of the mouth or ears to check on coloration, but had we seen this, we would have acted faster. Bottom line:  if you see the symptoms, act fast!

Further reading:

Immune system
Autoimmune disease
Dogs and Autoimmune Disease
Immune Mediated Hemolytic Anemia (IMHA)

Related articles:
Collie Nose: Discoid Lupus Erythematosus (DLE) In Dogs




  2. Some, sadly, to get this. But they can be saved if it's caught early ... that's why your story is so important! Hope you're doing great! (((hugs)))

  3. Our English Springer Spaniel was put down on Sunday. She was never, ever sick. All of a sudden she got weak, didn't want to eat and her back end gave way when we took her outside. We immediately took her to the animal emergency center and she was diagnosed with IMHA. He first gave her 15% chance of survival and then after the blood work only 5% chance. He said the disease was in her red blood cells and also her platelets. He never gave us the option to try treatment, he thought she was too far gone. They put her to sleep 1 hour after the diagnosis. How could we have saved her when she didn't have any symptoms except those above? Would there have been any chance at all if they would have given her a transfusion and steroids? I am so sad over this and wondering if they did everything they could to save her. I just wish we would have known sooner, then maybe she would still be with us.

    1. So sorry about your girl! Sometimes this happens very quickly. What her chances were would depend on how badly the values looked on the labs. When Jasmine was very sick we had the benefit of having a teaching hospital close enough to seek second opinion there. Not always the second opinion is different from the first. If you really want to know acquire her lab work and ask your family vet or another independent vet or on So sorry for your loss (((hugs)))

    2. How sad. My cocker spaniel, Zoe Christina, was diagnosed two weeks ago with IMHA. She is still undergoing treatment and I am hopeful that she will make a full recovery. Zoe was perfectly fine one day and the next morning, she couldn't even support her own weight. I called the vet, who recommended that I take her to an emergency hospital immediately. Within about thirty minutes of arriving, I was given the diagnosis. Since Zoe is my baby, I basically said, "do whatever you have to do, just make her better." Fortunately, she is recovering and I am so grateful for the quick diagnosis and successful treatment. We go back today for another blood test, but I can tell by her demeanor that she is doing well. In fact, the problem now is keeping her down, so her body can recover. Because she feels better, she wants to take our daily walks again, which the vet said should not occur because Zoe needs all of her strength to recover. For those of you who have lost pets from this dreaded disease, I am so sorry. Please know that those of us who love dogs offer you our sympathies. Spread the word to others to check their dogs gums when their dogs appear lethargic. I don't want to see others suffer the pain we have had to go through.

  4. My border collie has just been admitted to our vets hospital with this disease! She has only had it 24 hrs but is on a drip and steroids she was lethargic and not eating and that was not like her she loves her food!!! Took her to the vet immediately and now awaiting news on how she is doing!! Please please if your beloved pet suffers from any of thes symptoms take it to a vet right away it's the first 24 to 48 hrs are crucial to it's survival !!!

    1. Sorry about your baby! (((hugs))) Glad you caught it early and she is getting treatment. Do let us know how she's doing.

  5. My Pembroke Corgi was just diagnosed with IMHA. Last Thursday I took him to the vet because he had barely eaten for 2 days and was VERY lethargic. With in 30 min. the told me he was very sick and needed to go to the ER and had a 50/50 chance of survival. He has had 2 transfusions and is still tired and won't eat. We smuggled in a Burger King cheeseburger and he WOLFED it down... I confessed and was chastised..but he didn't vomit. At least he ate. Still have no idea whether he will make it or not. Time will tell. I am so broken up over this. It happened SO fast....

    1. Sorry about your pup. Yes, this happens very fast. Fingers crossed your baby is one of those who make it.

  6. Thank you Jana. Brought him home today to see if he would do better in a familiar environment. Platelets at a steady 17 (lower than when we admitted him) but at one point they were down to 9...

  7. He is doing okay. He has rapid breathing and we are concerned. The vet said it was either from the Prednisone, or small blood clots in his lungs.... :( (fingers are crossed, that my baby will make it!) thank you for asking :)

  8. We had to make the heart wrenching decision to have him euthanized last night. He was breathing very rapidly so we took him in and they said it did not look good. We did not want him to suffer any longer so we held him while he left us in this world. I'm sick. I loved that dog with every ounce of love in my heart, and he's gone. My life will never be the same without him.

    1. So sorry :-( I know how you feel. He will be forever in your heart (((hugs)))

  9. My little girl was just diagnosed with this. They said she has a 50/50 chance. Me and my wife love her so much I can't seem to stop crying. We can't have kids so she is our little daughter. She is a pom. Thank you for all of the post on here it gives me hope that she will be OK. To those who have lost there loved ones I am so sorry I know how it feels. I love her so much I'm so sad.

    1. Amanda, praying for your little girl that she recovers. Many dogs do make it through, particularly when it's caught early and treated aggressively.

    2. my 4 year old Gunnar a beagle sharpie mix has been home from the hospital 1 week today.Like everyone here ,one day he couldn't walk would not eat his poop and urine were orange.He was transfused 3time on iv's.he may be on the meds forever.No cause known,although he just had his shots on Feb.3 started back on heartworm &flea med march 3.I took him along walk about 2weaks after the flea meds,looking back he had to sit down and was breathing hard.I think he may have been getting sick then.Now he is due for another heartworm&flea pill I am scared to give this to him.This has been a devastating illness.

    3. Sorry about what Gunnar is going through. Which HW are you using?

  10. Thank you so much. We just got back from the vet and they let us bring her home. Her blood count went from a 7.5 all the way back up to a 37. They put her on a steroid for two weeks and we have to take her to several follow up app.

    1. That is very helpful progress! I hope she gets all better.

  11. I have a cat that was diagnosed 6 years ago with this disease. He underwent a blood transfusion (at that time is blood count was 8) and then started on large dosages of prednisolone. The dosage was tapered over the months-years and he remained on a small daily dose as maintenance. He has recently relapsed and we're not sure that he will be able to make a comeback this time. Waiting and hoping for the best. But I wanted to give others hope that it is possible for dogs/cats to respond to treatment. I realize that I am very lucky to have my sweet boy six years later.