Reduced red blood count and high white blood count they’re staying its cancer – Page 3

Keymaster

Mel,
I am a bit confused. The CBC I commented on previously was from 9-2. The CBC you are now referring to is from 8-23. There are only two files in Urgent Advice. No file for today 9-5?

Anyway, the CBC from 8-23 is markedly different from the CBC done 5 days later on 9-2. That’s not unusual to see and explains a lot.

There is a rapid increase in the overall WBC count from 8-23 to 9-2. The values were normal on 8-23. This indicates that something occurred very recently to cause high WBC count. But, as we discussed before, this could be new “Baby blood cells” that look like WBC but are not. If you did a test today on 9-5 we will know more about this.

There was a marked change in the HCT from 9.23% on 8-23 to 24.6% on 9-2. What is this and what does it mean.

Hematocrit is the value that measures the AMOUNT of red blood cells as a percentage of the total blood (in this case whatever is in the blood sample being examined.) So therefore each blood item has a percentage of the whole and together they equal 100%. This is how the laser analyzer evaluates the sample. Hematocrit is somewhat equivalent to the PCV packed cell volume, but slightly different. The normal average HCT is about 38-50%, with some variables according to breeds. I believe Beagles have a slightly higher normal HCT than other breeds. But in any case, if he reaches 38% he will be considered to have a normal amount of HCT.

The PCV value is determined VISUALLY, by holding a small tube of blood up against a chart and reading the values on the chart. See this page:
https://www.secondchanceaihadogs.com/AIHA_Terms/pcv-packed-cell-volume
I have found that in our very sick dogs the PCV is a more accurate measurement and I always recommend that an owner request that the tech, when drawing blood for the CBC, also draw enough to perform the test by hand: the PCV. There can be as much as 3-6 % difference in dogs who have experienced AIHA IMHA and bone marrow failure. The PCV is more accurate and usually has a higher (correct) value.

So when a dog has AIHA IMHA there have been significant changes to the normal blood elements. When an automated laser looks at this sample it may have trouble correctly defining all the cell types. It’s not a mistake per-say. The laser analyzer is an amazing machine and really modernizes veterinary medicine. But in these cases it isn’t as perfectly defined as we wish it to be.

From the 8-23 CBC we see the values you are asking about: MCV, MCH and MCHC . These are descriptions of the red blood cells. The define the red blood cells and tell us many thing about their health.

MCV is mean corpuscle value, simply the size of the red blood cells. Since RBC usually have a very defined size, anything larger or smaller denotes something out of range.

In this case, it makes perfect sense to me. On 8-23 Kingston was highly anemia and the HCT percentage was very low (9.23%.) The number of RBC was also understandably very low, 1.34 or 1,340, 000 red blood cells. The low normal value is 5.5 or 5,500,000 RBC.

As I explained before, when there is reticulocytosis, there will be a lot of “baby blood cells” put into circulation earlier than normal. These cells are larger because they still contain their RNA. In about 3-4 days they drop the RNA (the reticulated pattern inside the cell) and turn into mature (smaller) RBC. So the MCV is high on 8-23 because these immature cells are larger. It simply is indicative that there has been a sudden large increase in regenerative anemia.

And indeed, when we look at the 9-2 CBC we see a normal MCV value (most RBC are normal sized) and we see the number of RBC has gone from 1,340,000 to 3,530,000! That’s nearly 2 million more brand new red blood cells created in a very short time! The marrow has been working very hard to accomplish this!

The next two values are related to the MCV value. MCH is mean corpuscle hemoglobin. Simply, this is the average quality of the hemoglobin inside the RBC. This is the critical part of the RBC, hemoglobin “carries” the oxygen to the body cells. The better the quality of hemoglobin there is the better able it is to carry oxygen to the body cells ! And Kingston is showing this by his more relaxed and comfortable behavior. He simply feels better because his body is getting more oxygen to the body cells.

Finally the MCHC is another reading that describes something about the hemoglobin. Mean corpuscular hemoglobin concentration is the average concentration of hemoglobin in your red blood cells. This particular value may be used to determine the CAUSE of anemia. In some blood disease conditions, the RBC remain “pale” and this indicates not enough quality hemoglobin inside the RBC. If it is low and the RBC are pale then it might indicate iron deficiency. Not too many dogs will have this condition, but those that do are having either a nutritional problem absorbing iron from their food or there is storage and release problem with the liver. There is no need to worry about this high value on the CBC, this number will change very soon.

So in short, when there has been anemia (from any cause) we want a way to evaluate how hard the bone marrow is working to make new red blood cells and we want to know is it making really good red blood cells and in the quantity we need it to?

Because your vet never did a panel that included the reticulocytes, I had to go about figuring this out sideways, deconstructing the RBC values to determine that there must be reticulocytes being manufactured. It is always easier to just look at the reticulocyte value on the CBC to determine if there is regenerative anemia and in what quantity! This is a standard value on an anemia panel.

What Vally is referring to is the bilirubin value, this is a measurement of the amount of destroyed RBC material in the blood. It tells us that red blood cells have been destroyed and the waste is still in the blood. Unfortunately this also means that the kidneys and liver must process this material very quickly to avoid it from staying in the blood. If this doesn’t happen quickly enough you will see a dog become jaundiced, there is a lot of bilirubin (this waste is the brown bile from RBC) in the blood.

I’ve yet to see the chem screen so I have no idea if there is still red blood cell destruction continuing, if there is then you might need the aspirin to prevent an improper clotting cascade. If the hemolysis has stopped you do not need to use aspirin. Your vet says aspirin is contraindicated but in the critical acute stage of hemolysis, a dog can succumb quickly if rapid improper clotting is not controlled in some manner. This is called DIC disseminated intravascular coagulation.

It is always important to see how the prednisone is affecting the liver values (which can become very high), those are critical values on the chem screen also. Some dogs react badly to prednisone and develop a drug induced diabetes, need to see the glucose value. Did your vet offer to show you the chem screens?

Dr. Dodds commonly uses azathioprine in treatment along with cyclosporine, as you noticed when you read her protocol that I pointed out to you on this page:
https://www.secondchanceaihadogs.com/hemopetresources

“In cases where sustained more potent immunosuppression is required for clinical stabilization, azathioprine (Imuran) should be instituted along with cyclosporine. Dose is 1 mg/lb/day for 7-10 days initially followed by a downward tapering over several weeks. Azathioprine may be needed every other day or less often, on a longterm basis. As azathioprine takes about 10 days to effectively suppress T-cells,
clinical responsiveness will not occur immediately. Cyclosporine is therefore given concurrently in the early stages of the disease to provide rapid immunosuppression until the azathioprine takes hold.”

If you have already done the consultation with her she will have mentioned this to you as a possible treatment combination. There is nothing wrong with azathaioprine. It can be implemented alongside cyclosporine if needed. But in this case with Kingston he responded quite nicely to the prednisone and azathioprine combination without having to also use cyclosporine.

To avoid relapse it will be important to wait until he has reached a normal HCT / PCV (which is about 38-45%) and then to carefully reduce the prednisone at a rate of no more than 25-33% dosage per every two weeks. Then evaluate and repeat after another CBC in two weeks etc. The aza can also be decreased very slowly as well. Whether both can be reduced simultaneously is not known yet but I would advise caution doing that to avoid relapse.

These blood conditions are extremely variable from dog to dog and as of yet there isn’t really one single standard protocol that is shared by the entire veterinary community. Each vet and their clinic develops a protocol that they feel they have had success with over time. This is developed from clinical experience. Many vets simply do not receive complex training in hematology in college because across the multiple species they would have to study many different complex standards. Canine hematology is different enough to make it a field that must be carefully studied.

Some clinics very rarely see canine AIHA IMHA or bone marrow failure and when they do they probably begin by review older material. In the past 5-8 years there has been a number of vets finally beginning to follow a similar protocol to the successful protocol that Dr. Dodds developed nearly 20 years ago. It has been a very large learning curve.

In addition, in most cases from years ago the vet declared the cases as not having a defined cause and therefore they were considered primary cause or the immune system just became overactive on it’s own. That, too, has changed in recent years. Now more vets are understanding that in most of these cases there is a definable trigger that may respond to treatment. This is called a secondary cause, one that is mediated by some outside force. Thus the use of the term IMHA immune mediated hemolytic anemia (caused by some outside trigger) is now often replacing AIHA autoimmune hemolytic anemia, primary cause the immune system.

I have no doubt that Kingston had some outside trigger that started this. This most likely was a combination of having surgery with multiple teeth removed simultaneously with being given a multi vaccine booster shot. These two things were the tipping point. The immune system lost “self tolerance.”

A dog this age could have cancer, but right now I am skeptical about that considering how healthy he was prior to the dentistry work.

From now on it would be wise to follow Dr. Dodds minimal vaccine schedule. That is always available on our website directly at the top of the forum on this page:
https://www.secondchanceaihadogs.com/forums/forum/aiha-dog
Look for Dr. Dodds NEW 2016 Minimal Vaccine Schedule

Print this schedule and always carry it with you when you visit the vet. It is designed to ensure that dogs who had a previous autoimmune condition will not suffer a relapse of this. In your case, if this were me, I would never consider any more boosters and might think very carefully about getting a waiver from my vet about the legally required rabies vaccination as well.

Let’s hope we see huge improvements in the days and weeks to come!
my best patrice

Details