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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Wylies update and opinions please
| Just got back from the vet and Wylies HCT dropped from 47 to 41. So a little background first, Wylie 11+ year old diagnosed I cant believe almost a year ago, in APril. She had her spleen removed because of a growth found on it, was benign. She was on pred a short time and low doses. She had been holding around 39-41 which my vet thought was good because of her age and no spleen. Fast forward, a relapse in November, she had been off pred since July 1. This time she was put in higher dose of pred, 20 mg a day for 30 days and 30 days of azi 50 mg. next 30 days 20 mgs every other day. She had been holdig steady at 47! Next 30 days 10 mg every other day, still holding steady 46. We are now on 4th week of 5 mg every other day and she has dropped to the 41, which we thinking was her standard before this relapse. My vet wont be in unitl Monday to talk about her HCT going lower So I am looking at thoughts, I am wondering where you find that magic stable number? What if she continues to hold at 41, but knowing she had been up to 47 should her pred be increased? I honestly dont know what the vet is going to recommend. I have noticed her gum color fluctuating more too. Laurie |
| Laurie CA |
| I mentioned about her gum color fluctuating more, for instance this morning I noticed her gum color paler, and now its bright pink. I know Patrice has talked about resting states, which I think does happen, but I seem to be noticng this more and could you have a 6 point swing a a matter of an hour? Thanks Laurie |
| Laurie CA |
| Hi Laurie, Scary stuff, I don't have any advice, but I'm sure you are a little nervous, even though 41 is still a good, remission number. Tiggs never really gets above the lower 40's, I think his highest has been about 43.5. But, it does hold there, I think I would probably panic a little if it did drop too.. I'm sure some others will have good advice for you. The only thing I can say is hang in there and try not to panic. We'll be thinking of you and Wylie, and hoping it's not a big deal. melissa and tiggs |
| melissa slc |
| Laurie, Do you have your latest cbc? Do you have a number for the reticulocytes? Retic absolute and retic %, also number of RBC and Hemoglobin. Chance has no spleen and holds very steady at 38%. It's a good number and, from my vet's non scientific survey of spleen-less dogs in her practice, seems to be the norm for these dogs. That said, I would want to know why she has held well at the higher numbers while on the higher doses of prednisone. 20 mg of pred is an immunomodulator dose while 5 mg is closer to a sub clinical dose. The lower doses, and the slow reductions, are more done to insure that the adrenal gland begins to produce its own corticosteroids in response to the needs of the body. I am certainly no expert here, a clinical vet has the experience to "read" this in a way I can only guess at. So my less than expert thoughts would be to watch the reticulocytes very closely (along with the number of RBC and the amount of Hemoglobin). If the retic maintain around 1-1.5%, the RBC stay at least above 5-5.5 mil, and the hemoglobin falls within a somewhat normal range, then it would seem all is normal. If you are using an automated analyzer's number for the HCT (and not a spun PCV), the difference can be accounted for by a larger number of white blood cells (as explained to me by my vet). This number is a percentage of 100%, so if there are more WBC, then there will be % less of RBC. She said to discount the HCT and go by the PCV. I totally ignore the HCT now, which is always 5-7 points lower than the PCV. In fact, the American Red Cross (and other countries versions of this) all use the hemoglobin count as the official determination of anemia, rather than the PCV! If it's too low, you may not donate blood. patrice |
| Patrice NYS |
THanks Melissa, I read your post too about being concernded of lowering meds, its a scary process. Patrice, I think her last CBC was in beginning of Jan, but I dont think it was the full blown one, that was done in Nov when she had her relapse. but what I do remember from the one in Jan the numbers that were listed were in the normal range. I keep a spreadsheet at work, which stupid me I need to keep at home too. Its probably a good idea to do another total cbc. I will get the numbers I have on Monday and get back to you. Wylie gets the spun test all of the time, but when she does have the full bloodwork done,its includes the blood reading that is always at last 7 points lower,I am not sure if thats the automated analyzer. And they always do the spun one at the same time she has the full cbc since that one always is much lower. Thanks Laurie |
| Laurie CA |
| Laurie, Just another thought, Dr Dodds had us have an ultrasound done on Holly to make sure no more tumors or other problems eating up her red blood cells. But maybe you have already had that done with having her speen removed. Also just yesterday I posted that Dr Dodds wrote me because we are stopping the aziathioprine on Holly, but continuing the 2 mg of pred twice a week and she said that she might have to remain on that dosage. When I asked her why, she said if you discontinue all meds more chance for relapse. Linda |
| Linda Sapphire |
| Laurie: I'm not sure what to tell you either but if it's any consolation - Sheba's PCV has been fluctuating a little bit recently, too. We were at 41-42 and then it dropped to 37 two weeks ago. We had our retest yesterday (Saturday) and it was back "up" to 38.7. But the measurement for destruction of RBCs (can't remember what that term is right now) was up to 41 - about 7 points above the high end of normal. The vet said it could have been a bad draw or it could be a sign that she's starting to relapse. Sheba seems good at the moment - stool and urine look normal, no signs of jaundice, energy level seems good, gums/tongue pink so I'm inclined to think bad draw. The test results are off to ISU on Monday to see what they think down there so for now we are taking a wait and see approach. The vet also reminded us that older dogs like ours tend to have lower PCV values. And with her spleen gone, Wylie's numbers may tend to test on the low end anyway. Hang in there in the meantime and know that we are keeping our fingers and paws crossed and saying some prayers for you. The old dogs have to stick together! Rita, Mike and Sheba |
| Rita IA |
| Patrice, I am still waiting for the vet to call but here are the number I have relapse 11/1 12/17 1/10 2/21 PCV 27 45 47 41 WBC 15.7 8.41 RBC 2.93 5.03 MCV 77.4 71.7 MCH 27 31.6 MCHC 36 44 RDW 10 10.2 PLT 702 532 Can you decipher this? I should have had them run a full cbc again, I will next time I take her in. YOu explained to me before what the mc numbers mean and now I cant find it!! Thanks Laurie |
| Laurie CA |
This thread was discussed between 21/02/2009 and 24/02/2009
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