Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Ginger's PCV drop

Ginger's PCV has been holding steady in the low 40's for the last 6 months. Today I take her and it is down to 25, needless to say I was unpleasantly surprised. She is she is acting and eating just fine, her gums are red and she playing with my other dogs. I am at a total loss. Her vet told me to increase the Imuran from 1/2 every other day to a whole one every other day and gave me 30 Doxycline 100mg tabs and come back in a week to have it recheck. Has anyone had this happen to them and if so did the PVC continue to drop or did it come back up again or what did your vet prescribe, I would hate to see her have to back on the predisone.

Cheryl and Ginger Pineville pa

Cheryl, How long has it been since the last check? And what was the total dosage of meds at that time vs what they are now? patrice

Patrice NYS

She was last checked 6 weeks ago and she was on 1/2 Imuran EOD and that is what she has been on for the last few months. When she was checked 6 weeks ago it came down from 43 to 41, so the vet was not really concerned. In the mean time I added Yucca Intensive and Cetyl Myristoleate do to her arthrits and it has really helped with that but do you think that could bring her PCV down?

Cheryl & Ginger Pinville PA

Cheryl, No, I don't think that had anything to do with it. Did they do a full CBC this time? What is the number of reticulocytes? Look for something like absolute retic or retic %. You should see numbers like 65K or 1.5%. You may see something like RPI or reticulocyte production index. Also what is the RBC number? Should be somewhere around 5 or probably now near 4-5. HCT and WBC too just for reference. If you did a chem screen is there a number for bilirubin TBIL? When she was first diagnosed did the vet ever say something like she was "regenerative or non regenerative?" p

Patrice NYS

Cheryl, is it possible that there was something faulty about the test? Did the vet suggest doing a retest just to make sure that number was accurate? I find it odd that with such a drop, Ginger's gums look good and that her energy level is still up. Just a thought. deb and Duck

Debbie BC Canada

Cheryl & Ginger, I'm so sorry to hear this. I hope and pray this will just be a temporary drop. This disease is so scary. It's like we'll never be able to relax again. We're sending positive thoughts to you and beautiful Ginger. Sue & Boogie

Sue Moorpark

Hi Patrice No she did not take any blood work, as you get the PCV results after your visit with the vet and by then the vet has moved on to the next patient and the vet just relays the info through a vet tech. So I never got to ask her anything about the low number. Debbie I found this to be rather odd too, such a big drop and Ginger seems to be fine. They did not mention a recheck and either did I. I think I was in the state of shock, never expecting that low of a number. I am hoping that it some kind of error and as long as Ginger seems fine, I will try to be too concerned. She went for her 1 1/2 mile walk tonight and did fine and is wrestling with my other golden as I type this. She has a tech visit next Monday for another PCV test and if that comes back low again I will have them do the blood work. In the mean time we will just take it one day at a time and try not to worry about it too much.

Cheryl & Ginger Pineville PA

Cheryl, You need those numbers now. It would be unquestionably very important to know if she is going into hemolysis or if this drop is because of a non regenerative state. Or, if in fact, they made an error with the blood draw. If this is hemolysis, then your window of treatment opportunity narrows. If this is non regenerative anemia, then the older red blood cells are normally aging out... But they aren't being replaced by new ones. And this is a gradual decline over time. Not a crisis, but an indication that there may be damage occurring at the level of the bone marrow. When this happened with Chance, it was clear that it was a very serious sign of something wrong. He started out at 30 but dropped slowly and steadily towards the teens. In addition his wbc numbers dropped simultaneously. He certainly was very active and it was difficult to believe that he was declining. But the bone marrow biopsy showed no signs of cells. He was running only on red blood cells he had produced in the past. If this has been a bad blood draw, then a number of blood cells could have been damaged as they were drawn into the syringe or the sample could have been mishandled. In either case, it certainly would be nice to know sooner rather than later if this is what is happening! Honestly, if this happened at my vet's office, they would ask me to wait a few minutes so the vet could consult with me. I have even gone out into the waiting room to free a room and the vet has come right out to see me. Call them tomorrow and ask to leave a message for the vet. Then ask her to get back to you so you won't be so worried. patrice

Patrice NYS

Hi Cheryl, I would consider having your vet do another PCV check on Ginger. I had a simliar experience happen to me a few months ago. My dog Tipsi had been doing great with her PCV stable between 45-50. Then on a routine PCV check one day the results came back in the low 30's. I was shocked because Tipsi showed no clinical signs of a relapse. In fact she seemed to be doing better. Therefore the vet tech wanted to draw another sample and do another PCV check. I'm so glad she did because the second reading came back normal. There was an error in the first reading because whomever took the blood sample from Tipsi didn't draw enough to get an accurate reading. I really hope this is the case with Ginger! Tipsi and I will be thinking of you!

Layla Raleigh

As suggested I would get another reading. I also had 2 different readings. About 2 weeks after Wylie was Diagnosed, Luckily her PCV hadn't dropped too low, to 34. I asked the vet to get another opinion on another test and they also ran the hematocrit and she showed like 26. My vet ran his again and it was 34. Laurie

Laurie CA

I agree, i would get another test done as soon as possible, just to be on the safe side. I hope it was only a bad draw. It does seem odd that she would have that kind of energy, but mostly odd that her gums would be nice and pink. My golden boy had HCT of 20 when diagnosed on Oct 9, 2003. Only in hind sight did we realize he had not been quite as active for a couple of weeks. It was actuall finding pale gums that sent us to the vet. His HCT kept dropping and even transfusion of 2 units of blood a a time coudln't get it out of the teens. He died, still in ICU on Oct 16, 2003.

Sandra Texas

I have looked for a good reference to explain how a blood sample can be mishandled. Not much luck with canine venipuncture. Since only some of you are allowed to watch the process, it's important to understand that it is a skill that one can be very good at or very bad at, or somewhere between. In addition, the patient's condition can impact the quality of the sample. Most particular with our dogs would be dehydration. It can make a good draw very difficult. I have watched this with Chance and it was heartbreaking. If your dog is very nervous and jumpy, this can negatively impact the process as well. Here is a tutorial web site that explains the process in some detail. The words hemolysis and lyse mean the destruction of the red blood cell. It will spill the content into the sample and alters the rbc count and the hemoglobin amount, introduces fat to the sample making it cloudy. Patrice http://www.medicine.uiowa.edu/cme/clia/modules.asp?testID=13 Technique: Preventing Hemolysis (Skin Puncture) Julie C. Paulson Happel, M.T. (ASCP), M.A., Photographs by Joel Carl, M.A. Hemolysis may occur due to: 1. Residual alcohol on the skin puncture site. Alcohol lyses red blood cells. Ensure the site is dry before performing puncture. 2. Increased red blood cell fragility and/or high packed cell volume. This is often found in newborn infants. 3. Excessive squeezing due to poor or decreasing blood flow. It is better to perform a second skin puncture. Never re-stick the same site or re-use a lancet) 4. Scraping the collection tube against the skin. This will mechanically lyse the red blood cells. Always allow the drop of blood to fill the collection tube by capillary action. 5. Shaking the micro-collection tube too vigorously.

Patrice NYS

If the blood draw is not enough, it can become diluted and therefore will not show the true count. Have them draw another sample and have it run again. I almost fainted once when this happened with Sofie during her blood work, but the vet determined that there was not enough drawn and therefore the sample was diluted. When they did the second one, it was in the 50% range.

Joanne Wyoming

Ginger went back to the vet today for her PCV recheck and it was 27, so unfortunately I don't think the 25 last week was a mistake:(. They took blood work and also will run a thyroid check on her as she is being treated for hypothyroidism in addition to the chronic AIHA. She was put on 1 Imruan tablet everyday and will continue another week on the Doxcycline. We go back again next week for another recheck and her vet will give us a call with the blood test results in a few days. Ginger continues to act just fine and is as playful and energetic a nine year Golden can be. We are grateful it was no worse and actually went up a little. I will keep you posted. Thanks for all your support. Cheryl and Ginger

Cheryl & Ginger Pineville PA

Cheryl, I am glad Ginger is still acting fine and playing. Hopefully the drop is just a temporary thing and she will head back into the 40's soon. Penny

Penny Lytle Creek Calif

Keeping all our fingers crossed. I wonder about increasing the imuran- doesn't it take a long time to act??? does a jump in dosage work quickly. Is prednisone reasonable??? Sorry to give you more questions....but it is something we all will ask about too...

Chris Connecticut

cheryl- wishing the best, its crazy how these numbers bounce around sometime. sways count dropped out of the blue to 16 last weekend and now a week later she is back up at 26. hopefully ginger will be back in the 40's shortly

josh california

Ginger has been doing well as far as her energy level and her blood work came back within the normal limits, except for her PCV which was 30. But her appetite has decreased over the last two days and she won't eat without me putting some gravy on her dry food and she does refuse some of her treats. My question is do you think this is a side effective of the Doxie and Imuran she is on? She does go back to the vets on Monday and I can get her to eat but needing to be coaxed is very unusual for Ginger how is usually a chow hound.

Cheryl & Ginger Pineville PA

Cheryl, I am relieved to hear that her PCV is on the rise! It sounds like she is regenerating nicely. I am also on a list that discusses tick diseases. Doxycycline is the drug most used for treating these. It can be a very harsh drug for dogs to take. I know I have read dozens and dozens of owner's posts saying their dog is refusing to eat. Because it is so critical for them to get the drug to eradicate the tick disease, the owners most often have to persevere and figure out clever ways to get the doxy into the dog. This is the most likely reason that Ginger is losing her appetite. Doxy can also negatively impact the liver and often those people treating their dogs for serious tick disease see liver values on the chem screens rise alarmingly high. Sometimes they have to switch to a less effective drug, and there are only a few substitutes that do what doxy does to diseases like lyme. If you have a specific reason for Ginger to be on doxy, check with your vet about doing a chem screen routinely to check those liver values. If Ginger has been on this drug a long time (say at least 4 weeks) then ask your vet if she still continues to need to be on it. Tick disease treatment is usually a high dose for anywhere from 4-8 weeks. If a SNAP 4DX was done and was negative for tick disease, then you probably could stop the doxy now. If you really do have to continue giving her this drug here are some suggestions that have popped up on the tick list: Always feed a full meal or at least most of it before attempting to give doxy. Towards the end of the meal or at the end, offer a wonderful treat that has the doxy in it. They most likely will eat it. My vet told us to use really smelly food like canned fish. So I made small fish sandwiches in a little piece of bread, and dropped the doxy inside, wrapping up the bread tightly. Doxy tastes awful so don't get any on your hands that could be transferred to the bread or fish. Dogs are clever and will begin to associate their favorite treats with how bad the doxy makes them feel. Rotate the treats. Several suggestions include canned cheese, liverwurst, pill pockets, cheese bits etc. Give treats during the day other than when giving the meds so they can't follow a pattern. Try to avoid giving doxy at a time before the dog will be lying down and sleeping. Keep the dog fairly active after this. Good luck, Patrice

Patrice NYS

Ginger went back to the vet today for her PCV test and the first time they did it the results were 20. They did take the test again and drew more blood it the results were 25. The vet was not exactly sure as to what is going on with her. She was put back on 60 mg of pred a day (75 lb. dog) continue on 1 tablet of the Imuran a day and have a recheck on Saturday. She did take her off the Doxie. I am going to take a tip from Ginger and try not to worry about this minor set back and just be happy and take each day as it comes.

Cheryl & Ginger Pineville PA

Cheryl, While I don't have anything other than anecdotal information, it's possible the doxy has been contributing to the suppression of making blood. I have seen folks report on the tick list about problems with anemia popping up during treatment with doxy. Now tick diseases can contribute to developing anemia, so it's hard to sort out what was happening. If you were to look at the time period that she was on doxy and compare that with her pcv decline you might see some kind of correlation... or not. I think 25 is a fine number and certainly not in the danger zone. Sway has been riding around that number for a long time and doing ok. Chance lives at the low end of normal, around 35-38. Dr. Dodds often refers to this kind of mild anemia as "anemia of chronic disease." There is a very good explanation of this in wikipedia.org. Patrice

Patrice NYS

Thank you Patrice you are always very helpful. And it just goes to show that it all depends on the blood sample they take, we had a five point difference. The one that read 20 was a very small sample of blood and the one that read 25 was a much larger sample.

Cheryl and Ginger Pineville PA

My vet always takes enough blood to do two tests in order to compare the results to be sure it is accurate. You should suggest this to your vet if they don't already do this. Then you won't have to wonder.

Sue Michigan

How many times a day do you think I should be giving Ginger Pepcid she is on 60mg or pred and 1 tablet of the Imuran. The pred dosage is given as follows 1 tablet in the am, 1 late in the afternoon and 1 later at night. I was not sure if 1 or two pepcid would be the right dosage per day. Also does anyone know the correct dosage for milk thistle, she is getting 1 a day right now. Ginger weighs 72 lbs.

Cheryl & Ginger Pineville PA

Trooper- 50 pounds is on Pepcid 10 mg twice a day...

Chris Connecticut

Ginger went back for another PCV test and it was only 28, she last had it tested on Saturday and it was 27. I was hoping for at least a 30. She must stay on the same dosage of predisone she is on now for another week, which is 40mg a day and one Imuran EOD and get it checked it again in one week. I think if does not go up I will ask the vet to cut down on her predisone anyway as it really is taking a toll on her. She has lost so much muscle her hind end it she actually creaks. The same thing happened last time she was on the predisone and she did finally regain most of the muscle loss but now we are back to square one. I guess we should not feel to sad as we know there are many dogs out there in worse shape than she is in but it is very frustrating.

Cheryl & Ginger Pineville PA

Cheryl, I feel your frustration. I wanted to ask if you had ever considered visiting a homeopathic vet? I am not sure the loction of Pineville. The firat thing I did when finding out Choe's pcv had dropped was consulted with a homeopath I see in Yardley, PA. She put Choe back on several Chinese herbs and immune support supplements. I'll never know if it was due to this regimin, but his numbers did go up pretty quickly (also simultaneously upped the pred, of course). But then lowered it. Thinking of you.....Jan

jan philly

Jan The vet I go to is the Animal Healing Center in Yardley and I believe that is the same vet you are referring to. Do you happen to know the names of the Chinese erbs they put Choe on if so I will ask about them on her next visit. They have tried a few but no luck. Thanks for your help. Cheryl & Ginger P.S. Steve has a race just outside of Atlantic City (right near Wheaton Village) on 8/31/08.

Cheryl & Ginger Pineville PA

Oh, my that is interesting! Spleen Blood Activator, Blood Terrain, Liver Drain, Ars Alb/Merc Sol, Antler, Immugen. Dr. Rodriguez is the vet I have been using. She is very good about returning phone calls/keeping in contact. Keep me posted. Jan

jan philly

i just wanted to mention that sway was on chinese meds for her allergy issues at the beginning of 2007, and 2-3 months later she was diagnosed with AIHA. im not advocating for them or against them, because to this very second i still have no idea what caused AIHA in sway... and im not trying to insinuate that they were the cause, because i have no clue, but have always wondered if they played any role. i just wanted to mention it. they have obviously worked for jan and that is great. wishing a full recovery for ginger

josh california

This thread was discussed between 30/06/2008 and 25/07/2008

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