Old anaemic golden retriever

Re: Old anaemic golden retriever

Busybee — Wed, 29 Feb 2012 19:46:02 GMT

[quote user="james herriot lied"]Using any omeprazole on top?[/quote]

Was using omeprazole initially but cost was an issue.

If it was IMHA why did we see such a big improvement in the dog and it's parameters for a week, then a deterioration again? The ones I've seen before (not many!) have been consistently anaemic without appropriate therapy.

Discussed parasites and lungworm with the owner today. Sending faeces off for parasitology but owner didn't want to send for lungworm as well as she doesn't believe it is possible (advised although unlikely, could be possible).

Dog came in today. Shocking PCV of 19% again but TP 62 g/L. Very bright, membranes pale but not as pale as previously - appreciable CRT of 2s, comfortable abdomen, normal temperature, chest clear. Good appetite and no vomiting. Faeces dark and tarry but normal consistency.

Also significant weight loss (lost nearly 2kg in 9 days)

Re: Old anaemic golden retriever

james herriot lied — Tue, 28 Feb 2012 23:13:30 GMT

[quote user="Busybee"]

So dog continued to improve. Went home last monday on cimetidine and metronidazole.

O phoned today to say had been fine over weekend then yesterday and today had passed very dark tarry faeces.

[/quote]

Using any omeprazole on top?

Must admit, though - I still wouldn't turn my back on an IMHA - not completely convinced that the anaemia was non-regenerative (sorry, Kate), and RDW is always a useful marker if other parameters aren't completely healthy; ditto the spherocytes. Mark's comment re parasites is also timely, including lungworm - panacur would be a reasonable (off-label) adjunct in this dog.

Edit: also meant to say, it might be worth looking at thyroid function at the same time. Sometimes, AI diseases lurk in pairs or more.

Re: Old anaemic golden retriever

Mark Hedberg — Tue, 28 Feb 2012 22:46:07 GMT

Well, if it makes you feel better, I had a patient with random blood in vomit and occasional dark and light intermittent diarrhea. I ended up scoping him, nad stomach scoping, but nasty inflamed intestinal lumen, and a hookworm poked his beady little head out just in front of the camera. Honestly, the timing was brilliant. I put the dog on a few months of advocate, he made an uneventful recovery. (Developed kidney issues a few years later, but I trust that was fairly unrelated.)

Re: Old anaemic golden retriever

Busybee — Tue, 28 Feb 2012 22:24:40 GMT

So dog continued to improve. Went home last monday on cimetidine and metronidazole. Eating, bright, PCV increasing. Came back friday morning for a check up - still doing well, getting stronger, PCV now up to 34% and TP 68g/L.

O phoned today to say had been fine over weekend then yesterday and today had passed very dark tarry faeces. Dog getting bit lethargic again though still eating ok. Coming in tomorrow for a PCV and check up. So now looks more like upper GI/respiratory bleed. Still no cough, no vomiting, unknown weight change as not been weighed for a number of years though nothing drastic. May end up scoping, depending on how dog is.

Re: Old anaemic golden retriever

Mark Hedberg — Sat, 18 Feb 2012 21:18:46 GMT

[quote user="Busybee"]

I have explained this to the owner and feel the same really. If we don't know what we're looking for, why look?

[/quote]

Well, who knows what you'll find? ;)

Re: Old anaemic golden retriever

Kate Richardson — Sat, 18 Feb 2012 19:49:49 GMT

[quote user="Busybee"]I have explained this to the owner and feel the same really. If we don't know what we're looking for, why look? [/quote]

Only worth looking if it will change your treatment plans, which currently, sounds like it won't, although may help with prognosis, say worst case scenario gastric tumour, but seems unlikely with a dog that is still eating well. I assume no weight loss? and minimal vomiting. Depends a bit on owners expectations, but that shouldn't change you doing what you think is best for the dog.

Increase in wbcs could be inflammatory or a stress leukogram as well as infection, but if you have suspicion of a compromised git mucosa, then risk of bacterial translocation, plus metronidazole has immunomodulatory effects on the git. Buprenorphine can be given orally as well, so is something that can be given at home if nec, although could be costly in a large dog. Adoption of prayer position (even if not persistent) certainly suggests discomfort. Tramadol is another option.

Re: Old anaemic golden retriever

Michael Woodhouse — Sat, 18 Feb 2012 19:32:54 GMT

Are you in a lungworm area? Just a thought.

Re: Old anaemic golden retriever

Busybee — Sat, 18 Feb 2012 19:17:58 GMT

[quote user="Kate Richardson"]Sounds good so far and I think your tentative diagnosis is a good one. Moderate non regenerative anaemia with mild hypoproteinaemia certainly suggests chronic blood loss.[/quote]

yes, albumin was slightly low but a normal globulin - hence low TP.

[quote user="Kate Richardson"]I take it the dog is not on any long term medications? The progressive weakness could be due to progressive anaemia, but I would be suspicious it may be due to chronic arthritis.[/quote]

no long term medication. Last had NSAIDs 2009.

[quote user="Kate Richardson"]I don't think I would be in a hurry to ga and scope unless the dog was to deteriorate suddenly, and if you are happy with your abdo scan, how much will abdo xrays add?; if the dog remains bright and eating I would monitor the haematology and protein levels. I guess I would check a urine sample as well to check no haematuria as a cause of blood loss.[/quote]

I have explained this to the owner and feel the same really. If we don't know what we're looking for, why look?

[quote user="Kate Richardson"]The only thing I would add is pain relief, probably an opiod and poss some antibiotics, probably metronidazole.[/quote]

We often use buprenorphine for in-patient opiod treatment so this could be a consideration. Did consider antibiotics, but no pyrexia, very mild increase in WBCs (ie. around 19), and no D+. Is this in case we are looking at an ulcer?

[quote user="Kate Richardson"]Good job so far[/quote]

Thanks for the vote of confidence!

Re: Old anaemic golden retriever

Busybee — Sat, 18 Feb 2012 19:12:36 GMT

[quote user="robloxley"]I'd be following up the haematology - spherocytes is ringing alarm bells for haemolytic anaemia. Is the machine platelet count reflected in the smears? Have you spoken to the lab re the smear findings? What is the reticulocyte count? Is the lab reporting a normal MCV and microcytosis? Do repeat smears show the same findings?[/quote]

I tried to phone them but being a Saturday and after 12pm, all the pathologists had gone home! Will be chasing monday. They only mentioned 'occasional' spherocytes, and hence why we might get a Coombs' test done. I had a quick look at smears in house before they went and as far as I could see, there seemed to be enough, but there was no comment on the pathologist's report. I can't remember the reticulocyte count off the top of my head I'm afraid but I could definitely see some my end. Lab reporting similar MCV and microcytosis. Am also considering testing for/bolstering iron.

[quote user="robloxley"]The negative faecal occult blood test is interesting if we're considering chronic GI bleed as cause of the anaemia - was it a single or pooled multiple samples?[/quote]

single sample. Again, may consider further samples.

Re: Old anaemic golden retriever

Kate Richardson — Sat, 18 Feb 2012 18:43:48 GMT

Sounds good so far and I think your tentative diagnosis is a good one. Moderate non regenerative anaemia with mild hypoproteinaemia certainly suggests chronic blood loss.

I take it the dog is not on any long term medications? The progressive weakness could be due to progressive anaemia, but I would be suspicious it may be due to chronic arthritis.

I don't think I would be in a hurry to ga and scope unless the dog was to deteriorate suddenly, and if you are happy with your abdo scan, how much will abdo xrays add?; if the dog remains bright and eating I would monitor the haematology and protein levels. I guess I would check a urine sample as well to check no haematuria as a cause of blood loss.

The only thing I would add is pain relief, probably an opiod and poss some antibiotics, probably metronidazole.

Good job so far

Re: Old anaemic golden retriever

Rob Loxley — Sat, 18 Feb 2012 18:33:22 GMT

Sounds a pretty comprehensive investigation, but some thoughts.

I'd be following up the haematology - spherocytes is ringing alarm bells for haemolytic anaemia. Is the machine platelet count reflected in the smears? Have you spoken to the lab re the smear findings? What is the reticulocyte count? Is the lab reporting a normal MCV and microcytosis? Do repeat smears show the same findings?

The negative faecal occult blood test is interesting if we're considering chronic GI bleed as cause of the anaemia - was it a single or pooled multiple samples?