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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - HIGH BUN/Creatinine Ratio???
| Hello everybody. Tessy just got her results back from Hemopet and all in all everything looked GREAT!!!I was just wondering if anybody knew what a High BUN/Creatinine Ratio might mean. Tessy's ratio was 130 (reference range of 4-27). Her Creatinine was low at 0.2 (reference range being 0.5-1.6). Her BUN was high at 26 (reference range being 6-25). Amazingly enough all her other Chem numbers were all in normal ranges!!!! YAY She had a RBC morphology done and showed Anisocytosis +2 and Hypochromasia +1 ...didn't state anything about spherocytes etc...not sure why There were also not retic numbers found...also don't know why. She was showing elevated neutrophils at 11704 77 (2060-10600)...infection maybe? Here's where it kinda gets confusing....concerning her red blood numbers....I'll compare her results from here at her regular doctors office to that of Hemopets. What do you think... Regular Vet / Hemopet (from the same blood draw!) RBC 3.88 (5.5-8.5) / 4.9 (4.8-9.3) !?!? HGB 10.1 (12-18) / 12.2 (12.1-20.3) !?!? HCT 29.1 (37-55) / 37 (36-60) !?!?!?!?!?!?!? WBC 16.9 (6-17) / 15.2 (4-15.5) PLT 486 (200-500) / 509 (170-400) Is it just me or is this a big difference? I could see if all numbers were different but most of the "M" numbers are basically the same as her regular vets. I can't help but wonder if there was a mistake down there or if there's something wrong with the analyzer up here! Hope everyone and their furkids are doing good this weekend. Hugs from... Johnny & Tessy |
| Johnny |
| Wow Johnny, That would make me question the blood results also! Maybe something is out of wack with one of the analyzers. I wonder if a third sample would reveal another set of numbers. Sue |
| Susie Delaware |
| Johnny, A high bun (but not very high in this case) and a normal to low creatinine will indicate a high b/c ratio. My first thought was kidney disease, but I am not right about that. Your other chem values are normal. There are several things this could be. 1. Dehydration at the time of the blood draw. 2. Recent high protein meal. 3. GI (gastrointestinal bleeding) 4. corticosteroid use. Have you been using some kind of acid reduction med prior to meals with prednisone? Plain old over-the-counter pepcid at the regular dose should work just fine. If there is some kind of ulcerated area in the gastrointestinal tract, esp the esophagus and the stomach, you should be given a prescription for sulcrafate and that should be given at a time past a meal, best on an empty stomach at bedtime or very early in the morning. However, since you won't know if there is an ulcer unless there are tests done, why not just give in just in case? I didn't know so I just gave the sulcrafate to Chance. It coats the esophagus and stomach to heal any ulcers. If your budget is getting slim, I can send you a recipe to make something similar from slippery elm you can buy at the health food store. Make sure that your next test is preceded by at least a 6-8 hour fast so there isn't a recent high protein meal influencing the test. But be sure she has plenty of water. The higher PLT count leads me to believe she was dehydrated for this test. Dogs on prednisone will be dehydrated and you can tell by pinching up the skin on the back of their neck and letting go. If it returns to normal right away, there is plenty of moisture. If it stays up there a bit, stiffly, there is dehydration. Finally, if this is because of the prednisone, run this by your vet when you seem them next time. Those difference do not surprise me. There can be great differences from one automated analyzer to another. And in addition, if the blood sent to Dr. Dodds was done by hand by a tech, you would be seeing the difference between accurate numbers (hers) and a mis-calibrated analyzer. Does it make you feel better to know that the same thing happens to me when I take my vet's blood work to the specialist and he looks alarmed, does his own work up by hand and then comes back in and says "never mind, it's all fine." So, ALWAYS ask for your vet to do an additional spun PCV. This should be really inexpensive and is the most accurate measure of the true PCV because it is read visually. My vet charges me $8 in addition to the full CBC. And the automated analyzer *always* reads the HCT as around 34-36 and the PCV is always 38-39. Drop Jean an email, mention the b/c ratio and the difference between the two lab reports from the same blood sample. If Tessy is feeling and acting much better, then those results from Hemopet are probably the more accurate numbers. my best patrice |
| Patrice NYS |
| I should have added that if the PCV spun by hand is WNL, then you can assume that the other indices will track similarly. (In other words the RBC, HGB etc would be normal) p |
| Patrice NYS |
| Thanks Patrice. Tessy takes 10mg Omeprazole with her meds once a day. The blood was drawn 4.5 hours past the last food she had....which was only a small handfull of food given with her Cyclo and Eltroxin (on docs orders). She usually drinks lots of water and I don't think hydration was an issue. I've been leaning more towards possible ulcers....here's why I think this...am I right? On Friday evening when I gave Tessy her Cyclosporine (100mg) and Eltroxin with a little food as always, she puked approximately 35 minutes later. I found the best part of the Eltroxin but the Cyclo was dissolved. Since her doctors said if she pukes within an hour to redo her meds ... I gave her another Eltroxin pill and only 50mg of cyclo...I wasn't sure if the body had already absorbed some of the cyclo or not so I kinda played it safe. Anyhow, the next morning she took the same meds again and there were no problems. BUT, again in the evening when I give her the second dose guess what happened. She puked AGAIN, almost to the minute to the night before...35 minutes after taking the meds. I can't help but wonder if it's the cyclo pills dissolving around this time and affecting a possible ulcer and making her puke? I really have not idea but can't help but wonder if this was fluke or coincidence with the high BUN/Creatinine ratio? Any thoughts on this? I do still have a whole thing of sucralfate in the cupboard but won't give it to her. The last time she took sucralfate she relapsed 3 days later. Once she was taken off it her numbers started to climb again. I'm not 100% sure it was the sucralfate or not but from what I've been reading it can affect the absorption of drugs in the system. Might have been like reducing her meds for those few days...in a manner of speaking, that made her HCT drop 10 points. What is WNL? If there is GI bleeding I would probably notice something by now wouldn't I? The Slippery Elm....would that work in the same manner as the sucralfate? Would there be reason to be concerned if giving it to Tessy? Oh yeah...one more thing...the tests(i'ld assume) were done by analyzer. The top of the report states "Antech Diagnostics"...don't know if this is an analyzer or what...have seen this name before though. Johnny & Tessy |
| Johnny |
| I completely forgot to say that there was no mention of spherocytes on her reports because "THERE WERE NONE SEEN"!!!!!! YIIPPPPPEEEEE Johnny & Tessy |
| Johnny |
| Johnny: The high BUN/creatinine levels are most likely due to the cyclosporine. Sheba had that problem and we thought it might be due to kidney disease, which at her age (12), was a definite possibility. After some serious hunting, I did find some information on cyclosporine that indicated high doses can result in elevated BUN/creatinine levels in a small percentage of dogs. Ours just happened to be one of those dogs! After she was weaned off of all meds her levels dropped and returned to normal. So, I would continue to keep an eye on the levels but would seriously consider that they may very well be related to the high doses of cyclosporine and will hopefully return to normal once Tessy has stopped taking it. Hope this info helps! Rita, Mike and Sheba |
| Rita IA |
| Just got another one of Tessy's tests back from Hemopet (done with the same blood draw). This time it was her serum iron levels. Tessy's were high at 281 ....reference range being 65-125. Now I don't know if I should be worried or is this OK? I wonder if this has any relation to the high creatinine/BUN ratio? Also...I found out that the 37% was a spun PCV....they just wrote it down as HCT. Hope everyone is doing well today. Johnny & Tessy |
| Johnny |
This thread was discussed between 07/06/2009 and 09/06/2009
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