Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Update on Milly

Been awhile since I've been on the site and thought I would update on Milly's progress. I took her home 2 weeks ago (after 9 days in ICE and 3 transfusions). Her PCV as 26. The normal challenges since then - excessive thirst and hunger and all that goes along with that. Three blood tests since then - all show increasing PCV's and she's now up to 41 - which is all very encouraging. Last night the Dr called with other results from her most recent blood panel which showed elevated liver function -which is apparently normal with the steroids she's on. But her platelet count was also lower than normal which was of concern to the Dr. I'm not sure of the implication of this. We're doing another test to recheck the platelets next Tuesday. Does anyone have any experience with this issue? Otherwise, Milly seems better all the time - enthusiastic about life in general, more energy, playful, etc. She's gained nearly 2 lbs though so I'm going to start to reduce her food a bit. 2 lbs is a lot on a 27 lb dog. Any insights would be most appreciated. Happy holidays to all. All I want for Christmas is a healthy dog for all of us.

Judy Medford

Great holiday news regarding Milly's PCV! Elevated liver enzymes are another unfortunate side-effect of the steroid therapy. I would imagine that given Milly's normalish PCV, the vet will recommend SLOWLY decreasing Milly's steroid dosage. Is Milly on Azathioprine? That can contribute to bone marrow suppression which may account for the low platelets. I don't know enough as Maggie, if anything, has high platelets.

RobertN Superior

Judy, There are a couple of things that could be going on here. The most simple explanation is that the platelets clumped in the blood sample used with the automated analyzer and they couldn't be counted properly. This happens enough that most labs will note on the bottom something like "platelets clumped at feather edge, estimate ok." So this is a great place to start figuring this out. It is very common. The next thing to think about is the blood itself and the variables that existed when the sample was taken. Dehydration, esp in dogs with anemia and on prednisone, is a common problem with getting a blood sample. Add in that the best sample is taken after a 12 hour fast (in which the dog probably doesn't get enough fluid) and you can have a very dehydrated dog. This can influence the results of the test significantly. The third thing to think about is that all the blood cell components, red blood cells, white blood cells and platelets all come from the same precursor cells in the bone marrow. They are the template from which these elements are made. If there is a large production increase in one particular element, say white blood cells, there can be a "shortage" of precursor cells for the other two elements to be made. This could happen for instance if there is a serious infection and the body wants many white blood cells produced immediately. Of course, there is always the possibility that they really are low. In that case it would be wise not to make any med adjustments in the meantime and if you have decreased the pred recently, be prepared to go back to the previous dosage (after calling your vet first!). So, yes the wise thing to do is wait a few days and recheck. In the meantime you can monitor yourself for signs that they might actually be very low. And they have to be significantly low for their to be serious problems, so I have my doubts that they would have just let you bring Millie home if that was the case. The most visible sign you can monitor is to look for little pinpoint red dots (called petechiae) in areas like the groin. If you see something like this, call your vet. Otherwise, just keep Millie comfortable and try to keep her from being "too" active. (Which I know is hard since she clearly feels better!) my best patrice

Patrice NYS

From Patrice: "The most simple explanation is that the platelets clumped in the blood sample used with the automated analyzer and they couldn't be counted properly. This happens enough that most labs will note on the bottom something like "platelets clumped at feather edge, estimate ok." So this is a great place to start figuring this out. It is very common." This is exactly what occurs with my Maggie. Her platelets need to be hand counted versus machine counted and there is a note that accompanies all her lab work.

RobertN Superior

Thank you Robert and Patrice for your notes. Robert - I've been reading your posts on Maggie and hope she improves again soon after this awful setback. This disease has us on such a roller coaster it is difficult to ever relax even when they seem to be doing better. When is the other shoe going to drop? Milly is still on the high doses of Prednisone and if all goes well, is scheduled for a decrease (25%) after Dec. 28. She's also on Plavix, Doxyclycline (tick borne infection), Imuran (Azathioprine), pepcid, and Atopica. I will ask the dr if the Imuran can be contributing to the platelet count but I think (would hope) she would have told me. Patrice - good to know about the symptoms to watch for. I don't think she was dehydrated before her test - she's so thirsty all the time and I haven't been limiting her fluids at all. But I am going to ask the vet about all of these possibilities you have raised to try to shed some light on this. Best wishes to all.... Thanks so much! Judy

Judy Medford

Judy, Some tick diseases can be responsible for thrombocytopenia, low platelets. This is what the doxy is for. It would be wise to ask how they have determined this and what diagnostics they plan to do to measure the success of the treatment. my best patrice

Patrice NYS

Yes, that's why she's on the Doxy. She's will complete the 30 days in about a week. This was diagnosed in her initial blood tests when she first collapsed. I will add this to the list of questions. Thank you!

Judy Medford

Judy, Thanks for you note. No setback; another poster responded to and older thread to find out about Maggie's diagnosis and treatment from this past November. Maggie continues to improve with her last HCT from Monday at 35.2%. She is acting like her old self and on track for a full recovery.

RobertN Superior

Robert - so good to hear that Maggie is doing better. Keeping fingers crossed. Best wishes for a wonderful holiday season! Judy

Judy Medford

This thread was discussed on 16/12/2011

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