Thrombocytopenia

[Jo CIMDA]

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.

[Alison68]

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.

[Jo CIMDA]

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




 

[Alison68]

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 

[Alison68]

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. 

[Jo CIMDA]

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

[Alison68]

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.

[Jo CIMDA]

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

[Alison68]

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.

[Jo CIMDA]

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

[Alison68]

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

[Alison68]

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.

[Jo CIMDA]

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

[Alison68]

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. 

[Jo CIMDA]

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