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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Lab Result
So Buddy's result is in but I am not sure how to compare it between last week. Thought someone can help? I thought the greater ABS RET is the better? If yes, so this week's result is worse? The Vet wants to put Buddy with the same regimen for another 2 weeks. 5 mg (given 1 1/2 tablet) predisone twice daily, 10 mg famotidine (given a quarter at three times/day) and 20 mg of doxycycline (given 1 1/2 tablet twice daily). Is too strong for 12 pounds Daschunds? Last Week: COR REC: 7.4% ERLS 2.0 RETIC CNT 15.4% RETIC INDX 3.7h ABS RET 364980/MM3 HCT: 23 This Week: COR REC: 2.2% ERLS 1.5 RETIC CNT 3.0% RETIC INDX 1.5h ABS RET 114900/MM3 HCT: 33 Thank you all for your advise! |
| evi Illinois |
| Evi, I sure can help you with this! I know this looks like gobbledygook to you, but once I explain this, you will understand it. Yes, "absolute reticulocytes" is the best number to use for clinical purposes. It is actually the result of a mathematical formula that includes the number of reticuloyctes,the number of red blood cells and the current hemtocrit. First, follow me with an analogy I like to use that will help you understand what the body is doing. Imagine you have a glass and you would like to fill it up with water. You turn the tap on and begin to fill the glass, and as you near the top of the glass, your hand adjusts the tap so that the stream slows and then stops so you don't overfill the glass. Disregarding things like evaporation, the glass will just sit there full to the rim with water. Now imagine that the same glass has a hole in the bottom. You take it to the tap and begin to fill it with water, but after a while you cannot keep up. The glass is emptying faster than you can get the tap to fill the glass. Eventually it becomes a lost cause and the glass will not fill up and will begin to empty very quickly. The H in AIHA stands for hemolytic or hemolysis. This means destruction of red blood cells. This is what occurs that makes AIHA so deadly, the red blood cells are destroyed at an increased rate. Our body normally destroys and makes RBC everyday. As they age around 120 days they begin to get stiff and less able to perform their jobs. The body destroys them (in the spleen) and recycles many of the parts. The bone marrow responds to this small daily loss by taking red blood cell precursor cells in the marrow and turning them into reticulocytes. These cells have RNA inside of them as they are made and can be identified by a blueish color inside the cell that shows the RNA. After a few days, they drop the RNA and then exit the marrow to join all the other RBC in circulation. A blood test done on a normal human or dog will always show a small percentage of reticulocytes in circulation and this is normal. This number is around 1% - 1.5% and around 60,000 absolute. When there is great destruction of RBC in circulation, the body sends a signal to the bone marrow: MAKE MORE RED BLOOD CELLS! This is triggered by a low amount of oxygen making it to the body cells. In order to fill this need for more oxygen the marrow will actually push these baby blood cells, reticulocytes, out into circulation early and allow them to mature in the blood circulation. This is called reticulosis. A human or dog who has anemia and is doing this is said to have regenerative anemia. This is measured by examining the number of reticulocytes in the blood, the number of red blood cells and comparing all of that to the hematocrit. So a dog with a low hematocrit should be responding with a high number of reticulocytes! If you have a hematocrit that is critical, like around 8% for instance, you might see really high numbers! 5, 6, 7 % and upwards of an absolute of 500,000! But what is happening to these reticulocytes? After a few days they turn into mature red blood cells and are now counted with the RBC and not the RETIC! So going back to my glass of water analogy.. A normal body is like the glass without the hole in the bottom. The body fills up the vessels with RBC and there is an occasional reticulocyte. A body that is undergoing AIHA or hemolysis of red blood cells will be constantly calling for more reticulocytes and this number will constantly need to be increased. This is like the glass with a hole in the bottom. A body that has called for reticulocytes and they are now maturing into red blood cells will begin to slow down the request for reticulocytes and the number will begin to decrease. BUT you should see an accompanying increase in the hematocrit! This is like you repaired the hole in the bottom of the glass. And if you look at your blood work, you will see exactly that! The first report shows 364,980 absolute reticulocytes and a hematocrit of 23. The next test shows 114,900 reticulocytes and a hematocrit of 33. So 250,080 reticulocytes turned into red blood cells! YAHOO! The body is more comfortable with the level of oxygen being delivered to the cells (by the RBC) so it is slowly down the production of reticulocytes and is not shooting them out of the bone marrow early. So yes, it is a very good result and this is wonderful improvement. The low normal number for hematcrit is 37% so you are only a little bit below that at 33. Buddy is doing very well on this protocol. Enjoy this success! If this continues, then you could very well be looking at a decrease in the prednisone in the near future. my best patrice |
| Patrice NYS |
| Patrice, you are WONDERFUL!!! To explain this so well to Evi. I know this was a major problem that we had with Holly and not understanding the retic's at all in the beginning. Evi, so happy to hear the another fellow dachshund, Buddy, is doing well, keep up the good work and remember our dachshunds are very stubborn and fight very hard! Linda |
| Linda Sapphire |
| Yes, Patrice ...you are absolutely WONDERFUL!! Thank you and Thank you for explaining me about the co-relation one number to another number. Now, it all makes sense to me. You did an excellent job explaining it! Buddy's RBC is at 3.83 still low compared to the normal range 5.5-8.5. Also, I noticed that the PLatelets is 554. Should I be concerned? I know that I can't be worry about everything. I have also emailed the result to Dr. Dodds for her opinion. She is indeed very nice. This forum has been truly and extremely become my back bone in fighting this horric disease. Very grateful for all of you! Buddy also couldn't agree with me more, he is de-squeaking his toy as I type. evi. |
| eVi IL |
| Since platelets are also formed from the bone marrow precursor cells, it is possible that they will respond strongly to the message being sent to make more red blood cells. This might account for an increase in the platelet numbers as well. I remember reading this from Dr. Dodds somewhere but I can't find it now and I am really beat. Keep an eye on the RBC, HCT, HGB, PLT, WBC numbers for the next couple of CBC's. You should see them level out to normal range. This would be a good indicator that you are ready to begin a nice easy reduction in meds. If you do not see this happening, write here again. Yes, the RBC number will increase. By the way that is 3,830,000 red blood cells and the normal range (for your vet's analyzer) is 5,500,500-8,500,000. That's why automated analyzers were developed, so they could count that large number faster. But it is still possible to make a slide of blood for a microscope, quadrant the slide and count just those RBC and multiply to get the proper number. Its tedious work but it is a very reliable and accurate way to do it. I have a good neighbor who worked at Cornell U many years ago who did this lab work. She met her husband at that lab and they are still happily married many many years later. Ah, desqueaking. It is a little known fact that Giant Schnauzers are the breed that toy makers use as their reference for "heavy chewers." I have a couple hundred dollars of ruined toys around the house that lasted maybe one day each... Chance is doing so well that this morning he was running down the fence line barking at someone walking by and he was actually keeping up with Cassie. I was so amazed that I plopped down on the lawn in surprise. He is my miracle dog. my best patrice |
| Patrice NYS |
| Evi...Great news for Buddy. I know what you are saying about this website being your backbone through all this. I can honestly say I don't know where I'ld be right now or if Tessy would be here with me if it wasn't for this forum and the wonderfull people like Patrice that help make sense of everything. Good to hear that Chance is doing so well also Patrice. These dogs really are our little miracles. Cherrish each day with them. Give hugs to Buddy and Chance from Tessy & I. Johnny & Tessy |
| Johnny Nova Scotia |
This thread was discussed between 17/06/2009 and 18/06/2009
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