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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Alex
| We have been reducing atopica every month since his last relapse in April. We are down to 50 mg in am and 50 mg in pm. His red blood cell count and platlett count are normal however his reticulocytes are up from last time to 3.4% (0-1.5 is normal). Does anyone know what this means? Could we be heading for another relapse? I'm trying to read this medical jargon on the internet and it is way....over my head :) Chris |
| Chris Pa |
| Chris, I can understand your confusion about reticulocytes. This is a complex topic. It took me a bit of time to finally master it. Exactly what are the numbers on the *last test* for PCV%, RBC count (red blood cell) and reticulocyte % and reticulocyte absolute? This should be something like PCV 45%, RBC 5.5 (that's millions), Retic 3.4% and 150,000 retic absolute. Our body makes red blood cells everyday to replace old ones that become fragile and break apart. The body recycles the old materials and keeps what it can use, discarding the rest. So a normal RBC will live about 120 days, break apart and be replaced. This doesn't happen all in one day but is spread out over time so there isn't a great loss of RBC in one day. The replacements are made in the bone marrow where they normally mature and after about 3-4 days enter circulation as red blood cells. Occasionally immature ones (baby blood cells) do enter the blood "early" and these are called reticulocytes. This is where that NORMAL number of 1-1.5% comes from. When there is a great loss of red blood cells at one time, the body recognizes this by the low amount of oxygen reaching body cells. This O2 shortage signals a process started by the kidneys (go figure) to release a hormone called erythropoietin. This stimulates the bone marrow precursor cells to begin making new red blood cells. Do I still have you? <VBG> Because of the great need for oxygen, the bone marrow will shoot out these baby blood cells, reticulocytes, in great numbers to try to help the low oxygen situation. This is when you might see very high numbers of reticulocytes in the blood sample. This is called reticulocytosis. But these retic's aren't very good at carrying O2 quite yet and take a few days to mature into red blood cells. They are quite visible under the microscope as a different type of red blood cell. So for a few days there will be a high number of reticulocytes but in about 3-4 days they will convert to RBC. So the number of retic GOES DOWN and the number of RBC GOES UP. When a dog develops autoimmune hemolytic anemia it enters a state of hemoysis. This word means destruction of red blood cells. So the body begins to attack RBC causing a state of anemia. The body should respond immediately with reticulocytosis. There should be an accompanying increase in retic %. But there can be other causes for a higher reticulocyte count, in fact anytime there is blood loss. Although sudden blood loss is less a factor in this. But if there is a constant loss such as with internal bleeding of some kind perhaps like in an ulcer. What your vet must do at this point is *determine the trigger* for the high number of reticulocytes. Is this a repeat of the hemolysis? Is there some kind of internal bleeding that is triggering this? Is is possible that the PCV on the last test was lower than your dog's normal number so it's just trying to catch up? Some dogs will hover around the high 30's for a period of time before they finally get up into the mid 40's. This might be in response to a higher activity level as your dog feels better. The need for oxygen to the cells increases. So to these dogs a PCV of 38%, while normal, may be "low." This would be a good time to stay in touch with your vet, perhaps repeating the CBC in a week. If this were me, I might go in after a few days and just have a simple PCV done to see if that is rising, dropping or maintaining. This shouldn't cost more than $15 or so. Keep an eye on mucous membranes, looking for orange or yellow coloring and paleness. The same with urine and feces. If you see this, see your vet immediately. If you don't see this and your dog seems his cheerful self, then this would be a good indicator that this isn't hemolytic. I would advise caution but not alarm. The body is very good at monitoring and adjusting itself. If you weren't sampling his blood constantly, you might not have even noticed this higher retic count. Can you describe the events of the last relapse? Were there similar symptoms? my best patriced |
| Patrice NYS |
| Patrice, Thanks for your response. Your explanation really helps. His most recent RBC is 6.73; his homoglobin is 16.4; his hematocrit is 48.2%. His retic is 3.4% however I don't see a retic absolute. His platlett count is 200. I haven't seen any blood loss. His activity level has been the highest that it has been since before he got sick in May 2008. When he initially got sick the disease attacked his red blood cells and he had a PCV of 17. Once he started the meds it climbed and eventually was in the 40's. We weaned him off the meds slowly reducing them once a month throughout last fall and winter and were at 25 mg of Atopica in the am and 25 mg of Atopica in the pm by April 2009.(He's about 75 lbs). By the end of April his PCV was still okay however his platlett count dropped to 35. At that time I noticed some bruising on his belly. We then went back to square one with the meds and have been reducing them monthly since.He bounced back alot quicker than he did the original time. He is currenty at 50 mg in the am and 50 mg in the pm. I am hoping that this retic increase is from his increase in activity level as you mentioned and wonder if he is "over doing" things. His appetite is good also right now. He's had some diarreah over the past month, nothing significant and I could always pinpoint to a possible cause such as stealing and eating a 1 pound bag of treats off the counter, eating a meat flavored rawhide, or drinking out of the toilet (Yuk!!!! ) I will get him checked soon to make sure things are not dropping more. I'll keep a check too on the things you mentioned. As always your help is GREATLY appreciated :) Chris & Alex |
| Chris Pa |
| Chris, What is your dog's breed (and name!)? Interesting details. But let me check something first with the breed information. patrice |
| Patrice NYS |
| Patrice, His name is Alex and he's a 4 year old neutered standard poodle - A little on the chubby side from his prednisone days but still awfully cute and funny! Chris |
| Chris Pa |
| Chris, Thank you for the information. I was checking because a few breeds of dogs have a very high normal PCV, like Greyhounds and Dachshunds. I love Standard Poodles! They are incredibly smart dogs. These numbers all fall within the normal limits, except for the retic. So to answer your questions, this increase in reticulocytes seems unusual. I am not a vet and they may have an explanation for why this is happening from their clinical experience. It might be related to the kidney. In any case you will know what is happening with subsequent blood tests. Other information that I have squirreled away is that Poodles can have an inherited condition called von Willebrand Disease. This is a deficiency in a certain blood clotting factor (Type 1 vWD) inherited in Poodles. This is a minor deficiency and seems to only be bothersome when there is an injury or surgery. If there is minor internal bleeding, this may cause this increase in reticulocytes. You can have the clotting factors tested. If you do this and discover this deficiency, I have information about treatments that can be used when a dog with vWD is going to have surgery. Here are 2 websites that have some Poodle specific information on vWD. http://www.poodleclubofamerica.org/health.htm http://www.napoleon.org.uk/health/von_w.htm This is a link to a website that performs this kind of testing and you can read a little more here. http://www.vetgen.com/canine-vwd1.html Keep us up-to-date on Alex. I am hoping that everything is fine! my best patrice |
| Patrice NYS |
| Patrice, Thanks for all of your help and research. You are a god send ! I'll keep you posted. I know he did have a clotting test at one point in time and it turned up ok but I guess things tend to change too... Chris |
| Chris Pa |
This thread was discussed between 05/10/2009 and 06/10/2009
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