CIMDA

Hello to everyone on here, my 3 yr old whippet bella has had thrombocytopenia since April last year and been on steroids since and started imuran 9 or 10 weeks ago. She had bad calcium deposits 4 weeks ago and my vet contacted Bristol university for advice and said to drop the steroids quickly and she gone from 3 a day to half a tablet a day.  I'm a little concerned about bella's back paws they're looking rather flat I mentioned it to my vet yesterday and she didn't seem to concerned by it and at first she said that bella does have long toes and I said it doesn't explain why they are flat and then she said steroids can cause muscle wastage. I already know this myself and I did tell one of the young vets about 2 months ago that bella was loosing muscle tone in her back legs but the vet I saw then told me it was due to her loosing a bit of weight because she gained alot of weight and then lost some of it. She tried telling me bella's legs looked thinner and it was nothing to worry about. Elaine baker on a facebook whippet group im on suggested I come here.

Hi & welcome

You are in good company here.  I'm sorry Bella had thrombocytopenia.   Why did she recently start on Imuran? Is she in remission now?

It is not surprising that Bella has flat feet and this is typically seen as a result of prolonged steroids use.  In addition to steroids causing muscle weakness they also allow the  ligaments to stretch, this is probably due to the increased excretion of calcium and  inhibition of vitamin D.

I have had this problem with my dogs who have been on steroids and although there is nothing you can do to return their ligaments to normal, it is something you will get used to and accept that it is a drug trade off for getting Bella back into remission.  Her muscles will strengthen in time but you may have to watch the knuckles on her toes to see that she isn't catching them on the ground as she walks.  Now the steroids have been reduced to a very low dose this shouldn't get any worse. 

Jo

She was doing fine upto December last year and then dropped her steroids to 1 a day and 4 weeks later her platelets were low and upped her steroids to 2 a day for and it didn't help so was put back on 4 a day and it slowly started going back up and one of the young vets suggested putting her on the imuran and run it along side the steroids  so they could reduce them down . At first they only wanted to keep her on the Imuran for 6 weeks her platelet count is in the normal range now and has been for 3 weeks.  The vet is hoping to maybe get her on the imuran every other day when she's finally off steroids

Introducing Imuran was a good idea and it has allowed you to reduce the steroids.  It can take up to 6-8 weeks to really take effect so leaving her on every day dosing for a bit longer has probably been a good thing.  It seems like your vet has a good plan.

Jo

Thanks jo , Elaine baker speaks highly of you she's been following my posts on fb and said you've helped her a lot with her whippets

Hi Jo and Alison
         So pleased you finally made it on here Alison. Just to let you know Jo, Lois whippet finished her steroids and is doing great. (sRMA  case)
       Sorry to interupt the posts. Just good to see Alison getting some answers. I will go now.
    Elaine.

Horray for Lois!!!!

Congratulations Elaine.  You made it, without too many grey hairs, I hope.

Jo

Hi jo, things aren't too good with bella her liver enzymes have been high for months and she had to scan on her liver today there could be an acquired liver shunt, hopefully I'll have more information on it tomorrow when the vet speaks to the scan lady. Bella is fine in herself and still happy and rough plays with my terrier.

Hi Alison

Is Bella still on steroids, and if so what dose -  and if not, how long has she been off steroids?

The Liver will enlarge and the enzymes will rise, sometimes very high, when a dog is on steroids but when the steroids have been withdrawn or the dog is on a low dose the liver size and enzymes should return to normal or to an acceptable level over a period of months (this doesn't happen overnight).  This is a usual pattern when a dog has been on immunosuppressive doses of steroids.

I'm not saying this is the case with Bella, but I have known some vets to overreact to the liver readings and want to do all sorts of investigations when all it needs is time for the body to settle down after all the steroids it has had to process. The liver can take a lot of abuse and it regenerates when allowed to do so.  I hope this is the case with Bella, and as she is good in herself I would be more inclined to think this is just temporary, and an effect of the preds.  Liver enzymes have to be significantly raised before the readings are anything to worry about.  How about giving her Milk Thistle to support her liver or SAMe.  I would avoid biopsies etc., unless it is absolutely necessary.

Many years ago a lady telephoned me, and she was crying saying that the vet college wanted to do a biopsy of her dog's liver because the enzymes were high.  This dog had been on prolonged, high doses of steroids because she had SLE, and the dose was still being slowly reduced.  I suggested she get back to the clinician and say she couldn't afford to have the procedure done and to wait for their reaction.  The vet said, not to worry and to bring her back in 2 months for a blood test!  Two months later - because her preds were being reduced - her liver values were much lower and totally acceptable.  She lived until she was an old girl.

Bella sounds well - which is great news.


Jo

Hello Alison

Jo has already covered what I was going to say applied to us but I just thought I would write as well, so that you would realise that
others experience similar to what Bella is going through - though I am not saying that both cases are the same.

Harley's liver enzymes shot up significantly at the start and have continue to be higher than they should be but both my Vet and my referral centre assured me that it was to be expected due to the steroid dose he was on.     We used Sam-e for a while, things did improve but then I decided to give Milk Thistle a go and they have worked as well.    I deliberately 'manage' the fat content of his diet and whilst they do need some fat, I am careful to ensure the fat content is as low as possible.   
As far as flat feet and thin legs/muscle wastage goes, I'm afraid we have lived with this for a few years now, as Harley was 18 months when diagnosed and he is over 5 now.   When he was on high doses of steroids it was shocking to see, I could almost see the muscle tone drop away daily BUT as the steroids were reduced, very very gradually it slightly improved.   I have to say that his head shape hasn't regained it's 'normal' shape but then, we have had to revert to the I.S. dose of steroids three times and I feel that what we have now is the best we can hope for.
As soon as it was safe to do so, when his platelet count dictated, I did start to try and use exercise that would benefit his leg muscle but was really careful not to do things too quick or for too long, as this would have been dangerous.      He seems to have plenty of energy and I am always surprised that despite the muscle, he seems to have inner strength/sustainability.

How are the platelets and have any alternative drugs been suggested?     We are using Melatonin at the moment and it may be worth keeping this in mind and maybe asking about it's suitability for Bella?   I am unaware of any side effects so far but we are trialling it, as for Harley to remain on steroids this length of time isn't good I know.

Gwyneth

Hi Gwyneth

Thanks for replying to Alison.  Your experience of treating IMTP is invaluable.  I think melatonin is definitely worth starting. 

Jo

Bella is still on one 5mg steroid every third day and has been on that dose for about 2 months.  I had her scan results of the vet yesterday and the lady who did the scan said there's a few aquired shunts and her liver is smaller than it should be, her kidneys are brighter than they should be. She told susie the vet that if we biopsy her it'll have to be ultrasound guided because her liver is small and being deep chested it would harder to find the liver and also suggested  ct scan to do these it'll need to be done in n Bristol university.  Last month the lab said there was reason for concern with her liver . I told the vet yesterday I'm not taking bella to Bristol for any tests because what will we be achieving by

I forgot to mention that she isn't on the imuran she been off that probably 5 months or more . They took her off it because her liver enzymes were getting higher and higher and imuran can cause liver damage.  She's on samylin its a liver supplement and  been on it since we stopped imuran. The vet kept saying that her liver enzymes should be coming down now because she's been on a very low dose of steroids for a while . She also said that there's no treatment for bella's aquured liver shunt because you can't operateon it.  Bella has coagulation trouble this week as well.  She's in season at the moment and hasn't been in season since February 2014 it was before she had the thrombocytopenia.  It's 2 weeks tomorrow since she started her season

Sometimes, especially when on the face of it they are looking well, it is sometimes best to leave well enough alone.  Watch her closely over the next few weeks  because hormones can be a trigger for AI disease and this is another good reason why nothing should be done about her liver at this time.

Fingers crossed.

Jo

Yes I'll be keeping a close eye on her, only thing she'll be having done is her bloods and they're going to check her calcium levels when she has her next appointment on the 30th. There's a few bits in her spleen and was some somewhere else but can't remember where she said, I expect it's probably calcium deposits because there was some bits floating around inside her in may on a scan she had then.  Her legs healed up nicely from the calcium deposits that she had in may. 
      Thanks jo

Hi jo,  bella's blood platelets are still ok and she's been taking one steroid every fourth day for a while my vet said yesterday her blood test came back ok and what would I like to do next either stay as we are or try stopping completely.  I did say to take a gamble and stop for a month and then check her blood because if we don't try we want known.  But now I'm not sure if if I would be doing the right thing because of bella's previous history of going to low on the steroids and she relapsed in December 2014 . Her liver enzymes are still high and still at the same level as last month

How high is high for the liver enzymes - do you have the figures for ALT, ALKP and GGT? Is her Cholesterol result elevated? Just a thought but has she any symptoms of Hypothyroidism?  I have found that sometimes the ALT and GGT can be elevating when the dog is HypoT and then when it was given thyroid medication the ALT and GGT started to return to normal values.

I don't know the levels,  don't know about cholesterol I don't think that's been done. She's has acquired liver shunts not sure if steroids caused the shunts or the imuran that she was on for a few months. I'm just not sure if I should stop her steroids or continue with them permanent . It's just a bit of a worry about stopping and if she'll relapse because she's good now and she could end up back on high dose of steroids

Hi

5mg of prednisolone every three days is such a small dose, it is like a flip of a coin whether you should leave it off altogether or continue.

My own thought are this dose will not do her any harm.  This dose will not stop a relapse if she meets an appropriate trigger but what it may do, as she has been on steroids for a while, is maintain homoeostasis,  and that is not to be sniffed at.

When the dose is so low the permutations for dosing are numerous.  Her are a few options to consider.

One option is to give her 5mg pred every fourth day for a month and then every fifth day etc.,  until she is on one a week.  You can then decide whether you want her to remain on 5mg pred a week or stop it altogether.

Another option is to reduce the dose to 2.5mg for about one month or more, and then leave it off altogether.

Another option is to get some 1mg prednisolone tablets and gradually over a period of months reduce the dose by 1mg at a time.

I have known dogs to have been on all these options and none are wrong.

You must give more time for her liver values to return to normal. Unless they are very high this isn't usually a problem. 

You have lots of time to think about this as there is no hurry to do anything. I feel you will give it a lot of thought and come up with the protocol that will best suit Bella.

I know how anxious you are but you have to allow yourself to believe it is a great stage to be at.

Jo

Thanks jo, she's been on steroid every fourth day for a month, all I been told is her liver enzymes are very high and have been for months now but aren't getting any higher . In December 2014 we went down to 2.5mg every other day and then in 2 weeks her platelets were really low and then ended back on 4 steroids a day. Which gave her the skin condition that she had in April last year and we had to get her down quickly on the steroids to reverse the calcium deposits . That's why I don't want her to end up on hgh dose  again because she'll get calcium deposits back . I think I should keep her on low steroid dose . I'lltalk to my vet Monday and tell her

Hi
Have you considered introducing Melatonin to Bella's regime?  Look at these links.

http://www.ncbi.nlm.nih.gov/pubmed/12424512


http://www.ncbi.nlm.nih.gov/pubmed/9066251

Also, one of our members has kindly written her account of using Melatonin (see below).  Personally I would give Melatonin a try if I had a dog like Bella.  What have you got to lose?  Also, perhaps Bella would benefit from the use of Milk Thistle and SAMe etc., for liver support.

Jo



Our Personal Use of Melatonin by DW
« on: December 19, 2015, 12:52:31 PM »

   

I think I probably need to briefly say what meds we have been on/tried with Harley, for those that haven't been with the Group as long.
We are currently going through our 3rd attempt to regulate his  platelets and have tried different protocols each time.   This time, I have insisted staying close to Prof. Day's protocol but taking it even slower on the lower end of reduction.

He was diagnosed with IMTP 4 years ago.   His first blood count was 30 when diagnosed and he was given an immediate I.S. Dose of Preds (1mg/kg/12hr).  Follow up bloods a few days later saw a healthy increase in platelets so we knew he was steroid responsive.
However, we failed to achieve remission as Harley's platelets dropped as soon as we reduced the Preds to around the 10mg daily stage.
We embarked on the 2nd attempt, increasing the Preds to the I.S. Dose again.  This was such a blow, as one of the side-effects with Harley was significant muscle wastage and he had just started to recover and gain a little muscle-mass when we had to increase the meds.   He lost all that was gained and some.
His liver enzymes were very high but I was told to expect this and we started on Milk Thistle to help this.
When the 2nd attempt failed, despite increasing the Azathioprine, Atopica was suggested but personally I resisted using  this drug.   We asked to be referred to Cambridge and though we tried various regimes to regulate Harley's platelets, we failed and I had no other choice than to 'try' Atopica (I saw it as a last ditch attempt.   Even spleenectomy was considered but I had decided that I wouldn't be prepared to consider this).     Atopica was given at high doses but sadly, at the end of 6 weeks,  his platelets dropped to an all time low of  20, despite remaining on 5mg Preds as well.

The only thing left was to again, put Harley on a much higher dose of Preds for the 3rd time but the Vet at Cambridge wasn't happy to prescribe the I.S. Dose of 1mg/kg/12hr – instead we halved this and gave 30mg daily plus the Azathioprine.    We hoped that his platelets would rise but not necessarily as rapidly as we had seen initially, when he was on a higher dose.   This seemed to work and Harley's platelets started to rise slowly.
We discussed the possibility that Harley may have to remain on quite high doses of steroids and we would have to accept the long-term risks that followed.
About 6 weeks in,  I was asked if I would be happy trying a drug that my vet had heard was being used with some success in the treatment of IMTP in America,  where it was used alongside steroids or sometimes on it's own.

We give 6mg/12hr.  I use slow-release version and they are a prescription drug in the U.K.
The downside is that they are expensive.
In the States however, you can buy Melatonin over the counter at Health Food shops and I gather, this is what they tend to use.
At the moment, things have been so volatile with Harley, I am not prepared to take the risk of 'trying' the over-the-counter version but may consider it in the future.  They cost a fraction of the price.

Long-term side effects?    I have been unable to find documented feed-back but short-term, they seem to be tolerated well.   Certainly, I have not seen any side-effects.
We had Harley's bloods done yesterday and his platelet count was   364 and he is currently taking 4.omg Preds daily and 50mg Azathioprine EOD plus the Melatonin.
The hope is that we will continue to drop the Preds  *(and I have already mentioned that by my own choice – with the backing of my Vet though – I have decided to drop the Preds very very slowly at this stage) and then, we will start to reduce the Aza's -  then and only then, will we know if the Melatonin works!

* Next stage for us......to reduce the preds from 4.0mg daily   to alternate days of 4.0mg and 3.5mg for two weeks and then down to 3.5mg daily.

Hope this helps others.

Gwyneth

Bella's on samylin for liver support she's been on it for months . I've decided to drop the steroid  to one every fith day and see hhow it goes. I think it would be good if she could come off steroids. The vet is quite surprised on how bella is looking considering she has a few acquired shunts because she's a picture of health and looks fantastic

That seems like a good plan.  It is always so uplifting when the vet is pleased with their progress.

Good luck
Jo

Bella's been off the steroids for 8 weeks and her platelets are ok, her liver enzymes are higher on this week's test and she's lost some weight.  She lost 1.2kg in five weeks it's due to her not eating enough because some days she's fussy with her food. She's getting up at least once during the night to go for a pee she doesn't have an infection because a sample was checked in the lab last week.  She did have a urine infection a few weeks back and it cleared up

Hi

I wonder why Bella's liver enzymes are higher this week when she has been off steroids for so long?  It is usually the other way around.

It is such a shame she has lost so much weight.  Was she fussy with her food prior to her being on steroids?  Have you tried changing her diet to tempt her to eat?

I presume the vet did a full biochemical blood test which showed that her liver enzymes her high. Was there anything else that showed up on the test?

Is she drinking more during the day, which might cause her to have to get up in the night?

Jo

 

I was thinking perhaps her liver is getting worse due to the aquired shunts and that is why her liver enzymes are higher.  She isn't drinking excessively and her needing to get up through the night started when she had an infection and it cleared up with antibiotics but she still needs to get up to pee  in the night.  I was explaining to susie Monday that two years ago bella was not eating properly and lost weight  and also needing to get up through the night to pee and I had brought her in and the vet found nothing wrong with her but a few weeks later she had thrombocytopenia.  About her eating she usually tells me when she wants food because she'll go in the kitchen and bark for food

Hi

I do hope a relapse isn't looming.  You will be well prepared if she does, and watching her like a hawk, I expect.

Fingers crossed

Jo

Definitely watching her like an hawk. Got vet's on the 4th April to check her weight and probably her blood . I'll let you know how things go .

Hi , bella had her vet visit on Monday and she lost more weight she was 11.1kg . Took a urine sample and the vet dip tested it and there was aquite a lot of blood in so it was sent to the lab for testing and bella was put on antibiotics . The results were back today and there was no sign of infection but she said it was +4 blood in it so I've got to take her in tomorrow to do her blood  to check platelets and we might have to scan her soon to see what's going on in her bladder. She used to be 12.8kg and she's now 11.1kg . I'll let you know next week when her platelet count comes back

Fingers crossed for today.

Jo

Hi jo, just an update on bella. Had her blood done this week and the platelets are fine and liver enzymes are still has high has they have been but the vet said albumin is low which indicates the liver might not be functioning properly.  Bella now weights 10.8 kg her appetite is good so she hasn't lost weight due to not eating. She's been on antibiotics for three weeks because she's had blood in the urine for more than a month and she had a scan 4 weeks ago on the bladder to see what is going on. The vet said that there was a small area in the bladder that had some thickness and it could be due to recurring infections so bella was put on six weeks antibiotics and urine test after ton see if the bloods gone. So I don't know what willhappen next or how much longer bella will be here. At the moment bella is fine in her self and it's just a worry for me because I don't know if she'll deteriorate quickly or if she has months before it gets worse

Hi Alison

Thank for the update. I'm so please Bella is fine in herself so I* hope she will go on for a long time yet.

  Perhaps you can have a chat with your vet about giving her something natural that might help her liver and urine infections.  Here are a few ideas.

Have you ever given her Milk thistle to help her liver?  It has helped lots of dogs that have been on immunosuppressive treatment. The dose is:
'250 - 500mg twice a day for dogs depending on size and severity of the condition' (The Veterinarians Guide to Natural Remedies for Dogs by Martin Zucker)

  Also if you haven't already tried it you could give her Cranberry extract to help with he urine infections. Look at Cranimals link:  http://www.caninenaturalcures.co.uk/cranimals.html

Homoeopathic Cantharis is really good for urine infections.  I have known so many dogs (and humans) it has helped. The homoeopathic pharmacy Ainsworths are really good at giving consultations over the telephone and it might be worth giving them a call.   

Ainsworths

www.ainsworths.com

36 New Cavendish Street, London W1G 8UF · ~8.1 mi

020 7935 5330

Good luck with Bella.  She is a fighter for sure and I don't think she will give up easily.

Jo

Thanks jo, bella's been on samylin for months for liver support.  It's the weight loss that I don't like she's lost 2kg over the past few months . So she's looking a bit skinny now.  Her hips are showing and some of the spine so it's just a worry because I don't want her loosing anymore weight. She has these odd days when she's restless at night . It was just the vet saying something about albumin being low and it was worrying me really. Thing is she's been off steroids for months now and her platelets have been ok and I didn't think she would ever come off the steroids.  So the maddening thing is the thrombocytopenia is no longer the issue and the liver is the problem now.

Hi

Could Bella have a problem with her digestion?  Gastrointestinal disease can cause weight loss and a decrease in albumin.   Liver enzymes can be raised by unrelated liver problems.

Usually if a dog has primary liver disease, other liver enzymes such as ALT, ALP, AST, bile acids etc.,  are raised. and the ALT has to be significantly raised before any true liver concerns.  Can your vet look into other causes for low albumin?  Also, you may have a better picture if you get a copy of the blood results.

Jo

Bella has a few acquired liver shunts, she was scanned last October and the specialist scanner saw the shunts . Her liver enzymes have been high for roughly a year now and the vet put it down to the Iiver shunts.

Hi

I'm sorry, I had forgotten Bella has liver shunts. It is not something I know much about. I'm sure you have done your research.  Could adding Milk thistle alongside samylin have any benefit?  Can homoeopathy help?

Jo

Hi jo,  bella had bloods done this week.  Platets fine but liver getting worse , the vet suggested trying lactose because it can help . She lost a bit more weight she's 10.6kg. Bella's been a little quiet since last week,  vet wants to see her on 25th to see how she's getting on and to check her weight

Could you feed smaller, more frequent meals to see if that helps her weight?

Did you get her thyroid tested? Not all dogs with thyroid problems are overweight, indeed some are thin and also sometimes being Hypothyroid can give elevated liver readings.

Do you think the prolonged use of antibiotics could have added to any of the problems?

Has Bella seen/ or could see a specialist about her problems?

The vet was on about the albumin and ammonia levels and it's indicates her liver is deteriorating.

Hi
I'm sorry Bella isn't doing so well at the moment.  Has your vet considered surgery for her shunt?  Is it possible for you to take her to see a specialist to discuss the possibility of surgery and perhaps a full cure.

One of my dogs had hepatic encephalitis and I know how difficult it is to control the toxins with diet etc., The liver is an amazing organ and it can regenerate really well if the root of the problem is taken away, probably within 3 months.  If Bella is insured then it might be worth considering surgery because the prognosis is much better than leaving it to diet and pills in an attempt to control the problem. Medical and dietary management is not a long term solution unfortunately. If you do think surgery is a consideration then don't wait until the 25th, have a chat about a referral now.

I'm sure you have had a look on the internet but just in case you have missed these articles have a look at these links:

http://yorkierescue.com/livershunt/research2.html
http://www.vet.utk.edu/clinical/sacs/shunt/management.php
http://www.abbey-vetgroup.co.uk/Dogs_Liver_Conditions.html

Wishing Bella well
Jo

Suzie told me back last year that surgery couldn't be done on acquired shunts and could only be done with congenital shunts. I have have read up online about aquired shunts.

Hi

I'm sorry to hear that.  I suppose you just have to optimise Bella's condition.  You have obviously done your homework.  Have you found anything 'alternative' or natural that can help?

Jo

Hi Jo , I haven't posted in a very long time, Bella is still here and she's been doing ok for the past year. She been having her blood's done every three months and each time they come back the vet says the liver is getting worse but Bella is fine in her self,  this week her blood's came back and the protein level is low and albumin was 21.8 and her glucose was low . Bella is still enjoying life and isn't ill at all considering the liver doesn't work properly. She has a check up in a month to weight her

Hi

When you look back on Bella's history - my goodness,  she is doing well!    You (and your vet) must be doing things right for her to be enjoying life like this.

Despite the ongoing problems with her liver, she is quite remarkable.  The liver is a marvellous organ and it just goes to show that in some cases perseverance is worth it. This is encouraging for others who may have similar problems with their dogs.

Thanks for the update.

Jo

Hi jo, bella's fine in herself and she's gained weight this month and last month. On her blood results it's been showing damage to some blood cells and the vet said they're ferasite's i don't know if i spelt it correctly. Anyway the vet said sometimes it due to anemia but bella's not anemic and she thought it was from the blood being squeezed trough the arteries. Bella been to have blood done today and the vet was telling me that she been doing an online course with British Royal veterinary about hematology and mentioned bella and her liver problems and about ferasite's in the blood and royal veterinary said its impossible for bella to have this in her blood for 4 months and not be anemic and asked if a pathologist seen bella's blood, suzie said that more than one person in the lab would be checking the results. So today suzie will be sending bella's blood to a different lab and see what comes back. I said bella's a medical mistery, she's 6 yrs old next month.

Hi

It is such good news that Bella is fine in herself.  How is her liver now?

The red blood cells that you refer to are called spherocytes and these are usually present in large numbers when a dog is diagnosed with haemolytic anaemia.

Spherocytes are smaller than normal red blood cells and they are darker in colour and denser in appearance, but if examination is made of the tail of the blood smear, where the appearance is flattened and lacking a pale centre this can be mistaken for spherocytes. 

Often a low red blood cell count with 30-40% spherocytosis and auto agglutination of red blood cells (high antibody count)  is diagnostic of AIHA.

There can be other causes of spherocytosis (see below, it can explain it better than me) and I think the quantity is important.

Perhaps it is just something you can monitor.

Jo


http://www.eclinpath.com/hematology/morphologic-features/red-blood-cells/poikilocytosis/

Spherocytosis


Spherocytes in a dog with IMHA

Spherocytes are erythrocytes which have assumed the form of a sphere rather than the normal discoid shape. As a result, they appear on routine blood films as cells that are smaller and more dense than normal red blood cells of the species, and have a reduced area of central pallor. Because cats, horses and cattle normally have red cells with little central pallor, recognition of spherocytes is more difficult in these species than in dogs, whose normal red blood cells have distinct pale centers. Note that even though spherocytes appear smaller than normal red blood cells on a blood smear (because you are assessing diameter of cells on a smear, not volume), in most cases, they have normal volume and do not change the mean cell volume (MCV).

There are several causes of spherocyte formation and numbers do matter to some extent. Moderate to marked spherocytosis is diagnostic of immune-mediated hemolytic anemia (IMHA). Low numbers of spherocytes can be seen in conditions other than IMHA, therefore the presence of spherocytes (especially if in low numbers) is not always indicative of IMHA.
•Immune-mediated hemolytic anemia: Moderate to marked spherocytosis is characteristic of this disorder, although low numbers can be seen in some dogs and others may have no spherocytes at all. Some studies show that up to 66% of dogs with IMHA have spherocytosis, however in our experience, this number is higher (approaching 90% or more) in dogs with classic regenerative IMHA. Spherocytes are not as frequently seen in non-regenerative forms of immune-mediated anemia or the precursor-directed immune-mediated anemias. In classic regenerative IMHA, spherocytes are thought to be produced when antibody coating red blood cells bind to the Fc portion of macrophages, resulting in partial phagocytosis of the red blood cell. The remnant has a reduced surface area to volume ratio and assumes a sphere shape rather than a disc. A positive direct Coombs' test (also called direct antiglobulin test or DAT) or detection of spontaneous three-dimensional clumping of red blood cells (autoagglutination) confirms the presence of antibody on red blood cells.
•Other acquired diseases: These usually have low numbers of spherocytes and include fragmentation anemias, oxidative injury to red blood cells (although the cells are actually pyknocytes), coral snake envenomation, pyruvate kinase deficiency in Basenjis (spheroechinocytes) and disorders associated with abnormal macrophage function (hemophagocytic syndrome, histolytic sarcoma), and bee stings.
•Inherited red blood cell abnormality: Japanese black cattle can have a defect in erythrocyte membrane protein band 3, which results in hereditary spherocytosis (Inaba et al., 1996).
•Transfused or stored red blood cells: Stored red blood cells in blood bags will lose surface area with storage and, when transfused, will appear as spherocytes in blood smears from the recipient. In this situation, moderate to many spherocytes may be seen, depending on the ratio of transfused donor cells to the patient's own cells.
•"Normal" finding: A few spherocytes are frequently seen at or near the feathered edge of blood smears in many dogs (normal or ill) and should not be over-interpreted. Their presence should be verified by inspection of red blood cell morphology in the monolayer and deeper areas of the smear.

Hi jo, bella's bloods came back and they're saying that her red blood cells are in the normal range for ordinary  dogs but sight hounds usually have higher red blood cells than ordinary dogs, they said three are a some smaller red blood cells but could be microcytes and not spherocytes. Suzie said they could do a coombs test if i wanted to so I said yes because the insurance is paying for it so there's no worries about it being paid for. She said we'll need to keep a close eye on bella because her liver is obviously getting worse. Bella seems fine though and she doesn't have any bad days like she was having back last year.

Hi Alison

The good thing is Bella doesn't know about microcytes and spherocytes!  what is her HCT or PCV reading? It is worryingly low?

Yes sight hounds generally have HCT in the upper end of the reference range or slightly over, but the reference range is very wide and this is because individual blood counts vary in healthy dogs and it is difficult to know what is the 'norm' for Bella.  It is worth doing a Coombs test and it might just put your mind at rest.

It is great she will feeling so well.

Jo




 

I don't know the HCT levels, suzie done a PCV last month i can't remember what it was. I'll let you know next how bella's doing after her check up 

Hi jo, bella's Coombes test came back today and it was negative, she did say that the liver is getting worse. Suzie said she'll see bella on the 5 December and do her blood's then. 

Hi

I can't remember, is Bella on SAMe and milk thistle etc.....  I have a feeling she is but if she isn't then I would certainly get some for her.  If you want the doses then just ask.

PCV is a percentage of the red blood cell volume (count) and HCT is expressed as a decimal.  So they are both the same.

At least you know that the Coombs test is negative, but in real terms it doesn't mean much because a dog with primary non-regenerative haemolytic anaemia the Coombs test is usually negative.

Try not to read too much into it and go by her clinical signs, and if they are good then you can rejoice!

Jo

Bella's on samylin a liver supplement there's milk thistle in that. Bella's fine in herself and the vets been telling me for months that her liver is getting worse but bella's doing fine and gained weight the past two months so all good really.

HI

You can give both SAMe and Milk Thistle if you want.  Below is an extract that might be useful to you and Bella.

The Veterinarian's Guide to Natural Healing for Dogs by Martin Zucker states:

Liver Diseases:  Glutamine and Milk Thistle by Ron Carsten DVM

I have found that a majority of liver problems are closely linked to a digestive tract that is not functioning as well as it should.  To help here, I recommend the amino acid glutamine, a primary energy source for intestinal cells, along with milk thistle, an excellent herbal agent for the liver that acts both protectively and restoratively.  This simple two part supplement programme can substantially enhance any treatment your veterinarian has prescribed.  Animals often start to look and eat better, be more energetic, and become more interactive with their environment and members of the household.

Milk Thistle:  250 - 500mg twice a day for dogs depending on size and severity of condition.
Glutamine:  500mg twice a day for all animals.
A good probiotic is also recommended to aid the digestive process.



Jo

Hi jo, i have some good news for you, bella's liver enzymes have come down. The vet said that they've usually been between 200 - 300 and they are 75 this week. I said that is really good isn't it. Suzie said she'll see bella in 3 months time because she seems to be doing good.

That is wonderful news,  and she has done it!!!!!! 

It just goes to show that we mustn't write off these brave dogs.  A strong will and determined character will so often see many of these AI dogs battle against the odds and Bella is one of those.

Please give her a special cuddle from me.

Jo

I know and two and a half years ago that young vet who was treating her for those calcium deposits on her legs sai that if she got worse we might have to to think of the worst because it wouldn't be fair for bella to suffer. Well I chose not to listen to her and started see one of the main practice partners and suzie who has treated bella since then has done a great job with bella's treatment. Hopefully there's more good things to come. Merry Christmas Jo from myself and Bella. Will update you in three months time after bella's next appointment

Hi Jo, just an update on bella, she had her blood's done this week and suzie the vet was saying her red blood cells are low and if they get lower she'll have to go back on steroids, she's not showing any signs of anaemia but she could become anaemic, her protein levels are low. I was saying to suzie that bella seems fine in herself but struggles with walking while outside, I'm walking faster than her. I don't know if it tires her out or if her feet hurt. I was saying to suzie about bella being flat footed because she has tendon damage in her back feet from the steroids a few years ago. Suzie said bella's got good muscle tone in her legs. So she didn't have any answers.

Hi

How low are her red blood cells?  If they are low but she is not anaemia, does this mean that they are in the lower end of the normal range?

Have you had her thyroid tested?  Does she have other clinical signs besides lethargy?  Is she putting on weight, losing hair,  or even growing hair in odd places like on her face, scurfy skin etc.....?   Mild anaemia can be present with hypothyroidism.  It is just a thought.

Jo

I don't know how low the red blood cells are but if they go any lower then she will need the steroids. Her weight has dropped again but this happens sometimes with her, she loses some then later puts it back on. Her hair is fine and her appetite is good, bella is just a bit of a mistery. In the house she's happy running in from the back yard and bouncing around the settee but when out walking she's not good. I think it's her feet she seems to walk better on grass. I've got a short video of her walking Monday after the vet check up but i can't post it here. I can't message you it because i can't send messages on here. 

Hi

I have had a dog with stretched ligaments/cartilage because of excessive steroid use and it can hamper their walking.  I would be loathed to put Bella back onto steroids unless it has been confirmed that she has IMHA.  There are numerous reasons why a dog might become anaemic.  Do you know if her bone marrow is regenerating?

Have you tried feeding her 4 meals a day?  Sighthounds do process things differently and keeping weight on at times can be tricky.  Has your vet considered giving Bella an anti-inflammatory to see if that improves her walking?

Jo 

I'll ask the vet about the bone marrow when i see her and ask about anti inflammatories. Bella eats 3 or 4 times a day she tells me when she wants food, she'll bark for food and demands it when she wants it. If she's asking for food she gets it. I'll update you after the 9th April and tell you how things are going. Thanks Jo

Good luck

Jo

Hi jo, bella's had her pcv test done last Monday and again today. Last week pcv was 37 and its 40 today. So it's going back up to normal because it was down to 30. The vet sent blood to the lab today to check her coagulation. She was on about checking for dic. She did say maybe bella's had a small bleed in the gut somewhere previously and that would explain her pcv levels dropping a few weeks ago. She's gained her weight back on in two weeks and gained weight again today.

That is brilliant news.  I wonder if the previous blood sample had clotting which would have lowered the reading and given an artificial low result.  This is very common. 

Whatever it was, she is on the up and that is great news.

Thanks for the update

Jo

Hi jo, i haven't posted in a while, things have been really good with Bella, her liver enzymes are back to normal and have been for quite some time. Bella turned 7 in November, her weight has increased over the past 6 months or so and she's been holding her weight. Bella hasn't had any antibiotics for more than 6 months. She's been doing fine with out them. Bella's a picture of health when she had her check up this week the vet said she has a liver problem but considering that bella's doing fine and looks really good.

That is great news for Bella - and for you.

Liver enzymes have to be relatively high before there is any real concern, and there are a multitude of things that can make the liver enzymes go up, and it is often temporary, so don't worry at this stage and just keep an eye on it.

Thank you for this update on Bella.

Wishing you both a happy and healthy 2019.

Jo

Glad this story has a happy ending! I hope Bella is doing even better now.

Hi Resnake, yes Bella is fine and hopefully she will be for time to come. Bella's a fighter and she's proved the vets wrong and keeps bouncing back. She's been through a lot in the past five years. Thrombocytopenia first and then calcium deposits on her legs and a liver shunt that can't be repaired. It's 3 years since she was diagnosed with a shunt.

Hi jo, just an update on Bella, her thrombocytopenia relapsed in march and Bella had to stay in over night for treatment, she was put on 50mg steroids and given vincristine. Her platelet count was back to normal in a week, she's been on 15mg steroids  for  two weeks. Had her blood results for this week and platelet count is around 70 with a few clumps, so she's staying on 15mg for another month. Bella's blood platelets were ok for around four and a half years. I know that they can just suddenly relapse so I'm not worried about. This week I noticed a little bump in between her toes on her back foot, it looks like an interdigital cyst and the vet took a look at it Wednesday and wasn't too worried about, I can't remember what the vet said it could be.  Bella's doing fine and recheck bloods in a month.

Hi Alison

It is always very disappointing when these AI problems return.  At least you know that Bella responds pretty well to treatment but it is still exhausting - yet again!

If her platelet count was 70 but with clumps,  then you know the true count is much higher.  Perhaps next time they can use a bigger needle, to avoid any sample damage and,  if they don't already, then take the sample from the neck as opposed to the leg.

As Bella is a whippet, and they are much more sensitive to steroids than most other breeds, just keep an eye on her  adverse effects of the preds and if her clinical signs suggest then perhaps have another blood test before the month is out and if necessary reduce the preds a bit sooner.   The adverse effects of the preds can be a problem after a while. 

As for the thing on her toe, it could be several things including  an interdigital cyst or just  an infection.  Personally, if Bella wee mine,  I wouldn't want her put under a general anaesthetic for investigations, for fear of it triggering another episode of AI.

Many years ago I knew a bulldog who had interdigital cysts and this was successfully treated with Dorwest herbs, Garlic and Fenugreek and I think they also gave mixed vegetable tablets too.  It might be worth checking with your vet if Bella can take this or having a chat with Dorwest. It might be something to consider after the treatment for IMTP is finished.  See this link:

https://www.dorwest.com/common-problems/interdigital-cysts-in-dogs-cats/

Fingers crossed that the next blood test will show a rise in platelets, and at least a sample without clumping, so that you can have an accurate result.

Jo

Yes I'll be keeping a close eye on her regarding the pred's because five years ago while she was being treated for the first time she had thrombocytopenia she ended up with bad calcium deposits on the inside of her back legs due to being on steroids for 18 months and we had to quickly get her off them and her legs healed up nicely once the steroids had been dropped to a very low dose and she finally came off them.Bella's eight and a half years old now and still proving that she's determined to keep on living no matter what life throws at her. I want be doing anything drastic with the little lump on her toe. Her platelet count will more than likely be higher next month because last time she was on the steroids her platelets would drop a bit when she was on lower doses, it's just the way she is. Hopefully next month she'll be able to drop to 10mg a day. I'll keep you posted with how things are going.

Best wishes for Bella.

Fingers crossed!

Jo