Tuesday, March 19, 2013

Immune Mediated Hemolytic Anemia (IMHA) Survivor: Pete's Story

by Jenny MacKay

It was the evening of Monday, October 24 2011, when my husband, Mike, and I first heard the term IMHA

We searched the internet for everything we could find and what we learned filled our hearts with fear... but we hoped for the best.

This is the story of Pete's illness and recovery

Mike and I adopted Pete, a Basenji Corgi mix, from the BC SPCA Sechelt branch in April 2010. Pete was 10 years old, had serious allergies and eczema caused from the stress of being in a shelter environment; he had such a sweet temperament and obviously needed a loving home - it only took 5 minutes for Pete to steal our hearts.

Over the next year and a half Pete became, and still is, an integral part of our lives. He spends his weekdays in the office with Mike and the rest of the time snuggled next to us on the sofa, going for walks on the beach, or hogging as much of the bed as he can while we sleep.

Forward to Sunday, October 23, 2011, we left Pete at home happily snuggled in his bed, then returned 2 hours later to find a very different dog. 

He stood in the corner, his head lowered; we called his name several times and, when he finally turned toward us, he had trouble walking. His back legs buckled under him.

Something was dramatically wrong. 

We stayed up all night and watched Pete closely. In the morning we took him to the Urban Animal Hospital, they examined him, took a blood test, and advised that given the symptoms it might be something called IMHA but results of the blood test would confirm.

They sent us home and advised us to call if anything changed. 

We diligently monitored his behaviour and for a while he seemed to stabilize. However, within hours everything changed - Pete once again lost mobility and in the space of an hour he could no longer walk. We rushed him to the Vancouver Animal Emergency Clinic.

Following another blood test they diagnosed with IMHA - Immune Mediated Hemolytic Anemia

Pete was immediately admitted and put on several IV drips; the vet provided an overview of immediate treatment- the various costs and options (we are so thankful we had pet insurance with Trupanion). Then came the worst news, the vet explained in depth what IMHA is and cautioned us that even with early detection and appropriate treatment 80% of dogs diagnosed with IMHA do not survive beyond hospitalization. If they do fight the good fight and are able to go home the survival rate beyond 6 months is only 20%.

Pete stayed in the Animal Emergency Hospital and we walked back to the car with an IMHA pamphlet in one hand and Pete's leash in the other, not knowing if he would get the chance to wear it again.

IMHA is a life threatening hematologic disease. It is a disease in which the body's immune system attacks and kills its own red blood cells; without an adequate number of red blood cells the body becomes starved of oxygen and cannot survive.

The causes of IMHA remain largely unknown, with 75% having no found causation at all. 

While some cases may be triggered by an event such as cancer, vaccination, or infection, these do not explain why or how the immune system misdirects and harms the body it is meant to protect.

IMHA occurs more often in middle aged dogs 3 - 8 years old, and in females rather than males. It is a rapidly life threatening disease that even with appropriate treatment is often fatal.

Because IMHA is not well understood there are no known cures or preventive measures.

IMHA comes without any early warning signs. Once the typical symptoms present themselves your animal is already very ill and must get medical attention immediately.

Typical symptoms of IMHA include:
  • Pale or yellow tinged gums
  • Yellowed eyes
  • Dark or pinkish/red urine
  • Tiring easily or weakness
  • Lack of appetite, lethargy, or rapid breathing

**NOTE: IMHA is a very aggressive disease. It is possible for your pet to show no signs, then for the disease to take full hold within as little as 4 hours!

IMHA Resources: University of Prince Edward Island and Pet Place Canada

Following a very long night at the Animal Emergency Hospital we arrived home mentally and physically exhausted, went to bed but couldn't sleep. 

Early the next morning, groggy and tired, we readied ourselves to make the trip back to the hospital for an update on Pete's condition.

When we arrived the vet warned us that Pete had become very ill during the night and we should prepare for the worst. The vet took us to the back room where Pete was. Walking past all the other hospitalized animals, we readied ourselves.

Pete had an IV in each leg and the symptoms we read about had revealed themselves in Pete. 

His skin and eyes were bright yellow with jaundice; he didn't even have enough energy to raise his head.

When he saw us, he could only move just the very end of his tail... all his efforts to wag his tail were barely perceptible.

I have never before felt so helpless and hopeless in all my life.

Pete's case was very serious; they performed a full blood panel testing and his red blood cell count (RBC) was 12, a normal range is between 40-55. The vet recommended immediate blood transfusion, and reminded us that the procedure was not guaranteed to save his life, that he may require multiple transfusions, and that it would be very expensive. Even without knowing what his response would be or the survival rate, so long as it wouldn't cause Pete any additional pain, we would do anything and everything we could to save his life.

We visited Pete in the Animal Emergency Hospital 3 times a day for the next 7 days. Mike visited in the morning, I visited at lunchtime, and we both went together in the evening after work - staying as long as we could, begging for just a few more minutes after visiting hours closed.

Over the course of those 7 days Pete's condition fluctuated - improving, worsening, stabilizing, and around and around. 

The whole time he kept getting yellower and yellower - the jaundice was getting worse as his RBC was improving at glacial speed. He received all his nutrients, food, and medicine from an IV.

Each time we visited we tried to persuade him to eat; we took purred salmon, white rice, eggs, chicken stock, liver... all his favourites, but to no avail. Pete was just too sick to eat. He was losing weight rapidly. If he couldn't eat then we would do everything else we could think of to make him comfortable. We took his blanket, toys, even our own sweaters - in the hopes that he would recognize our smell and make his feel a little less lonely in the times when we couldn't be there with him.

One evening, when we were visiting the vet told us that she'd never seen it before but was convinced that each time we left Pete cried himself to sleep. It broke my heart. To be honest, it still does...

Mike and I grieved and hoped, hoped and grieved - with the exception of visiting hours when we saw Pete there was no joy in the world and time seemed to stand still.

Following the blood transfusions Pete showed very slow signs of recovery until finally he was stable enough to come home. 

He'd lost 30% of his body weight and much of his muscle mass, he couldn't walk for more than a few minutes at a time. It was still another week before he would eat on his own, and until he could we fed him from a syringe, ounces at a time, every hour. Pete's appetite slowly came back and within 3 weeks his appetite had returned.

Pete's release included a heavy regime of medications required every 4 hours; the vet warned us that because the medication was so strong and hard on the system that the medication might be as dangerous to Pete as the IMHA.

We kept him with us at all times so we could monitor his health. IMHA is a very tricky disease that has no cure, and only sometimes can it be managed. Relapses are always possible, and quite common, and happen without warning.

For the next 4 months Pete received weekly blood tests to monitor his RBC. 

The first few weeks nothing changed much, then slowly the RBC crept up. He was, and continues, to be on a daily regime of medications. Some suppress his immune system, while others promote the healthy growth of new red blood cells.

For the first two months the medications are not effective as they need to build up in the system before they can affect any change.

Yet, while they are ineffective in fighting the disease, they bring powerful and scary side effects. 

Pete suffered severe thirst. He couldn't drink enough water, always panting, and with that came round the clock visits to the little doggie room for bathroom breaks. Pete developed ulcers on his tongue and had multiple stomach troubles.

One of the medications suppressed Pete's immune system, as this was the crux of the disease, and as a result he was very prone to illness and infection from any cuts or sores. Each blood test the vet needed to work around the previous injection as each took weeks to heal.

More troubling, given his lack of immunity, he developed a serious skin infection and lost most of his fur. 

Given it was winter and he was still underweight, poor Pete was always trembling from cold. Pete accumulated quite the collection of sweaters, booties, and blankets.

While we waited for the medications to take effect, we tried everything we could to speed up and assist his recovery. 

We took him for holistic therapy, gave him vitamins and supplements, herbs, changed his diets, and many other things.

We lived our lives in weekly installments, always holding our breath for the results of the next weekly blood test. 

Slowly, Pete's personality came back. On Christmas day Pete was inundated with gifts from friends and neighbours, and for the first time since October he played (if only very timidly) with his toys.

During the first few months of recovery Mike had to carry Pete to the office, a walk he would normally look forward to twice a day every day. Pete spent his days relaxing under Mike's chair and receiving visits and best wishes from everyone in the office. It took 2.5 months before Pete could walk the whole 30 minutes to the office. 

In late February 2012 the vet gave Pete a 4 month clean bill of health. 

His RBC had gone up to 50. It would not be for another 3 months that Pete would have to endure another blood test. Even though the vet reminded us that the possibility of relapse was always there, and that Pete would be on medication for the rest of his life, we all slept soundly for the first time in 4 months. Mike and I were forced to the far edges of the bed while Pete slept in the middle; that night I even appreciated his snoring. 

On October 24 2012 it was a year since Pete's struggle with IMHA. 

He beat the odds, and is a healthy, energetic and happy dog.

In February 2013 Pete returned to daycare 1 day a week. He was so happy to see all his dog and human friends at Sit Doggie Daycare!

Pete survived the most dangerous first year with IMHA - I strongly believe his will to survive was no match for the disease.

IMHA cost 7 days in the Animal Emergency Hospital, 2 blood transfusions from a Boxer named Beau, 7 days of non-stop IV's, and 4 months physical rehabilitation. It still carries daily medications - this will never go away. And despite all this, it wasn't enough to dampen his spirits.

When we tell this story to others we often hear that they wouldn't spend such a large amount of money or expel that amount of emotional upheaval to control an incurable disease, or they wouldn't be able to watch their pet so ill. Yes, emotionally and financially it was very difficult.

We owe our ability to give Pete all the medical attention he needed to our Insurance provider, Trupanion.

They reimbursed us quickly so we could fund the next course of treatment.

As for the emotional side, it still makes me sad to think of it and even writing this story is hard, reliving those worst moments, but it's an important one to share so others who might be fighting this disease can take a little comfort from this happy ending. And for those who have not heard of it, maybe reading this story will help them recognize the warning signs in their pet.

Most importantly I tell everyone that when we adopted Pete from the BC SPCA, we made a commitment to him - to look out for him, protect him, and love him like a member of the family. It just so happens Pete is the only family member with fur. 

I would like to thank all the staff at the Urban Animal Hospital and the Animal Emergency Hospital - both located in Vancouver, Canada, and the blood donor dog Beau - without which Pete would not be with us. I would also like to thank all our friends for their support and kindness.

I don't know what the future holds for Pete but I do know that every day with him is something to be thankful for!

**This article has been written from my own experience and research. I am not a vet; please consult your vet as soon as possible if you believe your pet is ill. 
Jenny Mackay – - Owner, House of Pete www.house-of-pete.com


Related articles:
Immune Mediated Hemolytic Anemia (IMHA): Reader Stories (Part I) 
IMHA Is Not To Be Taken Lightly: Know The Symptoms
Dr. Jekyll And Mr. Hyde: Razzle's Immune Mediated Hemolytic Anemia (IMHA)
Battling IMHA With Integrative Veterinary Medicine (part 1)
Battling IMHA With Integrative Veterinary Medicine (part 2)
I Am An IMHA Survivor! Dylan's Story
Liver Tumor? IMHA? Daphne's Story (Part I)
IMHA Complications: Daphne Didn't Make It 
Immune Mediated Hemolytic Anemia (IMHA): Reader Stories (Part I) 
Immune Mediated Hemolytic Anemia (IMHA): Reader Stories (Part II) 


  1. I going thru this right now with Belle. Her appetite is still good and she is drinking and staying hydrated. She still gets up and walks to the food and water and anywhere the children are. We found out she had this when she was having a bad bout with diarrhea. The first cbc her RBC was 12. She was placed on a regimen of 40 mg of cortisteroids and an antibiotic. Her rbc went up to 16 in a week but two week later it started going down again to 15. The cbc also showed that her marrow was making red cells but were being overwhelmed with the increase of white cells so he changed her antibiotic to slightly higher level and we are now in a wait and see mode. He was surprised that it wasn't higher as he found her to be more alert and her coat looked shiny. And her gums are still pink. She doesn't pant as much as she was and being stubborn tries to go for walks on the leash which is pretty much once or twice across the front yard. I have to cut it short cause she will keep going and exhaust herself. This has my husband and I and the grandchildren very upset. She has always been a momma dog to them. We are hoping she starts to perk up. I have hope considering what you went through. She turned 12 this past April, that being the top of the bell curb for labs and they start to decline. This seemed rather sudden. She is a magnificent specimen of the breed.

    1. So sorry that you're going through this with Belle. Best wishes for good recovery.

    2. So sorry. I and my beautiful girl, Juno are going through this also. It was sudden. She was always a perky, excited about life kinda of girl and then....she wasn't. We've been battling this for 3 weeks now. I thought she was going to die last night. She has lost her spirit and my heart is shattered. She's tired, but she can't seem to rest. I don't know how old she is; I adopted her 3 yrs ago. The vet thinks "older" than our guessed age of 11. We have a vet appt. today....I believe we'll be saying our goodbyes. #thissux

    3. So sorry about Juno. This is a terrible disease, hard to battle.

  2. Thank you for sharing your wonderful story. Today we left our baby boy Rico to stay overnight for low blood count as well. We are worried SICK about him. I don't even think I can sleep..... Keep us in prayer...!

    1. So sorry about Rico. Wishing him successful recovery.

  3. We are going through the same with our Sammie, he is only 5.5 years old. 6 days in hospital, 1 blood transfusion so far. Lots of medications that worry us he may be worst just because them. He started to eat when bringing him home, he never had a day without us, we think he was suffering more being alone than the illness itself. He wants to eat all the time, drink a lot, pee a lot, it's a change in our lifestyle. He is our son, since we don't have kids. It's just been 13 days and feels like weeks. Sad to read that it can happen again, that it's not over, that he will have to be on medications for rest of his life, or he may not make it after so many...it's even hard to try to make him take them. Only time will tell. And yes, it's a very expensive illness, we don't know how far we will be able to afford for it...

    1. So sorry about your baby. Such things are always heartbreaking. Once he's over the initial crisis, try consulting an integrative or a holistic vet.

  4. Does anyone know the status of Pete today?

    1. I really don't know, their website is no longer live.

  5. 4 days of it. Vets were ...I don't even know the word... not really positive, didn't give enough information and really gave him no chance from the beginning. $5000 later...My beautiful, extraordinary baby boy... Jax died at 8 years old on 6/20/16. He couldn't breathe-basically he drown in his own blood and to say I am devastated is the most ridiculous understatement ever. My heart is gone

    1. So sorry about that. Not all dogs, unfortunately make it. And sometimes transfer to another hospital might be too much for them to make it too. So sorry for your loss.

  6. I feel guilty for not waiting for a turn around... I don't know if it was right thing to do or not...

    1. I doesn't always turn around ... sometimes relieving the suffering is the best thing you can do.

  7. We lost our lovely male cocker Sunny to this disease in just 3 days last June 2016. His CBc was 8. Came on very suddenly. 3 days hospitalized 1 transfusion drugs no promise of success he suffered terribly. In our 80s we could not keep fighting it as it took its toll on us. He was 10. A foundling he had tested positive for ehrlichia but it was in remission all 9 years we had him. a tick born illness we think it may have activated causing the MIHA that took him from us. Last week we scattered his ashes in the sea where he so joyfully lived to swim. We loved and miss him terribly. Our sympathies to all whose fur babies are going through this.

    1. So sorry about Sunny. It is a terrible disease. The tick-borne infection being present could have been behind it, though there are many different things that can trigger it. Letting a dog who is suffering go is the kind thing to do. So sorry for your loss.