Possible pure red cell aplasia?

RE: Possible pure red cell aplasia?

Sarah Keir — Sun, 04 Nov 2018 11:57:57 GMT

IMHAs are highly prone to thrombosis. I would routinely start an anti thrombotic at diagnosis.

RE: Possible pure red cell aplasia?

Kara Gibson — Fri, 02 Nov 2018 02:42:06 GMT

[quote user="Martin Atkinson"]Kara, you've made no mention of whether or not a platelet count was normal on the original haematology - the dog is unlikely to have developed IMTP overnight especially if it was on immunosuppressants and a 'presumed' bleed is not overly helpful.[/quote]

Her platelet count had been resolutely normal on every haematology, including the day before she passed away (before her blood transfusion).

I'm not sure I understand what's not helpful about my supposition of a presumed bleed - she had low platelets and passed away despite my colleagues best efforts. I think an immune mediated destruction is possible as her anaemia was not responding to immunosuppressive treatment but I suspect DIC may be more likely given the speed at which her thrombocytopaenia developed.

RE: Possible pure red cell aplasia?

Liz Barton — Fri, 26 Oct 2018 22:03:41 GMT

[quote user="Anthony Dennison"]Could the destruction of RBCs and release of haemaglobin into the circulation activate clotting pathways? Or could it be the damaged erythrocyte membranes activating things? [/quote]

Had never thought of that! Sounds feasible. Hope to get time to look into this, unless others have more answers?

RE: Possible pure red cell aplasia?

Anthony Dennison — Fri, 26 Oct 2018 14:18:25 GMT

[quote user="Liz Barton"]I've always presumed the thrombocytopenia in these cases is due to the IM processes (Evans syndrome). But was recently told it's often due to consumption secondary to bleeding in these cases. But I don't see why an anaemic dog is more likely to bleed if it's clotting and platelets are normal. And I can rarely identify any bleeding (am well aware this doesn't rule it out). So why should the platelets be low if there's no IM destruction? Am I missing something??[/quote]

Could the destruction of RBCs and release of haemaglobin into the circulation activate clotting pathways? Or could it be the damaged erythrocyte membranes activating things?

RE: Possible pure red cell aplasia?

Martin Atkinson — Fri, 26 Oct 2018 12:05:48 GMT

[quote user="Kara Gibson"]unfortunately the next day developed thrombocytopaenia and passed away presumably secondary to a bleed.[/quote]

Kara, you've made no mention of whether or not a platelet count was normal on the original haematology - the dog is unlikely to have developed IMTP overnight especially if it was on immunosuppressants and a 'presumed' bleed is not overly helpful.

RE: Possible pure red cell aplasia?

Kara Gibson — Fri, 26 Oct 2018 04:14:42 GMT

I also assumed that was the case in Evans syndrome. In this particular case I don't know if that is what happened or perhaps this dog developed disseminated intravascular coagulation?

RE: Possible pure red cell aplasia?

Liz Barton — Thu, 25 Oct 2018 09:23:58 GMT

[quote user="Kara Gibson"]unfortunately the next day developed thrombocytopaenia and passed away presumably secondary to a bleed.[/quote]

I've always presumed the thrombocytopenia in these cases is due to the IM processes (Evans syndrome). But was recently told it's often due to consumption secondary to bleeding in these cases. But I don't see why an anaemic dog is more likely to bleed if it's clotting and platelets are normal. And I can rarely identify any bleeding (am well aware this doesn't rule it out). So why should the platelets be low if there's no IM destruction? Am I missing something??

RE: Possible pure red cell aplasia?

Kara Gibson — Thu, 25 Oct 2018 05:13:15 GMT

Exactly what I did do - those were my thoughts as by a process of elimination a bone marrow disorder was the only logical diagnosis. We started her on cyclosporin liquid along side prednisolone (she is a small chihuahua so couldn't dose with azathioprine accurately) and she had a repeat blood transfusion but unfortunately the next day developed thrombocytopaenia and passed away presumably secondary to a bleed.

Very sad case but thank you for your input.

RE: Possible pure red cell aplasia?

Kate Richardson — Fri, 19 Oct 2018 16:42:07 GMT

I would look at what your differential diagnoses are and what the treatment options are and then decide if a bone marrow biopsy is going to change what you do. In most of these cases they are either going to respond to pred or they are not. Not really convinced BM biopsy adds much

RE: Possible pure red cell aplasia?

Rob Loxley — Fri, 19 Oct 2018 13:56:58 GMT

[quote user="Kara Gibson"]Do we think it is still worth doing a bone marrow biopsy even though she is on prednisolone?[/quote]

I'd speak to the pathologist who you'd send the BM biopsy to