Possible relapse

[Karen Churchill]

Hi
I am back on here a year after first diagnosis of IMT in our now 9 year old WCS, Pippa. She was successfully weaned off steroids and was discharged from the vet in March this year after stable platelets for several months. Whilst checking her over yesterday I discovered petechiae again on her gums. We made an out of hours appointment at our vet who ran blood tests to check for platelets and clotting time. The smear showed normal platelets on their in house machine (which is usually lower than actual). The bloods have been sent to the lab and she has been put back on 15mg prednisolone twice a day. We get results tomorrow. I am after any advice/idea as to what this could be if she has a normal amount of platelets. Could they be non functioning. I am devastated as she was doing so well and all her fur had returned to normal.

[Catherine]

Have you had the results today? I do hope they are okay. Is the petechiae all over the gums? Thankfully I haver not experienced that with my dogs but could it be bruising? Hopefully Jo will be along soon.

[Jo CIMDA]

Hi Karen

I am sorry that you have concerns with Pippa again.  Certainly with an autoimmune disease such as thrombocytopenia, the platelets would have to be <40 for bleeding to occur, so I wonder if there is another cause for the spots that you are seeing.  Could Pippa have knocked herself which may have caused bleeding under the gums?

This is an informative article that may give some alternative reasons for petechiae but I am hoping that, as the platelets are normal, there is not a problem and she will be able to be weaned off of the preds very soon.

https://vcahospitals.com/know-your-pet/testing-for-signs-of-bleeding

Has Pippa recently had anything like a vaccine, preventative treatments, season etc., that may have triggered an AI response?   Having said that, unless their machine is wrong, the platelets would not be in the normal range if it were IMTP

Fingers crossed

Jo

[Karen Churchill]

Hi Jo
Just had call from vet. Platelets all normal (217 in house, 138 in lab but lots of clumping so would be in normal range). So Pippa has unexplained petichiae. Got to keep her on steroids?, keep her safe and take her back on Thursday (earliest appointment!). The vet didn't have any idea what it could be! So I have sent an email to the specialist who treated her for Aspergillosis and asked them some questions. Don't like the ideA of her being on 'precautionary steroids' when they don't know what is wrong.

[Jo CIMDA]

Hi Karen

Does Pippa still have petichiae?  Could it have been a one off occurrence?    It can't be thrombocytopenia because her platelets are certainly more than adequate.  I agree, I wouldn't be happy for her to stay on immunosuppressive doses of preds unless it was absolutely necessary.

I do hope you get some answers very soon.

Jo

[Karen Churchill]

Hi Jo
We had another consultation with the vet today. Her platelets were done again and are 208. So we are tapering off the prednisolone over the next 6 days. They are now saying that the marks on her gums are probably not petichiae. They are more red blotches rather than pin prick marks.  One side has cleared up anyway. They think it is more irritation by something. To be safe they are asking the lab to look at the morphology of the platelets and are sending images to a specialist vet (Anderson Moore's) for advice/reassurance.
We are happy that this is the correct diagnosis (and relieved of course). The vet who saw her was a new, young vet who originally diagnosed the IMT a year ago. Her gut instinct was that it wasn't a relapse of her IMT but she consulted a senior vet who was the one who put Pippa back on the precautionary steroids. Sometimes new, fresh knowledge is better.

[Jo CIMDA]

That is good news Karen and to be honest I couldn't blame them for putting Pippa back onto steroids, but now that it isn't IMTP they are right to decrease the dose and wean her off.    It is good news and a relief that her platelets are within normal range.

Jo