Emeryville Animal Hospital

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106 EmeryDr., Emeryville, ON N0R 1C0
(519) 727 -3304 Fax: (519) 727-3125

Purple Heart

        Indy, a 9 year old female, spayed Shih Tzu presented to the Emeryville Animal Hospital this summer with a 24 hour history of decreased appetite and an episode of vomiting. Indy's owners also noted that she was less active and was exposed to lawn fertilizer the week before. Dr. Donatelli performed a thorough exam which revealed light pink mucus membranes in the mouth and a tense abdomen. Dr. Donatelli ordered a full organ function panel as well as a Complete Blood Count (CBC). The biochemistry panel revealed a mild increase in two liver enzymes and the CBC at that time was within normal limits. Possible rule-outs were gasto-enteritis (inflammation of the gastro-intestinal tract), a possible toxin exposure (lawn fertilizer), or cholangiohepatitis (inflammation of the gallbladder and liver). Outpatient treatment consisted of subcutaneous fluids to help prevent dehydration, an antibiotic, and a bland diet called Low Residue to be fed in small, frequent amounts.
        A few days later, Indy presented to the hospital again. Only this time, she was much more ill. Indy was not eating or drinking, and having episodes of fainting, weakness and increased lethargy. On physical exam Indy was dehydrated and her gums were pale and dry to the touch. A repeat CBC was ordered which revealed a Packed Cell Volume (PCV) of 26%. The PCV measures the amount of red blood cells (RBC) circulating in the body. Normal values for an adult dog are in the range of 37 - 55%. Indy's low value indicated an anemia. Dr. Donatelli was now faced with trying to determine why Indy was anemic. An abdominal ultrasound was performed to rule out blood loss due to intra-abdominal bleeding. Fortunately, no fluid was detected in the abdominal cavity, the organs appeared to look normal, and no masses were found. Based on the clinical signs, physical exam and test results, which included analyzing the red blood cell morphology under a microscope. Dr. Donatelli made a diagnosis of Immune Mediated Hemolytic Anemia (IMHA).
        IMHA is a life threatening disease where the body's immune system perceives its own RBC as foreign invaders and therefore attacks and destroys them. Without prompt diagnosis and treatment a fatal anemia will develop. There are numerous causes of IMHA, such as certain toxins and drugs, virus, cancers, etc. However, often the cause is idiopathic, meaning the cause is unknown.
        After the diagnosis was made, treatment was immediately initiated. Indy was placed on medications to inhibit further RBC destruction by suppressing her immune system. She was also started on gastric protectants which coat and soothe the gastro-intestinal system.
        Indy's PCV was closely monitored, being taken daily until she reached normal levels. It did drop to 16% at one point, but once the medications started to work, it gradually increased daily.
We are pleased to report that because of the patience and loving care her " pet parents" have given to her, Indy has stabilized and is doing well at home. Her PCV has returned to normal, and as a result, Dr. Donatelli is gradually decreasing the daily dosages of her immune-suppressive drugs with the hopes of weaning her totally off in the future.
Congratulations Indy on being such a brave little trooper throughout your illness!!

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