Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Tessy's New Blood Results

Tessy was in today to have her blood work done. I was really hoping that her HCT would be up and her platelets would be down but neither happened. Her are her full results... HCT remained the same as last week at 28.3 WBC dropped from 45.9 to 40.9 RBC rose from 3.37 to 3.54 HGB dropped from 9.7 to 9.6 PLT rose from 583 to 708 MCV dropped from 84 to 80 MCH dropped from 28.9 to 27.1 MCHC dropped from 34.3 to 33.9 RDW dropped from 15.8 to 14.8 MPV dropped from 6.2 to 6.2 %LYM dropped form 2.1 to 1.9 %MON rose from 1.1 to 1.4 %GRA dropped from 96.8 to 96.7 #LYM dropped from 0.9 to 0.7 #MON remained the same at 0.5 #GRA dropped from 44.5 to 39.7 I had a BioChem done and the results were as follows... ALB 39 G/L ALKP 99 U/L ALT 126 U/L CREA 115 umol/L GGT 12 U/L I put all the results down in hopes that maybe someone could see a patern that may help me out Or perhaps some things I might have to worry about? The doctor also said that Tessy's Lymph nodes were larger than they were last week also. LARGE BREATH!!!! Anyway, the large PLT number and the lymph node thing got me worried so I guess there will be some sleepless nights ahead! I'm glad that the HCT did not drop at least. I am having the blood sent off to a specialist at a Veterinary College to be analyzed. The results should be back tomorrow or Thursday. I will keep you all posted as the results come in. Thanks for listening and sorry for all the detail. I'll continue to pray for Tessy's health and also the health of all the other dogs affected by this disease. Johnny & Tessy

Jonathan

I just wanted to add a little to the previous post cause I forgot to say that at least for the time being Tessy seems to be just as perky as ever. She's always wanting to play and that must be a good sign! As for the blood test today...I have heard many times on here not to take the numbers too seriously. Several things can affect the numbers such as the time of day (in which her test was done in the aftenoon instead of the morning like last time) and problems with taking the blood (like today the needle did not find the vein as easy as it did the last time). I'm hoping that these factors may have played a role in these numbers. Anyhow....just thought I'ld mention this. Johnny and Tessy

Jonathan

Hi Jonathan, glad to here Tessie is holding. I had Wylie in yesterday for her CBC and asked abut her PLT that keeps rising. Hers is 798. He didnt seem too concerned and he said it will rise being on prednizone. Now I wished I had asked him since she is only only on 2.5 every other day from 20 mg a day why is it stil rising when we are reducing, doesnt make sense. I am expecting him to call about my other dog so I will ask. Patrice aso said many schools use a high range of 900 on the PLT. Looks like you are in range of all except the MCH, and the MCV but those are coming down. And the great news is to see Tessies ALT and ALK look so great, these usually skyrocket when on prednizone. Just remember if you go to an outside lab that does the blood version vs the PCV of her HCT, she will most likely show lower. The PCV really gives the true #. I am looking at Wylies from yesterday and her blood test was 37 vs the PCV thats the one they spin is 45 and thats what we go by. Wylies HCT has been fluctuating between 41 and 45 so dont get too worried if it dropss a little bit, I do believe it depends on their resting point as Patrice explained. Laurie

Laurie CA

Do you think I should be asking to have the spin test done as well each time?

Jonathan

Yes, make sure you have the spin test (PCV) each time, its the most accurate. Most people here that has given the range from the blood test vs PCV is 4-8 point difference of a higher reading. Since the blood test is part of the cbc reading, my vet just crosses it out and puts the PVC next to it. If your vet only did the blood test with the cbc, I would guess Tessie is around the 32 range. Laurie

Laurie CA

Jonathan, I am sorry this is late getting to you. I have been very busy this week. I don't know what your lab reference numbers are so I am going to use Idexx LaserCyte's ranges. Hematocrit 28.3 indicates anemia, but it is in a much milder anemia range, out of the seriously dangerous range. Getting a small pcv packed cell volume done at the same time will give your vet a *visual* and probably more accurate look at this indication of total "red stuff" in the blood volume. The automated analyzer tends to show the hematocrit to be lower than the PCV, even though they are supposed to represent the same thing. It shouldn't cost more than $15 to have the PCV done. There is a small rise in the number of red blood cells RBC, not a lot, but significant in that there is most likely some regeneration occurring and reticulocytes are maturing into red blood cells. The hemoglobin dropped a little and this is more likely because there are more immature red blood cells reticulocytes in circulation that don't have the capacity to carry this yet. They take up space for the test and lower the average hemoglobin count. In human medicine, this number is actually a bit more important an indicator of anemia. The platelets are higher and this could be a number of things. What does happen sometimes is that the bone marrow is responding to the the body's call to make more RBC and it stimulates the bone marrow precursor cells. These cells can become any of the three blood elements, RBC, WBC or platelets. So the platelet production may have been stimulated too and it over produced. Since there are so many factors that can cause this number to be high, the best thing to do is watch it over a series of blood tests to see if it is truly rising above normal and staying that way. I would talk to your vet if this continues to rise on the next one. MCV is mean corpuscle volume. Just the size of the red blood cells in circulation. This is still a bit higher than Idexx (77 is their high number). It indicates that there probably are a number of larger, immature reticulocytes that have just started the process of dropping their RNA and becoming RBC. MCH is mean corpuscle hemoglobin. You are within the Idexx range for normal. Dropping a little also indicates that there are a number of reticulocytes hanging around that aren't carrying hemoglobin. MCHC is mean corpuscle hemoglobin concentration. Again, it's lower, but not by much, for the same reasons. I wish your test included the reticulocyte numbers. I am surprised they are not part of this panel. I would consider those the most important numbers right now. You are seeing the effects that they can have on the process without the actual numbers of them! Overall WBC white blood cells numbers are still very high according to Idexx's reference range. But they are dropping. This is one indicator to watch carefully. Your vet's clinical experience will be important in targeting why they are so high. I would think of infection but there can be other causes. The lymphocytes are decreasing. They are within Idexx's normal range. But this is the group of wbc you want to suppress, the t-killer cells. This shows that there is proper suppression of them by the prednisone and the cyclosporine. Your chem screen numbers are not in the same range as Idexx but I can take a stab at what they really compare as. Alt and Alkp are the two liver enzyme numbers to watch to see if the prednisone is damaging liver cells. This will happen and there is not much you can do right now except make sure you are giving proper liver support with either a veterinary supplement: Denamarin or Marin or Denosyl. If you are cutting costs, then you can use over the counter: Country Life Liver Support Factors +/- Sam-e. Talk to your vet about the cost of Denamarin (the equivalent of otc Silymarin (milk thistle essence) and Sam-e). The purer forms are better. Your numbers: ALKP 99 U/L This is well within Idexx normal range. ALT 126 U/L This is 26 pts higher than top normal. GGT is a marker for cellular damage for the liver and bile ducts. Not sure what the range is, check to see if this is wnl. my best patrice

Patrice NYS

Patrice, thanks for explaining this, it sure helps a lot for all of us. Oops I missed the High WBC # on Jonathans cbc, so please do ask about that. ? for patrice, you mentioned not seeing the reticulocytes on Tessies CBC, I dont think I see it on mine either, how would that be listed. It would be nice it we could get some of this added to Joannes FAQ site. Thanks Laurie

Laurie CA

Thanks Patrice, you are more of a help than you probably know. I've been dealing with this disease for just over 4 weeks now and still alot of it doesn't make sense to me. The GGT reference range is 0-7 and Tessy's number was 12. The GGT and ALT were the only numbers over the reference range. Thanks again for explaining in such great detail. You help to relieve the stress! I've been thinking for the past week about giving Tessy a bath and today she is seeming more playfull and energenic than ever. I think I'm going to go ahead and give her a quick rinsing. It is really nice out so it's going to be now or never I guess. How are you feeling today Patrice? Are you getting better? How is Chance? Give him a hug from Tessy and I. I'll be thinking of you both and praying that you both get better soon. Tessy and Johnny

Jonathan

Patrice, this was so informative for us too. I don't see a reticulocytes % on the CBC they send out either.Could there be an other name for those things? Sometimes the pathologist just adds it to his comments. This is the reason I like the in house Lasercyte test better. On top I don't have to wait for 24 hours to gt the results. Is there any other benefit by sending it to a lab, other than having a pathologist actually looking at the blood? The more I learn, the more I realize how little I know. Brigitte

Brigitte BC Canada

You probably won't like this answer, but I can't imagine why a test would call these anything other than what they are: reticulocytes. Here is a section from: http://medical-dictionary.thefreedictionary.com/Reticulocytes (book mark this dictionary!) "reticulocyte a stage of erythrocyte maturation, between normoblast (metarubricyte) and mature erythrocyte, showing a basophilic reticulum (residual RNA) under vital staining. corrected reticulocyte percentage (CRP) percentage reticulocytes ÷ (hematocrit ÷ normal hematocrit); a measure of reticulocyte numbers adjusted for the degree of anemia. reticulocyte count performed on blood mixed with a supravital stain such as new methylene blue or brilliant cresyl blue. An increased count indicates active erythropoiesis. reticulocyte production index (RPI) corrects the reticulocyte count, taking into account the presence of anemia and the presence of shift reticulocytes producing a more accurate indicator of red cell production. reticulocyte response the release of reticulocytes in response to erythropoietin or administration of specific therapy for anemia, e.g. a deficiency of iron or folic acid. A reticulocyte response does not develop until the anemia is marked in cattle and not at all in horses. shift reticulocyte, stimulated reticulocyte with intense stimulation of erythropoiesis there is premature release of reticulocytes from the bone marrow into peripheral blood. These are larger and contain more reticulum than normal reticulocytes. erythroblast originally, any nucleated erythrocyte, but now more generally used to designate the nucleated precursor from which an erythrocyte develops. normoblast a nucleated precursor cell in the bone marrow of the adult circulating erythrocyte. Developmental stages include the pronormoblast, the basophilic normoblast, the polychromatic normoblast, and the orthochromatic normoblast. After the extrusion of the nucleus of the normoblast, the young erythrocyte becomes known as a reticulocyte and enters the circulating blood." The reasons for sending out blood to an outside lab can be varied. Does the facility even have an automated analyzer? They are pretty pricey. If they do have one, would they prefer a specialty lab to do the counts by hand and do a cytology on a blood smear? My specialist actually does his own anemia panel by hand. When they use an automated laser analyzer, the machine must "match" the items it "sees" to its references for what these things should look like. It can make errors if the sample was damaged or there are wide variations in the sample because of a disease condition. I don't necessarily like the idea of sending out blood, I prefer to have it tested immediately and not sit around. But that doesn't mean sending it out is a bad thing. But they should be able to do an immediate pcv at any clinic. And very good vets will know enough to be able to do a preliminary blood smear and make a few guesses at what they are seeing. My own human doctor used to do this in her office to save money and time. The last time I saw her in January, she was flipping out about how hard it is for her to take care of her patients properly because of how complex the health care system has become. It's in a very bad state. Dogs get better care sometimes than humans. patrice

Patrice NYS

Thanks Patrice! I knew there was a reason why I became a Kindergarten teacher and not a vet or doctor. There is so much that you were able to explain to me, but some goes right over my little head. I am sure glad there won't be a test!!! I am definitely equipped to ask some more questions when we see the vet next Monday. Until then I will do some studying. I hope things are better with you Patrice, and Chance is fine too. Take care and many thanks! Brigitte and Kahlu

Brigitte BC Canada

Brigette, Ha Ha. And I don't think I'd last two days in a room full of screaming kids... Seriously, medical terminology is not as hard as it first appears. Much of it is based on Greek or Latin and there are certain rules to how the words are formed. Let's look at something easy. Osteoarthritis. Do you notice the O in the middle of the word? This is a connector that takes two things and puts them together to mean something else. So oste means bone, connector O and arthritis is an inflammation of the joint (itis means inflammation, arth is joint) Hemolysis. Hem(e) is blood, connector O, lysis means destruction or more technically, lysing of a cell, literally breaking apart. It's actually kind of fun to read the history of medical words and take them apart to figure out what they mean. Since I had to learn many thousands of words for anatomy, physiology, neurology, physics etc, I had to find some way to remember them all. Breaking them apart was the answer. If I only understand one part of the word, I can guess by the context what the whole word means. As far as canine hematology, I am a mere novice with only textbook knowledge. I have read the information and I can understand it, but applying it to a clinical situation is a very different skill. Remember this, your doctor could have graduated med school with a 4.0 or a 2.9 (is this possible?) and still be a doctor. Which doc is better? The doc with the 2.9 average may be a more visual, hands on learner and has incredible intuitive skills when it comes to diagnosis and treatment. I would never worry about seeing someone like this because I know that if they don't remember some fact, they will go look it up. The doc with the 4.0 may be very rigid and dependent solely on trying to fit your illness to something they remember reading in a text book. Or it could be the other way around. I am sure you see the beginnings of these personality traits in your kindergarten students? You have so much influence on the rest of their lives. Maybe it's important to "soften up" the children that are a little too rigid? Help other students master "really" memorizing something important? I taught swimming on Saturday mornings at the Y for many years. I saw these little people already exhibiting many of the traits that they would have as adults. I remember one particular family with two boys. I taught the older boy for a number of years and progressed him into a high level of classes. He was a very perfect swimmer and wanted each stroke to look just right. Then a few years later after he started, I had his little brother as a beginner. This fellow threw all caution to the wind. He was overjoyed to be in the pool and just experimented with his water skills. He was really having fun. Fast forward about 15 years... I get an invitation in the mail from this family to attend the younger boy's Eagle Scout ceremony! Come to find out that both boys obtained this highest level and that the younger boy specialized in swimming for his Eagle Scout badge. What was even more amazing is that they remembered me and especially wanted me to come! What a great honor that was for me. So I guess I do love teaching, even if the kids could get out of control sometimes. enough patrice

Patrice NYS

Patrice, I can't say you would be a good teacher....You ARE a good teacher! Teaching swimming and hematology! Take care, Brigitte

Brigitte BC Canada

I'm learning something new everyday! Thanks Patrice. Johnny & Tessy

Jonathan

This thread was discussed between 17/03/2009 and 19/03/2009

Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index

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