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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - some disheartening news
| Hello everyone. Sorry I haven't posted in awhile, I have been really busy up at college and barely have any free time--I've been visiting home a lot to keep an eye on lola and make sure i don't notice something that my parent's may have missed She has been very perky and happy lately--and an outsider would probably think she was a normal healthy dog, but of course, I can still tell that she is very different. Anyway, I have been worried about her liver enzymes, so we got her blood taken yesterday to do a check on everything--the results weren't very great, and since our vet isn't a specialist, he has no idea where to go from here ...so basically I am once again relying on you guys- who I credit Lola being here right now to. I am just going to list the abnormal results because I don't really know what they mean or what to adjust to fix the levels. ALK PHOSPHATASE - Reference Range 10-150 U/L - LOLA = 533 HIGH ALT (SGPT) - Reference Range 5-107 U/L - LOLA = 537 HIGH GGT Reference Range 0-14 U/L - LOLA = 289 HIGH AMYLASE Reference Range 450-1240 U/L - LOLA = 222 LOW CHOLESTEROL Reference Range 112-328 mg/dL - LOLA = 436 HIGH PHOSPHORUS Reference Range 2.1-6.3 mg/dL - LOLA = 6.4 HIGH TCO2 (Bicarbonate) Reference Range 17-24 mEg/L - LOLA = 25 HIGH CHLORIDE Reference Range 105-115 mEg/L - LOLA = 98 LOW B/C RATIO Reference Range ----- --- - LOLA = 30 HIGH Absolute Lymphocyte Reference Range 1000-4800 /uL - LOLA = 749 LOW Anion Gap Reference Range 12-24 mEq/L - LOLA = 27 HIGH t4 Test - result = 2.3 - normal in reference range of 1.0-4.0 ug/dL WBC = 10.7 (better than last week) RBC = 5.55 (better than last week) HGB = 14.4 (better than last week) HCT = 41.1 (worse, was 43.1 last week) MCV = 74 (last week was too high at 81) MCH = 25.9 (last week was too high at 26.2) Neutrophil Seg = 87 (too high on reference range of 60-77%) Lymphocytes = 7 (too low on reference range of 12-30%) Eosinophil = 1 (too low on reference range of 2-10%) Platelets= 178,000 --still normal but went down from last week from 230,000 I am very very worried about leaving my little girl and I don't know where to go from here--if her liver enzymes are too high, what am I giving her too much of?? since her t4 levels are normal, should i cut back on the thyroxine ? i am also worried about her platelets dropping so much --i really need help. incase anyone forgot, her current list of meds are --pepcid & sucralfate --atopica --prednisone --thyroxine --pet-tinic --milk thistle --probiotic --some herbal medicines she is on a very strict diet of chicken- rice-and veggies- we also put some salmon oil on her food please any advice is more than helpful xo christina, lola, and family |
| Christina New Jersey |
| I'm sorry to hear about Lola's levels being lower, from what I've been reading here, there is a lot of ups and downs to regulate them. Some dogs seem to do well and others take a little longer. Give big hugs to Lola for me, cuz we are all cheering her on to get better. I noticed that you had put down under her medication "some herbal medicines" I believe in using natural products for myself and I was wondering if there was that I could give Chloe. Thank you Christina Cindy & Chloe |
| Cindy California |
| hi cindy and chloe! lola went to a holistic vet and she put her on epimedium powder capsules, gui pi tang capsules, forti flora, and (IN CASE OF EMERGENCY BLEEDING) there is an herbal medicine called Yunnan Baiyao Pill --the vet said i can even give her a capsule before i cut her nails in case i get nervous (but i haven't done that) --the in case of emergency med is a chinese herb that apparently warriors used to take during battle to stop bleeding- and women now take them when it is their time of the month as well--i can't say as to whether or not the meds helped, but her wbc and platelets did increase simultaneously when we started them-- thanks for the support! |
| christina new jersey |
| Christina, Pleas don't be too alarmed about the liver values. he liver is an amazing organ, quite capable of repairing itself. I remember my dog having way higher values and once we reduced prednisone and azathioprene, those values went down to normal. to help the liver we gave milk milk thistle and also Sam-E, available through your vet. Maybe somebody else has some more insight on those liver values. I would not reduce the thyroxine. It clearly does it's job and by reducing the thyroid levels would most likely go down again. I am sorry, I have no experience with low platelets, but since they are still in the normal range, I would not worry too much. I know with this disease we are in a constant state of worry. You are doing all you can for Lola! ive yourself a pat on the back for that! Best wishes, Brigitte |
| Brigitte BC |
| i would take a deep breath, your pooch is still a lot of drugs including pred and the drugs do inhibit their body's ability to produce higher counts because they are inhibiting their over active immune systems. once they start to come off of the drugs especially the pred, you usually see the counts to come up to a normal count.take care bev |
| Bev |
| Christina, The important CBC values: WBC = 10.7 (better than last week) RBC = 5.55 (better than last week) HGB = 14.4 (better than last week) HCT = 41.1 (worse, was 43.1 last week) MCV = 74 (last week was too high at 81) MCH = 25.9 (last week was too high at 26.2) These are showing an increase in the number of red blood cells that are better able to carry oxygen to the cells. This is a good thing because these values are near normal. The "M" values are showing that reticulocytes, baby blood cells, are maturing into red blood cells. This is good too. The small decrease in HCT hematocrit can possibly be due to dehydration when the test was taken. Generally you cannot have an improvement in the number of red blood cells and an increase in overall hemoglobin without an improvement in hematocrit. At this point I would recommend that each time you have a CBC done, you also request a visual PCV packed cell volume test done as well. It shouldn't be more than about $10. but will probably be less and they may even do it for free as a addon to the CBC. It is really the same thing as HCT but tends to run a few points higher. Chance's values were pretty routine, HCT at around 33 and PCV around 37-38. 37-38 is low normal. My vet has informally found that some dogs that have recovered from AIHA/IMHA or bone marrow failure tend to the lower values for the rest of their lives. 41 is well withing normal range (unless your breed is a sighthound) and is quite adequate. Some of your chem screen values are not normal and your vet should explain to you what they mean and what they want to do to resolve them. Electrolytes are carefully monitored by the body and it does not like it when they go out of range. If there is one thing on this test I would pointedly ask about it would be this. Kidney values B/C RATIO Reference Range = 30 HIGH are showing a ratio between the BUN and Creatinine. We don't know the actual BUN and Creatinine value and that is actually important. If one is normal and one is a little high that is different than if both are high. However, this could be elevated simply due to dehydration when the blood was drawn or a high protein meal before the test. It's tough to say, but best to ask your vet about. I think the lower platelet count may have been due to platelet clumping on the feather edge. This is a common difficulty with making a slide for the automated analyzer. As they smear the blood onto the glass some platelets will clump at the feathering and are unreadable. They usually note this on the test results and say something like "platelet estimate adequate." Neutrophil Seg = 87 (too high on reference range of 60-77%) High Neutrophils segs indicate a greater number of circulating white blood cells in response to infection or stress and may even be a result of high dose prednisone therapy. The T4 thyroid number is not really of much value by itself in evaluating thyroid function but it's good to see it is in the normal range. Bridgette can help me here with the recommended values from Jean's book. I believe the T3 is really the more important value. Carefully evaluate any herbal supplements you are giving to make sure they are not conflicting with the prescribed medications. Some of these can be very potent and have unexpected results when combined with medications. my best patrice |
| Patrice NYS |
| Sorry Patrice, I can't help with the thiroyd function numbers. You have way too much faith in my medical knowledge:) I lent the book to my vet and can't even look it up. Maybe Richard? Brigitte |
| Brigitte BC |
| Hi, Just got my book back from a friend in Kelowna. A book to be shared, I guess. From "The Canine Thyroid Epidemic" By Dr. Jean Dodds and Diana R. Laverdure: Thyroid reference levels: "Testing T4 only is not sufficient to detect autoimmune thyroiditis." T4 (ug/dL) FreeT4 (ng/dL) T3 (ng/dL) FreeT3 (pg/ml) Puppy/Adolescent 1.60-3.80 .90-2.50 35-70 1.6-3.5 Adult 1.40-3.50 .85-2.30 35-70 1.6-3.5 geriatric 1.20-3.00 .70-1.75 30-70 1.6-3.5 Also, analysis for presence of TgAA (Canine Thyroglobulin Autoantibodies) There are also additional reference ranges for Large breed dogs and sight hounds. Richard |
| Richard Burnaby |
This thread was discussed between 01/10/2011 and 04/10/2011
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