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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Question about low neutrophils
| We’re hoping someone else has had a similar experience with low neutrophils and AIHA and can give us some advice, insight, encouragement, etc. We took Sheba in this morning to have her CBC run as we stopped the last of her meds 2 weeks ago. (We were down to 10 mg of Atopica daily and were hoping today would be the day we could declare her AIHA “in remission”.) We were hoping for a PCV of 42 and were pleased to hear that it is still holding steady. (Yeah!) However, our local vet noted that her neutrophils were in the basement (I got the impression almost zero) compared to the last few times. (It has been on the low end of normal but nothing we’ve been too concerned about before today.) He said he’d give ISU a call to see what they thought and get back to us. (It being a holiday, none of us were sure if he’d be able to get ahold of our vet there.) By the time we got home (15 minutes) there was a message on our machine asking us to come right back in and to bring Sheba. Panic city – that can’t be good can it!? When we got back to our vet’s office he said he’d talked to the vet there and that she was very concerned and wanted us to bring Sheba down to ISU immediately if we could. He ran down the list of things she thought could be wrong (infection, cancer, abdominal masses, septicemia…), discussed everything with us and then gave us a little time to talk about it. When he came back in I asked if the original blood test could have been a fluke. He said it was something to consider and since he still had her blood sample he’d rerun the test. On the second run through, everything came back roughly the same except the neutrophils. That count came back closer to what has been normal for Sheba the last few times. Naturally we were all a little bit relieved but still concerned. After some discussion we all agreed the best course for now would be to give her a shot of Baytril and then treat her with antibiotics (Orbax 68mg) for a week. We’ll retest everything next Wednesday (including a urine sample – fun fun!) and go from there. In the meantime, we will be watching her closely for any signs of illness, weakness, vomiting, diarrhea, unusual behavior, etc. (She’s been fine these last two weeks other than a little tired from all of the holiday travel/excitement/etc.) The only other thing I forgot to mention is that Sheba’s BUN has been slightly elevated, too, so we are switching to a lower protein diet to see if we can’t nip any problems. (We’re going to try Hills K/D.) So, it appears we are still not out of the woods yet (d*!n) and we are hoping someone out there has faced something similar and can give us some advice. Thanks in advance and we hope all of you have a healthy, happy new year! (Heaven knows we’re working on it here!) Rita, Mike and Sheba |
| Rita IA |
| Rita, This is somewhat puzzling but I can offer you a few ideas that I have. When we use prednisone in high doses we suppress all of the immune system and that would include the neutrophils to a certain extent. Atopica is more tailored to suppress the T-killer lymphocytes. So you are past the point where there would normally be significant suppression of the neutrophil line by a medication. However, the effects of the atopica can last for a period of time after the med is stopped. When Chance was diagnosed in late May 07, his entire red and white cell lines were diminishing slowly. He had a non-regenerative anemia, but he also had neutropenia, or a low number of neutrophils. After some testing and advise from Dr. Dodds we determined that he was probably not only destroying his red blood cell precursor cells in the marrow but also the white blood cell precursor cells. So thus he had slowly diminishing counts in both red and white. The cause of this was probably autoimmune in nature, though we will never know for sure. The treatment was certainly effective in a way that points to this diagnosis. What is curious about Sheba is that the red cell line has recovered with treatment. Is there something similar happening to her with her white blood cells that happened to Chance? I would have your vet look through *all the meds* (and this includes all supplements as well) she has been on and carefully look for any side effects of suppression of the white blood cells in the marrow. This may be a possibility. When this is ruled out you can begin to look at other causes. While Atopica suppresses white blood cells, it is usually only the lymphocytes. Is this an odd situation for Sheba where it is affecting the neutrophils only? I am not a pharmacist so that's something I can't answer. I hate to say this, but if this were me I might want a bone marrow biopsy to find out what is happening to the white cell precursor line. I know I always say that *I feel* this is an unnecessary (and expensive) step for dogs who clearly have AIHA of the non regenerative type, but in this case something is wrong and this test will give the vet a clearer look and might give you an answer. One of the things that should be ruled out would be any kind of neoplasm, or tumors as your vet suggested. This might cause this odd kind of suppression. So this could be either in the marrow or it could be in the body. In any case, yes, you should have Sheba on antibiotics. You should also be monitoring her temperature at least twice a day. High would be considered closing in on 103. In that case, it would be an emergency. We had to check Chance's temp like this for several months until he began making his own white cells again. This would be considered a compromised immune system. Try to avoid a lot of unnecessary contact with the outside world right now. Please keep us posted what your vet decides to do. I will be hoping it is nothing. my best patrice |
| Patrice NYS |
This thread was discussed between 31/12/2008 and 01/01/2009
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