Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Duck Update 2/13/08

Hi everyone. The roller coaster ride continues for us. Took Duck to the vet for a regular blood check yesterday. His PCV is down to 34.8 from 41 on Jan. 30. We were all surprised by that because his colour is good, he is alert, happy, active, playful ... The vet even re-spun his blood but got the same reading. The worrisome thing is that his reticulocyte count didn't even register on the printout. So, we will wait a week and recheck his blood. I'm so glad we didn't go ahead with the reduction my vet and I had decided on at the January 16 appointment! She went away on holiday and before proceeding, I decided to get the opinions of Dr. Dodds and my specialist in Washington about how to reduce. So I didn't go ahead with the pred reduction. A small blessing! I've been in contact with Dr. Dodds - mainly to get her opinions about further med reductions. She recommended running a full thyroid antibody panel. I will get a sample off to her lab next week and hope that maybe that will give us some answers about these recent PCV fluctuations. Take care everyone. deb and Duck

Debbie BC Canada

Hi Debbie I know it may seem like a setback but Duck has been fighting this a long time. (I remember you from when I lost Georgie back in July). You are lucky to have Dr Dodds, she seems to really get to grips with AIHI. Let me know how you get on. I hope it is just a blip. Steph

Steph Wales

Debbie, Do you have an older cbc with the retic count on it? What was that #? I can help you figure out what is going on with the numbers. Good that you are doing thyroid. This may be your answer. Dogs waiting to go out... Patrice

Patrice New York State

Steph and Patrice, thanks for your comments - it's so nice to have a group to reach out to in times of emotional stress. Knowing that you understand and are sympathetic really helps. So thank you. I'm sure this will pass but right now I'm quite worried. Patrice, my vet's machine doesn't print out an absolute number of retics, just a percentage. Here are the two before yesterday's CBC: Jan. 16/08 PCV 35.9 Retics .9% Jan. 30/08 PCV 41 Retics .5% I don't think these percentages are what you're looking for but if you can shed some light I would be grateful. deb and Duck

Debbie BC Canada

sorry to hear about duck's drop in PCV, i hope some answeres come to the surface for you soon. i know what it feels like to have no answers, sway still is hovering at around 20% good luck to you guys

Josh california

Debbie, Anyone, human or dog, should have a pcv within a range of about 37-55%. There are of course exceptions. Some dogs like Greyhounds require a very high pcv (or hematocrit) to be considered in normal range. Chance has had his spleen removed and it is considered "normal" for his pcv to be a little lower but very healthy. Your latest numbers: Jan. 30/08 PCV 41 Retics .5% show an *absolutely normal* pcv number. In humans and dogs, the reticulocyte count should be around 1% or less. That is actually the precentage of retic in blood circulation. In a healthy dog you really want retic to mature in the bone marrow and then be released as mature blood cells. But it's quite normal to see a small number of them in the blood stream. The body will respond to anemia (pcv or hct lower than approx. 37%) by releasing more of these immature blood cells into the blood stream due to the hypoxia of tissue (shortage of oxygen going to tissue cells). They really aren't as good as mature ones, they can't carry oxygen very well and they still have their RNA. In a few days they drop the RNA and become mature rbc. You are currently (as by your Jan 30 results) in an absolutely normal state! I could wish for a pcv of 41 for Chance, but he will probably never get above his 38%. Why is that normal for him? His retic count hovers around .7-.9%! That is perfectly normal! Now, what is ominous and what we saw with Chance last year in April was a pcv or hct slowly dropping.... down to 18%, and an absolute retic count of 13,000. Probably about .3-.5% retic. That is indicative of non regenerative anemia. That means the body isn't making any more baby blood cells. And indeed when we measured his bone marrow with a biopsy, there weren't *any* cells in his marrow. Dry tap. The damage was being done at the cell precursor line in the marrow. Do you understand this? It is very complex to understand. I spent several months studying it and doing math to get a good grasp of what is happening. I have used this analogy before and it seems to help people understand: Imagine you are filling a glass with water from a tap. You take a normal glass and fill it. It stays filled. Occasionally there may be a little evaporation, so you might need to top it off a tiny bit. Great, everything is stable. Now imagine you are filling a glass that has a hole in the bottom. You keep running the tap but the glass never seems to stay full. Eventually you are going to lose, the glass will empty faster than you can keep up. This is kind of what happens with hemolysis. The body keeps destroying blood cells, the marrow attempts to fufill the need with retic into the blood stream. There reaches a point where it won't be able to keep up. There will be a very high retic count in the blood and the pcv will begin to drop. The making of blood is not a process that is entirely off by itself. The whole body and all of its systems contribute with many feedback loops to control this process. Overall general health, nutrition, the kidneys, the immune system, etc all function together to make blood and keep it at the right consistency and the cells healthy to perform their job. Since our dogs have all been very very sick, it takes time for all these things to get together in peak performance. So you may see small fluctuations in your numbers as Duck heals. You might see a 39% pcv next time, but if you don't see a huge number of retic like 5.7%, then it is just a small bump in the road, nothing serious. If you see a drop to something like 25% pcv, a large number of retic like 5.7% then there is some kind of rbc destruction happening. If you see a drop to 25% pcv and a retic count of .3%, then it would indicate non regenerative anemia. Of the two, the non regenerative is far more serious. So, please don't worry, just continue to have cbc's done and monitor the numbers carefully! Patrice

Patrice n

Josh, thanks for your good wishes. I think of you and Sway often - wondering how things are going and hoping for the best for you. Patrice, yes, what you said I followed and it makes sense. Hopefully this is just a blip and things will be back to normal. Of course my worry is that Duck is developing non-regenerative anemia. He has always been regenerative, right from the beginning. You said that Chance developed non-regenerative in April last year. How did you treat this and get Chance back to normal and healthy? deb and Duck

Debbie BC Canada

Hi Deb and Duck! I wanted to let you know that Kent just dropped mysteriously from 36 where he was holding steady to 31. We were considering kidney disease, addisons, the whole nine yards, and i was worrying myself sick. Today we took him to vet for a recheck after those numbers and it was 35. Yeah! I am very happy about that, but his behaviour continues to be odd - sitting and looking at you funny (schnauzers do that anyway), sleeping earlier at night and longer, weird appetite that changes food preferences from morning to night. His poop is no longer containing tarry blood, that's great! He is being treated with baytril for bacterial infection found in his urine culture. Heres another weird thing - his urine protein creatine ration came back at 31 - baaaad, leading us to think kidney failure. Last week, it came back at 21. Why? I dont know. normal is 2, but his is dropping, and i guess that must be good though still problem in the kidneys somewhere. I'm telling you about all this because kents hematocrit dropped and i could not tell you why, then climbed, one week later, again, why?. Dont know. Hang in there, Duck may be having a blip like Kent. Keep posting, Christine

Christine Florida

Debbie, I just read in another post that you said your vet saw some spherocytes on a smear? Has the vet been checking a smear each time or was it just this time? They are using an automated analyzer, right? And you got a dashed line where the retic count was supposed to be? Is this the first time? Even if it was low, there should be some kind of number. You will need to have this number in combination with your pcv before you can decide anything about med reductions or increases. Did the hemoglobin fall in the normal range? One of the deficits of spherocytes is that they have less carrying capacity for hemoglobin. They are more fragile. It would be of interest to compare your hemoglobin count from when your pcv was at 41 vs the 34. If this were me, I would do another cbc by monday. If you can afford it, might be good to have a chem panel done too to look at the bilirubin count. Ask them to do a manual exam of the spleen if they haven't already. Patrice

Patrice NYS

Debbie, I was reading your update and have seen Dr. Dodd mentioned several times...who is this? Thanks. Kathy

Kathy N

Hi Kathy. Dr. Dodds is a well known veterinarian and research scientist in the fields of animal vaccinations and hematology. She opened the first non-profit animal blood bank in California. The website for the blood bank is: http://www.hemopet.org/ That site also gives you contact information for Dr. Dodds. I have e-mailed her a couple of times and am so impressed at how quickly she responds. Hope this helps. deb and Duck

Debbie BC Canada

This thread was discussed between 13/02/2008 and 19/02/2008

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