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   Molly passed away June 24, 2001 after a quick but hard and courageous fight with a terrible disease.  Molly had been diagnosed with Autoimmune Hemolytic Anemia (AIHA) less than 48 hours before she was put to sleep. In her final hour, Molly let it be known in her own way that the fight was over. This disease was to take her life.

What is AIHA?    

AIHA is a disorder in which the survival of red blood cells is shortened because the dog's immune system targets and destroys its own red blood cells. This type of immune dysfunction in which the host develops a reaction to and damages its own tissues is termed autoimmunity . In most cases, the dog's body will attempt to compensate for red blood cell loss by increasing production of new red blood cells. However, if red blood cell loss proceeds at a rate faster than the rate of replenishment, a condition of life-threatening anemia will develop.

What causes AIHA?   

 The exact mechanisms which trigger the dog's immune system to attack and destroy its own red blood cells are unknown, however, the disease process is believed to occur when antibodies coat the surface of the red blood cells tagging them for destruction by the white blood cells. When the body is invaded by an infectious microorganism or agent, the body produces a number of antibodies that range in specificity for that particular invading antigen. Some of the antibodies are highly specific, however, others will bind with less specificity. In the normal immune system, suppressor T-cells ensure that these non-specific antibodies do not react with normal host tissues. However, it is believed that some dogs may have poorly regulated T-cell suppression that allows these non-specific antibodies to attack their own cells. Such a genetic predisposition for AIHA has been suspected in several breeds of dogs including Old English Sheep Dogs, Cocker Spaniels, Poodles, Lhasa Apsos and Shih Tzus.

What are the symptoms of AIHA?  

  Symptoms of AIHA depend on the severity of the underlying autoimmune reaction which is influenced by the level of autoantibodies directed at destroying the red blood cells as well as the efficiency of the white blood cells to target the red blood cells and the ability of the bone marrow to replenish circulating red blood cells. In cases of acute hemolytic anemia, the dog may experience fever, depression, weakness, fatigability , and pallor of the mucus membranes. In some cases, the spleen may be noticeably enlarged.

What is the treatment for AIHA?  

  The most frequent course of therapy for AIHA is the administration of high doses of corticosteroids such as prednisone, which have a pronounced anti-inflammatory and immunosupressive action that impairs functions of various components of the immune system. Once the disease is in remission, low dose, intermittent therapy is continued for several months. Some dogs, however, do not respond to corticosteroid treatment and require more potent immunosuppressive drugs that are often combined with corticosteroid treatment. Such drugs include cytotoxic agents such as azathioprine and cyclophosphamide. Other therapies which have been indicated in the treatment of AIHA because of their ability to mediate immune response include Danazol, which in addition to its immunosuppressive characteristics, is incorporated into and stabilizes the red blood cells making them more resistant to destruction, intravenous gamma globulin, and cyclosporine.

What is the prognosis for AIHA?  

  The clinical course of AIHA can range from mild and in some cases even subclinical, to severe and fatal. Fatality is most often associated with severe and rapid red blood cell destruction. Fatalities, however, may also occur as a result of secondary complications. For example, breakdown of red blood cells releases coagulants into the blood circulation that may result in pulmonary blood clots. Additionally, fragments of destroyed red blood cells are believed to produce kidney damage that may lead to kidney failure. Dogs experiencing life-threatening hemolysis and requiring transfusion are at higher risk to developing these secondary complications and therefore, are considered to have a poor prognosis for recovery.

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