Haemolytic Anaemia in Dogs

What is Autoimmune Haemolytic Anaemia in Dogs?
Autoimmune haemolytic anaemia (AIHA) is an immune mediated disease in which the dog’s immune system attacks and destroys the body’s red blood cells. It is a potentially life-threatening disease and vets are seeing it with increasing frequency.

Causes of Autoimmune Haemolytic Anaemia in Dogs
Haemolytic anaemia in dogs can be primary (idiopathic – unknown cause) or secondary.

Dogs with primary AIHA have immune systems that are not working properly. They produce antibodies that target, attack and destroy the body’s own red blood cells. Approximately 75% of dogs with haemolytic anaemia have primary AIHA.

Secondary AIHA is caused by an underlying disease or reactions to certain drugs or toxins.

For example:
• Bee stings
• Cancer
• Certain drugs (such as heparin, quinidine)
• Chronic inflammatory diseases (e.g. IBD)
• Infections (e.g. caused by leptospirosis, ehrlichia)
• Snake bites
• Toxins and chemicals (e.g. pesticides, fertilisers, flea/tick prevention meds, household cleaning products)
• Vaccines

The disease or toxin basically changes the surface of the red blood cell, so that the immune system mistakenly ‘thinks’ that the blood cells are ‘foreign invaders’. The immune system therefore targets and launches an attack on these cells.

Once targeted, the red blood cells are destroyed by a process called hemolysis. They can be destroyed either within the blood vessels, or when they circulate through the liver or spleen.

When red blood cells are being destroyed, they release haemoglobin, which has to be broken down by the liver. As you can imagine, this puts extra burden on the organ. That’s one of the reasons why dogs with AIHA are also prone to liver disease or failure.

Symptoms of Autoimmune Haemolytic Anaemia in Dogs

Different dogs show different initial symptoms, the most common ones include:
• Lethargy and weakness
• Not eating
• Pale gums
• Weight loss

As the disease progresses, the dog may show additional symptoms, such as:
• Bleeding gums
• Blood in urine and/or stool
• Collapsing
• Fever
• Jaundice (yellow discolouration of the skin, eyes, and plasma – this occurs when red blood cells are destroyed and bilirubin levels increase)
• Limping and lameness
• Panting
• Peeing in the house
• Vomiting

Health Complications Caused by AIHA in Dogs
AIHA can cause a host of other secondary health conditions. Eg: due to not having enough oxygen delivery to cells and organs, major organs such as the liver and kidneys will be adversely affected. In serious cases, it may cause organ failure.

The most common complication is thromboembolic disease (i.e. A blood clot formed in a blood vessel that breaks loose and being carried to plug another vessel). This may result in complications such as respiratory difficulty, or even sudden death.

Diagnosis of Autoimmune Haemolytic Anaemia in Dogs
If your vet suspects haemolytic anaemia in your dog, he will do diagnostic tests to confirm the diagnosis. These tests will include:
• a complete blood count (CBC)
• a serum biochemical profile
• a urinalysis He may also do some other tests to rule out cancer or infectious diseases.

Conventional Treatment of AIHA in Dogs
Being diagnosed with AIHA doesn’t mean the end of the world for a dog. AIHA is a treatable condition, but conventional treatment is aggressive and the dog may have to be hospitalised.

The main goals of treatment are:
• To control the destruction of red blood cells by the immune system: This is usually achieved by using immunosuppressive drugs, such as steroids (prednisone, dexamethasone). Initially, high doses of a combination of immunosuppressive drugs may be needed to stop the immune system from further attacking the red blood cells. Once improvement is seen, the dosage can be tapered off.
• To prevent blood clot formation: This is achieved by using thromboprophylactic drugs, such as aspirin and heparin.
• To treat anaemia: In serious cases, this is achieved by blood transfusion.

Additional medicines will also be given if the dog is suffering from other symptoms, such as vomiting or stomach issues.

Of course, if the dog’s AIHA is caused by an underlying health condition, the vet will also have to treat that condition.

Since haemolytic anaemia is a highly complex condition, treatment for each dog is slightly different depending on the dog’s symptoms and condition. Working closely with a knowledgeable vet is essential!

Natural Remedies To Help Dogs with Haemolytic Anaemia
Since strong medications (ie: steroids) have to be used to treat haemolytic anaemia in dogs, and since such medications come with a host of adverse side effects, you may want to use some natural remedies to help minimise the bad effects on your dog.

Liver Protection
To protect your dog’s liver, use the herb Milk Thistle. This is ‘the’ herb for liver support. It can boost liver functions and help protect the liver from damage due to toxins and excessive drug use. Also, cleanse your dog’s liver on a regular basis (sample of suggested diet below).

Stomach Protection
Steroids such as prednisone can also cause stomach issues (eg: ulcers) in dogs. To protect your dog’s stomach, the following herbs are helpful:
• Licorice Root: This herb stimulates cell growth, helps protect the stomach’s walls, and alleviates ulcers. (Dosage: 100-300 mg depending on the size of the dog, up to one week.)
• Slippery Elm: This herb soothes, lubricates and protects the stomach walls and digestive tract, and is ideal for treating ulcers. (Dosage: 1/2 teaspoon to 1 tablespoon depending on the size of the dog, 3 times a day. Use the powdered form of the herb and mix it with warm water until it forms a paste.)
• Aloe vera: The juice of this herb prevents nausea and help ulcers heal faster. Remember to get a drinkable aloe vera juice that contains only the inside of the leaf (inner fillet). Do NOT get one that is made from ‘whole leaf’ as the outer rind can cause diarrhoea.(Dosage: one-two teaspoons of the juice once a day can be added to the dog’s drinking water.)

AIHA Dog Diet
Meals for dogs with haemolytic anaemia should be given in small portions, and should be grain-free (no corn, soy, or wheat).

In addition, a diet rich in iron, vitamin B12, and protein is essential in helping the production of red blood cells.

Suitable foods include:
• Liver (iron, B-complex vitamins, protein);
• Green vegetables such as broccoli, green beans, kale, spinach (the chlorophyll in the veggies can help the body to produce healthier blood);
• Kelp (iodine and trace minerals). You can sprinkle kelp powder over your dog’s food daily. (Use 1/4 to 1 teaspoon daily, depending on your dog’s size.)

If your dog has no appetite, consider adding some human grade Bone Broth to the food to add more flavour (and nutrients).

If your anaemic dog suffers from bleeding, use Yunnan Baiyao, either topically or internally (depending on where the bleeding is). Yunnan Baiyao is a Chinese herb and it has been found to be very effective in stopping bleeding anywhere in the body.

Other Ways To Help Dogs with AIHA

Frequent Potty Breaks
One side effect of immunosuppressants (steroids such as prednisone) is increased thirst and excessive water intake. Therefore, be prepared to let your dog out for potty breaks more often.

It may be a good idea to get your dog an indoor toilet or some pee pads if you are not home during the day to let your dog out.

Stress-Free Lifestyle
Stress is one big trigger of autoimmune diseases such as AIHA. So try and let your dog live a stress-free life as much as possible. Avoid using chemicals and toxins on the dog and in the environment.

For example, use natural tick/flea remedies rather than chemical ones. Also try not to use chemical pesticides and insecticides around the house.

As much as possible, minimise the use of medications (especially antibiotics) on your dog to address minor health issues. Very often, natural alternatives can do the job in a safer way.

Also, avoid using chemical based household cleaning agents, detergents, fabric softeners, and synthetic air fresheners. Find or make natural alternatives instead.

Equally important is to pay attention to your dog’s emotional health. In particular, avoid putting stress on your dog by keeping a relatively regular and stable daily routine. Avoid boarding your dog at a kennel if at all possible.

Avoid Over-Vaccination
Although there is no “hard evidence” connecting vaccinations with AIHA in dogs directly, many holistic vets are of the opinion that over-vaccination is one big factor in autoimmune diseases such as haemolytic anaemia.

Some vets now suggest that future vaccination should be avoided if a dog is diagnosed with haemolytic anaemia. At the very least, do a titer test (detects the presence and measures the amount of antibodies within the blood) first before considering any booster shots.

Example of liver cleansing diet

• 3 cups sweet potatoes
• 3 cups pollack, cod or other low-fat white fish fillet

1. Peel the potatoes and cut them into 5cm pieces. Cook until soft.
2. Poach the fish in a frying pan with water until the fish is white and flaky.
3. Combine the potatoes with the fish and mix well.

Add a teaspoon of chopped fresh parsley and a pinch of turmeric to the food. These herbs not only are naturally detoxifying, but they also add flavour to the food. A win-win for dogs!

Statistics on AIHA in Dogs

Age at Diagnosis
47% of the dogs surveyed were diagnosed between 6- 8 years old; 40% were 5 years or younger and 14% were diagnosed at 9 years or older.

54% of the dogs diagnosed were female and spayed, while 28% were male and neutered. This correlates with study findings that AIHA is more prevalent among spayed female dogs.

Out of 100 dogs diagnosed, 40% had primary haemolytic anaemia with no known cause; 22% were the result of vaccines; 10% were caused by flea, tick, or heart-worm meds; 9% were due to pre-existing health or genetic conditions.

Statistics on Treatment
67% of the dogs treated required emergency blood transfusion therapy, while 31% needed other IV drugs.

For immunosuppressive treatment, 94% of the dog patients were treated primarily with Prednisone (or Prenisolone).

Famotidine (Pepcid) was used on 62% of the dogs as a stomach protector.
About 29% of the dogs received treatment for up to 3 months. Another 29% of the dogs received treatment between 3 and 6 months. About 21% of the dogs were treated between 10 and 12 months.