VetNet®
VetNet® AIHA discussion forum
VetNet® Forum
Lifelong Learning Network
www.vetnetlln.ac.uk
Veterinary Recruitment
Premier Partner Program
Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Keeli's Update
| Just took Keeli back for lab and PVC was 32. A small improvement but at least it is an improvement. We came up from 31 last week to 32 this week. Was hooping for more of an increase but I know it is slow. She seems to be doing better. Tried to go after the mail man's car and had to stop her and she is now barking more. Appetite is ferocious with the Pred. Am still on the same medication regimen because it is working. Thanks to all of you who have kept my spirits up and for all the advice. I have learned so much from all of you. Patrice is it normal for very small increases and is it better for the PVC to increase at a slow rate? You seem to know so much about this and I appreciate your input. Joann and Keeli |
| Joann Binger Oklahoma |
| Joann, A PCV of 32 is very good and there should be few serious symptoms of anemia from this. But the ideal is to get up to around 37-38. You are not far away. How long has it plateaued at this spot? That would be of more importance. Once the body attempts to resolve anemia, it usually wants to get back to normal. There can be some reasons why it reaches a spot and then pauses. One of them is that the medications that are being used to suppress the immune system are doing such a good job that they over-suppress the bone marrow. Sometimes just lowering the dose of a med may be all that is needed to get the marrow working at full speed again. Another reason may be that there is a nutritional deficit that isn't providing enough of the needed materials to make blood cells. Sometimes if this is suspected, its a good idea to test the levels of B12 (cobalamin), iron and folic acid to see if they are at normal blood levels. Shots can be given to help this. Often, if there is a serious deficit, there is a mal-absorption problem in the small intestine. Giving these three supplements orally may not be sufficient to get them up to proper levels. There may be hypothyroidism. The thyroid gland drives many body systems and if it isn't doing its job properly, the body systems may become sluggish. Testing a full thyroid panel can be quite informative. This is resolved with giving two small pills daily. More and more dogs are developing hypothyroidism. Dr. Dodds hemopet.org does comprehensive thyroid testing. my best patrice |
| Patrice NYS |
| Patrice We have tested the thyroid level and that is ok. Keeli has been at 31 to 32 for approx. 2 weeks. We won't take her back till Sept 9th for her next check. She seems to be functioning well at 32. We are still on cyclosporine 100mg every other day, prednisone 10mg twice a day, azothioprine 25mg one daily, pecid 20mg daily, carfate 500mg three times daily, pet tinic 3cc daily, denamerine (milk thistle) daily. Her meds have not changed. We are still on the same dosages we were. Should I request a reduction in something? What do you think? Will have them check B12, Folic Acid, and Iron at the next visit and let you know the results. Thanks for your help. Many Thanks Joann and Keeli |
| Joann Binger Oklahoma |
| Joann, I think that you should proceed with a full CBC at your next visit because there are some things from that test that will define more why she is leveled out. The first thing I would want to see are the number of reticulocytes, baby blood cells. There should be more than 60,000 absolute (more than 1%). If this number is at 60,000 or lower then that would be indicative that this anemia has become non-regenerative. So the question would be why? First, let's look at a reason why a PCV of 32 may be normal! A PCV of 32 is not considered normal, (that is in most dogs or humans) and the low normal is around 37-38. But then again, while the high value is usually considered around 55, most dogs tend to average around 45. I know of some dog breeds (Greyhounds for instance) that normally have a high value of over 55, upwards of 65! So there are exceptions to even these normally finite numbers. It is very possible that Keeli's breed and her genetic makeup allow for a lower PCV to be normal. So back to the test. What is true, and how you will determine what is going on, is that other numbers on the test will also show either a normal state or an abnormal state. Two of those that you can look for on the next test results (which you will automatically request of a copy of to study!) are the number of red blood cells and the value of hemoglobin. (RBC: 5.5 - 8.5 Hgb: 12.0 - 18.0 ) If these are within normal limits then it may be that Keeli's body will have decided that 32 is "her" optimal PCV. However, if they are still not within normal limits (written as WNL) then she has some recovery still ahead of her. Then we would look at 32 and say she is close but not yet. She will not be in danger with a PCV of 32 like a dog with a PCV of 15 is. Then after looking at the numbers for RBC and HGB (if they are low on the test), if the reticulocyte value is less than 60,000 then you are looking at either a non-regenerative state (that is possibly autoimmune), a maturation deficit (can't make blood cells well enough so that they survive) or suppression of the bone marrow. (there are a few other rarer causes too, but start with the big three) That would be when you would decide if other testing may be necessary, like looking at the B12 (cobalamin), iron (ferritin) and folate. Or reevaluating the dosage of the azathioprine. This drug has a *well known side effect* of bone marrow suppression (myelotoxicity or myelosuppression). Myel"o" means marrow "plus." I would also want them to do another chem screen to determine if the kidney function is good, (among other things that you check while using prednisone like the liver values) because the kidneys play an important role in stimulating the bone marrow. For now enjoy that she feels better and relax a bit. Still do treat her like a patient, meds on time, excellent food, lots of quiet time and rest and low stress. my best patrice |
| Patrice NYS |
This thread was discussed between 28/08/2011 and 31/08/2011
Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index
This thread is from the Vetnet archive. The live Vetnet forum is active now.
