Anemia in Dogs

Types of Anemia in Dogs

Vets also describe anemia as regenerative (the marrow is releasing young red cells, called reticulocytes, to make up the loss) or nonregenerative (it is not). Blood loss and red cell destruction are usually regenerative, while kidney disease and marrow problems are nonregenerative.^1,2

Signs of Anemia

• Pale pink or white gums^2,4
• Tiredness, weakness and not wanting to exercise^2,4
• Fast breathing and a fast heart rate^4,7
• Poor appetite^2,4
• Yellow gums or eyes and dark urine when red cells are being destroyed^2,4
• Black, tarry stool if the bleeding is in the gut^14,15
• Collapse with sudden, severe anemia^4,16

Anemia that develops slowly can cause only vague signs, because the body adapts, so it is easy to miss at home.^2,16

Common Causes

• Internal bleeding from a ruptured spleen or liver tumor, often in older large-breed dogs.^1,17 See hemangiosarcoma in dogs.
• Rat poison that blocks blood clotting.⁸
• Fleas and hookworms, which can cause life-threatening anemia in puppies.^18,14 See hookworms in dogs.
• Toxins: onions and garlic in any form, and zinc from coins or other metal objects.^9,1,19
• Tick-borne disease such as Babesia, more common in pit bull-type dogs and Greyhounds.^20,10
• Kidney disease, because the kidneys make the hormone that tells the marrow to produce red cells.¹³
• Anemia of chronic disease, the most common mild anemia, from long-term inflammation, infection, cancer or hormone disorders.¹³
• Iron deficiency, which in dogs is rarely caused by diet and usually means slow, ongoing blood loss.¹³
• Bone marrow disease, including leukemia.^13,21 See leukemia in dogs.

Diagnosis

• Packed cell volume (PCV): a quick test of the percentage of blood made up of red cells.^1,10
• Complete blood count with a reticulocyte count and blood smear: shows whether the marrow is responding and looks for parasites or damaged red cells.^1,10
• Tests for IMHA: a saline test for clumping red cells, the Coombs test and counting spherocytes (small round red cells). A negative Coombs test doesn't rule out IMHA.^10,22,16
• Chemistry panel, urine test and fecal test for kidney and liver disease, bilirubin and parasites.¹
• X-rays and ultrasound to look for bleeding, tumors or a swallowed metal object.^2,10
• Tick-borne disease tests, and a bone marrow sample if the cause is still unclear.^10,1

See blood tests for dogs for what the numbers mean.

Treatment

Treatment targets the cause: stopping bleeding, treating poisoning or infection, deworming and flea control, or managing kidney disease.^2,1 Dogs with severe anemia may need a blood transfusion, usually of packed red cells, to keep them stable while other treatment starts working.^6,16 Dogs with kidney disease may be given a medicine that stimulates red cell production.¹³ Don't give iron or other supplements unless your vet confirms iron deficiency.¹³

Immune-Mediated Hemolytic Anemia (IMHA)

In IMHA, the immune system destroys the body's own red blood cells. In most dogs no trigger is found. In others it follows an infection such as Babesia or certain medicines, and cancer is a possible trigger.^5,10,22 Cocker Spaniels are the breed most often reported. Springer Spaniels, Old English Sheepdogs, Irish Setters, Poodles and Dachshunds are also mentioned, but any dog can be affected.^4,22

Signs often come on quickly: weakness, pale or yellow gums, fast breathing, dark urine and sometimes fever. Many dogs arrive at the vet as emergencies.^5,16,4

How IMHA is treated

• Steroids are the main treatment. A second immune-suppressing medicine is added for severe cases or when steroid side effects are a concern.⁶ Studies haven't shown that this improves early survival, but it may lower the chance of relapse.^11,12
• Anticlotting medicine is recommended for nearly all dogs, because dogs with IMHA are prone to dangerous blood clots.^6,7
• Transfusions support the dog until the medicines start working, which takes several days.^5,16
• Hospital care usually lasts about 2 to 7 days.^4,5

Medicines are reduced slowly once the red cell count is stable. Steroids are usually given for 3 to 6 months, and all immune-suppressing treatment for about 4 to 8 months. Your vet will check the red cell count before each reduction.⁶

Outlook

IMHA is serious. In studies, between about 1 in 5 and 3 in 4 dogs die, and the 2019 specialist guidelines say up to half. Deaths happen most often in the first two weeks and often from blood clots.^6,3,2,5 Dogs that get through the first weeks usually do well long term, and many live normal lives.⁵ About 1 in 7 to 1 in 10 dogs has IMHA come back, so regular rechecks matter.^6,4 Your vet can estimate your dog's outlook.

Life Expectancy and When to Say Goodbye

Outlook depends on the cause. Anemia from blood loss, parasites or toxins usually resolves once the cause is treated.² Anemia of chronic disease often improves when the underlying illness is treated.¹³ Anemia from cancer or bone marrow disease has a more guarded outlook.^13,21

If anemia can no longer be controlled, or your dog stops eating, can't walk or rest comfortably, or needs repeated transfusions without recovering, talk with your vet about your dog's quality of life.²³ See quality of life and when to say goodbye.

Frequently Asked Questions

Can a dog recover from anemia?

Yes. Many dogs recover fully once the cause is treated. Dogs with IMHA that survive the first weeks usually do well.

What is nonregenerative anemia in dogs?

The bone marrow isn't making enough new red cells. Kidney disease, long-term illness and marrow disease are common causes.

Is IMHA painful for dogs?

Dogs with IMHA mostly feel weak and tired. Tell your vet if your dog seems sore, restless or is breathing hard.

Can food cure anemia in dogs?

No. Iron deficiency in dogs is rarely caused by diet, and food doesn't treat IMHA. Avoid onions and garlic, which can cause anemia.

How long can a dog live with IMHA?

The first two weeks are the most dangerous. Dogs that recover can live for years, though IMHA comes back in about 1 in 7 to 1 in 10.