Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Update on Riley's blood results

Well, I am officially confused. I posted too soon with Riley's in-house PCV of 34.6 - the external laboratory CBC has come back today saying it is 0.28. The total red blood cell has improved from 4.4 on 23 November to 4.52. On the advice of the University vet, who did not want any medication reduced until the PCV reached the reference level (37-55), I now will put back the half tablet of pred, going back to the two and a half tablets (12.5mg), with half an azathioprine every other day, and 50mg of cyclosporine each day. My vet explained to me that she was okay with the PCV and that the in-house result as "relative" to the external result. I thought we had gone forward. Riley was once at 34 with the external lab - would that have meant if he had an in-house PCV done at that time, he would have been within the reference range? Can anyone help with explaining the differences to me? I guess I feel a bit low now, though I know that the numbers are ok, all things considered. Silka & Riley

Silka Melbourne Australia

Hi Silka I understand how frustrated you must be. At the beginning I had so much trouble with readings in house at our vet in Geelong. The PCV was coming in lower. On the second occasion they told us to go back to Werribee because Mill had dropped back to 20. Full CBC at Werribee came back at 29. This muck up cost me 300 dollars as it also resulted in an over night stay for Mill. My personal experience is that I dont rely on the in house tests but the CBC. Maybe it is worth getting another test done to be sure before upping the Pred again? I know it is expensive but the difference is strange. Let me know how you go. Sam and Millie.

samantha geelong australia

Thanks Samantha, its good to know Im not the only one who is having trouble understanding this - this is the first time I have had in-house tests - and they are doing these for me as it is cheaper, given my current situation of unemployment - as it only costs $12.50, compared to the $75 - but the variation is inexplicable - my situation appears to be the opposite of yours. Once before we dropped that half tablet of pred after Riley reached 34, and the next week it dropped back to 29 - thats when I had that strange vet who accused me of tampering with the medication - we increased it again, with that elusive half. I have sent an email with this problem to the vet at Werribee - she is on leave at the moment, but I have to say she is lovely and very accommodating - she did want me to wait a month whilst on this new dose of cyclosporine before re-testing. She returns from leave on 6th, and I may hear from her beforehand. I will also see what Kim - the vet who owns the surgery as I know they were contacting her as well. Its a rotten time of year. This vet was the one who did the last in-house coming in at 34, and yesterday she did it as well as the full count, which I asked for, and hers came in at 34.6. Odd indeed. Thank you, Ill let you know how I go.

Silka Melbourne Australia

Silka, I've also been through the exact same as you. I can't even begin to count the times this has happened to me. The only difference being that the PCV at our regular doctors is usually anywhere from 3-8 points lower. Go figure eh. It's possible that the external labs use different machine or maybe they do the counts by hand. I'ld be finding htis out if I were you. If they count by hand then it will most likely be the most accurate way to go. Is the inhouse PCV actually a PCV or is it a HCT? This would make a HUGE difference. I'ld almost have to say that it seems like the inhouse is a PCV and the external is either HCT or handcounted. You should find htis out. A simple phone call would tell you this. If I were you I wouldn't have increased the pred back to where it was. UNLESS there was obvious destruction going on. It just doesn't make sense to me that they are unwilling to reduce until the crit gets to normal ranges. I also thought this way until I talked to Dr. Dodds and she recommended we reduce when Tessy's crit was only at 28%. It wasn't until then that her crit started to climb!!! Bone marrow suppression??? I'm not sure. What are Riley's REtic #'s lately? Let me know how it goes. Johnny & Tessy

Johnny

Hi everyone again, Johnny thanks for your message, as always. I have phoned my vet today - Kim, who is back from some leave - she is very pregnant right now - so Im always glad to speak with her. The PCV in-house as she explained it, is done in about 10 seconds, and I was there when it was being spun in some kind of machine - she said it is like using a ruler for a quick guess - whereas the hematocrit counts each blood cell individually, and that is the one that was done with the CBC, so the 28 is the accurate one. So there you go, I got excited way too soon. I do wish it was the other way around as for you and Samantha. Kim agrees that we go back to the original dose for the time being until we hear from the University vet - it is quite a way until the "reference range" thats for sure, particularly at this rate. Johnny there has been reductions - it was double the dose it is now, and Riley is in his third month with this illness. Here is a copy of what the University vet said: "I would like to see a little more improvement in the PCV before we start to taper doses but I am pleased that there has been an increase thus far with the increased dosage of cyclosporine. It will be a bit harder for him in the hotter weather but remember that the high doses of immunosuppression should only be temporary." I guess I have to find out what she would rely on - the PCV or the hematocrit. I only kept her informed of the in-house number - and it was my idea to get the full count done as I wanted to know what the platelet count was and it is 967! I think Riley has got someone else's platelets now as well as his own. Johnny, Riley's retics this week came in at 579 (12.8%) - comments on the report are "anaemia - regenerative occcurs with haemolysis or bleeding. No evidence of agglutination or spherocytosis so latter more likely. Rouleaux suggests inflammation (havent heard this term before). Neutrophils may indicate inflammation or be reactive. (neutrophil number is 25.7 (84%). See anything worthwhile? Thanks again folks Silka

Silka Melbourne Australia

Silka, Sorry I have been busy and not paying attention this week. Hmm what a confusing scenario for you. The PCV, as you saw, is a visual exam of the "red stuff" vs the "white stuff." The HCT hemtocrit is one element of a panel called the CBC complete blood count. This is usually done now-a-days with an automated analyzer. And this is where the problem lies. The laser that is looking through the sample is identifying cells by recognition and comparing them to data that it has stored as a reference. But, as will all computers, when there are A LOT of things that are a bit different from the normal it has to figure out exactly what it is looking at. And it can make mistakes. In your case Rileys' test showed "retics this week came in at 579 (12.8%)". Gasp. This is a huge huge number of reticulocytes. This is considered highly regenerative. These cells DON'T LOOK LIKE RED BLOOD CELLS. They are larger, have RNA remnants inside them and have very little hemoglobin quantity. So the laser doesn't count them as RBC. But they are RBC in the making. In just a day or two they shed that RNA and become real honest to goodness RBC, and work just as hard. They get smaller and the color variance the laser sees will diminish so that there will be less "polychromasia." My vet, who is originally from Canada, told me that yes, the HCT and the PCV are essentially the same thing BUT when the blood contains many out of the ordinary cells, the automated analyzer just isn't going to do a great job. Oh somewhere on my computer I have an article written by a vet to other vets explaining how the visual examination of the blood smear is one of the most forgotten but most important elements of a good vet exam. So yes, someone should have looked at the smear at some point. Did that happen? The other thing she said is that in Canada, to this day, the Red Cross evaluates blood donors for anemia, not by their PCV or HCT but by their hemoglobin count! And they actually use a blue liquid that they put the blood drops in and if they sink to the bottom of the tube, then there is an appropriate amount of hemoglobin and the donor is accepted. Why would it sink?? Anybody? Because hemoglobin contains IRON and iron is heavy... What is the result of the hemoglobin count? It takes about 2-4 days for the reticulocytes to turn into red blood cells, so that massive number of retic are going to turn into RBC very soon. You should be seeing that number change to over 5.5 (million) any day now. Remember, the number of RBC, the hemoglobin and the PCV are all related proportionally. If there are more RBC that are healthy and viable, the numbers of the hem and the PCV will rise, there is no other way for this to work. The only two things that could go wrong is if 1. There is hemoysis 2. There is a maturation problem and the cells are not healthy. I think you will see excellent results on the next test. By the way, Chance always measures around 34 HCT but his PCV is always around 39. The 39 is the number the vets use for reference because his hemoglobin is well within normal limits. This means he is carrying plenty of oxygen to the body cells. Is this as clear as mud? my best patrice

Patrice NYS

Yes, I still feel that this is related to inflammation. This is called anemia of chronic disease and is related to changes in the body due to illness. Until the related illness is addressed, the anemia persists. I hate to use Sway as an example, but I think Josh would not mind so much. I studied her blood tests for over a year and she remained around a PCV of about 28 for the most part. All I could see over and over was poor response of the marrow producing the red blood cells. It kept pointing to some kind of nutritional deficiency. I struggled to find some kind of way for Josh to supplement her diet, but nothing worked. I studied the cell attributes that came up on her tests and I had to conclude that, each time, they pointed to a specific problem, most likely a liver shunt (thus causing a severe nutritional deficiency). He checked with his vets and they said, no it could not be. But in the end, they finally agreed that this was what was wrong. By that time, it was really too late for any kind of treatment, the shunt had become too convoluted for surgery. This is anemia of chronic disease. and chance wants attention right now, so no more typing my best patrice

Patrice NYS

Good to see you Patrice, thanks for your post. Im VERY intrigued by your comments. Riley's haemoglobin came in at 85 with the reference range being 120-180. on 23 November the retics were 14.3 (corrected for PCV says little note at the bottom) - the reference value on this was 0-1.5. This blood count was done at the lab at Melbourne University Vet Clinic, looks rather different to the most recent. The haemoglobin on 23 Nov was 94 and the PCV was 0.29 - it is stated as PCV on that one, whereas on the one my local vet uses it is Hct (hematocrit). If I understand you correctly, does this mean that the 34/34.6 reading was possibly correct? This is what I assume that the in-house PCV count is - I watched her put in the gadget to spin and then I saw her do the visual exam. Maybe, just maybe, that is what she was trying to explain to me that "it is relative" when the external one came in at 0.28. Today my vet said she would pay attention to the hematocrit. Patrice, how long do you think I should wait to have another test, and would it be worth just doing an in-house smear to see what the result is? How does one tell if there is hemolysis? The pathology says there is no evidence of this - perhaps bleeding? Not sure what this means either. I keep re-reading your post to try to digest it all. Re the haemoglobin for Chance, what is his reading for this if the other is 34/39? It is warm here, and Riley has been panting a lot today - I do wonder if this is uncomfortable for them - would this have something to do with the fact that the haemoglobin is low? On my spreadsheet, the highest the hameoglobin has reached (apart from the normal of 155 at the start of all of this) was 107 and the hematocrit then was 34. Pancreatitis and hospital got in the way of that. These two times are the only times that I have utilised the in-house smear test - other times when checking the platelet levels. I know Chance is a giant schnauzer - are you saying that even with a relatively low PCV/HCT that because the haemoglobin level is normal, that it is keeping him ok? Would Riley stop panting if the haemoglobin was higher? I know Johnny has talked about it as well, taking my focus away from the PCV/HCT. Thank you again, I know how busy you are, so your post is much appreciated, as always. Silka

Silka Melbourne Australia

Har! Chance wins :) We must have been typing at the same time, but I took longer. I must admit, I do wonder what else could be wrong - the University vet had an x-ray and said there was nothing untoward, though I dont understand the results - slightly enlarged heart with fat. I also asked for an iron count and it was within limits. You have talked about nutritional deficiency before in regard to Riley - we cannot get Pet Tinic here and I dont think it can be sent through if it is a liquid. I give my dogs this health booster: http://www.pookinuk.com.au/product-selected.asp?productID=717 It was okayed by my vet, developed by an Aussie vet - says he has developed this product "to give every day pet owners a natural alternative to synthetically manufactured vitamin and mineral supplements". Thanks again Patrice. HAPPY NEW YEAR EVERYONE - 4 hours to go.

Silka Melbourne Australia

Oops sorry, I forgot something. I am stunned by the story of Josh and Sway - I had read his story here in the archives and have had a weep over it. The story of the liver shunt also upsets me, but it must have upset you and Josh quite considerably. Unbelievable.

Silka Melbourne Australia

Silka Azi had a count by machine the other day of 21, the vet then did one by hand which came back as 24. The vet said that the hand count is more accurate and should be the one to trust. Regards Ian

Ian Cheltenham

Thank you Ian,that is important information for me. Hope Azi is doing ok. Silka

Silka Melbourne Australia

This thread was discussed between 30/12/2009 and 01/01/2010

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