Anemia in Dogs: A Dog Parent’s Guide

Anemia in dogs (i.e. low red blood cell numbers) is a symptom of many different diseases, so it can be difficult to know what it might mean for your dog. Integrative veterinarian Dr. Julie Buzby hopes to clear up some confusion by discussing the types, diagnosis, treatment, prognosis, and prevention of anemia in dogs.

Blood. You can’t live without it, but just the thought of it makes some people squeamish.

Arguably, blood’s most important job is to transport oxygen from the lungs to all the organs, tissues, and cells of the body to keep them alive. Once that oxygen is off-loaded, the blood carries the waste product carbon dioxide back to the lungs to be exhaled.

When you think about it—and please only think about it if the thought doesn’t make you pale and clammy—it really is a remarkably elegant and impressive system.

What is anemia in dogs?

Red blood cells (and the oxygen-carrying molecule hemoglobin within those cells) are the components of the blood tasked with this vital oxygen-transporting job. You can think of the red blood cells in your dog’s blood as the delivery trucks for oxygen. And the molecule hemoglobin in the red blood cell is the delivery person who drops the package at your door.

The result of either low red blood cells or low hemoglobin levels is the same—your dog’s cells, tissues, and organs are unable to get the oxygen they need to function appropriately. This is what happens in anemia.

However, you need not immediately panic if your furry friend has been diagnosed with anemia. Generally speaking, the body can compensate fairly well. While mild and moderate anemias certainly should not be ignored, they are usually not immediately life-threatening. Your veterinarian should have time to try to get to the root of the problem with additional testing. And in many cases, you can work together to find a targeted treatment to get your pup’s red blood cell counts back to normal.

If moderate anemia goes undetected and progresses to become severe anemia or a dog suddenly develops severe anemia (e.g. due to severe and rapid blood loss), that becomes a much bigger problem. In severe anemia, the red cell count or hemoglobin level drops below a critical threshold and the body can no longer compensate. Your dog’s organs can begin to shut down from lack of oxygen. And, unfortunately, severe anemia can become fatal if it is not quickly addressed.

What are the symptoms of anemia in dogs?

The good news is that you can easily assess your dog at home for one of the most classic anemia signs in dogs. This technique I’m about to explain doesn’t require any special medical equipment and only takes a few seconds.

It turns out that the secret to catching anemia as soon as possible is as simple as lifting your dog’s lip. You see, moderately to severely anemic dogs will have pale mucous membranes (i.e. gums, inner lips, conjunctiva. etc.).

As alluded to, the easiest way to check your dog’s mucous membranes is to gently lift the lip to look at the gums. Your dog’s gums should be a nice bright pink.

If he or she is showing other signs of not feeling well and the gums are pale pink, you should consult your veterinarian. And if you notice gums that are almost white combined with signs of illness, your pup should have an emergency vet visit immediately. White gums may indicate severe anemia, which can be a life-threatening emergency.

Other symptoms to watch for

In addition to pale gums, there are some other symptoms to keep an eye out for. Most of the other signs of anemia are related to the dog’s body being deprived of oxygen. Just like the anemia itself, these symptoms can range from mild to severe.

Dogs with chronic anemia have a red blood cell count that has dropped slowly over time. This means they have had time to enact various measures to compensate for the decreased oxygen-carrying capacity of the blood. As a result, their anemia may be more substantial before you notice an issue with how they are acting at home.

On the other hand, dogs who suddenly lose a lot of blood have acute anemia (i.e. sudden anemia). They are more likely to have significant symptoms even with a less substantial drop in their red cell count. This happens because their body does not have time to compensate for the rapid decrease in oxygen delivery.

Other signs of anemia (acute or chronic) include:

• Weakness
• A lethargic dog or one who tires more quickly than normal
• A dog’s back legs collapsing or the dog collapsing completely
• Labored breathing or a dog who is breathing fast
• A rapid pulse (to learn to check your dog’s heart rate, check out my blog on checking your dog’s vital signs)
• Decreased appetite
• Eating or licking abnormal material like dirt, bricks, or rocks (i.e. pica)
• Weight loss—mostly with chronic anemia

Talk to your vet if you see symptoms of anemia

This is important so I want to say it again. In severe cases, anemia can kill dogs. If you are worried your beloved dog is anemic, the best thing to do is to contact your veterinarian. He or she can help you decide if the situation warrants an immediate emergency visit or if you have enough time to schedule a more standard veterinary appointment.

How is anemia diagnosed?

If your veterinarian agrees your dog might be anemic, he or she will start with a simple blood test. This might be a standalone test called a PCV test. PCV stands for packed cell volume, and is the percentage of the blood made up by the red cells. A normal PCV is roughly 35% to 55%.

Alternatively, the test for anemia can be part of a larger blood panel called a CBC. A CBC, or Complete Blood Cell Count, is a blood panel that evaluates the:

• Red blood cell count
• Size and shape of the red blood cells
• Total white blood cell count
• Number of the different types of white blood cells
• Platelet count

The value on a CBC that your veterinarian will be most interested when assessing for anemia is the HCT (i.e. hematocrit). It is similar to the PCV in that it is the percentage of the blood made up by red blood cells.

If the PCV or HCT reveal your pup is anemic, your veterinarian’s next step will be figure out why your dog’s red cell numbers are so low.

What are the types of anemia in dogs?

While it is easy to initially think of anemia as a specific disease, it is really a symptom of a number of different primary problems or diseases. All of these causes of anemia can be broken down into three categories:

• Blood loss anemia
• Anemia caused by the destruction of red blood cells within the body
• Anemia caused by decreased production of red blood cells

It is important to note that there are still multiple specific diseases that fall under each of those broad types of anemia in dogs.

Anemia due to blood loss

Sometimes anemia occurs because of the loss of red cells from internal or external bleeding. This bleeding can be sudden (e.g. blood loss due to a traumatic wound or large gastrointestinal bleed). Alternatively, the dog may chronically lose smaller amounts of blood, which tends to be less obvious. Chronic blood loss can in turn lead to a very specific form of anemia known as iron-deficiency anemia in dogs.

Some potential causes of anemia that fall into this category include:

• Trauma
• Bleeding tumors within the abdomen (i.e. hemoabdomen)—splenic masses in dogs and hemangiosarcoma in dogs are common culprits
• Gastrointestinal (GI) ulcers
• Gastrointestinal cancer
• Severe flea infestation (i.e. flea anemia)
• Intestinal parasites like hookworms
• Severe bleeding secondary to a low platelet count (i.e. immune-mediated thrombocytopenia)
• Anticoagulant rodenticide toxicity
• Bleeding secondary to other clotting disorders

Anemia due to destruction of red blood cells

Red blood cells normally live in circulation for approximately four months. Therefore, any process that destroys a significant number of red blood cells within a shorter timeframe will lead to anemia. The most common cause of this type of anemia is immune-mediated hemolytic anemia (IMHA in dogs). This is a condition where the immune system inappropriately attacks and destroys the red blood cells, leading to severe anemia.

Some other potential causes of anemia aside from IMHA that fall into this category include:

• Toxins (many of which cause a specific type of anemia called Heinz body anemia in dogs)
  • Zinc
  • Onions
  • Garlic
  • Acetaminophen
• Damage to red cells as blood flows through abnormal blood vessels (i.e. microangiopathic hemolysis)
  • Severe heartworm disease in dogs
  • Hemangiosarcoma
  • Splenic torsion
• Severely low blood phosphorus levels from another underlying condition
  • Diabetic ketoacidosis
  • Refeeding syndrome (i.e. a condition which occasionally occurs in dogs who were chronically malnourished and begin to receive nutrition again)
• Infections
  • Babesia
  • Bartonella
  • Anaplasmosis

Anemia due to decreased production of red blood cells

The bone marrow constantly makes red blood cells to replace the old or damaged cells that the body takes out of circulation. Anything that slows or halts the production of new red blood cells within the bone marrow will lead to anemia.

The most common cause of mild to moderate non-regenerative anemia (i.e. anemia where the body isn’t producing new red blood cells to replace the lost ones) is anemia of chronic disease. This happens because any significant and long-lasting disease process can cause the body to divert energy away from red blood cell production.

Some other conditions that can cause the bone marrow to not produce enough red cells include:

• Cancers affecting the bone marrow
  • Leukemia
  • Lymphoma in dogs
• Nutritional deficiencies or starvation
  • Iron
  • B vitamins
  • Copper
• Moderate to severe kidney failure in dogs
• Autoimmune diseases
• Aplastic anemia
• Scarring of the bone marrow (i.e. myelofibrosis)
• Situations where the bone marrow makes abnormal blood cells (i.e. myelodysplasia)
• Toxicity
• Medication side effects

How does the vet determine which type of anemia a dog has?

As you can see, anemia can be a symptom of a vast number of conditions. Thus, the vet will have to do some detective work to figure out which type of anemia your dog has and why it is happening. This will involve:

Finding out about your dog’s history

Your veterinarian will start with a thorough history to help narrow down the cause of your canine companion’s anemia. He or she will ask questions about:

• How long any concerning signs have been present
• Your dog’s diet
• Medication and supplement use (prescription or over-the-counter)
• Your dog’s preventative care regimen (i.e. vaccinations, routine wellness visits, and flea, tick, intestinal parasite, and heartworm preventive use)
• Any potential exposure to toxins

Performing a physical examination

Next, your veterinarian will carry out a nose-to-tail physical exam. First, he or she will check your pup’s vitals and assess the gum color. This will help your vet determine how severe the problem is and if your dog requires emergency stabilization.

If your dog is stable, the vet will spend time palpating your dog’s internal organs and lymph nodes. He or or she will also look for any evidence of bruising or external parasites like fleas. A rectal exam, while not terribly fun for your canine companion, is another important part of the physical exam for all anemic dogs. It can help your veterinarian determine if your dog has black tarry stool or red stool. Either of those stool colors could indicate a GI bleed as the cause of the anemia.

Determining if the anemia is regenerative or non-regenerative

Your veterinarian will also attempt to figure out if the anemia is regenerative or non-regenerative as part of the investigation. This typically involves using a blood smear or a CBC to assess the number of reticulocytes (i.e. baby red blood cells) in your dog’s blood. If your dog’s anemia is regenerative, that means the bone marrow is trying to make up for the anemia by pumping out reticulocytes. It is “regenerating” red blood cells.

On the other hand, if your dog is anemic and the reticulocyte count is NOT high, the anemia is considered non-regenerative. That can simply mean the bone marrow has not had time to kick into high gear and make extra red cells. However, if after five to seven days there are still no extra reticulocytes and the anemia remains non-regenerative, the problem most likely lies with the bone marrow’s ability to make red blood cells.

Said another way, if the anemia is non-regenerative, your veterinarian will focus on causes in the “decreased production” category above. And if the anemia is regenerative, the cause probably lies in the “blood loss” or “destruction of the red blood cells” categories. Thus, a simple reticulocyte count can go a long way in narrowing down the list of causes.

Performing additional testing

Even with the list of causes narrowed down a bit by the history, physical exam, and CBC or blood smear, there are still a lot of options left. Your vet will work closely with you to decide which additional tests will be most useful to pin down the specific condition causing the anemia.

Some of the more common tests include:

• More bloodwork
• Fecal tests for dogs
• Chest X-rays
• Abdominal X-rays or an abdominal ultrasound
• Infectious disease testing
• Bone marrow testing

Depending on the severity or complexity of the situation, your vet may also discuss referral to an internal medicine specialist.

What is the treatment for anemia?

Once your veterinarian diagnoses your beloved canine companion with anemia, the first step will be to determine if this anemia is severe enough to warrant a blood transfusion in dogs.

Blood transfusions for anemia in dogs

The blood count results alone won’t determine if your dog needs a transfusion. This is the case because dogs with chronic anemia can often remain stable with more severe decreases in their red blood counts. And dogs with sudden bleeding (or other causes of sudden anemia in dogs) may be unstable after losing a lower quantity of blood.

Your veterinarian will assess your dog’s vitals and use those parameters, along with the physical exam and blood counts, to make a decision about a transfusion.

Most dogs can have their first blood transfusion without any additional testing to ensure the donor blood is compatible. After a few days, however, your dog will have had time to make antibodies to certain types of blood. This means that any additional blood transfusions will require a test known as a crossmatch.

Cause-specific treatments

Aside from a blood transfusion in cases of severe anemia, there is no other universal treatment for anemia. Instead, the treatment depends largely on the underlying cause of the anemia.

For example, if your pup’s anemia is due to a gastrointestinal ulcer, your vet may recommend GI protecting medications like omeprazole for dogs. Or if the anemia is from an autoimmune condition like IMHA, your dog may need immunosuppressive medications like prednisone for dogs. And if the anemia is from cancer, your vet might discuss chemotherapy.

The list of possible things to do for a dog with anemia goes on and on. The treatments are just as variable as all the potential causes. While this may seem overwhelming, rest assured that your veterinarian will work closely with you to get your pup on the right treatments.

There are diets, foods, or supplements that may help boost red blood cells numbers in some cases. However, there are no uniformly good ways to treat anemia at home. Plus, any natural or holistic treatments for anemia may not be sufficient to address the underlying cause or correct moderate or severe anemia in a timely fashion. Relying on your vet’s advice really is the best plan.

What is the prognosis for dogs with anemia?

Just as the options for treating anemia in dogs are quite variable, so is the prognosis. Your veterinarian will ensure you understand your dog’s specific situation. And he or she can help prepare you for exactly what to expect regarding your pup’s prognosis.

In general, mild to moderate anemia has a much better prognosis. Your veterinarian will have more time to get to the bottom of the cause. Also, your pup will be more stable, which allows time for the prescribed treatments to take effect.

Unfortunately, the prognosis for severe anemia is more guarded. But even still, some dogs with severe anemia, such as from IMHA, can respond well with blood transfusions and aggressive treatment. They may even go on to recover completely.

Are there ways to prevent anemia in dogs?

Understandably, talking about the outlook for anemic dogs also raises the question about preventing your dog from becoming anemic. In keeping with most other aspects of anemia, the answer to that question is that it varies based on the cause of the anemia.

There probably isn’t anything you can do to keep your dog from getting a splenic tumor or chronic kidney disease. However, you can ensure your dog is on year-round heartworm, flea, tick, and intestinal parasite preventives. Plus, you should allow your vet to run yearly heartworm tests and fecal tests on your dog to screen for heartworms or intestinal parasites.

You can also ensure that all toxins are out of your dog’s reach, and promptly contact your vet should you have any concerns about your dog’s health. The sooner your dog gets help for anemia, the better.

Tackle anemia in dogs with the help of your vet

Hopefully, you made it through this article without feeling too queasy. If so, you now know the signs to watch for that might indicate your dog is suffering from anemia. Keep them in mind and make it a regular habit to check your dog’s gum color as part of your at-home dog wellness scan.

If you find yourself suspecting your dog is anemic, remember that a trip to visit your veterinarian is the first order of business. You can use your new-found understanding of anemia to work closely with your veterinarian and advocate for your dog. With your diligent care and unconditional love, and your vet’s deep knowledge and expertise, your pup will hopefully be on the road to recovery in no time.

Have you dealt with anemia in your dog?

Please comment below.