Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Holly's update 10-16-07

Hi all, Just got Holly's blood work back and we are pretty happy I think. Her PCV is 41.4, but her retic count is on the rise again :( Three weeks ago her retic count was 0.3 and today it is up to 0.9. Still in safe zone, but climbing again, so now I don't know what to think. I know that this means destruction is still going on and am just depressed because 3 weeks ago I really thought the Imuran was doing its thing, but now being up to 0.9, I am afraid we will have to up the prednisone again. Her absolute retic are up to 58770 and three weeks ago they were 17700, which I don't think is good at all, but still so very confused on these. Her alkaline phosphatase has come down, back on august 21 that was 808 and now is 476 so maybe the milk thistle has helped. Another one I don't know about is her Lipase count has really gone up since August 21. It was 454 and now it is up to 1408. I don't really know what that means (Lipase) and her Platelet count is also just a tad high at 429. I will have to fax this report to her internist in Atlanta on Thursday, but in the mean time any help or suggestions would be so appreciated. Am I just worrying to much about all of this. Should I be happy with a PCV of 41.4? Guess I just didn't pray hard enough :( Linda

Linda Sapphire

Linda, Stop worrying! .9% reticulocytes and and absolute number of 58,770 reticulocytes with a pcv of 41.4 is perfectly normal! A normal dog or person will have between .5-1% reticulocytes in circulating blood. The normal standard for absolute retic is < 60,000 (when the pcv is in the normal range). Your alkp number is very good too! It shows that the drug related liver injury is diminishing. Excellent. Here is a little information about lipase for you to read. Talk to your vet about this when you can. If your dog had acute pancreatitis, you would probably notice her as being very sick. Is that the case? Note what I have highlighted below that 1. prednisone can increase lipase values and 2. moderate increases may be accounted for by non-pancreatic causes. Patrice snip> (note: still within normal range) Amylase (AMYL): 500 - 1500 U/L Definition: An enzyme released in the pancreas. Useful in diagnosing pancreatic disorders snip> http://diaglab.vet.cornell.edu/clinpath/modules/chem/lipase.htm Causes of increased lipase * Drugs : *Corticosteroids are reported to increase lipase values.* * Acute pancreatitis: Destruction of pancreatic acinar tissue results in the escape of pancreatic enzymes into the pancreas and peritoneal cavity. The enzymes enter the blood by way of lymphatics or capillaries with subsequent elevation of serum levels. Increases of at least 2 x normal are seen in pancreatitis. In dogs, lipase increases within 24 hours and peaks (at a higher level than amylase) at 2-5 days. Increases of 3 times normal support a diagnosis of pancreatitis more strongly than more moderate increases, *which may be accounted for by non-pancreatic causes.* Lipase may be normal in up to 28% of dogs with pancreatitis.

Patrice New York State

Patrice, I know you are correct and I show not be worrying, HA! Just comes natural. AFter looking back at Hollys records, the last CBC and retic was done on Sept 24th and PCV was 39.3 and retic was 0.3 at which time she was on 2.5mg predisone daily and 2.5mg Imuran daily. On Sept 26 we started our decrease to EOD of the prednisone, still 2.5mg. So that is probablly why the increase of the retic up to 0.9 and the platelet count. No Holly is not vomiting or acting sick, she did have a little diarraha the other day at the vets office more mucous very runny. After research last night I did find that the Imuran will also cause the Lipase count to go up. Thanks for the link about Lipase! I am still so very confused on the Platelet count, do you know about that. I know you explained to me a while back so very very well all about the retic and how it works, just wondering if you could explain to me about the platelet count also, you are so very good at explaining things, that stupid people like me can understand. I am thinking the platelet count are the baby red blood cells and the reason they increase is that they are producing more to try and counteract the antibodies killing them off?? I will be faxing this report to Dr Langs in Atlanta tomorrow and see what she suggests next, we were not due to reduce prednisone again until next week to every 3rd day. I know she told me in the beginning they really want the retic count to be at 0, that is the goal, meaning Holly would be perfectly healthy. Thanks again Patrice for your help. Linda

Linda Sapphire

Linda, Platelets are the clotting agents in the blood. They help control bleeding and are very important not only outside the skin, as when you cut yourself, but also inside the body where it controls any kind of internal bleeding. Your numbers are close to normal ranges right now. I would not worry about it right now. Just ask your vet on the next visit. Your constant interest and questions show your willingness to learn and support your girl. Each time you read a new thing and learn it, you increase your knowledge. I think you are very clever to look at your blood work and ask intelligent questions about what you don't understand. Relax right now and enjoy Holly's good health. She will enjoy it too. Big hug from me. Patrice

Patrice New York State

Linda, This is great news. Way to go Holly. Those levels sounds really great. If you are concerned about the platelet count, speak to your vet but these numbers are so close to the normal range, and normal for each dog can be a little different. When Tess came home her platelets were in the 600s and the vet prescribed a baby aspirin each day as therapy (like a heart patient) but with numbers in the 400s we discontinued this. Claudine

Claudine Milton

those are great results for holly, happy to see those 40#'s cant wait till we get that high!!!

josh cal

Josh how is sway doing?

Jackie pembrokeshire; west wales; uk

Thanks all, and to you Patrice for explaining about the platelets. So basically we don't want the platelets to go over the 400 mark because if they do then her blood can clot, is this correct? Don't get me wrong we are really very happy with her latest results. I did not hear back from her Internist in Atlanta today but sometimes takes a few days. I am thinking we will not reduce prednisone to every third day next week. Think maybe we will wait another 3 weeks and do the bloodwork again and then see if we can reduce. It is just that after 8 months just want this to be over and I guess just pushing to hard for it to be. I know in my heart that someday it will be and I have to learn that patience is a virtue. Thanks, Linda

Linda Sapphire

Linda, Hopefully soon you will be able to look back on this time as just a nightmare that will be over. Glad to hear Holly is still doing so well. Penny

Penny Lytle Creek Calif

Hi all, Just wanted to let you know that I heard back from Holly's Internist in Atlanta. Her advise is to STOP the prednisone effective October 26th, check PCV in one week and if normal recheck retic count in 4 weeks. If retic count is normal (under 1%) after the 4 weeks, then go to every other day on the azathioprine and slowly taper over the month depending on PCV/retic. I have put a call into her, not sure she will call back today to find out why not going to every third day rather then just stopping, or her reason for just stopping cold turkey, unless because of her Lipase count being 1408. I also have a call into our vet to ask his opinion on the same question. If they both say okay, that is what we will do. Linda

Linda Sapphire

wow. that's an interesting recommendation...to stop cold turkey. I would ask, like you for an explanation. Why not taper to 1.5 for 4 weeks? You don't want her to relapse. When I tapered Choe's dose to 1.5 he went down from 40 to 33. Just be careful. Ask questions and make recommendations yourself if you feel more comfortable. Jan

jan philly

My vet did call me back, the Internist from Atlanta did not. The vet thinks it will be okay, because she has done so well on the 2.5mg EOD for the 4 weeks. In fact when switching over to the EOD her PCV actually increased from 39.3 to the 41.4. So at this point we will try it for the week and then recheck her PCV the first Monday in Nov and see, I will probably not wait an additional 4 weeks before checking retic count. Jan when you tapered Choe from 2.5 to 1.5 was he on EOD on the 2.5?? Then what did you do go to every third day to get to the 1.5? Linda

Linda Sapphire

Linda, no I never got to the EOD regimin. We were decreasing to 1.5 from 2.5 on a'every day' schedule when he suddenly relapsed. Then we had to start all over again at the 10mg dosgae and wean back down. We're now at 3.5 mg day. Every vet seems to have a different opinion regarding a decrease regimin. It may be helpful to collect informaion from this site as to how others stopped the pred. Might just make you feel better! The worse thing is to have an 'emergency' and then try to scramble for answers. I am very glad for you Holly is doing so well. Jan

jan philly

This thread was discussed between 17/10/2007 and 20/10/2007

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