Anemia in dog

Re: Anemia in dog

Martin Atkinson — Thu, 13 Nov 2014 17:21:47 GMT

[quote user="Stigen"]There are no more radioopaque elements in the stomach...luckily they have passed, I`m glad I did`nt have to open it up.
The dog seems brighter and happier.

I think it is a secondary IMHA after a systemic infection of sorts. [/quote]Pity you couldn't identify the metallic objects, still if it was zinc its gone now.

I just wondered how long ago the dog was last vaccinated. I had one which developed acute IMTP (OK not IMHA) 2 weeks post vaccination, it responded rapidly to immunotherapy and was weaned off the preds without recurrence.

Also a spurious case of IMHA diagnosed by another vet on the basis of a very mild anaemia with disproportionate lethargy and a +ve saline agglutination test. They put it on immunosuppressive doses of steroids which made it worse as it caused gastro-intestinal bleeding and melaena. I gradually weaned it off and all it did was improve. We did every test under the sun but never made any diagnosis The moral of these cases is: OK try some immunotherapy and hopefully the RBC parameters will improve but try to carefully wean it off in case its a spurious diagnosis.

Re: Anemia in dog

Stigen — Thu, 13 Nov 2014 14:08:56 GMT

I saw the dog back today, very uplifting examination. The results from the lab left no doubt about it; this is typical for IMHA...and I suspect it is a secondary IMHA, based on todays results.

HEMATOLOGy dog

WBC 16,5 (6-12 10^9/l),

LYM% 32,3 (0-100),

Mon% 4,3 (0-100),

Gra% 63,4 (0-100),

(Eos%) 2,7 (0-100),

Lym# 5,3** (1-3.6 10^9/l),

Mon # 0,7** (0-0.5 10^9/l),

Gra# 10,5** (3-10 10^9/l),

Eos# 0,44* (0-0.6 10^9/l).

RBC 3,11* (5.5-8.5 10^9/l),

HGB 4,41* (9.31-12.42 mmol/l),

HCT 0,222* (0.440-0.570 l/l),

MCV 71 (60-77 fl),

MCH 1,43 (1.06-1,43 fmol),

MCHC 20,0 (19,25-23,60 mmol/l),

RDW 15,9 (14-17 %).

PLT 310 (200-460 10^9/l).

MPV 11,4`* (6,7--11,1 fl).

These were the lab results translated properly:

Erythrocytes show severe anisocytosis and polychromasia. There are

few normoblasts in the blood smear. Spherocytes can also be found.

Leucocytes were mostly juvenil neutrophils. Eosinophils could also be

found.

There are mostly small lymphocytes. Lymphocytes and Monocytes seems

to be activated. Cell counts apear to be normal.

Platelet counts seems to be normal to mild decreased.

Macrothrombocytes could be found all over the blood smear.

Blood parasites or atypical cells could not be fount in this moment.

Interpretation

Blood smear shows a mild regenerativ anemia. Sherocytes could be

caused by an immunhemolytic process.

Juvenil neutrophilie with severe left shift could be cause by an

acute infection or inflammation.

A follow-up is recommended.

So unlike 3 days ago there is now a leucocytosis, with a left shift with marked band neutrophils.
The anemia has really improved markedly, both RBC,HGB and HCT.
There are no more radioopaque elements in the stomach...luckily they have passed, I`m glad I did`nt have to open it up.
The dog seems brighter and happier.

I think it is a secondary IMHA after a systemic infection of sorts. The dog is now on 1mg prednisone twice daily, and on antibiotics. The owners are exstaticly happy to get a diagnosis. I even printed the 5-minute consult "information sheet for owner with dog with IMHA" for them to enjoy.
They were so happy that I`m expecting a bottle of wine any day now :)

Re: Anemia in dog

Julian Earl — Thu, 13 Nov 2014 09:40:00 GMT

For IMHA have you done a saline agglutination test. That, if positive is a very reliable sign; also a smear for spherocytes? Both important indicators for IMHA.

Re: Anemia in dog

Anonymous — Wed, 12 Nov 2014 22:02:20 GMT

[quote user="Andrew Kent"]Those results look like an IMHA if my interpretation/translation is correct (severe regenerative anaemia, agglutination, spherocytes).

this is a severely anaemic dog which is likely to be falling, I would suggest you get it back ASAP and hospitalise it whilst you start treatment. We need to know where the PCV is now and then very likely get going with immunosuppressive drugs.

we also need to check if those metallic objects have moved as this could fit with zinc even with the normal blood levels.

Andy

[/quote] I am veryfing this because I am German and understand this convoluted translation....(Do not mean to be offensive at all, Stigen, well done if you translated it yourself but if it is a Google translation....)

Re: Anemia in dog

Andrew Kent — Wed, 12 Nov 2014 21:12:56 GMT

Those results look like an IMHA if my interpretation/translation is correct (severe regenerative anaemia, agglutination, spherocytes).

we also need to check if those metallic objects have moved as this could fit with zinc even with the normal blood levels.

Andy

Re: Anemia in dog

Stigen — Wed, 12 Nov 2014 20:56:26 GMT

[quote user="Andrew Kent"]

If I am reading the results right do they say there was agglutination at room temperature? This could be quite supportive of IMHA.

Has there been a comment on the smear yet?

[/quote]

There was a comment...but it was in german(thank you very much Laboklin..)... I made a rudimentary translation....but I`ll ask them for a proper translate so nothing gets misinterpreted.

" In this blood film the red cells appear reduced ,

highly anisozytär and polychromatisch.Normoblasten could
are found sporadically . Spherocytes are throughout the preparation
distributed .
The leukocyte count is estimated in the low normal range . the
Neutrophils show a significant core shift left .
Eosinophils are increased. There are primarily
small-cell lymphocytes before . Monocytes appear activated . the
Total number is estimated in the normal range .
The platelet count seems normal to slight decreases .
Macro platelets are present in the whole preparation .
Blutparasitäre structures and atypical cells could be this
Time will not be detected .
 
interpretation
It shows a regenerative anemia appears . spherocytes can
Be an indication of immunohemolysis .
The neutrophilia with a marked left shift indicates a on
acute inflammation or infection events out . the
Anaplasmenverdacht abschlieβend is by determining the
Antibodies are verified .

It is advised to follow-up.

Iron                        49.2  µmol/l       +   15-45
* Neutrophils               30    %            -   55-75
* Lymphocytes               29    %                13-30
* Monocytes                  1    %                0-4
* Eosinophils                5    %                0-6
* Basophiles                 0    %                0
* Band Neutrophils          35    %            +   0-4
* Hypochromasia         pos.                   neg.
* Anisocytosis          pos.                   neg.
"

I`m not entirely sure how to read the coombs results they sent me..they looked like this;

Coombs test (direct/indirect):


agglutination on room-temperature

Coombs-Test(IgG)         1:8                   < 1:8
(complement)             1:8                   < 1:8

cold agglutination (4 degree Celsius)

Coombs-Test(IgG)         1:8                   < 1:8
(complement)             1:8                   < 1:8

Interpretation:
The Coombs test detects antibodies bound to the surface of RBC in
immune-mediated haemolytic anaemia (IMHA).
Positive results can be due to primary (autoimmune) or secondary
haemolysis caused by infections with Babesia, Haemobartonella,
or Ehrlichia.



Anaplasma phagozytophilum (Antibody, IFAT)

A.phago-Ab:            < 1:40                  < 1:40

Interpretation
Titers 1:40  and higher are considered positive. "

Re: Anemia in dog

Andrew Kent — Wed, 12 Nov 2014 15:14:05 GMT

If I am reading the results right do they say there was agglutination at room temperature? This could be quite supportive of IMHA.

Has there been a comment on the smear yet?

Re: Anemia in dog

Stigen — Wed, 12 Nov 2014 13:40:18 GMT

Labresults don`t seem too telling at the moment. Normal Zinc , and looks like some reticulocyte activity, but not enough to classify as regenerative anemia;

Parameter Value Reference value

Zinc 15.2 µmol/l 7.7-19.9

Iron 49.2 µmol/l + 15-45

Microscopic picture folgt Retikulocytes (Laser-light scatter hematology system) Reticulocytes 32.2 /nl < 60.0

Interpretation Reticulocyt count: Elevated reticulocyt counts reflect the grade of stimulation in a regenerative anaemia: In dogs reticulocyt counts > 60.0 /nl and in cats reticulocyt counts > 30.0 /nl argue for a good regeneration.

CHR 25.1 pg > 20.1 Interpretation CHr (hemoglobincontent of reticulocytes) is earliest mediator (50 to 60 h) of an irondeficiency erythropoiesis and reacts immediately in case of ironsupplementation.

Coombs test (direct/indirect): agglutination on room-temperature
Coombs-Test(IgG) 1:8 < 1:8 (complement)
1:8 < 1:8 cold agglutination (4 degree Celsius)
Coombs-Test(IgG) 1:8 < 1:8 (complement) 1:8 < 1:8

Interpretation: The Coombs test detects antibodies bound to the surface of RBC in immune-mediated haemolytic anaemia (IMHA). Positive results can be due to primary (autoimmune) or secondary haemolysis caused by infections with Babesia, Haemobartonella, or Ehrlichia. Anaplasma phagozytophilum (Antibody, IFAT)

A.phago-Ab: pending < 1:40 Interpretation Titers 1:40 and higher are considered positive. Positive antibody titres only confirm pathogen contact. The titre level only represents the immunological reaction of the body and serological findings should therefore be assessed alongside the clinical picture.

Re: Anemia in dog

Andrew Kent — Wed, 12 Nov 2014 11:15:13 GMT

It's not unusual for anaemic animals to get pica and we often find all sorts of objects - interpreting the significance can be difficult, but they should be moving through regardless. If you do need to go to surgery then a transfusion before would probably be a good idea.

I would get this dog back today if you can - the anaemia is pretty severe and as we don't yet know the aetiology I would want to check the its not plummeting further.

Andy

Re: Anemia in dog

Martin Atkinson — Wed, 12 Nov 2014 10:56:44 GMT

[quote user="Stigen"]

I have asked the labpeople to test the blood for zinc levels...at least then I can know before I open it up..

[/quote]High zinc or not, if those metallic looking bits don't shift I'd want them out the way.

Re: Anemia in dog

Stigen — Wed, 12 Nov 2014 10:37:18 GMT

I have asked the labpeople to test the blood for zinc levels...at least then I can know before I open it up..

Re: Anemia in dog

Stigen — Wed, 12 Nov 2014 10:32:55 GMT

[quote user="Laura Kidd"]

Hi,

Also think the consider the significance of the abdominal opacities.

Had a dog several years ago with zinc toxicosis secondary to chewing at feet of settee. Presenting signs all related to non-regenerative anaemia.

http://www.merckmanuals.com/vet/toxicology/zinc_toxicosis/overview_of_zinc_toxicosis.html

Other causes of non-regenerative anaemia obviously need to be considered and may need BM biopsy.

Laura

[/quote]

I`ve been considering Zinc or lead toxicity from those objects in the stomach...But find it very atypical...as the biochemistry is all normal, and no vomiting or any Gi-signs..Urine sample was perfectly unremarkable.
.I think it is strange if the metal bits are remaining in the stomach without passing on. They`re not big bits and should`nt cause a blockage.
Seems like it is a non-regenerative anemia, but still waiting for some lab results. I`m seeing it back tomoroow, and will do some more bloods and x-rays then.. I`m a bit reluctant to open it up at the moment...as it is weak and anemic...but if it could be curative..then it should be done...

Re: Anemia in dog

Hannah Wynne Richards — Wed, 12 Nov 2014 08:37:51 GMT

Fair enough.

Wynne

Re: Anemia in dog

Laura Kidd — Tue, 11 Nov 2014 21:44:27 GMT

Hi,

Also think the consider the significance of the abdominal opacities.

Had a dog several years ago with zinc toxicosis secondary to chewing at feet of settee. Presenting signs all related to non-regenerative anaemia.

http://www.merckmanuals.com/vet/toxicology/zinc_toxicosis/overview_of_zinc_toxicosis.html

Other causes of non-regenerative anaemia obviously need to be considered and may need BM biopsy.

Laura

Re: Anemia in dog

Stigen — Tue, 11 Nov 2014 20:20:35 GMT

[quote user="Hannah Wynne Richards"]

Lungworm?

Wynne

[/quote]

It`s not been coughing,no sounds in the lung field, and no interest in eating slugs...as far as I know....and also I work in Norway these days, and there are no lungworms here..

Re: Anemia in dog

Stigen — Tue, 11 Nov 2014 20:17:12 GMT

[quote user="tess"]

I would second the blood smear too. As a result of someone posting on here I've just completed an Idexx CPD called "How to read a blood smear in under 3 minutes" . It was really helpful.

[/quote]

I think I`ll have it in tomorrow to check the blood smear. I have however already sent a smear to the lab to have the histopathologist give his opinin. I did see that IDexx video some years ago, but have pretty much forgotten everything...

Re: Anemia in dog

tess — Tue, 11 Nov 2014 20:04:24 GMT

I would second the blood smear too. As a result of someone posting on here I've just completed an Idexx CPD called "How to read a blood smear in under 3 minutes" . It was really helpful.

Re: Anemia in dog

Hannah Wynne Richards — Tue, 11 Nov 2014 15:23:51 GMT

Lungworm?

Wynne

Re: Anemia in dog

Andrew Kent — Tue, 11 Nov 2014 11:14:53 GMT

Generally loss of whole blood will reduce blood protein as well so a haemolytic disease or a failure just of red blood cell production seems most likely. An assessment of the smear by a clinical pathologist should help you to determine whether this is regenerative and whether there are signs of haemolysis (you won't always get increase in bilirubin/hemoglobin with haemolysis if the rate is low etc).

I agree with Martin that if the foreign material contains Zinc it could be significant.

Has the dog ever travelled outside the UK?

I would assess the smear and then decide about treatment or further investigation (bone marrow) if it does appear non-regenerative.

I would also measure a manual PCV to make sure it fits with the machine calculated HCT and be prepared to transfuse this dog if it falls any further.

Andy

Re: Anemia in dog

Martin Atkinson — Tue, 11 Nov 2014 10:40:11 GMT

I think you have to consider the radiopaque objects to be significant until proven otherwise. Correct if its lead you would expect neurological signs but Zinc poisoning can cause anaemia. The X-rays are not clear but could they be metallic bits of a zip off some clothing it's chewed? If they're not shifting you need to get them out