Tilly\\\'s labs :/

[Patrice]

Erica wrote:

Happy holidays, everyone!  I hope you’re having a wonderful week and know that I’m thinking of all of you and your fur babies.

Tilly’s pred taper couldn’t be going any better.  She is holding steady with PCVs of 44-46% and will only take 1/4 of a pill (1.125 mg) every other day for the next 2 weeks.  We sent out a CBC and the vet is troubled by her rising and still elevated reticulocyte counts.

When we began her taper in August and on Aug. 28 her bloodwork was:

PCV: 39%

RBC: 5.3 low (range 5.5-8.5)

% reticulocyte: 2.8% high (range 0.5-1.5%)

reticulocyte count: 150 high (range 10-110)

She also had low lymphocytes, absolute lumphocytes, absolute eosinophils and eosiniphils and high monocytes, absolute monocytes and auto platelets.

Repeating this panel on Dec. 26 we have:

In-house PCV: 45%

WBC: 25.6 high (range: 5.7-16.3)

% reticulocyte: 3.0 high (same range 0.5-1.5%)

reticulocyte count: 192 high (also same range: 10-110)

In addition to these parameters she also had high neutrophil seg, monocytes, auto platelet, absolute neutrophil seg and absolute monocyte, and low lymphocytes and absolute monocytes.

 

Can someone please help me interpret these trends?  The vet says overall it’s good news but is troubled by the high amounts of baby red blood cells in her body in spite of the autoimmune process being arrested.  He is again discussing splenectomy and emphatically dismissed my curiosity about allergy testing or thyroid testing for Tilly.  Any insight would be much appreciated!

Best wishes,

Erica

• This topic was modified 10 years, 10 months ago by Patrice.
• This topic was modified 10 years, 10 months ago by Patrice.

[Patrice]

Erica wrote:

Happy holidays, everyone!  I hope you’re having a wonderful week and know that I’m thinking of all of you and your fur babies.

Tilly’s pred taper couldn’t be going any better.  She is holding steady with PCVs of 44-46% and will only take 1/4 of a pill (1.125 mg) every other day for the next 2 weeks.  We sent out a CBC and the vet is troubled by her rising and still elevated reticulocyte counts.

When we began her taper in August and on Aug. 28 her bloodwork was:

PCV: 39%

RBC: 5.3 low (range 5.5-8.5)

% reticulocyte: 2.8% high (range 0.5-1.5%)

reticulocyte count: 150 high (range 10-110)

She also had low lymphocytes, absolute lumphocytes, absolute eosinophils and eosiniphils and high monocytes, absolute monocytes and auto platelets.

Repeating this panel on Dec. 26 we have:

In-house PCV: 45%

WBC: 25.6 high (range: 5.7-16.3)

% reticulocyte: 3.0 high (same range 0.5-1.5%)

reticulocyte count: 192 high (also same range: 10-110)

In addition to these parameters she also had high neutrophil seg, monocytes, auto platelet, absolute neutrophil seg and absolute monocyte, and low lymphocytes and absolute monocytes.

 

Can someone please help me interpret these trends?  The vet says overall it’s good news but is troubled by the high amounts of baby red blood cells in her body in spite of the autoimmune process being arrested.  He is again discussing splenectomy and emphatically dismissed my curiosity about allergy testing or thyroid testing for Tilly.  Any insight would be much appreciated!

Best wishes,

Erica

[Patrice]

Erica wrote:

Also, sorry for the extra forward slashes in the title of my post. I don’t know how those got there!

Erica

• This reply was modified 10 years, 10 months ago by Patrice.
• This reply was modified 10 years, 10 months ago by Patrice.

[Patrice]

Vally wrote:

Erica I think Patrice is in the midst of moving the forum to the new site. I’ve sent her an email in case she hasn’t seem this.

Regards Vally.

• This reply was modified 10 years, 10 months ago by Patrice.
• This reply was modified 10 years, 10 months ago by Patrice.

[Patrice]

Vally wrote:

Erica I think Patrice is in the midst of moving the forum to the new site. I’ve sent her an email in case she hasn’t seem this.

Regards Vally.

[Patrice]

Sheena wrote:

Hi Erica – great news on Tilly’s PCV – what a lovely Christmas present!  But as usual, there’s always something with this disease for us to worry about!

The high level of reticulocytes could be because her RBC is still a bit on the low side, but there can be other reasons for this.  Was she given or is she still taking iron supplements at all?    Do you have any MCV or MCHC figures?  Do you have haemoglobin figures?  What other drug(s) is Tilly taking now?

The high WBC may be just due to corticosteroids, but do you think she is showing signs of any infection?  That could certainly be a cause of raised WBC & monocytes.  I think you vet would probably have thought of this though,  and neutrophils would probably be raised too.

You are welcome to e-mail the full test results to me at sheenapalmer@orange.fr – Sorry I am nowhere near as much of an expert as Patrice, I’m afraid, but I will gladly take a look.  You could look at a human blood result site http://www.iwmf.com/docs/documents/bloodcharts_cbc(1).pdf yourself if you’d rather – it explains high & low values, but sometimes all the individual elements of the test have to be seen as a whole picture to really see what is happening – that is NOT easy to interpret.  Did your vet think that Tilly’s spleen is still destroying her red blood cells?  Is that why he wants to talk about a splenectomy?  Would your vet consider contacting Dr Jean Dodds for some specialist advice?

Worzel had lots of reticulocytes & small RBCs when he was being weaned off the meds & from what I have read, this is normal during recovery from anaemia. The kidney monitors the oxygen content in the blood & produces more or less erythropoietin which stimulates the bone marrow to produce more or less red blood cells as the body needs them.

During the pred withdrawal, Worzel had several abnormal MVC & MCHC readings, which is usual during recovery.  When we started to reduce the azathioprine, his red cell production went massively high as his bone marrow had stopped being suppressed & I started to be concerned that he was developing polycythaemia (too many red cells) – this disease scares us all – all the time – sometimes we just have to think that “overall good news”  is GOOD NEWS!

Sorry I can’t be more help, but I’m always here for moral support of course.

Take care & send me those tests if you would like to

Sheena, Worzel & Ollie

Sheena wrote:

Hi Erica – great news on Tilly’s PCV – what a lovely Christmas present!  But as usual, there’s always something with this disease for us to worry about!

The high level of reticulocytes could be because her RBC is still a bit on the low side, but there can be other reasons for this.  Was she given or is she still taking iron supplements at all?    Do you have any MCV or MCHC figures?  Do you have haemoglobin figures?  What other drug(s) is Tilly taking now?

The high WBC may be just due to corticosteroids, but do you think she is showing signs of any infection?  That could certainly be a cause of raised WBC & monocytes.  I think you vet would probably have thought of this though,  and neutrophils would probably be raised too.

You are welcome to e-mail the full test results to me at sheenapalmer@orange.fr – Sorry I am nowhere near as much of an expert as Patrice, I’m afraid, but I will gladly take a look.  You could look at a human blood result site http://www.iwmf.com/docs/documents/bloodcharts_cbc(1).pdf yourself if you’d rather – it explains high & low values, but sometimes all the individual elements of the test have to be seen as a whole picture to really see what is happening – that is NOT easy to interpret.  Did your vet think that Tilly’s spleen is still destroying her red blood cells?  Is that why he wants to talk about a splenectomy?  Would your vet consider contacting Dr Jean Dodds for some specialist advice?

Worzel had lots of reticulocytes & small RBCs when he was being weaned off the meds & from what I have read, this is normal during recovery from anaemia. The kidney monitors the oxygen content in the blood & produces more or less erythropoietin which stimulates the bone marrow to produce more or less red blood cells as the body needs them.

During the pred withdrawal, Worzel had several abnormal MVC & MCHC readings, which is usual during recovery.  When we started to reduce the azathioprine, his red cell production went massively high as his bone marrow had stopped being suppressed & I started to be concerned that he was developing polycythaemia (too many red cells) – this disease scares us all – all the time – sometimes we just have to think that “overall good news”  is GOOD NEWS!

Sorry I can’t be more help, but I’m always here for moral support of course.

Take care & send me those tests if you would like to

Sheena, Worzel & Ollie

[Patrice]

Sheena wrote:

Erica

Something you could take to your vet – it shows a calculation for erythrocyte maturation which might help them with evaluating Tilley’s retics/RBCs.  They might already know this, but worth mentioning?

https://ahdc.vet.cornell.edu/clinpath/modules/rbcmorph/cretic.htm

Sheena

xxx

Sheena wrote:

Erica

Something you could take to your vet – it shows a calculation for erythrocyte maturation which might help them with evaluating Tilley’s retics/RBCs.  They might already know this, but worth mentioning?

https://ahdc.vet.cornell.edu/clinpath/modules/rbcmorph/cretic.htm

Sheena

xxx

[Patrice]

Erica wrote:

Thank you Vally and Sheena for your replies!  Sheena, I’ll email you Tilly’s full report.  Her Hgb, MCV and MCHC were normal both in August and now.  She has not taken iron or any other supplements aside from Greenies Dental Chews in the interim.  She remains on full doses of cyclosporine and mycophenolate.

In the past 1.5-2 weeks Tilly has grown a small bump on her lower right eye lid which is likely a blocked duct or small infection and probably explains her current elevated WBC.  It’s shrinking on it’s own so I didn’t bother having it formally evaluated and treated.

My understanding is the vet feels the spleen is still destroying RBCs so removing it should stop the anemic process and help her effectively get off the meds.

I think I will email Dr. Dodds first and see if she will evaluate the labs too, how to best arrange contact with my vet, etc.

Many, many thanks to you all.  Wishing a healthy and happy 2014 to all of you.

Erica

Erica wrote:

Thank you Vally and Sheena for your replies!  Sheena, I’ll email you Tilly’s full report.  Her Hgb, MCV and MCHC were normal both in August and now.  She has not taken iron or any other supplements aside from Greenies Dental Chews in the interim.  She remains on full doses of cyclosporine and mycophenolate.

In the past 1.5-2 weeks Tilly has grown a small bump on her lower right eye lid which is likely a blocked duct or small infection and probably explains her current elevated WBC.  It’s shrinking on it’s own so I didn’t bother having it formally evaluated and treated.

My understanding is the vet feels the spleen is still destroying RBCs so removing it should stop the anemic process and help her effectively get off the meds.

I think I will email Dr. Dodds first and see if she will evaluate the labs too, how to best arrange contact with my vet, etc.

Many, many thanks to you all.  Wishing a healthy and happy 2014 to all of you.

Erica

[Patrice]

Sheena wrote:

Hi Erica

Will get back to you in half an hour or so – hope I can come up with some answers for you.

Speak soon!

Sheena

Sheena wrote:

Hi Erica

Will get back to you in half an hour or so – hope I can come up with some answers for you.

Speak soon!

Sheena

[Patrice]

Sheena wrote:

Hi Erica

Had a look at various resources – lymphocytes low, monocytes high point to long-term high dose corticosteroid (prednisolone) use which is called Cushings disease.  Raised neutrophils points to bacterial infection BUT can also be caused by corticosteroids.  So it’s hopefully just the long term effects of the drugs.  Again, raised platelets points to inflammation OR those corticosteroids.  Automatic counting systems at labs can apparently mistake platelets for red blood cells, but it does say platelets “appear” increased on your test.  It would be worth getting a coagulation profile done to make sure all is well, especially if they creep toward the 1,000,000 level (that would be 1,000k on the lab report).  I also read that hypothyroidism can cause platelet counts to rise, but I suspect it’s just those corticosteroids again!  It looks like the weaning off the prednisolone will help all these things & she is doing really well as far as PCV Haemoglobin & RBC –  fantastic normal Ievels.  I also noticed that they have corrected the WBC count when they looked at the sample under the microscope because of the presence of nucleated RBCs, so this may be a “false” high WBC reading as a calculation has to be done – see https://ahdc.vet.cornell.edu/clinpath/modules/hemogram/NRBC.HTM

It also says that nucleated RBCs are often seen in haemolytic anaemia during regeneration, so don’t worry about that. High levels of reticulocytes are seen with nucleated RBCs too.

PHEW!!!!!  I really hope this helps.  I would not worry about splenectomy at the moment – RBCs, HGB & PCV are fine.  I suspect these other blood test anomalies are due to the drugs as every single thing I looked up mentioned corticosteroids & Cushings Disease – it is the most obvious cause BUT she might also have an infection that needs treating too.  I hope everything will soon improve with lowering the pred even more during the weaning process.

 

Let me know if I’ve not explained anything properly  ……   and don’t worry too much as all the red stuff looks great!

Best wishes

Sheena

PS It’s after midnight, so I’m off to bed now!

Sheena wrote:

Hi Erica

Had a look at various resources – lymphocytes low, monocytes high point to long-term high dose corticosteroid (prednisolone) use which is called Cushings disease.  Raised neutrophils points to bacterial infection BUT can also be caused by corticosteroids.  So it’s hopefully just the long term effects of the drugs.  Again, raised platelets points to inflammation OR those corticosteroids.  Automatic counting systems at labs can apparently mistake platelets for red blood cells, but it does say platelets “appear” increased on your test.  It would be worth getting a coagulation profile done to make sure all is well, especially if they creep toward the 1,000,000 level (that would be 1,000k on the lab report).  I also read that hypothyroidism can cause platelet counts to rise, but I suspect it’s just those corticosteroids again!  It looks like the weaning off the prednisolone will help all these things & she is doing really well as far as PCV Haemoglobin & RBC –  fantastic normal Ievels.  I also noticed that they have corrected the WBC count when they looked at the sample under the microscope because of the presence of nucleated RBCs, so this may be a “false” high WBC reading as a calculation has to be done – see https://ahdc.vet.cornell.edu/clinpath/modules/hemogram/NRBC.HTM

It also says that nucleated RBCs are often seen in haemolytic anaemia during regeneration, so don’t worry about that. High levels of reticulocytes are seen with nucleated RBCs too.

PHEW!!!!!  I really hope this helps.  I would not worry about splenectomy at the moment – RBCs, HGB & PCV are fine.  I suspect these other blood test anomalies are due to the drugs as every single thing I looked up mentioned corticosteroids & Cushings Disease – it is the most obvious cause BUT she might also have an infection that needs treating too.  I hope everything will soon improve with lowering the pred even more during the weaning process.

 

Let me know if I’ve not explained anything properly  ……   and don’t worry too much as all the red stuff looks great!

Best wishes

Sheena

PS It’s after midnight, so I’m off to bed now!