Questions to ask your veterinarian

The window of opportunity to properly treat AIHA is small since it is a life threatening disease that can kill within days. Your veterinarian needs to have experience administering the drugs and to be aware of conditions that warrant an aggressive approach.

Do not accept ego or financial driven reluctance to make a referral to a specialist. The decision to go to an Internal Medicine Specialist or teaching hospital versus staying with an inexperienced vet can mean the difference between life and death.

Please ask these questions to make sure that you are in the hands of a competent veterinarian.

Veterinarian's experience treating AIHA
Explain that you want to ensure that your dog has access to the best possible care, regardless of distance or cost.

• How much experience do you have treating AIHA? How many cases?
• What is your experience with AutoImmune Hemolytic Anemia? What were the outcomes?
• Phrase a statement like "I know you will to be responsible enough to refer me to a ACVIM specialist or a teaching hospital that deals with cases like this all the time and has experience in treating AIHA in an aggressive manner."
• Who is a ACVIM Specialist you can refer me to with experience with AIHA?"
  Veterinary Internal Medicine Specialists have experience in a wide range of skills since they see challenging, complex cases on a daily basis. They have an additional 3 or 4 years of veterinary education and are Board Certified in Internal Medicine. The "Specialist" title is used for those that complete a residency, pass a series of exams, conduct research and publish articles in veterinary journals. To find one in your area, visit the Accredited College of Veterinary Internal Medicine.
• If there really are no specialists or teaching hospitals within as accessible distance, make sure that your vet contacts a ACVIM specialist or teaching hospital to consult during the therapy to ensure treatment is being monitored by a competent professional. http://www.afn.org/~afn43914/vetschools.html

Familiarity with treatment options

• What treatment options are you familiar with in treating AIHA?
• Are you aware of the array of treatment and therapy options?
• Are you familiar with studies regarding the best drug combination and survival rates?

Proper diagnosis and search for secondary causes

• Can you recognize autoagglutination?
• If not, what are the results of the DAT?
• Are there spherocytes?
• Are there reticulocytes? How many? Enough to show a regenerative response?
• Are platelet values normal?
• Did she test positive for Babesia, Ehrlichia, Leishmania, Hemobartonella and Dirofilaria?
• What are the results of her x rays and ultrasound? "If you don't have the capabilities to perform these tests, please refer me to a facility that does so we can ensure that we aren't missing some greater problem. "

Initial drug therapy and preventative medications

• Based on the clinical and physical finds, what type of destruction is occurring?
• Is the spleen enlarged? Is the liver enlarged?
• What course of therapy do you recommend initiating?
• Given the onset and degree of destruction, should we incorporate additional drugs into the therapy in conjunction with prednisone?
• Is there blood in the feces or urine? If so, does that mean that intravascular hemolysis is occurring and an aggressive approach should be started initially?
• What GI preventatives will be administered?
• Should she be on an antimicrobial therapy to avoid infections?
• Should we administer Heparin to avoid thromboembolic disease?

Need for a Transfusion

• What is her PCV?
• Does she need a transfusion?
• At what level do you transfuse?

Immunosuppressive reductions

• Are we reducing the drugs slowly enough?
• Are we reducing the drugs in large enough time intervals?

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