Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - High Platelets/Aspirin/Med Reductions

Tessy had another CBC done today and her results had mixed reviews. Her HCT rose from 28.3 last week to 29.5 today. Everything else seemed to improve except for her WBC (which only rose 2 points to 42.8) and her Platelet numbers, which are VERY high at 1022. The doctor had to dilute her sample to 50% to get the reading which actually showed 511 which she said had to be multiplied by two. Anyhow, I can not seem to find anything regarding causes or medications or cures for higher than normal platelet numbers. They are rising every week and I'm scared the number might become unmanagable. Tessy has been fighting this disease for just over five weeks now. The doctor wants me to put her on 8mg of aspirin now. My question now is when and how often, with food? before meds? with some sort of stomach protectants? etc. etc. etc. Also, I have read that many dogs are only put on aspirin at the beginning stages of this disease and are taken off once they begin to stabilize. I'm wondering if the aspirin would even be necesary because her results came back from a specialist saying that her platelets looked "normal". However, it also stated "Moderate thrombocytosis"....don't know this one yet. I'm going to scan the results and put them on the site with Tessy's pictures in case anyone wanted to see them. One more quick thing. The doctor was talking about reducing the Pred next week. This worries me because of Tessy's HCT range only being at around 30%. Do you think that lowering either the Pred or Azathioprine could have an impact on her platelet numbers? Thanks to all who can respond. Your support and guidance means so much to me. I'll be praying for all affected by this terrible disease. Johnny & Tessy

Jonathan

Jonathon, I think that Tessy's gradual rise in HCT is a good sign. Staying stable is excellent. I am going to take a stab at your platelet question with the understanding that there are so many causes of this high number, and that I don't have access to the kind of test results your vet has at his fingertips. Everything I have researched shows me that the platelet count is most often a *symptom* of a condition. This is called reactive thrombocytosis. This means simply that there is an underlying cause to the platelet numbers increasing above the normal range. The most simple cause is a temporary increase due to exposure to epinephrine, or put simply, Tessy gets all stirred up going to the vets and is in a high state of arousal when they draw her blood. The body will respond with this stimulation and that will increase platelet count in anticipation of having to act in "fight or flight." The spleen is usually responsible for removing the excess platelets after the event and is very efficient in this. I have already discussed the stimulative effective on the bone marrow precursor cells and how that can stimulate an over production of platelets as well as red blood cells. 1022 is a very high number and the trends are showing that it is going up. The very first thing that I think of is the continued high white blood cell count. That could indicate infection or inflammatory disorder of some kind and that could be the trigger for the platelet count going up. Hypothetically getting the infection under control would also decrease the # of platelets over a period of time. Other information I have found indicates that reactive thrombocytosis is a common observation in canine hyperadrenocorticism. This simply means that if there is a large increase in the level of cortisone in the body, then the platelets can increase in numbers. I don't know the specific clinical differences between true Cushing's Disease (disease of the adrenal glands) and Iatrogenic Cushing's Disease (artificially caused by high doses of prednisone) in relation to this high platelet number. I can only assume that the body doesn't care one whit whether the cortisol levels are high because of a disease state or because of an artificially induced state. So hypothetically, if the dose of prednisone is lowered, then the platelet count may decrease. There can also be a myeloproliferative disorder, disease of the bone marrow, in which there is an abnormal increase in platelet production. This is called primary thrombocytosis - also called essential thrombocythemia. I can assume that a bone marrow biopsy would be the diagnostic tool used to determine this. Finally, I think one other possible cause might be some kind of tumor or cancer. This can also be a contributing factor in an anemia so they can go hand hand. Your vet has done some significant diagnostics, if I remember correctly, to rule this out. Your vet should be actively addressing the primary cause of the increase. However, regardless of what is driving this, you do need to worry about making sure that inappropriate clot formation doesn't occur. You should ensure Tessy is adequately hydrated and is getting up and moving around on a regular schedule. If you can encourage her to take short walks every couple of hours I think that would help a lot. The use drugs such as aspirin and anticoagulants such as heparin injections may be used, but this is your vets call, not mine. You can research something called DIC disseminated intravascular coagulation. I don't want to frighten you, but you should understand this risk and I think you are adept at reading and understanding this kind of literature with a detached attitude. Please keep me up to date on what is happening. my best patrice

Patrice NYS

Jonathan, You might want to check out this article and perhaps even pass it along to your vet: http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=19204

Joanne MN

From what I can understand from the reading I've been doing, Aspirin should be added!?!? Yeah...the whole DIC thing got me kinda freaked out now! I don't think Tessy has this but I'll keep it in mind. I think I'm going to have coagulation tests done REALLY soon. I'm also going to have them check for infections or inflamations. Bone marrow biopsy? Are these safe? I'll have to look this one up also cause it's a new one for me. Thanks for the article Joanne, it really makes it easier to understand the high platelets aspect of this disease. Thanks again for your help, Johnny and Tessy

Jonathan

I just had Tessy out for a walk and she went farther than she did since she's been diagnosed. Actually, I haven't really tried to make her do any exercise of any kind since today. I noticed something odd while we were out. Maybe someone has had this happen to them? Tessy seemed to squat for pees fairly frequent. Even when there seemed to be nothing coming out. Does this mean anything specific I wonder. Johnny & Tessy

Jonathan

Just one more thing to add tonight that I totally forgot to mention. Tessy had swollen lymph nodes (near the neck). Does this mean an infection?

Jonathan

Jonathan, squatting and nothing happening, sounds like a bladder infection to me. Kahlu just got diagnosed with one on the weekend. It is fairly common and easy to treat with antibiotics. Get it checked out asap, you don't want it to get worse! Take care, Brigitte and Kahlu

Brigitte BC Canada

Absolutely. I am pouring over the blood test results and the wbc could be indicating an infection. read here: http://www.marvistavet.com/html/urinary_tract_infection.html have a test done tomorrow. she feels better because the cbc shows a nice gradual increase in her red blood cell regeneration. p

Patrice NYS

Also ask about struvite stones.

Patrice NYS

What kinds of tests should I have done? I'll get a urinalysis done to check for bladder infections but are there other tests to check for infections? Can antibiotics be added regardless as an "INCASE OF" precaution? Thanks for your responses, they are all greatly appreciated. I wish I could hug you all for your help. Tessy & Johnny

Jonathan

http://marvistavet.com/html/body_canine_struvite_bladder_stones.html I have dietary information for this if this is indeed the case.

Patrice NYS

This thread was discussed between 24/03/2009 and 25/03/2009

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