Suspected IMHA for Macy and waiting on official blood work results – Page 4

Keymaster

Lynette,
I’ve looked over you lab results and I can say that most of it looks perfectly normal!

A few things on the chem screen that are not normal are the liver enzymes, which are high. Don’t be alarmed, this is normal to see when you have been dosing prednisone. The liver cells process the medicine and during this those cells are damaged. The liver is highly regenerative and once the dose is dropped, the liver will return to normal if there was no organic disease prior to this disease.

I also see a bit higher glucose level. Not extremely high. This can be a normal reaction under the stress involved in going to the vets and having a blood sample drawn. It can also occur if the blood is drawn too close to a recent meal. From now on make sure that Macy has fasted (with plenty of water) for about 10 hours before they draw blood. This will reduce the impact that fat and glucose from a recent meal can have on the blood sample.

Dehydration can make the HCT lower, as it is a percentage of the whole and this may be part of why you are seeing a lower value.

Finally I see that the monocytes are slightly high. These white blood cells play a role in our immune system’s response to invaders or inflammatory conditions such as infection. It’s not clear what this might be, but my guess would be a reaction to the liver enzymes. If all the white blood cells were elevated, I would be far more worried.

Many dogs that have AIHA, IMHA or bone marrow failure can tend to struggle a little in the early days of recovery as their bodies try to get back to homeostasis. You will see the PCV and the HCT wobble up and down over time. They were really sick and the body is working to get better. Small changes are insignificant and not worth getting alarmed about. Our body systems are dynamic and make adjustments constantly to get us back to normal. It is really amazing how hard our dogs work to get better.

In addition a blood sample and the subsequent CBC result is only a momentary measure in time. In fact, our HCT and other values rise and fall throughout the day in response to many factors, when we last ate, have we been sleeping or running? Are we dehydrated, stressed? If our dog is still taking some prednisone this can influence these values as well. Right now Macy has high liver values and that contributes to inflammatory stress caused by inflammatory cytokines circulating in the body.

I have seen over the years a trend in many of our recovering dogs of a slightly lower normal hematocrit. The ranges in Chance tended to be 34-37% HCT while if we did a PCV at the same time, it would be higher, say 36-39%. Right when he began to recover and he was regenerating red blood cells with gusto his HCT was around 45%. But his body settled into this perfectly normal lower HCT over time. I know this because his reticulocytes stayed at a very even .9-1-1.5% range.

Ask your vet each time to take a hand done PCV for comparison to the automated analyzer results. I think you will see something similar.

If you ever look at a series of several CBCs in the period just after recovery and you begin to see a gradual decrease in HCT combined with a continued decrease in reticulocyte values below 1% and 60,000 absolute then it is wise to carefully monitor this situation for a relapse or bone marrow failure.

Do a PCV in one week and be sure to tell me what that value is. In 2 weeks do another CBC and please ask the vet to add in the reticulocytes on this test (they are not on the current test.) In any dog that is being treated for this disease, the reticulocytes are a critical value to monitor.

Do you have any more questions?
my best, patrice

Details