Immune Mediated Hemolytic Anemia (IMHA) treatment options, recommended remedies and helpful information for dogs and cats with IMHA. This material and the holistic protocol that follows have been provided by certified Master Herbalist Philip Reich and certified Canine Nutritionist Maria Reich. Philip and Maria specialize in medical herbalism and nutrition for animals with conditions like IMHA. They approach this situation in a holistic manner with the main priority being the health and safety of your animal.
We deal with problems like IMHA frequently with numerous clients from all over the country. Our experience with issues like this has helped us become one of the few places people can go for answers to help solve tough issues with their dogs and cats. We have helped hundreds of animals just like yours - it is what we do! See what others have to say about us by reading some of The Pet Health and Nutrition Center Testimonials. Feel free to contact us by email if you have any questions or just use our toll free number 888-683-3339 during normal business hours. We provide free telephone consultations and are here to help!
l. What is IMHA?
Anemia 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 blod 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 the body's own white blood cells attack its 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 or drugs such as methylene blue, dl-methionine, 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 your animal's anemia is using the proper diagnostic tests before assuming it is immune-mediated hemolytic anemia.
Symptoms of anemia include:
ll. Causes of IMHA
There are two forms of IMHA: 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 conditions, exposure to a recent vaccination seems to be a very common association in our experience, but others include:
lll. Standard Veterinary Medicine Approach
The first line of treatment in IMHA is immunosuppressive corticosteroids. The addition of secondary and tertiary immunosuppressants, such as cytotoxic drugs, may be indicated when 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 danger of infection.
Corticosteroids include dexamethasone and prednisone or prednisolone 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 include polyuria, polydipsia, polyphagia, increased panting, gastrointestinal ulceration, and increased susceptibility to infection.
Azathioprine is an immunosuppressant drug that works by works by decreasing the activity of the body's immune system so it will not attack its own tissue. It has 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. Azathioprine can cause severe bone marrow and hepatic toxicosis in cats and is not recommended.
Cyclosporine is a potent T-cell suppressor that blocks production of immune activating factors in both T-helper cells and T-cytotoxic cells resulting in a reduction of cell-mediated immunity and antibody production. Side effects include gastrointestinal upset, gingival hyperplasia (can regress with dose tapering), increased susceptibility to infection and lethargy. The one retrospective study that investigated cyclosporine showed no benefit compared with other drug protocols. However, it seems to be one of the more commonly used drugs - go figure!
Cyclophosphamide is an alkylating agent that suppresses the immune system. Side effects include gastrointestinal upset, myelosuppression, and hemorrhagic cystitis. Because of the severity of some of these signs, cyclophosphamide is not widely used in the long-term treatment of IMHA. Instead, it is commonly used in early treatment of severe refractory IMHA. Cyclophosphamide has fallen out of favor since a randomized, controlled, prospective clinical trial published in 2003 showed no improved recovery or survival times in patients treated with cyclophosphamide and prednisone vs. prednisone alone. Many other studies have also documented decreased survival in patients treated with cyclophosphamide. Wonder how many animals died before they admitted this?
If the above do not work 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 IMHA 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, and those that do survive it live in spite of the therapy not because of it!
We have a client that has a very young dog that survived IMHA using our protocol and weaning off the immunosuppressant drugs. 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 on our protocol and the other unfortunately did not by following the standard veterinarian course that seldom works but vets keep doing it over and over and over...
One thing that stands out when I read comments on a forum, and I haven't read every one (I am sure there must be some success stories), is that in every single post I have read so far the person's dog has died from IMHA after extensive veterinary treatment with the vet finally saying: "I'm sorry there is nothing more we can do...". This is strange, but to this date all of my clients that have followed my protocol have survived up to this point! This is of course no miracle cure or guarantee as all animals are individuals. What I am trying to say is that there is something more the vet could have done - they just didn't do it.
And when treatment with immunosuppressant drugs doesn't seem to be working, increasing the dosage or switching to another dangerous drug is not the answer. The sad thing is that many of these vets truly feel there is nothing more they could have done and that is very sad for all their future clients that come into their office hoping for them to save their beloved family member. Because more times than not, it is just not going to happen and that animal is most likely going to die.
lV. Holistic Natural Protocol Goal
We are not permitted to diagnose or treat specific diseases. All of our protocols are designed to use supplementation and diet to promote the health and rebalancing of organ systems that may be contributing to your animal's condition.
The goal of our natural IMHA protocol is to help balance your animal's immune system to prevent further damage to red blood cell tissue while at the same time promoting development of new red blood cells and their oxygen carrying capacity. We also want to provide a plethora of organic, whole food nutrition to improve the health of your entire animal. 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 imbalance 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 animal to maintain their health especially at the begining. Even though immune suppressing drugs are used immediately at the diagnosis of IMHA, animals that do the best, and by that we mean live, are the ones that are weaned off of the medications as soon as possible. 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.
V. Holistic Natural IMHA Protocol
Core Recommendations Suggested products are included in the Core IMHA Package found below.
Our "Core Recommendations" form the backbone of our Natural IMHA Protocol. They consist of the supplement recommendations we feel are the most important to provide to your animal companion for this condition. They are displayed individually or as a package at the bottom of this page along with other helpful products from which you may make additional selections. Pet foods can be purchased at your finer, local pet stores. As always, we are here to help and you may contact us by phone or email if you need more individualized attention.
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 for this condition. BioPreparation can cross the blood brain barrier to feed the brain, support the hypothalamus to help balance the entire endocrine system and even cross the blood retinal barrier to nurture the eyes. We have had outstanding success with this product so it is highly recommended. Select the F3+ Forte for this condition.
Core Recommendation #2 - Daily Multi PlusOur 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 this condition - 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 those with conditions like IMHA because research indicated that a constituent in hydrangea root, called halofuginone, halted the progression of autoimmune disease. This formula will help to reduce inflammation and modulate the immune system for the benefit of your pet with IMHA.
Core Recommendation #4 - ChlorOxygen
This is a very concentrated source of chlorophyll for the dog 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 is why we have included it with our core recommendations.
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 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, 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.
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 those 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. For a quick and easy way to add high-quality protein to your pet's diet take a look at our Whey Protein Isolate. For more information, when your animal is better, read our article How to Feed Your Dog or How to Feed Your Cat that can be found in our Education section.
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. Lab tests of PRP's have demonstrated their ability to stop the progress of overly aggressive immune responses associated with autoimmune conditions like IMHA.
Earlier we indicated the benefit of eating liver for those with anemia. Here we have some freeze-dried, New Zealand liver glandular with all the nutrients of liver in an easy to feed capsule.
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 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.
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.Vl. Natural Remedies for IMHA
Hi - I wanted to let you all know of my recent experience with Pet Health & Nutrition Center... I started doing my own research and found the Core IMHA package on the Pet Health & Nutrition site. I ordered my first pack and received it promptly from Maria at Pet Health & Nutrition, along with a hand written note which included instructions for the Biopreparation F3 and well wishes... Two weeks later, Feb 11, Enzo’s PCV was 39%. I truly believe that the supplemental core IMHA regimen alongside Leflunomide stopped the disease progression in its tracks and turned it around quickly. Additionally, the products have protected his liver and his ALT & AST continue to be within normal range... We have truly appreciated the support of Maria and her team while dealing with this traumatic pup situation... Thank you for all of your help thus far! Valerie G.