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IMHA (Immune-Mediated Hemolytic Anemia) in Dogs

What is IMHA (Immune-Mediated Hemolytic Anemia) in Dogs?

IMHA, or Immune-Mediated Hemolytic Anemia, is a condition in dogs where the immune system mistakenly identifies and attacks the body’s own red blood cells (RBCs), leading to a deficiency in these cells. This can occur without a known cause (primary IMHA) or as a result of an underlying condition (secondary IMHA). In either case, the immune system produces antibodies against the RBCs, causing their destruction.

Anemia occurs when there is a shortage of red blood cells or hemoglobin, the protein responsible for carrying oxygen in the blood. Red blood cells play a vital role in transporting oxygen to the body’s tissues and organs. When there is a decrease in RBCs or hemoglobin, oxygen delivery to the organs is compromised, potentially causing organ damage or failure.

Given the severity of anemia and its potential to become life-threatening, it is crucial to seek immediate veterinary attention if a dog shows signs of anemia. An emergency veterinary hospital should be visited promptly if there are concerns about a dog’s health.


  • Lethargy or a lack of energy
  • Difficulty tolerating exercise
  • Pale gums often accompanied by a yellowish tint (jaundice)
  • Loss of appetite
  • Vomiting
  • Dark orange to brown-colored urine
  • Shortness of breath or rapid breathing
  • Elevated heart rate
  • Weakness or collapsing episodes


The causes of IMHA in dogs can be classified as primary or secondary. Primary IMHA is characterized by its idiopathic nature, meaning the exact cause is unknown. Dogs with primary IMHA experience their immune system suddenly attacking their own red blood cells without apparent reason. This form constitutes approximately 75% of all IMHA cases and can occur independently or alongside other autoimmune diseases. While the precise cause remains elusive, there may be a genetic predisposition, with certain breeds such as the American Cocker Spaniel, English Springer Spaniel, Old English Sheepdog, Irish Setter, Poodle, and Dachshund being more susceptible.

Secondary IMHA, on the other hand, occurs when the immune system targets red blood cells in response to an underlying issue. Common triggers for secondary IMHA include:

  • Infections, such as tick-borne diseases like Ehrlichia, Anaplasma, Mycoplasma, and Babesia
  • Viruses, including chronic persistent upper respiratory or gastrointestinal viruses
  • Bacterial infections like Leptospira, as well as various acute and chronic infections
  • Neoplasia (cancer) of any form
  • Inflammatory conditions capable of overstimulating the immune system and triggering autoimmune responses
  • Drugs, including vaccines, non-steroidal anti-inflammatories (NSAIDs), sulfonamides, penicillin, cephalosporins, and others
  • Toxins like bee stings, snake bites, zinc, onions, and garlic


Veterinarians typically diagnose IMHA in dogs by observing physical signs such as pale to yellow gums, skin, and eyes during a thorough examination. However, confirmation of the diagnosis is achieved through a complete blood count. If anemia is confirmed, additional in-house blood tests are conducted to determine if IMHA is the underlying cause.

Following the results of these in-house tests, veterinarians often initiate treatment. However, they may also opt to send further confirmatory tests to a laboratory. These tests may include a Coombs test, CBC with pathology review, and reticulocyte count, all aimed at providing additional diagnostic information. Baseline serum chemistry and urinalysis are also conducted to assess organ function.

Subsequent testing aims to identify any secondary causes of IMHA in pets. This typically involves chest X-rays, abdominal ultrasound, and infectious disease testing.


While IMHA in dogs cannot be cured, it can often be managed effectively, leading to remission in many cases. However, due to its life-threatening nature, aggressive therapy and hospitalization are typically necessary.

In some instances, early detection through bloodwork screening allows for outpatient management with medications. However, most cases require hospitalization for intravenous fluids and blood transfusions. The primary aim of transfusions is to stabilize the patient, providing time for other treatments to take effect. Multiple transfusions may be needed in some cases.

The cornerstone of IMHA treatment is immunosuppressive therapy. Initially, high-dose steroids like prednisone are used, alongside long-term immunosuppressive medications such as mycophenolate, cyclosporine, and azathioprine. Additional therapy may be required for secondary IMHA, targeting the underlying cause with antibiotics or anticoagulant therapy like clopidogrel (Plavix).

Due to the complexity of IMHA cases, veterinarians tailor treatment plans to each dog and may collaborate with or refer to a veterinary internal medicine specialist.

Living and Management

Early detection and aggressive treatment are crucial for favorable outcomes in cases of IMHA in dogs. Despite therapy, approximately 50% of patients with IMHA will survive long enough to be discharged from the hospital.

Most dogs require hospitalization at a 24-hour veterinary emergency facility for 2-7 days to undergo IMHA treatment, including blood transfusions for stabilization.

After discharge, regular check-ups with an internal medicine specialist or veterinarian are necessary to monitor the dog’s red blood cell count. Over time, the dosage of high-dose prednisone is usually tapered off and eventually discontinued, while long-term immunosuppressive medications may be continued indefinitely. IMHA cannot be cured, but with consistent follow-ups and medication adherence, it can be effectively managed. Relapse rates range from 11-15%.

It’s important to inform any new veterinary professionals about the dog’s IMHA condition, even during remission, and maintain a record of current medications. Future medications, medical conditions, or vaccines may potentially trigger a relapse by overstimulating the immune system of a dog with a history of autoimmune disease. Your veterinarian will collaborate with you to address your dog’s long-term requirements.

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