When I examined Max during a routine health check I had no idea that in 3 days time he would be fighting for his life. In contrast to his usual lively and enthusiastic self he had become profoundly lethargic and frighteningly pale. Admitted to the "surgical unit" it was clear from our investigations that the disease process engulfing Max was both acute and extremely severe. He had developed a condition known as "autoimmune haemolytic anaemia".

Max's red blood cells, which transport oxygen throughout his body, had become altered with a cell marker. This alteration to the surface of his red blood cells then identified them to his immune system as being a potential foreign invader. Consequently, a potentially cataclysmic process unfolds as his defence mechanisms set out to destroy every red blood cell in his body.

This process, which is remarkable for it's ability to seek out and destroy harmful viruses and bacteria, is both dramatic and overwhelming. Anyone who has been laid low by influenza will appreciate how significant and suddenly these changes can occur. The obvious problem here being that these defence mechanisms are now being turned on the patient himself.

The treatment strategy is twofold. Stop the immune system from further destruction of red blood cells and secondly keep the patient alive until he can manufacture more red blood cells. Very potent drugs are required to stop the immune system in it's tracks.

Additionally, blood donated from "Dudley" a dog belonging to Corrie, one of our nursing staff, was able to buy "Max" some time whilst his own body continued the recovery process of red blood cell production. At one stage "Max's" red blood cell count was 8 where normally the figure should be between 37-45. This figure is generally considered to be incompatible with life and how "Max" was able to hang onto the precipice of his very existence is known only to him!

Two weeks later and "Max" is transformed and looks back to normal. His recovery has been a real team effort including his owners who visited him daily and not to forget the insurance company who coughed up nearly £3000! It later transpired that "Max's" mum and a littermate died as a result of the same condition!

Terry Dunne BVMS, Cert SAO, MRCVS

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