I is for ITP and IMHA
I is for ITP or Immune-mediated Thrombocytopenia (also known as IMT), a disease that causes excessive bleeding and bruising. I is also for IMHA or Immune-mediated Hemolytic Anemia, a disease that causes destruction of red blood cells which decreases oxygenation of the body. I am going to focus on dogs for this post, although it can be found in other animals and humans. Check out Mayo Clinic for more human information!
The problem with ITP and IMHA is basically that the body attacks platelets and red blood cells and destroys them. Platelets are required for clotting, so when you don’t have them, you can’t clot, therefore, you bleed. Red blood cells are required to carry oxygen throughout the body so that you don’t die from cellular suffocation (ok, a little dramatic, but true). In dogs, the diseases are most common in Cocker Spaniels, Old English Sheep Dogs, and Poodles, although any animal can develop these conditions. There appears to be a hereditary component, so animals that develop ITP or IMHA should not be bred. Animals that have relatives that have one or both of the conditions should be monitored closely for evidence of the diseases. The underlying cause of ITP and IMHA have not been proven, although anything that stimulates the immune system could potentially cause an ITP or IMHA crisis – illness, vaccination, or anything that stresses the immune system. (This does not mean that you should not vaccinate your pet – please discuss any concerns you may have with your veterinarian)
The story I am about to share, is from a patient of mine a number of years ago while at my last clinic of employment, Memorial Drive Veterinary Clinic, I have since begun work at Mishicot Veterinary Clinic. Chloe is a Cocker Spaniel and this is her story (shared by her humans):
Chloe’s story began in October 2012. She had received her rabies vaccine and her humans, Jay and Deb, thought nothing more of it. In less than a month, she went from being an outwardly healthy and active dog to being so weak that Jay had to pick her up because she could not walk. It seemed to happen overnight. She was not eating much and stopped jumping on the love seat and the bed. She loved looking out the front window (people and dog watching), but couldn’t jump up to do it.
It was a Sunday night and she had gotten so weak over the weekend, that Jay had to actually pick her up to put her into the kennel. That was the point that they decided to call the veterinary clinic. Dr. Melanie (that’s me!) was on call and asked different questions. One of the questions was, “What color are her gums?” The answer was, “Very pale. Grey in color.” Dr. Melanie told me to bring her in. Deb just could not go because she thought this was the end and losing Chloe would be so hard. Jay came home after several hours, with no Chloe.
Chloe had a disease called ITP (and IMHA). her blood was like watered down Kool-aid, and her hematocrit was 12% (this is a measurement of red blood cells compared to fluid in the blood, anything under 37% is low – generally under 14% a blood transfusion is needed). She would bleed with little instigation. Jay had a choice to make, either put her on steroids and hope that it would help bring her numbers back up or put her down (euthanasia). It was a hard decision to make, but he decided to try the steroids.
It took several days at Memorial Drive Veterinary Clinic, and then several more days at Lakeshore Veterinary Specialists, a 24 hour emergency/specialist hospital in Port Washington, WI, before she was able to come home. She got poked and prodded (which she did not like). She was on steroids and azathioprine from November 2012 until the beginning of 2014. She started at 3/4 tablet twice a day and was weaned down to 1/2 tablet every third day. Side effects of the steroids made her want to eat constantly and she put on a lot of weight – she got up to 46 pounds. Her hair coat had gotten patchy as well. As she was weaned off of the medication, her hair started to grow in more normally, she ate less, and started to lose that weight.
Today, she is off all medications and is jumping back on the bed and watching people walk by while lying on the top of the love seat. her appetite is good and she sometimes gallops like a horse. She will be nine years old at the end of April, and we are both so glad that we had the chance to spend more time with her.
As my dad used to say, “She is the best dog you ever had.” – Jay and Deb Ney
Chloe’s situation is rare and common all at once. ITP and IMHA are common enough that we see the diseases (with and without vaccinations), but they are not something that the average clinic sees on a regular basis. It is also rare (at least in my experience), that people put in the time, money, and effort into turning around a complicated medical case. For over a year, Jay and Deb medicated and did recheck testing to monitor Chloe’s response to treatment. Chloe would get snippy, she was tired of the poking and prodding. Yet, given time and dedication to healing, she made it through amazingly well.
That being said, it is a large financial, emotional, and time commitment to treat ITP and IMHA, they can also recur, so remember that a decision to euthanize in the face of these diseases is not necessarily the wrong decision. Your veterinarian will help you determine if this is something you can do, but ultimately, it is your decision. I pray that you never need to go through this with your pet, but if you do, know that you are not alone!