Anemia, a condition characterized by a decrease in the red blood cell (RBC) mass within a dog’s body, is a common issue encountered in veterinary practice. In this post we will discuss symptoms to look for, recommended treatments and what an anemia diagnosis could mean for your furry friend.

Anemia occurs when the number of red blood cells in the bloodstream drops below normal levels. Red blood cells, responsible for carrying oxygen throughout the body, are produced in the bone marrow. When there’s a decrease in the production of these cells, if they’re being destroyed faster than they can be replaced, or if there is direct blood loss, anemia can result.

Anemia can also be categorized based on it’s cause and the body’s response:

Regenerative Anemia: This occurs when the body responds appropriately to the decrease in red blood cells by producing more of them. It’s often seen with conditions like blood loss, where the bone marrow ramps up production to compensate.

Nonregenerative Anemia: In this type, the bone marrow doesn’t adequately respond to the drop in red blood cells. This could indicate issues like bone marrow disease or chronic conditions that affect blood cell production.

Anemia in dogs can stem from various factors:

Blood loss can occur for various reasons such as trauma, internal bleeding (caused by medications like NSAIDs or steroids, or conditions like parasites such as hookworms or severe flea infestations), and bleeding tumors.

Increased Destruction of Red Blood Cells: Anemia in dogs can result from increased destruction of red blood cells (RBCs) due to factors such as immune-mediated diseases like immune-mediated hemolytic anemia (IMHA is commonly triggered by vaccination), exposure to certain substances like onion or acetaminophen, and RBC parasites such as Hemotrophic Mycoplasma spp. or Babesia spp.

Mechanical damage to red blood cells (RBCs) can happen in conditions like disseminated intravascular coagulopathy (DIC) and heartworm disease.

Decreased Production of Red Blood Cells: This type of anemia, classified as non-regenerative, is particularly challenging to treat. Diseases, nutritional deficiencies, medications, cancer, and infections affecting the bone marrow can all reduce the production of red blood cells.

Chronic renal disease, for instance, leads to non-regenerative anemia due to decreased production of erythropoietin. For more information on anemia caused by kidney disease, click here. Similarly, chronic liver disease can alter the shape of red blood cells and reduce their lifespan. To learn more about canine liver disease, click here. Conditions like hypothyroidism or hypoadrenocorticism (Addison’s disease) may also lead to non-regenerative anemia.

Certain drugs or chemical exposures can also cause non-regenerative anemias at the bone marrow level. Examples include chloramphenicol, various chemotherapeutic agents, lead, griseofulvin, methimazole, phenylbutazone, phenobarbital, albendazole, fenbendazole, estrogens, and trimethoprim-sulfadiazine.

Symptoms of anemia in dogs can vary depending on its cause and severity. Common signs include:

• • Progressive lethargy/weakness/collapse
  • Pale gums
  • Increased heart rate & increased respiratory rate
  • Heart murmur
  • Difficulty Breathing
  • Weight loss
  • Fever
  • Jaundice
  • Excessive bruising
  • Signs of bleeding including: Nose bleed (epistaxis), blood in the urine (hematuria), digested blood in feces (melena), frank blood in feces (hematochezia), vomiting blood (hematemesis)
  • Enlarged abdomen +/- palpable abdominal mass
  • Evidence of external trauma

In chronic cases of anemia, symptoms may initially be subtle and overlooked by dog guardians. It’s crucial to pay attention to any changes in your dog’s energy levels. Starting treatment for the disease as soon as possible significantly improves the chances of a positive outcome.

If you suspect your dog may be anemic, it’s crucial to seek veterinary care promptly. Your vet can perform tests to diagnose the underlying cause and recommend appropriate treatment.

Diagnostics testing:

• • CBC blood test: Anemic patients have low packed cell volume (PCV), RBC count, and hemoglobin concentration. PCV indicates the percentage of blood composed of RBCs.  Total solids (TS) can be a more sensitive indicator of hemorrhage than PCV in initial stages especially with blood loss.
  • Reticulocyte Count: Quantitative measurement of reticulocytes is the most important laboratory test that determines if anemia is regenerative or not.
  • Cytology: RBC morphological changes on blood smear cytology can help determine the underlying cause of anemia.
  • Slide Agglutination Test: A slide agglutination test can be performed to look for evidence of immune-mediated hemolytic anemia. Agglutination can occur because of antibody-mediated aggregation of RBCs.
  • Biochemistry Panel: Abnormalities reflect the underlying disease. Total protein levels can be decreased in patients with blood loss. Patients with hemolytic disease can have hyperbilirubinemia. Elevated renal parameters can indicate chronic kidney disease. Marked hypophosphatemia can cause hemolytic anemia.
  • Urinalysis: Hemoglobinuria may be present in patients with intravascular hemolysis, and bilirubinuria may be detected in cases of extravascular hemolysis or liver disease. Hematuria may occur with bleeding disorders. Other abnormalities may be present because of underlying disorders, such as diabetic ketoacidosis, chronic kidney disease, etc.
  • Bone Marrow Evaluation: Bone marrow aspirates or biopsies can be obtained to search for potential causes of anemia, especially in cases of persistent nonregenerative anemia. In one study of dogs with nonregenerative anemia, bone marrow examination was imperative in obtaining a final diagnosis in 9/14 cases.
  • Diagnostic Imaging: Radiology and ultrasonography may be performed to search for underlying causes of the anemia.
  • Further testing may be required such as serology for various infectious agents; evaluation of fecal samples for intestinal parasites; serum iron profiles; coagulation profiles; blood lead measurement; endocrine testing (e.g. thyroid, cortisol assays); Anemia profiles.

Therapy for anemia involves identification and treatment of the underlying cause.

Transfusion of blood products may be indicated in cases of severe anemia.

While anemia caused by iron deficiency is more common in people, this condition is rare in dogs, although it can sometimes be found in dogs with malnutrition and puppies with hookworm infestations.

Supporting your dog’s immune system is paramount when dealing with anemia.

• • Medicinal mushrooms: Turkey Tail, for example, contains protein-bound polysaccharopeptides that promote immune response by both activating and inhibiting specific types of immune cells and by suppressing inflammation. Check out my full blog on using medicinal mushrooms to enhance your dog’s immune system.
  • Support Gut health: with 70-80% of the body’s immune system located in the gut, making it vital to maintain optimal gut health. This is because the gut microbiome significantly influences immune function and overall well-being. Check out my blog on gut health in canines.
  • More targeting remedies can be pursued once the cause of the anemia is established.

A diet rich in iron, vitamin B12, and protein can help boost the production of red blood cells. It is also imperative to feed fresh, real food and avoid processed diets when your dog is fighting disease. The byproducts of highly processed foods increase the workload on the gastrointestinal (GI) tract, liver, and kidneys, diverting attention from managing the current illness. Check out my blog on preparing homemade diets.

Recommended foods include:

• • • Liver (iron, B-complex vitamins, protein), salmon
    • Vegetables such as spinach and kale (the chlorophyll in the veggies can help the body to produce healthier blood)
    • Kelp (iodine and trace minerals): You can sprinkle kelp powder over your dog’s food daily. (Use 1/4 to 1 teaspoon daily, depending on your dog’s size.)

Prognosis varies depending on severity, underlying cause, ability of the bone marrow to respond, and success of therapy for the underlying cause.

Canine anemia is a complex condition with various underlying causes, ranging from blood loss to decreased red blood cell production. Recognizing the symptoms early on and promptly seeking veterinary care is essential. Through appropriate diagnostic testing, veterinarians can pinpoint the specific cause of anemia, enabling targeted treatment strategies.  In severe cases of anemia, your dog will need assistance from a conventional veterinarian, such as an internist or emergency veterinarian. However, I strongly advise consulting with a holistic veterinarian as well to ensure a comprehensive care plan and achieve the best possible outcome. 

So, if you notice any signs of anemia in your dog, such as lethargy, pale gums, or weakness, don’t hesitate to consult with your veterinarian. Together, we can ensure the best possible care and quality of life for our furry friends.

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