anemia, red blood cells dropping rapidly in my pit bull :(

[sways_bodyguard]

over the past 2 months there has been 2 blood tests done, both confirming a steady drop in her red blood cells.
my holistic vet told me that a normal range of cells is at around 40%...
last month my dog was in the 27-29 range...
just got the latest results back today and she is at 19%
i am devastated because he said this could potentially be a very difficult case to crack...and at her rate of drop, it is already becoming extremely concerning.
he said anything below 15% is very dangerous and i dont know what to do, she is very close to that now.....

we have setup an ultra sound on thursday with a speacialist and from there my vet will hope to find something that can be pointed to as being the cause of all of this.
if nothing shows, he said a bone marrow test would be another step we can go for,

some history on my dog...
she is a pit bull, 6 yrs old and has had an very troublesome environmental allergy problem for over the past 2 years.
she has been on cyclosporine and allergy shots for the better of the last year or so.
...the cyclosporine caused major digestive tract issues with her so she was taken off them completely about 6 weeks ago.
...one would assume the cyclosporine might be the culprit for the blood cell loss but it has continued to go down even weeks after being taken off completely.
:sad:

she currently is on a vitamin 'advanced-cell' or something along those lines, as well as the medication 'cypro' for a urine infection.
both of which i was told to stop, as of today...

this is my dog:
http://www.flickr.com/photos/claritysix/515907061/

if anyone has any info they can provide, ideas, or just hope, i would be indebted to you.

thanks for reading.

[chico2]

I don't have any help to offer,just wanted to say,she's a sweetie and I hope all goes well

[mummummum]

Has your vet considered Autoimmune hemolytic anemia (AIHA aka IMHA) ?

Here's a link.. http://www.marvistavet.com/html/body_imha.html

or renal disease ?

[Dr Lee]

sways_bodyguard,

Not only is anything under 15% dangerous but a steady fall in red blood cells at 19% is VERY DANGEROUS. This requires aggressive medical attention.

Did the veterinarian mention a concern regarding IMHA (immune mediated hemolytic anemia)? Bone marrow disease? How are the platelets?

I urge you to continue an aggressive diagnostic plan until a cause is found with a veterinarian immediately. The plan of an ultrasound with a specialist is an excellent idea. I would recommend that between now and then you have another red blood cell percentage (called a PCV, packed cell volume or hematocrit) performed prior to Thursday.

With that said. What causes low red blood cells in general:

Main causes
Blood loss - trauma, bleeding out, intestinal hemorrhage from medications such as aspirin or viruses like parvo, third spacing (blood loss that remains inside the body) - such as rupture of splenic tumors, blood clotting issues such as rat poison or liver disease leading to bleeding in the abdomen or chest which is unapparent, and IMHA which is a auto immune disease where the body has an 'allergic' (to keep it simple) reaction to its blood cells for unknown reason and begins to destroy them suddenly. Other causes are possible but these are some common ones.
Lack of production - bone marrow disease such as cancer, and bone marrow suppression from certain types of toxins, hormones, medications, etc...

Note on the cyclosporine. If is was in the form of Atopica, then its interference is low. With some IMHA patients, cyclosporine is acutally used to treat. GI upset is common because the carrying agent is castor oil which some dogs get an upset tummy on. Other side effects can occur but are less common, kidney and liver disease, etc....

Best of luck. Let us know the results of the specialist examination.

[Dr Lee]

mummummum,

It is sometimes frightening to me how we think alike!

[mummummum]

Awww...shucks

[sways_bodyguard]

thanks for the responses...
to give you guys some more information.

mummummum-
yes, i believe IMHA is one of the cheif concerns or assumptions...
my vet mentioned that as a possibility but wants to do the ultra sound to see if there is a specific thing that would be directly causing this.

dr. lee-
bone marrow testing was something they said would be done down the line if nothing was pin pointed from the ultra sound she will be getting tomorrow...
as far as the PCV is concerned, i dont think that is what sway got because the results were sent out and returned a few days later...
everything ive read on a pcv is that it can be done in the office on the spot.
correct me if im wrong, because i certainly could be...

i also read that cyclosporine was used as a treatment for this type of situation in some cases.
sway was originally on Atopica and then switched to the a generic brand because it was cheaper.
this was done last year as a plan of attack against her severe environmental allergies.
(she literally chews her padding from her feet, causing extreme rawness for weeks till they grow back.)
after about 6 months on the cyclosporine, she began to stop chewing all together...this lasted about a month and then just all of a sudden the digestive issues began.
these digestive issues were horrrible, she would go poop uncontrolably in the house, loose stools, like once every 5 minutes...
this happened within a 2 hour period one night (January) and i rushed her out for care...
by the time i got her to the 24 hour vet, it was running out of her behind in bloody water like fashion...portions/chunks of her intestine lining were coming out as well.
months down the line after cyclo was stopped, a food change was done and they put her back on it to make sure it was the cause of the digestive issue.
sure enough, after a week it began to happen again...
from that point the cyclosporine was stopped all together and that issue (allergy) is yet to be solved either.

she goes in for the ultra sound 2morrow in the morning, i need to drop her off before work and wont know the specifics until i get off afterwards.

as far as her demeanor...she is very laid back but she definately has been a few levels low on the energy/interest for sure.
her gums are definately white in spots, and i know that is a tell tale sign of blood drop.
she still is eating fine, but that could be due to me lately feeding her skinless chicken breasts & veggies...she hogs those down.
also, she is still capable of running around, as i take her to the beach and she is pretty active there atleast.

i am very concerned as well with the rapid drop, because i dont notice anything from the exterior about my dog that is any different than the last 6 months to a year.
my vet, who does incorporate holistic into his practice, has said that she should be okay for the next step to be the ultra sound on thursday.
he didnt seem to think the drop would go much lower by 2morrow but it worries me that you think it very well could?
he has however told me that this is very serious and didnt give the impression it was being treated as anything other than very serious.
so i took him at what he suggested...
do you think they are not being assertive enough?

thanks for the interest for those who responded, i appreciate it and will update you with any news i find out.

[chico2]

OMG,both you and Sway have certainly had a hard time,so sorry:sad:
She's probably had enough of vets by now, that she'll do ok tomorrow and you'll have some answers

[sways_bodyguard]

^^^thanks chico2...i hope so as well, we will get thru this!

[shredy]

I just wanted to wish you and your sweet pup the best of luck. I know exactly how you feel, we are in a wait-and-see situation with my dog and it is killing me.

Keep an eye on Sway until tomorrow and trust your instincts. I hope you find the answer to her problems.

[hazelrunpack]

Good luck with the specialist tomorrow, sway's bodyguard!

I've got no advice for you...just wanted to send some s and let you know we have four hands of s and 28 crossed s here, all sending you the best of luck! I hope they find something easily treatable!

So sorry you and sway have to go through all this

[mummummum]

Wow Sways has been through so much

You are right about the hematocrit ~ it's done ons-ite with a centrifuge. This is a link to the Merck explaining the blood work Sways has likely had so far.

http://www.merckvetmanual.com/mvm/in...&word=aplastic

Has your vet done a Coombs test http://en.wikipedia.org/wiki/Coombs_test yet or is that happening tomorrow along with the ultrasound ?

for tomorrow

[SEVIIN]

God I wish I knew what to say. I will see if I can look into it for you and we are going to our vet tomorrow so maybe we can ask her if she knows what might be going on. Such a beautiful dog! I really hope and pray everything goes up for her from now on. Pretty scary situation :frown: My thoughts are with you and your baby.

[rainbow]

One of my previous huskies had the same drop in his red cells and he got down to 18%. We live in a small town with no access to ultrasound. As he was also not eating my vet suspected a stomach or intestinal tumour was causing the blood loss. She phoned the vet school in Saskatoon and they said time was of utmost importance and suggested she just open him up and have a look.

I agreed to let her and she found a four inch tumour in his intestine just past his stomach. She removed it and had to stretch his intestines to sew it back together. She sent tissue samples from his intestines on both sides of the tumour as well as his stomach. The results showed the cancer was spreading through his lymph system and his prognosis was 8-10 months. I was lucky enough to have him for 22 months after his surgery.

Good luck.

[sways_bodyguard]

thank you all for your kind words and concerns...
i dropped her off an hour ago so i should know something by this afternoon.
unfortunately im at work now so shes gotta spend all day at the vet :frown:
we are going to make i thru all of this...staying positive!!!

[Dr Lee]

In house or sent out PCV:

Most all veterinarians should have hematocrit in house capabilities and most have in house CBC (complete blood count) machines. However your veterinarian may have wanted to send the blood out for a variety of reasons: reticulocyte counts can be helpful to see if the anemia is regenerative, blood parasite evaluation, higher white blood cell differential ability, etc....

Also another possible reason to send it out is that all machines (in house or different out sourced laboratories) have slightly different ranges. So when trending a lab value, using the same machine can be very important.

Wishing you both the best!

[sways_bodyguard]

^^thanks dr. / thanks everybody...

[sways_bodyguard]

an update on my pup...
on friday 27th i went to pick her up and the ultra sound was getting ran while i got there...
i didnt receive difinitive word about the results until the following day because the specialist ran late and my vet had to leave...
it came thru pretty much clear of any red flags (internal bleeding/tumors), which is great and i thank God, but it also gave us no answers so we are continuing in the dark...
her % also dropped another point, down to 18%.

this is the wording exactly off the report:
they noted that the liver & spleen were mildly abnormal...
impression: diffuse hepatic and splenic parenchymal lesions were present.
differential diagnoses include steroid hepatopathy, inflammatory hepatopathy, splenic hyperplasia, rickettsial disease, and immune mediated hemolytic anemia (IMHA).

so with that, my vet thought it would be the best use of our resources to proceed with a prednisone treatment...
she now is taking 3, 5mg prednisone tablets twice daily,
as well as 100mg of doxycycline twice daily.

we also are running lab tests on a specific type of tick that could have been laying dormant in the blood.
my vet said it was a longshot but he thought since sway was originally a stray as a baby and we are from ohio, that it wouldnt be a bad idea to have her tested just to make sure.

on saturday the 28th her red blood cell % had dropped again to 17%
she was given a steroid shot in vet office on saturday morning,
i was given, and started all the meds on saturday night...

for dr. lee----
these are some of the stand-outs from the results of the full blood panel that was originally ran on the 17th of july-

reticulocyte count: 12.5 (very high)
absolute reticulocyte: 470,000 (very high)
retic production index: 2.9 (high)
amylase: 1542 (high)
albumin: 2.3 (low)
tc02 (bicarbonate): 14 (low)
chloride: 121 (high)
RBC: 3.76 (low)
HGB: 5.6 (very low)
HCT: 21.2 (very low)
MCV: 56 (low)
MCH: 14.9 (very low)
MCHC: 26.4 (very low)
AUTO PLATELET: 991 (very high)

[sways_bodyguard]

...

[chico2]

Sorry nobody has answered you,I know nothing of what you are talking about,just your pup will be ok..
Dr Lee is not on the Forum like we are,but I am sure he'll get to you as soon as he is..

[pitgrrl]

I'm really no help, but I had to tell you that that's one of the cutest dogs I've seen. I wish you luck in figuring out what's going on.

[Dr Lee]

I am sorry that I haven't responded, I have been out of state and without my laptop (it was hard to be away from the website!) I hope your baby is doing better.


The high reticulocyte count is encouraging. It means that the bone marrow is producing red blood cells in response to the anemia. It rules bone marrow disease out and allows her to avoid bone marrow biopsy which is not comfortable.

It sounds like your veterinarian is doing a good job! The doxycyline covers for rickettsial diseases and the steroids cover IMHA and other inflammatory diseases. Wasn't Sway also on azathioprine? Is she still?

I am encouraged to see the platelet numbers as being high. A common complication with IMHA is Evan's Syndrome which is a combination of IMHA and IMT Immune Mediated Thrombocytopenia (just like IMHA but it destroys platelets too). So this is good to see.

The waivering in the high teens of the HCT/PCV is acceptable. Granted high teen percentage is still life threateningly dangerous but in light of her status it is far, far better then it dropping into the low teens. Often the cycle of inflammation takes a bit of time to start to reverse so initially there is some variation. Clearly continued rechecking of the blood % is necessary. Your vet may want to do the PCV in house but may also want to send out in order to get a better count on the platelets (remember Evan's Syndrome). He may also want to continue to check the liver enzymes and albumin level.

I hope this helps! I am not going anywhere for a while so should be accessible.

[sways_bodyguard]

oh no need to apologize dr!
i appreciate you even taking the time to consistently respond and check in

as far as sway being on azathioprine, no...she isnt taking that one and hasnt in the recent past.
is that something that would be of better benefit than what she is on now?

for the last year the only things she has really been on were her allergy shots, cyclosporine on and off, and then from february to june she was on chinese medicine as a different approach to treat her crazy allergy issues...
the 2 she was on were 'gui pi tang' & 'external wind'
ive been thinking in my own mind that maybe the chinese medicine caused this...

for comparisons sake...
back in december of 06' this is what her bloodwork looked like:
RBC – 7.7, HGB – 9.6, HCT – 36%, Platelet – 569

is a large increase in platelet (to 991, 6 months later) any cause for concern?

she is still eating pretty good, stools are consistently ok, seems to be a litttttle more energetic than she has been...
so hopefully this will reflect a rise in the % when she is tested later in the week.

thanks to all who keep checking in!

[mummummum]

Sways_BG. Did your Vet make up your Chinese medicines ? Please understand, I'm a supporter and user of homeo and naturopathic remedies but as their composition is largely unregulated and unmonitored I worry about their use in combination with Western medicine and most particularly for people and animals who are ill rather than as preventatives.

Any chance you can provide more information about their composition ? And the info about the allergy shots Sways was getting ?

I'm just wondering if it's all too coincidental...

[Dr Lee]

[QUOTE=mummummum;458688]Sways_BG. Did your Vet make up your Chinese medicines ? Please understand, I'm a supporter and user of homeo and naturopathic remedies but as their composition is largely unregulated and unmonitored I worry about their use in combination with Western medicine and most particularly for people and animals who are ill rather than as preventatives.QUOTE]


IMHA can be triggered by many different medications including vaccinations and certain antibiotics such as cephalexin (Keflex). Also onions and garlic cause a similar, albiet more transient problem of anemia. Any members of the genus Allium (onions, leeks, shallot, chive, garlic) contain n-propyl disulfide which causes oxidative damage to the red blood cells which leads to red blood cell loss.

Obviously not every dog on cephalexin or other antibiotics comes down with IMHA - so it is plausible that some compound in a homeopathic remedy may have a propensity towards triggering IMHA in only a small percentage of dogs. Hard to tell. I would say, that even if an herbal remedy was proven to trigger IMHA, it wouldn't make it a bad remedy - just one that needs to be given with prudence. (there is hardly a drug on my shelf that I don't have some possible consequence with). Take home tips: Many homeopathic remedies help and improve quality of life, nothing is without risk or cost, and do NOT blame yourself.

When dealing with any serious immune mediated disease - it is my firm belief that ALL homeopathic medications and ALL other 'regular medications' need to be stopped until the matter is resolved - unless otherwise specified by your doctor. I like homeopathy and belief strongly in the potential of holistic treatments but ANY and ALL medications can potential interact with autoimmune diseases.

Azathioprine. This may be a drug which could help your pet out. It is an immunosuppressive drug used in a variety of autoimmune diseases. (cyclosporine is also used but less likely for IMHA). Many specialists recommended days to week on prednisone alone and then will institute azathioprine if the body fails to respond in that time. The advantage to azathioprine is added suppression of the body to stop killing RBC's. The disadvantage to azathioprine is 1) it has a greater lag time to start working than pred (one reason why some vets start it immediately. I am not one of those). 2) it makes the tapering of the medications later more complex and 3) it is more medication in the system that may not be needed if the prednisone works. If you are wondering about it, ask your vet. I am sure that your vet has her/his own time table for when to institute this drug.

Keep us posted!

[mummummum]

How is Sways today ?

[mummummum]

Any news ?

[sways_bodyguard]

i just got back from the vet...

after a week of being on the prednisone we ran another PCV and her count had dropped again
it was 16.5 last saturday and today it was 15.5
i know there is some instances where it takes more time for it to kick in, so that continues to give me hope, but i was hoping they would rise :sad:

dr. prescribed me some aziathioprine (imuran), 50mg per day 1x daily to mix in with the prednisone in hopes that this might help make these suckers rise.

my doc is concerned because sway is showing really no signs of being hymolytic...she isnt running a fever, her energy level has been up since being on the prednisone, stools are normal, from the outside she seems mighty ok.
he is concerned it might be in the bone marrow but we have held off on running bone marrow and auto immune tests to verify because the treatment for it would be the same as she is already on anyways...
and with the expenses of those tests, there is always a chance they could come out inconclusive and we are at the same spot.

the babesia titer came back negative so the internal tick has been ruled out as a cause...

anyways, we are giving the prednisone another week or so to make some improvements before an additional step is taken.

i have also started her on hemoplex pills which was suggested for anemic dogs in martin goldsteins book...

sway will be PCV tested again next saturday barring any emergency and i pray to God something turns this constant drop around

[Dr Lee]

Sounds like you and your vet are doing everything possible...
I will hold out good thoughts and prayers.

[sways_bodyguard]

random question dr...
with sways platelet count being so high (991), is she then at a higher risk for blood clottage?
or is this something that shouldnt be of concern in her situation...