Immune-mediated bone marrow destruction

Re: Immune-mediated bone marrow destruction

Gareth Dowdeswell — Fri, 18 Mar 2011 17:20:42 GMT

Dog improved intially for a couple of days on the preds but came in yesterday lethargic, not eating/drinking. Gums were white as a sheet, tachycardic and hypothermic so PTS as it appeared pretty certain disease had progressed and prognosis was very poor.

Dog had only been on preds for 6 days so hadn't run any bloods by that point to assess if responding - perhaps I'll monitor the next one more closely but this case wasn't insured so was trying to strike the balance between monitoring vs the owner's bill. Confirms the rather poor prognosis most other people in this thread have experienced!

Re: Immune-mediated bone marrow destruction

Vikki Halliday LLB — Wed, 09 Mar 2011 23:50:30 GMT

Preds sound like a good choice, you could also add azothiaprine if it doesn't look like it is responding?

Re: Immune-mediated bone marrow destruction

Utlendigur — Wed, 09 Mar 2011 20:50:20 GMT

I looked up the details of the case I saw. Sounds a very similar lab report - maturation arrest in erythroid lineage. Lab thought immune-mediated most likely due to lack of other changes eg fibrosis. It had an initial HCT of 16% and also had a severe neutropenia of 0.47 (2.5-12.5 normal range). After 1 wk on 2mg/kg preds bid the HCT was 24% and the neutrophil count was, I think, back to normal. After another week the HCT was 27% but then she started to develop a steroid myopathy and hepatopathy. We were already starting to reduce the preds so ciclosporin was added and the preds reduced more quickly than otherwise would have been the case. But then the lab started finding atypical lymphocytes in the smears. They initially thought these were reactive but quickly changed this to myeloproliferative disease. At this point the dog was PTS.

So the initial response was good, but it all went pear shaped from about 3-4weeks. Good luck...

Re: Immune-mediated bone marrow destruction

Gareth Dowdeswell — Wed, 09 Mar 2011 17:38:40 GMT

Thanks for the replies, owner didn't want referral so have started on 2mg/kg preds with covering abs. Plan is to repeat bloods in 2 weeks when hopefully they'll be better but based on the cases people remember here I'm not optimistic!

Re: Immune-mediated bone marrow destruction

Mary Thomson — Fri, 04 Mar 2011 22:47:48 GMT

I dealt with a case years ago (this is from memory so detail will be sketchy). A 2 or 3yo F Dobermann, presented with lethargy and pyrexia. Bloods were relatively normal initially other than extremely low neutrophil count and other WBCs low. I referred her to Langford after initial investigation as she was insured and the diagnosis they came back with was neutrophil maturation arrest (the dog literally had no neutrophils). There was no history to suggest a possible cause, dog was vaccinated (but no vacc immediatly prior to the onset) and no history of illness. I can't remember whether other cell lines were affected eventually- I think RBCs were OK. She was PTS within six months of work up. I think we managed her on antibiotics and lithium on the advice of the clinicians at Langford. From memory the lithium was by injection, and this did pick up the neutrophil count for 3-5 days each time. However, it was v expensive and the insurance funds had run out by then. Also QOL was deteriorating. Sorry there's not more detail!

Re: Immune-mediated bone marrow destruction

Utlendigur — Fri, 04 Mar 2011 22:02:48 GMT

[quote user="Richard Carter"]

.Not quite sure how this dog is functioning if pcv genuinely 17%.

[/quote]

I think like a lot of problems, they can compensate if it develops slowly. It's the ones that drop PCV quickly that come in collapsed. Sounds like a case I had a couple of years ago. Young (2yr?) golden ret. with recurrent FL lameness but no other reported health problems (resting her may have masked exercise intolerance). That also had problems with other cell lines too, which I seem to remember were immune-mediated destruction within the bone marrow. She was insured so I referred her but she still ended up pts.

Re: Immune-mediated bone marrow destruction

Gareth Dowdeswell — Fri, 04 Mar 2011 20:33:37 GMT

[quote user="Richard Carter"]

mmm - you are getting the strange once in a lifetime cases all in one go.

1. non regen anaemia PCV 17% - you happy sample didn't clot? Did you do your own bloodsmear/ pcv in house?

2. dog not been abroad/ contact with dogs been abroad (leishmania/ ehrlichia type disease) - are tests - PCR/serology ? Ronaxan drug of choice

3. owner giving any 'tonics' or access to any owner meds (especially any chemotherapy meds).

Not quite sure how this dog is functioning if pcv genuinely 17%. Am just scanning the BSAVA clin path book and they mention oestrogen toxicity which can cover all cell lines being depleted. Definitely castrated, not cryptorchid?

If not going to refer I would give ronaxan, immunosuppressive cortisone and vitamin B12/iron injection and resee 4- 5 d time if no setbacks and redo bloodsmear/ pcv.

[/quote]

Was a good bleed, no evidence clotting. Bloods weren't done in house, were done by NWL including smear exam, would expect them to mention if sample seemed clotted. Dog apparently wants to go for walks and play with ball but tires v v quickly - as expected with PCV 17. Gums were definately pale so think PCV is accurate.

Cheers for the other suggestions, all things I hadn't thought to ask/check! Bone marrow smear report mentioned lots of Iron seen so probably not needing iron injection?

Re: Immune-mediated bone marrow destruction

Richard Carter — Fri, 04 Mar 2011 18:48:36 GMT

mmm - you are getting the strange once in a lifetime cases all in one go.

1. non regen anaemia PCV 17% - you happy sample didn't clot? Did you do your own bloodsmear/ pcv in house?

2. dog not been abroad/ contact with dogs been abroad (leishmania/ ehrlichia type disease) - are tests - PCR/serology ? Ronaxan drug of choice

3. owner giving any 'tonics' or access to any owner meds (especially any chemotherapy meds).

If not going to refer I would give ronaxan, immunosuppressive cortisone and vitamin B12/iron injection and resee 4- 5 d time if no setbacks and redo bloodsmear/ pcv.