Veterinary Guide to Canine IMHA 2025 🩺🐶

By Dr. Duncan Houston BVSc

🧬 What Is IMHA?

Immune-Mediated Hemolytic Anemia (IMHA) occurs when a dog’s immune system attacks its own red blood cells (RBCs), leading to severe anemia, poor oxygenation, and potentially organ damage—making it a life-threatening emergency.

👥 Primary vs Secondary IMHA

• Primary (idiopathic): ~75% of cases, no underlying trigger found.
• Secondary: occurs secondary to infection (Babesia, Ehrlichia, etc.), neoplasia, drugs (NSAIDs, penicillin, vaccines), toxins, or inflammatory diseases.

👀 Common Signs & Presentation

• Lethargy, exercise intolerance, weakness, and collapse.
• Pale or jaundiced gums due to hemolysis.
• Increased heart and respiratory rates; breathlessness.
• Dark urine from hemoglobinuria; vomiting and anorexia.
• Splenomegaly or hepatomegaly may be present
• Acute collapse/jaundice in intravascular hemolysis cases.

⚙️ Pathophysiology

Antibodies (and sometimes complement) target RBCs, which are destroyed in the spleen/liver (extravascular) or directly within blood vessels (intravascular), releasing hemoglobin into the bloodstream. Lab findings include spherocytosis, autoagglutination, and polychromasia due to bone marrow regeneration.

🔬 Diagnostic Workflow

1. Physical exam: pale/jaundiced mucous membranes, tachycardia, respiratory distress.
2. CBC: regenerative anemia (low PCV/HCT, high reticulocytes), spherocytes, autoagglutination.
3. Coombs test or slide agglutination: confirms immune-mediated RBC destruction.
4. Chemistry + urinalysis: evaluate organ function and detect hemoglobinuria.
5. Imaging and infectious disease screening: chest/abdomen imaging and tests for Babesia, Ehrlichia, etc. to detect secondary causes.

🛠️ Treatment Strategies

🏥 Hospitalization & Supportive Care

• Blood transfusion: to stabilize anemia and oxygen levels.
• IV fluids: support circulation and prevent kidney injury.
• Oxygen therapy: if respiratory distress is present.

💊 Immunosuppression & Adjunctive Drugs

• High-dose corticosteroids (prednisone/prednisolone) – cornerstone therapy.
• Second-line agents: azathioprine, cyclosporine, mycophenolate to reduce steroid dependence.
• Anticoagulation: clopidogrel or aspirin to reduce the risk of thromboembolism.
• Address secondary causes: antibiotics for infections, chemo for neoplasia.

🩺 Monitoring Progress

• Daily PCV checks during the acute phase; adjust meds accordingly.
• Monitor for transfusion reactions, infections, and steroid side effects.
• Periodic ultrasound/X-rays and infectious disease testing if underlying causes are identified.

📈 Prognosis & Long-Term Outlook

• Short-term mortality ranges from ~26% to 70%, often due to anemia or thromboembolic events.
• Factors linked to poorer prognosis: thrombocytopenia, high bilirubin, and renal dysfunction.
• Long-term survival (beyond 3 months) possible: 2664 days reported for non-associative cases.
• Relapse rates ~7–15%; lifelong monitoring often necessary.

🏥 At‑Home & Ongoing Care

• Gradual tapering of immunosuppressives and transfusion support as directed.
• Regular CBC/PCV checks: weekly → monthly → quarterly.
• Continue anticoagulation to prevent clots, if advised.
• Watch for relapse: pale gums, lethargy, dark urine—seek vet promptly.

📱 Ask A Vet Telehealth Integration

• Remote vet video evaluations: owners show gum color, behavior, and breathing.
• Lab reminders: App alerts for blood tests and rechecks.
• Medication scheduling: Helps track steroids and immunosuppressives.

🎓 Case Spotlight: “Ruby” the Cocker Spaniel

Ruby, a 5-year-old Cocker Spaniel, presented with pale gums, lethargy, tachycardia, and dark urine. CBC showed HCT 15%, spherocytes, and positive Coombs. She received two transfusions, high-dose steroids plus mycophenolate, and clopidogrel. After 10 days in the hospital, she returned home on tapering meds. One month later, her PCV was normal, and she transitioned to maintenance therapy. With Ask A Vet’s lab reminders and medication scheduling, Ruby remains in remission 18 months later 🐕❤️.

🔚 Key Takeaways

1. IMHA is a medical emergency—early recognition and stabilization save lives.
2. Primary (idiopathic) and secondary causes both occur—investigate thoroughly.
3. Multimodal therapy: transfusions, immunosuppression, and anticoagulation are essential.
4. Mortality is high early on; long-term survival is achievable with support and monitoring.
5. Ask A Vet provides comprehensive telehealth support from the acute phase through long-term management. 🐾

Dr Duncan Houston BVSc, founder of Ask A Vet. Download the Ask A Vet app today for remote guidance and support through your dog’s IMHA journey—from triage to treatment, monitoring, and prevention. 🐶📲