Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Riley update

Riley's latest blood results are in, havent collected all of them but the PCV has dropped from 0.30 to 0.29, the RBC from 4.08 to 3.99 and the WBC still high, rising from 32.9 to 36.7. I have to collect them so I dont know what the pathology description is, probably the same old stuff. Im disappointed as I really thought Riley had shown some improvement, and Im tired of being held to ransom with numbers. I know Im not long into this game and many of you have significant experience with this, but is this something that should get me down to this extent? My vet is pregnant, and not always at the surgery and I would like to get a specialist view now so that I know exactly how to deal with this and whether we are all on the same page, so I have an appointment with the Melbourne University Veterinary Clinic and Hospital - with a great referral from some Aussies here, thank you Samantha. *Sigh*

Silka Melbourne Australia

Hi Silka, Try not to panic, a lot of times there will be a little bit of statistical variation when they do the test. At times, Tiggs would fluctuate up to 5 points, so I found it to be very important to go by his clinical signs of how he was acting day to day. You said you thought Riley was improving, so that must mean that his clinical signs are good- that can go a long way when the numbers aren't seeming to go up. At this point, I would be more worried about why the white cell count is up, than the actual PCV. That jump seems a little more worrisome, but if there is some kind of underlying infection, perhaps with an antibiotic, you'll see his PCV rise as well. We had a couple of infections that set in when Tiggs was about where Riley is now, and we did a 21 day course of Doxy. His PCV rose quite a bit, and the white cell count finally came down. I hope that it's not a trend, but really, try to relax and focus on how Riley is acting, which sounds very encouraging. Hugs, melissa and tiggs

melissa slc

Silka, This is really a small insignificant drop. If Riley looks clinically better to you, he probably is. there can be many reasons for a drop like that. The difference in a full or empty stomach at the blood draw or how hydrated the dog is at the time, if the dog is agitated or stressed could be just some of the reasons. Don't get hung up on the numbers! i know it is easier said than done. I am glad you get to go to see a specialist. this disease is so complex and it helps to consult with somebody that has lots of experience. Best wishes, Brigitte & Kahlu

Brigitte BC Canada

Thank you Melissa and Brigitte. Valuable advice in both posts thank you. Brigitte, last night when the blood was being taken from the jugular, I was in the room but couldnt look so heard them struggling for the vein with Riley making funny noises, so I know he was stressed. I was so upset I left the room. I had no idea this could affect the results. Melissa, I am worried about the white blood cells - it has been high for a bit now and he has had two courses of antibiotics, and then I thought it was the pancreatitis brewing. Ive seen many threads mention Doxy, so Ill put it on my list. Gathering all the info I can. Clinically, I believe Riley is doing better, but thank you, this info helps a great deal.

Silka Melbourne Australia

Hi Silka, I'm glad you are going to Werribee. Are you seeing Leonie Richards? Leonie is Millie's vet. Millie also saw Trudi McAlees - but she was in Emergency and I don't think she consults in the day clinic. Trudi was fantastic during Millie's crisis. It is hard not to get hung up on the numbers, but honestly Millie was at PCV 27 for about a month. Then we got our rises slowly. I was frustrated too. Even now, we have fluctuated from as high as 45 to as low as 38.... and Millie has been stable for months now. However, there might be more going on with the white cell count in Riley's case and other speaking from experience should be able to help you. I have been lucky enough that we never had a lot of problems and I must say compared to a lot of others on here, it's been smooth sailing. Results always in the normal range.... Maybe Millie is a textbook case of what should happen on the recovery from IMHA - I am very lucky. Please don't let the numbers get you down. If all is going as it should, the numbers will rise - they have to. Does Riley have regenerative anaemia? Or is he only mildly regenerative? Did you end up ordering any Bio Prep? Good luck and please let me know how you go. Samantha.

Samantha Geelong

Hi Samantha, thanks for the advice. I will be seeing Linda Abraham, Senior Lecturer - I noticed your Leonie is the Head of Practice - which is better? Details were faxed to them today and I am booked in for the 16th, I did that on purpose as then Riley will be due for another blood count and they can do it. Riley jumps from profound regeneration to mild regeneration but I believe it has always been regenerative - guess their comments depend on numbers they get. I picked up the report this evening and it says he has "ongoing anaemia (PCV much the same as previous) but with slightly less regeneration. Nucleated red blood cells are part of the regenerative response. It also says "leukocyte (white blood cells) response likely associated with bone marrow response or steroid treatment?" - "Lowered lymphocytes are usually due to stress/steroids". All in all the results are not much different to ten days ago, except those silly old band forms are back that my vet doesnt like, but she wasnt there to discuss it with. Oddly enough, last time the platelets were 990 and they said they were "moderately" increased. Today they are 907 and suddenly they are "markedly" increased. Who writes these things! I have your story here Samantha, and I take heart from it.

Silka Melbourne Australia

Try not to stress too much. They don't look like a very marked difference in counts either way, so that is good. I'm sorry it is not what you were hoping to see, but your pup is there with you, clinically doing well and that in and of itself is a blessing. Keep thinking positive. It will be alright....I'll be thinking of you both. Mardi

Mardi Northern Calif

Thank you Mardi for your thoughts and kind words.

Silka Melbourne Australia

Hi Silka, Riley has still got good numbers, try not to stress as others have said. Probably very good to get specialist advice as you know then that you are dealing with the best. Good luck with you next set of tests. Julie.

Julie Australia

Hi Julie, thanks for the reassuring words, I know Im the impatient type. Silka

Silka Melbourne Australia

Silka, doesn't this just bring back the memories for Tessy and I. If it makes you feel any better TEssy's crit rose to 30 within the first 5-6 weeks post diagnosis and then is leveled off here for almost 3 months. In those 3 months her crit would fluctuate between 27 & 30.....extremely frustrating! Like Melissa was saying....don't get tied up with the numbers. Go by how he acts instead. Tesy also had a high WBC at htis time also. Not to mention her platelets were well over 1000. We had to put her on low dose aspirin when her platelets were this high. In time her WBC and platelets finally went down....still not in normal ranges but close enough to not worry me so much. I used to drive myself crazy back then wondering things. Lowered lymphocytes is a good thing! This most likely means the drugs are doing their job. The whole point of the drugs is to get the lymphopenia where we want it to stop the destruction.....I think. I don't know if this is possible to do from there but if I were you I would have the blood sent to Dr. Dodds for analysis. It was by far some of the best money I've spent while dealing with this disease. Hoping and praying for Riley. Johnny & Tessy

Johnny Nova Scotia

Hi Johnny, how funny you should post! I have been looking back over the archives to read some of the stories, and I just read most of yours today - your story is much like ours, as you say. Hmm..I will check on the Dr Dodds situation, I know its come up before in other posts, but I dont know if it can be done from this distance. I will try not to get locked into the numbers game, but its hard not to, but I know I have to, as it sometimes doesnt make sense. Riley doesnt have his old spark, but he walks around, takes himself off to do his duties, and wants to know whats going on - barks if someone walks past like he used to. I have raised the issue of aspirin, but this all started with Immune Mediated Thrombocytopenia so the vet didnt want to do the aspirin thing. Is Tessy clinically well? May I ask what medication she is on now? Thanks for the thoughts Johnny, they are much appreciated. Silka

Silka Melbourne Australia

Silka, clinically Tessy is doing great. Her CBC results could be a bit better but her chem panels are great. I started her on pet tinic last week in an attempt to beat the microcytic anemia. I think she might just need a boost so to speak. She's down to 7.5mg pred, 12.5mg azathioprine and 50mg cyclosporine everyday still. I'm not sure if we are going to lower her pred down to 5mg or take her aza to every other day. She has an appointment set for Tuesday so we'll discuss this matter then. Oh and she still takes omeprazole for to protect her stomach. I'll probably take her off this in the near future. It seemed like it took Tessy forever to get some spark back. Everyday she seems to be improving. She gets to chase the ball everyday so that makes her happy. It wasn't until I started lowering her meds that her crit jumped up over 30. I started to lower her meds when her crit was around 28/29 on Dr. Dodds' advise. Sounds like Riley is getting clinically better. As far as the numbers go I only get worried if they drop by more than a few points. I was and still am the same as you. It's easier said than done to not think about the numbers. The best thing for you to do if you want to send the blood to Dr. Dodds is to email her and ask some questions. I know that they ship blood all around the world so I can't see why you couldn't ship to her. They'll package the blood properly for you. You know....I hear people say all the time to get a specialist involved and to me I think that's the best thing anyone can do when in this case. With Dr. Dodds you get decades of experience. She's picked up on things that specialists up here in Canada didn't. She said that just comes from years & years of experience in dealing with this disease. Like I said before......it was money well spent. I just wish I would have sent it earlier. Best wishes and prayers, Johnny & Tessy

Johnny

Hi Johnny, thank you for the quick response. Im keen to know what Dr Dodds picked up on with Tessy that specialists did not pick up. Im interested also in the reduction in meds for Tessy even though the crit is at 28/29, right where I am at the moment, and I would love to reduce the pred as I feel that is what is holding Riley back - he is clinically okay but I feel he could be better, as Im sure we all feel and I know if I reduce things too quickly, he may go downhill. Riley is on 12.5 pred each morning, with half an Imuran every second day, also Atopica each day - and my vet didnt do that, the emergency centre felt he was on too much of a cocktail when he had the pancreatitis, so they checked with a specialist and he said it was much of a muchness which drug was reduced as they all had an impact but go with the Imuran first. They are tough characters our doggies, and its fantastic that Tessy is playing ball, that must do your heart good to see that. My two dogs used to play and chase each other around the house and I loved to see that, and Bonnie, my border collie, sometimes tries to start that, and I can kind of see that Riley would like to, but obviously the body cant. Thanks Johnny, interesting stuff about the blood and the reduction. I did see in one of your archive threads you had to cut off and arm and sell it to send the blood to Dr Dodds - what would I have to cut off, living in Oz? :)

Silka Australia

This thread was discussed between 06/11/2009 and 08/11/2009

Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index

This thread is from the Vetnet archive. The live Vetnet forum is active now.