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Pet Forum / Miscellaneous / Animal Health / June 2007Canine Non-regenerative Anemia Questions
We have a 9 year old large breed male. He is post splenectomy (late March) that had an attached benign 7lb hematoma. He was reopened the next day looking for bleeders and then transfused (first time). He seemed to recover very well for about 2 weeks and then began to fatigue easy with diarrhea. I asked for a pancreatic panel and it came back fine except for low to non-existent cobalamin (B12). I have been giving him weekly injections of B12 since then and he was give Metrodonazole for 30 days to resolve any small intestine bacterial overgrowth (if that was a possible cause). His breed can also inherit a B12 malabsorption. He has also received Soloxine for about 4 years for borderline low thyroid. We thought he was improving quite nicely but he has recently had two separate episodes of syncope (fainting) after vigorous exercise. He did not lose consciousness. Gums were pale and there was a bit of tetany in the back legs for about 1-2 min. But he recovered well enough to walk home again. After xrays of the heart, the vet and consulting specialist agree that the heart is in good shape. Successive blood tests are showing more and more loss of rbc (and other blood cells) and now we are seeing lower and lower numbers of wbc as well. A test about 1.5 weeks ago only showed lowish numbers. The test this week showed more of a slide and the vet said she is worried and that it might show non-regnerative anemia. We are scheduled for a bone marrow biopsy tuesday. He has reached a point where he is exercise intolerant in about the last week. We are used to taking at least two 40 min walks a day. He can still charge out to bark at squirrels and can be quite powerful when he wants to go in a certain direction. I have done a lot of research on anemia in the past weeks. I am still unable to find the connection I think there is with the removal of the spleen, the hematoma and the B12 malabsorption. He has always eaten a raw diet and still has a great appetite. His digestion seems to be working fine. Can anyone give me any insight into what is happening here? I suppose we will know more after the tests but I would like to be more prepared with my questions. How can a dog go from producing blood (after the surgery as shown by tests) to not making enough blood or at all? Did the transfusion have something to do with this? > We have a 9 year old large breed male. He is post splenectomy (late > March) that had an attached benign 7lb hematoma. He was reopened the [quoted text clipped - 7 lines] > a B12 malabsorption. He has also received Soloxine for about 4 years > for borderline low thyroid. > Successive blood tests are showing more and more loss of rbc (and > other blood cells) and now we are seeing lower and lower numbers of > wbc as well. A test about 1.5 weeks ago only showed lowish numbers. > The test this week showed more of a slide and the vet said she is > worried and that it might show non-regnerative anemia. How can a dog go from producing > blood (after the surgery as shown by tests) to not making enough blood > or at all? Did the transfusion have something to do with this? ........interesting question. Have no idea but decided to research a bit. There's some interesting articles here if you search with splenectomy dog: http://bloodjournal.hematologylibrary.org/ .........what are the platelets doing - decreasing also? If platelets are also going down, dog has pancytopenia. Here's a human site which defines all the *penias*: http://www.fpnotebook.com/HEM84.htm what do liver tests show? Were there any other abnormalities in the bloodwork? When was the last time you had a full CBC and a chem panel? ...........were steroids used at any point? .......how long ago was the Metronidazole used? It can suppress white counts. ........I wonder about tick disease. Do you know anything about how the blood used for transfusions are screened? Or perhaps the absence of the spleen has caused a disease to come to the fore. http://www.peteducation.com/article.cfm?cls=2&articleid=293 haemobartonellosis In the dog, the disease is generally not apparent unless the dog has previously had its spleen removed (splenectomy), has a suppressed immune system (e.g., from taking cancer chemotherapy), or is infected with other organisms such as Ehrlichia. The spleen is responsible for filtering the blood and its job is to remove and destroy damaged red blood cells, like those seen in haemobartonellosis. That is why a dog without a spleen is more susceptible - there is nothing to remove the infected cells (and the mycoplasma) from the bloodstream. http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&Produk tNr=223841&ArtikelNr=78853 http://www.adopt-a-greyhound.org/advice/hemotropic.html The subclinical carrier phase is the most common form of babesiosis in adult dogs in the U.S. The carrier results from a fine equilibrium-between the parasite and the immune mechanisms of the host. A breakdown in homeostasis resulting in clinical babesiosis may develop following stress, immunosuppression due to chemotherapy or other factors, or splenectomy. Such dogs may serve as an important source of infection if used for blood donors or for breeding purposes. Infections with multiple tick disease organisms are possible: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85300 ehrlichiosis in dogs http://www.peteducation.com/article.cfm?cls=2&cat=1556&articleid=430 Blood tests show that one or all of the different blood cell types are decreased. One cell type, the lymphocyte, may increase and be abnormal in appearance. This can sometimes be confused with certain types of leukemia. If a dog becomes chronically infected, the disease can keep coming back, especially during periods of stress. ........So which white blood cells are decreasing? All of them? While tick disease doesn't really exactly fit the current blood readings, nevertheless I'd definitely ask your vet to consider it as dogs (and humans) without a spleen are especially susceptible. Did anyone do an examination of peripheral blood smear to look at morphology of blood cells? Could this be done before bone marrow biopsy? And when was the last time you had thyroid function tested? Ever had a 6 panel thyroid test run? http://ajplegacy.physiology.org/cgi/content/abstract/204/3/415 Some readings on bone marrow biopsies: http://courses.vetmed.wsu.edu/samdx/bm.asp http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1236113 .....my dogs are agitating to get out....wondering if there's more than one thing going on. Anyway, this may give you a start on questions, if you have enough time to read all of it! Hope you get an answer for your pup and that it's entirely fixable. Please post back. buglady take out the dog before replying > > We have a 9 year old large breed male. He is post splenectomy (late > > March) that had an attached benign 7lb hematoma. He was reopened the [quoted text clipped - 89 lines] > buglady > take out the dog before replying Buglady, Thank you for taking so much time to respond. I appreciate all the links that you have found for me and have been browsing them. I wish I had put even more information in than I did. I tried to be as brief as I could. First: yes, I am very familiar with tick diseases and had a complete panel done with Protatek Labs when the mass was discovered. At that time we didn't know why his spleen was so large and why the cbc and blood slides showed so many odd cell types. It could have indicated a hemangiosarcoma but was not definitive. The tests for tbd all came back negative, esp. the erlichia. The ultrasound showed only a singular mass, with no signs of sarcoma. The surgery confirmed that it was just this benign mass, no signs of tumorous growths anywhere in the body cavity, all organs visible looked extremely healthy. We had an original CBC and chem panel done immediately when the abdomen appeared distended. The only unusual result was that the amylase was low. We could not find anything indicating that there was a problem with that. Follow up cbc's and smears have shown the kind of cells that they expected would be there from a splenectomy: fragments, immature cells. All the stuff that the spleen normally cleans up. Even the vet wondered how much the liver would take over this function. After the surgery the vet reported that his blood was clotting well and that he was making rbc and sending out small ones in an effort to keep up with the demand. Apparently a sign of regenerative anemia. We didn't have another cbc done until after the 2nd collapse. At that time there was a minimal anemia and the wbc count was a bit lower. She said it was concerning, but not alarming. About 1.5 weeks later, the cbc showed both the rbc count and the wbc count were much lower. Now into the alarming stage. I cannot tell you about the platelets. I don't have the actual test results in front of me. I have been studying canine hematology on line wherever I can find information, but it is a massively complex topic and I feel, even with a para medical degree, that I am unable to put all the pieces together the way an expert diagnostician can. The vet discussed neutropenia with us. So I believe that this is part of the problem. She also mentioned microcytic anemia. He was on the metro for approx. 30 days: The treatment protocol for small intestine bacterial overgrowth. He may have the inherited b12 malabsorption, but wouldn't he have been sickly all his life? Not the case. He has been prone to diarrhea occasionally that we never were able to determine the cause but it wasn't serious enough to be worried about. Now his digestion and elimination are all fine. Thyroid: I had a panel done last fall that showed the same lowish numbers as before. The diagnostic lab commented that it is not exactly indicative of either a problem or no problem. In these cases they say that administration of soloxine and the resulting improvement of the dog show that it is working for him. I had to stop those meds before the surgery and then returned him to them a time after he had recovered. Now we have discontinued from information we found on the internet that the soloxine may be interfering with his ability to resolve the anemia (from human cases where the anemia resolved after the removal of soloxine and then the pts were returned to it afterwards.) I am not sure if any liver function tests were done unless that is part of the chem panel. That would have been the last one done, just before the surgery. All results were within the proper range. Nothing unusual except the odd stuff in his blood. Yes, my crew are anxious to get out too. Thank you Matoca had a complete panel done with Protatek Labs when the mass was > discovered. . The > tests for tbd all came back negative, esp. the erlichia. The > ultrasound showed only a singular mass, with no signs of sarcoma. The > surgery confirmed that it was just this benign mass, no signs of > tumorous growths anywhere in the body cavity, all organs visible > looked extremely healthy. .........am assuming a histopath was done on the spleen and mass? Follow up cbc's and smears have shown the kind of > cells that they expected would be there from a splenectomy: fragments, > immature cells. All the stuff that the spleen normally cleans up. Even > the vet wondered how much the liver would take over this function. > After the surgery the vet reported that his blood was clotting well > and that he was making rbc and sending out small ones in an effort to > keep up with the demand. Apparently a sign of regenerative anemia. .......thought you said it was non-regenerative anemia??? > We didn't have another cbc done until after the 2nd collapse. At that > time there was a minimal anemia and the wbc count was a bit lower. She > said it was concerning, but not alarming. About 1.5 weeks later, the > cbc showed both the rbc count and the wbc count were much lower. I am unable to put all the pieces together the > way an expert diagnostician can. The vet discussed neutropenia with > us. So I believe that this is part of the problem. She also mentioned > microcytic anemia. ............check the lab report (get a copy of you don't already have) for platelets; if the vet didn't mention them then perhaps they're normal. Microcytic anemia - hmmmm, usually due to lack of iron in the system: http://www.vet.uga.edu/VPP/clerk/mwoods/index.php ......I ran across some reference to iron this AM, but I'll be danged if I can remember what it was. more on anemias: http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2003&PID=6508&O=Gene ric https://app.vetconnect.com/5min/data/01960197.htm > He was on the metro for approx. 30 days: The treatment protocol for > small intestine bacterial overgrowth. He may have the inherited b12 > malabsorption, but wouldn't he have been sickly all his life? ........one would think so. A question for the vet. >Now his digestion and elimination are all fine. > > Thyroid: I had a panel done last fall that showed the same lowish > numbers as before. ........huh, where did you get the panel run? Was it a 6 panel? Shouldn't the test show normal thyroid levels since your dog is on thyroid meds? There's also such a thing as euthyroid sick - euthyroid means normal thyroid, but the dog is sick with something else. Many times an illness depresses the thyroid function as the body throttles down to try and deal with the illness. The diagnostic lab commented that it is not exactly > indicative of either a problem or no problem. In these cases they say > that administration of soloxine and the resulting improvement of the > dog show that it is working for him. ........well, yes and no. Anyone taking thyroid meds gets a jolt - as it revs up the metabolism......so dog is more active and feels better. Doesn't necessarily mean that the meds are actually taking care of a problem. Sort of like drinkig coffee when you're tired. I had to stop those meds before > the surgery and then returned him to them a time after he had > recovered. Now we have discontinued from information we found on the > internet that the soloxine may be interfering with his ability to > resolve the anemia (from human cases where the anemia resolved after > the removal of soloxine and then the pts were returned to it > afterwards.) .....huh, interesting. > I am not sure if any liver function tests were done unless that is > part of the chem panel. ......yep, part of the chem panel: ALT, AST, alkaline phosphatase ........one thing I hope they rule out with the bone marrow draw: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1481457 buglady take out the dog before replying > had a complete panel done with Protatek Labs when the mass was > [quoted text clipped - 89 lines] > buglady > take out the dog before replying These are very interesting comments you make. Yes, the whole mass was sent out for pathology. I watched the whole surgery and then watched as they cut the thing up to actually get it into a huge jug to send out. The results came back as benign hematoma. It really looked very solid and "clean" looking (no ugly masses of any kind), like a brain made out of liver if you can imagine such a thing! Yes, when they tested him in the days after the surgery, the blood panels showed the beginnings of him making blood at a prodigious rate but of course the cells were small but the vet said the body was pumping them out in anyway just to keep up with demand. That is why I don't understand this turn around. Could the tranfusion have confused the blood tests? They did a variety of tests like clotting time and examining a smear. It showed what you would expect without the spleen to clean up unusual blood cells types. He seemed to feel better for about 1-2 weeks! Then he began to drag again and have diarehha, that is when I had the pancreatic panel done that showed the low B12 and began the metro. Iron, very interesting. I have been giving him a lot of liver and he gets a great raw diet. But what if the lack of B12 is causing him not to utilize the iron? Thyroid: Giant Schnauzers are really prone to low thryoid and symptoms. We weren't just working blindly but with information from many other owners who experienced the same symptoms and found that they responded to soloxine. He had been getting dumpy looking, didn't like to stand or sit etc. When we started giving him the soloxine, he responded well. He looks great now, lean and muscled. And he had a lot of energy until this all happened last fall. Liver, then if the panel had those on it there was nothing remarkable prior to the surgery. They have not been done since the surgery. I am not sure why so many things you mention were not done, but probably tomorrow morning they will be. I will let you know what we find. thank you > had a complete panel done with Protatek Labs when the mass was > [quoted text clipped - 89 lines] > buglady > take out the dog before replying Buglady, Long day. In short, the blood tests show non regenerative anemia. He did 2 aspirates and 3 core samples. None of them had any marrow in them. He concluded that there is no marrow left. He is unsure of the cause. Sent us home with prednisone and asked us to restrict activity and monitor temperature 4 times a day. He is on amoxicillan. If his temperature rises above 103 we are to bring him to the vets for immediate attention. I don't know how well this therapy works or if it works in most cases. I am really tired right now. So I am a lot discouraged. > > > He was on the metro for approx. 30 days: The treatment protocol for > > > small intestine bacterial overgrowth. > Long day. In short, the blood tests show non regenerative anemia. He > did 2 aspirates and 3 core samples. None of them had any marrow in > them. He concluded that there is no marrow left. He is unsure of the > cause. .........oh no! When you recover some, find out if they did stains of the aspirates. Did he mention the term myelofibrosis? If that's what it is, some dogs do recover. To repeat this url: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1481457 and: http://apt.allenpress.com/aptonline/?request=get-abstract&issn=0891-6640&vol ume=016&issue=02&page=0174 OK, just found this: http://avmajournals.avma.org/doi/abs/10.2460/javma.2005.227.263 drug exposures that should increase suspicion of possible bone marrow necrosis include chemotherapeutic agents, phenobarbital, carprofen, metronidazole, and mitotane The same guy did another more recent study: http://avmajournals.avma.org/doi/abs/10.2460/javma.230.5.697 .......You might check to see if your vet receives the JAVMA so he can copy these articles for you. AVMA doesn't allow mere commoners to look at more than an abstract online. If your vet does not have the journal, call around to other vets or ask if he can get copies or if you live near a big U. with a vet school it should be in the library. I did once call the AVMA and they are willing to send you a copy free if they can have the name of your vet so they can send a copy to him/her also. I once called a guy who had a mention of a study using melatonin on mast cell cancer dogs which was published in a book on melatonin and he actually talked to me...........so don't be shy. The guy doing the study may be willing to talk to you. There's little enough in the literature about this particular disease and since he mentioned metronidazole he may be able to tell you more about the incidence. I've been unable to find any other info on this drug (FLagyl) and bone marrow necrosis, so you might want to nail that one down. Sent us home with prednisone and asked us to restrict activity > and monitor temperature 4 times a day. He is on amoxicillan. If his > temperature rises above 103 we are to bring him to the vets for > immediate attention. .................so the bone marrow degeneration may be drug induced...........which is good news as your dog may recover. I've never heard of such a reaction to this drug. It may be that this particular drug compounded whatever was going on. Also this might be helpful. Hoping for the best for you and your up buglady take out the dog before replying > > > > He was on the metro for approx. 30 days: The treatment protocol for > > > > small intestine bacterial overgrowth. [quoted text clipped - 52 lines] > buglady > take out the dog before replying Buglady, Finally getting some results back from testing. The blood tests at the specialist showed nonregenerative anemia. He asked to do a bone marrow biopsy. He said he had trouble getting any bone marrow and tried 5 core samples. The pathology results came back today, there were no cells, thus no bone marrow. He asked us to go to the vets here and have another blood panel done. I have not seen the numbers yet, but my husband said they have slid even more than before. We are looking at both wbc and rbc lines declining. The specialist asked us to up the dosage of the prednisone. Reticulocytes were low last tuesday, but platlets were normal. PCV was about 30%. The chem panel was absolutely normal except for a slightly high BUN. I read somewhere that a dehydrated state might cause this and he was preparing for anaesthesia so perhaps he was just dehydrated? I hope that's all it is. Thank you for link you sent for the Bone Marrow Necropsy study. My vet did get it for me to look at. I read it today. There were 3 dogs in the study who had been given metrodonazole for diarreha and developed low rbc and wbc counts (pancytopenia). In this study, the dogs who had drug related anemias recovered for the most part after treatments with prednisone. The few that died, did so almost immediately after the bone marrow biopsies, so they must have been very sick. Chance doesn't seem that sick to me. His appetite is still good and he is still somewhat active. It is very hot here (and he hates hot weather), so I have been limiting his outdoor time to very little. But it is supposed to cool down and I expect he will be able to at least walk for 10 min at a time? We keep taking his temperature and it is constantly around 99-101, never higher and generally around 100.5. I just don't understand how he can be so sick on paper and not seem too sick? His gums are never very red, mostly a light pink, however last night they were red. thank you for all your help, Patrice The blood tests at the > specialist showed nonregenerative anemia. > [quoted text clipped - 3 lines] > and he was preparing for anaesthesia so perhaps he was just > dehydrated? ........maybe, hard to say at this point. I just don't > understand how he can be so sick on paper and not seem too sick? ..........I've had several pets who looked almost dead on paper and recovered. It is good that your dog maintains energy and appetite......keep focusing on that and hope the pred does its job. buglady takeout the dog before replying in thread news:1183003363.085958.126160@q75g2000hsh.googlegroups.com: Matoca <polockhart@sprintmail.com> whittled the following words: >> > > > He was on the metro for approx. 30 days: The treatment protocol >> > > > for small intestine bacterial overgrowth. [quoted text clipped - 92 lines] > thank you for all your help, > Patrice Please keep us updated on what you find out. You stay in our thoughts > > We have a 9 year old large breed male. He is post splenectomy (late > > March) that had an attached benign 7lb hematoma. He was reopened the [quoted text clipped - 89 lines] > buglady > take out the dog before replying Buglady, I have been further studying the links and information that you have provided for me. I think I may have found some information of real interest. The link about the routine connection between splenectomy and anemia (resolving in as long as 6 months!) was very interesting. I had theorized already that the loss of the spleen was causing him to not have the kind of access to blood that he needs when he is exercising energetically. The authors of this article believe that is not the case. Still something to discuss with the specialist. Perhaps he just needs a few transfusions to help him start making his own blood. The other link of interest was the discussion about pancytopenia. I discovered that this can be caused by a severe B12 deficiency. Exactly what a pancreatic panel showed! However, I wonder if the once weekly shots I am giving him aren't enough. That will be a good topic of discussion with the specialist tomorrow morning. I can't thank you enough for giving me something of substance. The internet has a lot of information out there but sometimes a search is ineffective unless you know exactly how to phrase it! |
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