What are your thoughts on IMHA in dogs?

Our question this week was:

Hello Dr. Debra,

I have a 6-year-old Toy Pomeranian. The other day I noticed that she was lethargic and not her usual self. When we have dinner she is usually around the dinner table but I guess she was so weak and unable to get herself up off the couch that she decided to stay there while we ate. After awhile I noticed she urinated where she was laying and that's very unusual for her since she's potty trained. I took her to the 24 hr. hospital right away. They took her blood pressure, and also checked if she had a fever. The only thing they told me was her breathing was abnormal, and I should get it checked out.They also recommended x-rays and blood tests to see if there was anything wrong with her. I waited until the next morning and brought her to her reg. vet. They gave her a blood test and sent it away to the lab. The results that came back were NOT GOOD. Everything was either very low or high. They immediately asked me to take her to the 24 hr. clinic for a blood transfusion.She's in critical condition and has been at the hospital for the last 48 hrs and they're closely monitoring her and checking for blood clots, etc. They've diagnosed her with IMHA and she has had two blood transfusions over the course of 48 hrs. When she's stabilized and her medication starts to work then I can bring her home and that could take between 3 to 5 days to find out. The vet told me that she will have to go for weekly check ups for the next 3 to 4 weeks and she'll be on medication for the next 6 mos.Have you heard of this disease and can it be treated? I've been told that she could relapse at anytime but there have been cases where they've lived happy lives after they've had treatment. What are your thoughts on this disease and do you think that her chances of surviving are good? I am trying to be positive since she's part of our family. However, I would love to hear your honest opinion. Please kindly give me your expert advice. I really appreciate your time on this serious matter.

Thanks Dr. Debra.
Best regards,


Hi June – thanks for your email. I'm sorry to hear about your dog and the IMHA. What you described is very typical of IMHA.

As you probably know, IMHA stands for immune-mediated hemolytic anemia. It is a disease that results when the bodies immune system attacks the bodies own red blood cells causing life-threatening anemia. The most common signs are lethargy and weakness. I hate this disease. It is especially hard because it occurs quite suddenly and the success of treatment is not all that good. In one study, approximately 85% of dogs did not survive or were euthanized.

The treatment is to give drugs to try to prevent or minimize the destruction of the red blood cells. If the blood count falls low enough, blood transfusion are also given. The blood transfusion does not treat the disease but gives the needed blood to allow the body to better function while hopefully the body has time to respond to the drugs. Common drugs used are prednisone, and other immunosuppressive drugs such as azathioprine, cyclophosphamide, cyclosporine, danazol, or leflunomide.

The prognosis is guarded. I always feel better about 5 to 7 days of treatment. I've seen some dogs do well for the first few days then decline and other dogs that seem really bad improve and do okay. I'd recommend sticking it out for at least a week until you can determine how she will respond.

An article that might be helpful to you is Immune-mediated hemolytic anemia in dogs.

Best of luck!

Dr. Debra

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