I always knew diseases like immune mediated thrombocytopenia in dogs (also called IMT or ITP) could attack any canine at any time. It doesn’t matter the dog’s age or breed, as IMT is relentless in its pursuit of trying to destroy your pet. I never thought my dog, an otherwise healthy Cocker Spaniel, would nearly die from IMT, but that’s exactly what happened.
It all started when I began our bedtime ritual of brushing my dog’s teeth. I noticed splotchy red marks on his inside cheek and some slight bleeding along the gumline. Thankfully, there’s a 24-hour emergency vet located ten minutes from our home. The vet tech took one look at my dog’s gums and his symptoms and rushed him to the back of the hospital.
“Your dog has zero platelets, his immune system is seriously compromised, and without critical inpatient treatment he may die, but there are no guarantees,” the vet shared, nearly knocking me to my knees.
Anyone who’s ever faced a life-threatening moment with their dog knows the soul-crushing angst that washes over you like a tsunami. This blog post will serve as a journal of my dog’s battle to fight IMT and what we experienced and learned. I’ll share a link further down to our step-by-step journey to save my dog’s life after he was diagnosed with IMT.
Time is the enemy of IMT and most immune system diseases in dogs. Stopping IMT in its tracks as soon as you may improve your dog’s prognosis. All dogs are different, but there are many treatments available. IMT and its nasty cousin, IMHA, are not necessarily death sentences. Never wait to get medical attention for your pet. There is hope for dogs with immune mediated thrombocytopenia, but you must act fast.
What Is Immune Mediated Thrombocytopenia in Dogs?
Primary immune mediated thrombocytopenia (IMT) occurs when a dog’s immune system attacks and essentially destroys platelets in his blood. The immune system mistakes platelets as invaders and literally eradicates them.
Platelets come from bone marrow, so you can imagine how important they are to a dog’s overall well-being. Bone marrow is the soft material located in the central portion of many bones. Dogs need platelets for blood clotting. When platelets are low, dogs may bruise, bleed, become anemia, collapse, or die.
With this condition, the immune system malfunctions and recognizes certain cells as foreign, our internal medicine veterinarian explained. Because of this malfunction, platelets and sometimes other circulating cells are destroyed.
What Are the Symptoms of IMT in Dogs?
Here are some of the symptoms dogs may have when IMT, IMHA, or Evans Syndrome (a combination of IMT and IMHA) is developing:
- Bleeding from the nose or gums, in or around the eyes
- Pale gums and other moist tissues of the body
- Blood in the urine
- Heavy, rapid breathing (tachypnea)
- Weakness or fatigue
- Splotches (especially on the skin/belly/ear flaps, and/or gums); also called petechiae
- Darkened, tarry stools (internal bleeding)
- Lack of appetite
- Difficulty breathing
When we rushed our American Cocker Spaniel to the emergency clinic at midnight after a fun-filled day at a pet-friendly beach, a sudden life-threatening illness was the last thing on our minds. Dexter was wagging, eating, and drinking, having spent the day playing and walking along the shoreline with me and my spouse. Sick dogs don’t act like that, I convinced myself.
Some dogs don’t show outward signs of any pain or problems, which is very scary.
IMT is difficult to diagnose, which is why you should always check your dog’s gums, stool, and watch his breathing patterns. My dog was acting fine, but the vet told us without urgent care, Dexter would not have survived the night. He would have likely died from internal bleeding.
What Causes IMT in Dogs?
“We see a lot of dogs coming in with autoimmune diseases, and they are often very difficult to treat,” Dr. Robert Runde of Northeast Veterinary Referral Hospital in Plains, Pennsylvania, shared. “Unless you can find something that caused it for certain and treat it, like a drug reaction, it’s difficult to identify what causes this.”
Although in most cases, the cause of IMT is never known, we were fortunate in that we suspect a nasty tick bite several months earlier. In-house blood testing for six different vector-borne diseases such as Lyme and heartworm proved negative. Serologic testing from an outside lab tested positive for A. phagocytophilum (E. equi), which causes anaplasmosis that shuts down platelets. A tick-borne disease like IMT can sit in a dog’s bone marrow, waiting to rear its ugly head. That day arrived.
When a cause can be identified, IMT may be triggered by:
- The breed of dog: Cocker Spaniels, Poodles, German Shepherds, Beagles, Collies, Irish Setters, Afghan Hounds, Doberman Pinschers, and Old English Sheepdogs are all at higher risk for autoimmune diseases, but any dog can get IMT.
- Tick-born infectious diseases that trigger IMT
- Vaccines in some cases
- Certain medications
- IMT can be secondary to other diseases like cancer, bacterial infections, or a virus
- A stressful event
There must be something we can do to stop this horror from affecting so many dogs other than being diligent and aware. My friend and holistic veterinarian, Dr. Laurie S. Coger, DVM, told me, “Use a minimal and thoughtful vaccine protocol. Minimize chemicals like flea and tick products, avoid the oral preventatives and chemical collars, too.”
How Is Immune Mediated Thrombocytopenia In Dogs Diagnosed?
The dog’s clinical signs coupled with a platelet count may lead to the diagnosis of IMT. Sadly, there is no one specific test to diagnose IMT. There are other diseases that can cause a low platelet count, which is why an internal medicine specialist experienced with autoimmune diseases in dogs is best.
“The diagnosis of primary ITP is one of exclusion,” Shana O’Marra, DVM, shared at the Dove-Lewis Annual Conference. “In veterinary medicine, consensus guidelines are lacking, however, severe thrombocytopenia in the absence of identified underlying disease is often the only criteria
An overactive immune system causes IMT, so other tests are generally performed. I’ve outlined my dog’s journey with IMT in great detail below, but other tests that were performed on admission to the vet hospital and during his stay included:
- Full CBC and chemistry panel
- Packed cell volume (PCV) blood testing several times a day in house
- SNAP 4DX in-house tick testing*
- Abdominal ultrasounds to check for internal bleeding
- Blood draw for serum to send out for tick titers
- Platelet checks once or twice daily
- Urinalysis and bacterial culture of the urine
- Additional tests as needed to rule out other conditions
*Ironically, my dog’s SNAP 4DX test at the vet hospital was negative for any tick-transmitted pathogens. However, during his hospital stay, the internal medicine vet sent my dog’s blood sample to an outside lab, the results were startling.
As noted above, my dog tested positive A. phagocytophilum (E. equi), which causes anaplasmosis that shuts down platelets. The in-office SNAP 4-DX blood test did not show this result. I still have the SNAP 4DX test performed once a year on my dog during routine in-office screening. However, a highly specialized lab test like the one performed on my dog picked up on something the SNAP test did not.
How Is IMT Treated in Dogs?
While in-house, my dog received a specific cocktail of drugs that included steroids, antibiotics, gastric care, melatonin, and the chemotherapy drug, vincristine. If his condition did not improve or if it worsened, care would be transferred to a higher-level facility like the University of Pennsylvania in Philadelphia. He would remain on steroids for 61 days, at which point they were stopped due to steroid-induced pancreatitis that landed him back at the emergency hospital—twice. He was sicker and more symptomatic with acute pancreatitis than he ever was with IMT.
Most dogs are treated with a cocktail of steroids, antibiotics, vincristine, GI protectants such as omeprazole, and sometimes blood transfusions. My dog received a chemotherapy drug, which I discuss in his diary below. Long-term IMT is managed with steroids, very frequent blood draws, melatonin (in our case), and follow-up visits with your dog’s internal medicine vet.
In the IMT dog journal link below, I indicate every drug dispensed and every treatment my dog experienced. Your dog’s treatment may be different, but I feel it is important to share the protocol that saved my dog’s life.
“Since this was caught early, the hope is he will respond more robustly; however, it is possible that he could decline despite our therapies,” the emergency vet on-call wrote on Dexter’s admission records.
Sometimes the spleen is removed as an alternative treatment option when nothing else helps. The spleen is the primary site for the clearance of the platelets. When the spleen is removed, the thought is this also prevents the production of autoantibodies
What Is The Long Term Prognosis for Dogs With IMT?
Why some survive and others don’t is one of this disease’s mysteries. Timing is crucial, and getting to the emergency vet when we noticed the splotches and bleeding gums probably saved Dexter’s life. I learned those splotches are called petechiae, or blood vessel leakage, a hallmark sign of IMT. Blood transfusions don’t generally raise the platelet count and the body may destroy them anyway.
Excessive bleeding can be fatal and side effects from medications are common. Long-term steroid use may increase the likelihood of developing Cushing’s syndrome. A dog’s already weakened immune system is more prone to opportunistic infections, so close monitoring is essential.
Steroids nearly killed my dog. The same steroids that helped save my dog’s life caused severe pancreatitis twice. After 61 days of steroids, we had to slowly taper down under the direct guidance and directive of the internal medicine veterinarian.
Long-term steroids can cause problems, too. Things like skin breakdown, infections, increased urination and hunger, and behavioral changes are all common side effects of long-term steroid use. When bone marrow doesn’t perform as it should and regenerate blood cells, dogs can become anemic and suffer bone marrow suppression.
When caught early, IMT has a good overall recovery rate. Relapses are possible, but many dogs survive without another relapse. It is imperative you have an ongoing, long-term relationship with a skilled internal medicine vet who deals with immune diseases in dogs regularly.
“Prognosis for primary immune-mediated thrombocytopenia in dogs is generally favorable,” Dr. O’Marra reported. “
Compliance with medication, treatment, blood draws, and vet visits are essential to helping your dog survive IMT. My dog is now several years out from his IMT diagnosis, and we are grateful that he has not relapsed. I’ll share more about things we’ve done to try and prevent a recurrence of IMT in the link below.
Can Dogs Have An IMT Relapse?
Yes, studies indicate some dogs relapse after being treated and ‘cured’ from IMT. Dr. O’Marra reports the platelet number alone does not predict mortality or the need for transfusions. She says some dogs relapse and some do not. After four years’ time, we have not had a relapse, knock on wood.
“Since vaccinations have been thought to precipitate future relapses of immune-mediated diseases, it is recommended for Dexter not be vaccinated in the future if possible,” our internal medicine vet shared on my dog’s discharge from the hospital.”
The key is eliminating the triggers and potential stressors that caused your dog’s IMT in the first place. Some dogs respond beautifully to treatment and along with owner compliance, they thrive, survive, and do not relapse.
Some dogs can be taken off steroids and do not relapse. Other dogs remain on low-dose steroids for life. I know many dogs who have successfully beaten IMT. I know other dogs who have relapsed one or more times and went on to survive. I know some dogs who weren’t as fortunate and passed away. It seems as though IMT success stories are higher than IMHA dogs, but there are many IMHA survivors, and my dog’s littermate brother is one of them.
Dr. Coger says that any time you inappropriately overstimulate the immune system, diseases like IMT and its ugly counterpart, IMHA (immune-mediated hemolytic anemia) can occur. Dexter’s nephew, also a Cocker Spaniel, was diagnosed with IMHA and survived. In a strange twist, he too went to the same hospital and was treated by the same team. Perhaps there is a familial component to this, or not, as nothing is certain with this disease. Scarily, sometimes IMT and IMHA gang up on a dog to create Evans Syndrome, a fate I wish on no one.
Is IMT In Dogs Expensive To Treat?
IMT is not an inexpensive disease, as our bills surpassed the $13,000 mark over one year’s time. We’re “do whatever it takes” kind of people and the investment in pet health insurance over the past 28 years has paid for itself time and again.
Part of the expense was in Dexter’s hospitalization and treatment, but a lot of it came in the year after. Over the next 12 months, the frequency of vet visits for blood checks and testing decreased, though my need to obsess over Dexter’s gums increased to several times a day. Thankfully, he survived. There is hope for dogs affected by immune system diseases, but not everyone is as fortunate. Early intervention with prompt treatment is key.
I recommend pet insurance, a savings account, or some form of funding you set aside for medical emergencies and the general well-being of your dog. Veterinary bills, diagnostic tests, and treatments can add up quickly,
Here’s what to do if you can’t afford your vet bill.
Can IMT Be Prevented In Dogs?
No, immune mediated thrombocytopenia in dogs cannot always be prevented. Most often, a cause cannot be identified. We were very fortunate in learning a tick nearly killed my dog and caused his IMT.
Cocker Spaniels seem to be over-represented with immune diseases, so pay close attention to any changes in your dog and act promptly. I am not anti-vaccine, but I am anti-overvaccination. I follow Dr. Jean Dodds’ vaccination protocol, performed titers on my dog in lieu of vaccines, and removed chemicals from his life as much as possible.
I use more natural flea and tick preventatives, but I do give my dog a heartworm preventative every 45 days year-round. He has been fine on it.
Should I Put My Dog Through IMT Treatment?
Dogs are amazingly resilient and rely on us, their pet parents, to do right by them.
The first time we visited Dexter at the hospital, my heart sunk at the sight of his overly shaved paws, IV lines, and needle jab marks, offset by the never-ending ‘wigglebutt wag,’ the happy indicator of his personality. He remained under close supervision and treatment for nearly a week, at which time he was discharged with a boatload of medicines and frequent follow-up appointments for blood draws.
Ironically, his discharge date coincided with the day our first Cocker Spaniel crossed the rainbow bridge. Because I’m about signs and postcards from the bridge, a wave of relief and comfort washed over me.
The nurses and vets kept us up-to-date on his care, mood, vitals, and everything else. We visited him daily and they allowed us to feed him. So, yes, in our household we are first and always about the dog. He is a family member and that entitles him to the same rights and privileges we bestow upon ourselves.
More About Immune Mediated Thrombocytopenia in Dogs
As promised, I journaled every single step of our dog’s journey with IMT. I highly suggest you read this story for more details, things we did to help him survive, and changes we made in his life since that time.
IMT in Dogs: How my dog survived an autoimmune disease
Four Years Later: How we helped our dog survive and beat IMT