Immune Mediated Hemolytic Anemia (IMHA)

Immune Mediated Hemolytic Anemia Holistic Protocol for Dogs and Cats has been developed by a certified Master Herbalist and certified Canine Nutritionist with The Pet Health and Nutrition Center. Our IMHA Protocol is the finest coordination of science and research-based recommendations that include diet, supplementation and herbal remedies to help support your dog or cat with immune mediated hemolytic anemia. Everyone here at The Pet Health and Nutrition Center truly cares and wants to help your pet get better.

1. What is IMHA in Dogs and Cats?

Anemia in your canine or feline is a term used to describe a number of different disease conditions caused by an inability of the blood to carry sufficient oxygen to cells. This can be caused by too few red blood cells or a deficiency of hemoglobin.

Hemolytic anemias are conditions in which red blood cells (RBCs) are destroyed at an accelerated rate and a normal regenerative response is seen in the bone marrow. This means that normal blood cell production is occurring and there is some causative action for the destruction of the red blood cells.

Immune-mediated hemolytic anemia (IMHA) or Autoimmune hemolytic anemia, is a complex disease in which hemolysis, the rupturing of erythrocytes (red blood cells), occurs because of erythrocyte antibody production. This is an autoimmune reaction in which your dog or cat's white blood cells attack their own tissue.

Other anemia conditions can be caused by the destruction of red blood cells or problems with the red pigment called hemoglobin contained within RBCs. These other causes of anemia include zinc or copper toxicity (common in dogs because high zinc concentrations can be found in pennies minted since 1983, board game pieces, zippers, zinc oxide ointment, and various other sources they can easily ingest); Heinz body anemia that can result from ingested onions, certain drugs or vitamin K3; hypophosphatemia which is an electrolyte disturbance in which there is an abnormally low level of phosphate in the blood; hemorrhagic anemia caused by bleeding ulcers; or iron deficiency anemia. Thus, it is imperative to investigate what the underlying cause of the anemia in your dog or cat using the proper diagnostic tests before assuming it is immune-mediated hemolytic anemia.

Some Terms Related to IMHA with which You May Wish to Become Familiar:

Autoimmune Disease - Occurs when the body’s immune system mistakenly attacks its own normal cells.

Complete Blood Count (CBC) - Measures the volume of three types of blood cells: red blood cells which carry oxygen, white blood cells that help with immune function, and platelets that help clot the blood.

White blood cell (WBC) count - Also known as leukocytes, white blood cells are a major component of the body’s immune system and typically are high in a pet with IMHA.

Red blood cell (RBC) count - Also known as erythrocytes, red blood cells distribute oxygen to tissue throughout the body and will be low in a pet with IMHA.

Hematocrit (Hct) Test - Tests what proportion of the blood is made up of RBCs and typically are low in a pet with IMHA.

Platelet count - Measures the amount of platelets which are small cells that help the blood to clot. Platelet count may be normal, but it is very common to see platelet destruction in IMHA called thrombocytopenia. Thrombi may form due to platelet aggregation as a complication of IMHA.

Bilirubin test - A yellowish pigment that is made during the breakdown of red blood cells. Depending on the severity of disease this may be high in an animal with IMHA.

Reticulocytes - Are immature red blood cells and typically are high in regenerative IMHA and low in non-regenerative IMHA.

Regenerative Anemia - Bone marrow responds appropriately by increasing production of new red blood cells.

Non-Regenerative Anemia - Bone marrow is unable to produce sufficient new red blood cells. Acute cases may initially be diagnosed as non-regenerative as the body’s regenerative response takes approximately 3 to 5 days to occur.

Agglutination - High levels of RBC autoantibodies can result is red blood cells clumping together called auto-agglutination and can support an IMHA diagnosis.

2. Causes and Symptoms of IMHA in Dogs and Cats

What are the Causes of IMHA in Dogs and Cats?

There are two forms of immune-mediated hemolytic anemia in canines and felines: primary (or idiopathic), and secondary IMHA. With primary IMHA, your pet's immune system mistakenly produces antibodies that attack its own red blood cells. Any breed can be affected with primary IMHA, but in certain dog breeds such as cocker spaniels, poodles, Irish setters, and old English sheepdogs, it seems to be more common.

With secondary IMHA, the surface of your animal’s red blood cells are modified by an underlying disease process, drug, or toxin. Your dog's immune system identifies the modified red blood cells as something foreign and destroys them. When too many red blood cells are destroyed and not replaced quickly enough by bone marrow, the patient becomes anemic. Secondary IMHA can be triggered by a variety of events that a dog or cat may experience, but exposure to a recent vaccination or flea and tick product seem to be a very common association in our experience. Others causes of IMHA in our pets include:

• Cancer
• Chronic infections such as pyometra, abscesses, urinary tract infections and discospondylitis
• Blood parasites
• Drug reactions (flea and tick products)
• Exposure to certain chemicals and toxins (Vaccinations)
• Bee stings or other allergic reactions
• Ehrlichia and Dirofilaria species or the hemoprotozoan Babesia gibsoni have also been associated with anemia in dogs

Below is a graphic showing what hemolysis looks like as it destroys a red blood cell. When red blood cells are destroyed in this manner by an autoimmune condition, as in IMHA, it is called extrinsic hemolytic anemia.

Symptoms of IMHA in Canines and Felines

• Pale gums
• Acting tired, weak, or listless
• Shallow or rapid breathing
• Faster than normal pulse
• Lack of appetite
• Weight loss
• Black/Tarry stools
• Eating dirt

3. Standard Veterinary Medicine Treatment for IMHA in Dogs and Cats

The first line of treatment for dogs and cats diagnosed with IMHA is immunosuppressive corticosteroids. The addition of secondary and tertiary immunosuppressants, such as cytotoxic drugs, may be indicated when pet patients present with severe IMHA (very low hematocrits, severe autoagglutination, intravascular hemolysis, or thrombocytopenia), when glucocorticoids do not adequately control the destruction of your animal's red blood cells, or when the side effects of glucocorticoids become unacceptable. The use of multiple cytotoxic drugs in combination requires careful monitoring, however, as there is a risk of severe immunosuppression and the subsequent danger of infection in your canine or feline.

Corticosteroids are glucocorticoids thought to prevent destruction of RBCs by decreasing the clearance of antibody-coated RBCs by macrophages, reducing the amount of antibody binding and complement activation on RBCs, and, in the long-term, minimizing autoantibody production. Side effects of this drug therapy include polyuria, polydipsia, polyphagia, increased panting, gastrointestinal ulceration, and increased susceptibility to infection.

Various immunosuppressant drugs that work by decreasing the activity of your dog or cat's immune system so it will not attack its own tissue. These have numerous side effects including the possibility of serious infection and may increase your pet's risk of developing certain types of cancer, especially skin cancer and lymphoma. Some can cause severe bone marrow and hepatic toxicosis in cats. Certain of these immunosuppressant drugs have showed no benefit in studies yet are commonly used by the veterinarian community for both canines and felines!

If the above do not work for an animal's IMHA disease and they too often do not, your dog or cat will be subject to repeated blood transfusions which is an attempt by the veterinarian to increase the concentration of red blood cells. This can be life saving and we are not against this procedure. However, we know of animals that have received six transfusions that did not save their lives.

It is our experience that an animal with immune-mediated hemolytic anemia goes to the vet and gets diagnosed because they are very sick. They receive a blood transfusion and begin immunosuppressant therapy. It is our experience that few animals survive this therapy on its own, but we see much more success when used in conjunction with our holistic IMHA protocol.

We have a client that has a very young dog that survived IMHA using our protocol and weaning off the immunosuppressant drugs as the dog improved (please wean off medications under veterinary supervision). She met a woman very sad at the recent loss of her dog from IMHA after expensive veterinary treatment and six blood transfusions! As they talked she discovered that the two dogs were from the same breeder. Her dog survived using our protocol and the other unfortunately did not by following the standard veterinarian course exclusively that seldom works but vets keep doing it over and over and over...

And when treatment with immunosuppressant drugs doesn't seem to be working for a dog or cat, increasing the dosage or switching to another dangerous drug is seldom the answer. The sad thing is that many of these vets truly feel there is nothing more they could have done. This is very sad for all their future clients that come into their office hoping for them to save their beloved canine or feline family member. Because more times than not (up to 80% of the time), it is just not going to happen and that animal is going to succumb to IMHA without proper supplementation.

What is the canine autoimmune hemolytic anemia survival rate?

Figures that we have seen indicate that when only the typical veterinary treatments for IMHA are used the survival rates for dogs and cats is in the area of only 20%! This is very sad and is primarily because vets follow the same regimen over and over again even though they see little success. When our holistic protocol is followed the survival rate for canines and cats increases to in the area of 80%!

You may wonder why this is and why more veterinarians don't use a similar protocol to ours. The primary reason for this is because veterinary training is in allopathic medicine which is the use of pharmaceutical drugs to combat symptoms. Many don't believe in holistic alternative therapies. In the case of IMHA, medications alone are just not going to be enough in most cases and the body is going to need some help to rebuild and maintain blood cells and enough oxygenation. Even when approached by our clients with the improvement being seen in their pets after following our protocol the majority of vets just don't believe it and again, this is very sad.

4. Holistic IMHA Protocol for Dogs and Cats

The goal of our Holistic Immune-Mediated Hemolytic Anemia Protocol is to promote the natural creation of new red blood cells and improve their oxygen carrying capacity to initially save your dog or cat's life.* After the initial acute IMHA therapy we continue to provide the proper supplementation to strengthen your entire canine or feline so their body will have the strength to rebalance their own immune system and continue to create healthy amounts of red blood cells to become an IMHA survivor. In addition, in a holistic fashion, we want to educate you and help you to recognize, and then remove, any contributing factors whether these are in your pet's diet, environment or occur during veterinary visits. We do not necessarily know the root cause(s) of the anemic condition in your particular animal, but we do know from our research and experience the primary culprits.

In the case of IMHA, pharmaceutical drugs, and possibly even a blood transfusion, are often part of a holistic protocol for your canine or feline to regain their health especially at the beginning. Even though immune suppressing drugs are used immediately at the diagnosis of IMHA, animals that continue to get better are the ones that are weaned off of the medications as soon as is safe when your dog or cat begins to stabilize and improve. If medications can be reduced when using our protocol this must be done in conjunction with your veterinarian so your animal can be properly monitored.

What can I expect for my dog or cat with IMHA?

1). When using our holistic IMHA protocol you can expect a better chance of survival compared to using standard veterinary medicine on its own. This is because our protocol provides the nutrition a dog or cat's body needs to create new red blood cells while increasing the oxygen-carrying capacity of existing red blood cells. This alone can be the difference between life and death for your canine or feline. Modern veterinary medicine uses drugs to suppress immune activity, nothing more - your dog or cat needs more to increase their chance of survival!

2). Initially your dog or cat's RCB count may show a decline when compared with the previous blood test. This can depend on when the last test was done and when you started our protocol - so don't be disheartened and continue to provide our IMHA supplements to your animal. If you speak with us we may recommend increasing the frequency/dosage of some supplements.

3). We wish we could make more promises beyond this. But the truth is your animal could still not make it. Your animal's survival depends on factors outside of our control such as their overall vitality, genetics and the effort you put into providing the supplements to your canine or feline companion as recommended. Some clients are extremely dedicated, some more lackadaisical - but IMHA should be taken very seriously!

What is IMHA recovery time for dogs and cats?

Recovery time varies greatly from animal to animal, so it is hard to provide an answer to this question. Some canines and felines respond quickly and in a matter of days we are seeing progress and they are on the road to recovery. Other pets need a blood transfusion or three and their recuperation can take weeks to months. However, we can say in the majority of IMHA cases when our holistic protocol is included in your animal's treatment regimen they will be more comfortable and often appear completely healthy even though their red blood cell count is still low. This is because of the support our supplements offer to improve the health of existing red blood cells and their oxygen carrying capacity.

Core Recommendations Suggested products are included in the Core IMHA Package found below.

Our "Core Recommendations" form the backbone of our Holistic Immune-Mediated Hemolytic Anemia Protocol for dogs and cats. They consist of the supplement recommendations we feel are the most important to provide to your canine or feline companion for this condition. Supplements for IMHA are displayed individually or as a package at the bottom of this page along with other helpful remedies for your canine or felines IMHA therapy from which you may make additional selections.

A complimentary IMHA Help Sheet is included with every core IMHA package purchase. If you require more direction please feel free to use our Email Consultation Form.

  Core Recommendation #1 - BioPreparation

This special blend of four unique algae was developed by a Russian Scientist, Dr. Michael Kiriac after decades of research. It is grown in controlled hydroponic conditions so it is the purest microalgae supplement on the planet. Its thousand of nutrients are so bioavailable they do not have to be digested, they easily pass through the digestive tract and feed cells on a cellular level - very important and beneficial for dogs and cats with anemia. We have had outstanding success with this supplements for our clients with IMHA so it is highly recommended. Select the F3+ Forte for this condition.

Please Note: It has been brought to our attention that there is an IMHA chat-room/group in which some members caution against using BioPreparation. This is because they believe it stimulates the immune system which, of course, is not recommended in the case of autoimmune disorders. Let us make clear that BioPreparation does not stimulate a dog or cat's immune system. It is a blend of microalgae that feeds cells on a cellular level and improves the function of the hypothalamus. This has amazing benefits and acts to strengthen the entire body including the immune system. But this action works as an immunomodulator, which means it helps to bring the body, and immune system, back into balance. People that post to groups may have good intentions but we are the experts and our knowledge and experience lead us to highly recommend this product for those animals with IMHA.

  Core Recommendation #2 - Daily Multi Plus

Our Daily Multi Plus is formulated with organic, whole foods that are extremely important to an animal's nutritional needs but are often missing from the majority of canine and feline diets. This special formula provides the enzymes, probiotics, prebiotics, glandulars, vitamins, minerals, antioxidants and phytonutrients that are so beneficial to the body's daily maintenance and repair needs for healthy aging. In this formula you will find the vitamins, minerals and antioxidants recommended by the veterinarian community for immune-mediated hemolytic anemia - only in an organic, whole food form!

 Core Recommendation #3 - Immune Balance

This herbal remedy has been formulated by a certified Master Herbalist with organic herbs that have a long history of benefiting those with autoimmune conditions. In addition, a new study has provided yet more hope for dogs and cats with conditions like IMHA because research indicated that a constituent in hydrangea root, called halofuginone, interfered with the progression of autoimmune disease. This formula will help to reduce inflammation and modulate the immune system to support your canine or feline with immune-mediated hemolytic anemia.

  Core Recommendation #4 - ChlorOxygen

This is a very concentrated source of chlorophyll for the dog or cat suffering with IMHA. Chlorophyll is related to a compound in blood and can help the animal suffering with anemia produce more oxygenated red blood cells. We feel this product can be a life-saver and makes an amazing holistic therapy for those canines and felines suffering with immune-mediated hemolytic anemia.

Highly Recommended Products

  Whole Food Nutrition

With a autoimmune condition like IMHA in which red blood cells are being destroyed we feel it is beneficial to feed small, nutritious, frequent meals. This is because a dog and cat's digestion requires an awful lot of energy from the body, diverting the body's blood flow to the digestive system. This can be counter-productive in cases of anemia for obvious reasons - blood is in short supply! So feed three to five small meals throughout the day. A whole food diet is important always for canines and felines, but especially at this critical time because kibble diets are harder for an animal to digest and this is the last thing your pet needs to expend energy on when suffering with immune-mediated hemolytic anemia.

Probably the best food for an animal with anemia is calf liver (approx. 1 oz per 25 lbs). This food is a natural source of iron, B12 and folic acid, all of which are important nutrients for those with anemia. In addition, liquefy and feed a mix of organic, green leafy vegetables (not iceberg lettuce) which are naturally high in soluble chlorophyll. The chlorophyll molecule is similar to the hemoglobin molecule and can greatly benefit dogs and cats with anemia. You can also mix in some free-range eggs (higher in beneficial nutrients than standard supermarket brands) and other types of meat or whole foods your animal likes.

If you decide to make a homemade diet for your canine or feline please research the proper way to do this and make sure to add a calcium source. For more information read our article How to Feed Your Dog or How to Feed Your Cat that can be found in our Education section.

  Colostrum

The proline-rich polypeptides found in colostrum have been shown in studies to regulate immune response by inhibiting the over-production of T-cells, the white blood cells largely responsible for the autoimmune response in dogs and cats. Lab tests of PRP's have demonstrated their ability to stop the progress of overly aggressive immune responses associated with autoimmune conditions like IMHA, making colostrum a wonderful addition to a holistic protocol.

  Liver Glandular

Earlier we indicated the benefit of eating liver for a dog or cat with anemia. Here we have some freeze-dried, New Zealand liver glandular with all the nutrients of liver in an easy to feed capsule that can greatly benefit a canine or feline with immune-mediated hemolytic anemia.

Vaccinations and Toxins

Vaccinations and/or toxins from topical flea and tick products, household cleaners and lawn chemicals may have caused or contributed to your animal's IMHA. Vaccinations should be avoided for those dogs and cats with IMHA and you should be able to get an exemption for the rabies vaccination with a letter from your vet (read our article: Are You Over Vaccinating Your Dog or Cat). Topical pesticide products would be a big 'no' for your animal and you should eliminate their exposure to household and lawn chemicals for the good of their long-term health. An effective holistic regimen for immune-mediated hemolytic anemia includes controlling what your animal is exposed to in their environment and during veterinary visits.

References

Hoffman, D. (2003). Medical herbalism: The science and practice of herbal medicine. Rochester, VT: Healing Arts Press.

Murray, M. T., & Pizzorno, J. E. (1998). Encyclopedia of natural medicine (2nd ed.). New York, NY: Three Rivers Press.

Pitcairn R. H., & Hubble-Pitcairn S. (1995). Dr. Pitcairn’s complete guide to natural health for dogs & cats. Emmaus, PA: Rodale Press, Inc.

Pitchford, P. (2002). Healing with whole foods: Asian traditions and modern nutrition (3rd ed.). Berkeley, CA: North Atlantic Books.

Puotinen, CJ. (2000). The encyclopedia of natural pet care (2nd ed.). Los Angeles, CA: Keats Publishing.

Tilford, G. L., & Wulff, M. L. (2009). Herbs for pets: The natural way to enhance your pet’s life. (2nd ed.). Irvine, CA: BowTie Press.

Thibodeau, G.A., & Patton, K.T. (2008). Structure & function of the body. St. Louis, MO: Mosby.

5. Natural Remedies for Dogs and Cats with IMHA