Staffie X Tiger Diagnosed with AIHA – Page 5

Keymaster

Adam,
This is the second time you have reported that the vet’s office claimed a value was wrong because the tech did the test wrong. I’ve mentioned this to you before that you should try to get this under control to your satisfaction. This is not a minor mistake. The treatment protocol is dependent on the results of these tests. The next time you go in, please request that the vet do the blood draw. Smile and be polite but remind the vet that this is the second time this has happened (are there more?) and it is really getting on your nerves. (Not to mention mine as well.)

On your end make sure that Tiger is prepared properly for these tests. He should be fasted at least 10 hours beforehand and should have plenty of water to drink. Fat in the blood from a meal can cause artifacts that can alter the values significantly.(The technical reason for this is that fat is light refractory and most clinics now use laser analyzers that can make mistakes when there is fat in the sample – think of how oil looks on a puddle of water.)

Dehydration will also significantly alter the values on a blood test and it makes it harder for the tech to get a proper blood draw, this leads to damaged red blood cells and that can cause these values to be extremely variable (and incorrect).

To technically to understand this, think of these values as percentages of the whole of the blood sample. So they have a relationship to each other. If you take three quarters cup of white rice and a quarter cup of wild rice and put them in 4 quarts of water and then take a small sample you will find very little wild rice and not much white in the sample, in fact you may not even see any wild rice! Take that same cup of mixed rice with a half cup of water and you will see a lot of both rices in the sample, like too much! We want the blood to be properly hydrated, somewhere between these two extremes so that the measurement of the different cells are properly measured.

Be sure to pick a quiet time of the day and get there early so that you can get Tiger calmed down with a walk and some relaxation in the waiting room. If this was not explained to you before and they claim that is the reason the tests are variable, smile and say “perhaps you can test him again for no charge since it wasn’t made clear to me.”

All this said, a tech really should know when they have made mistakes, to them it is apparent. They know when they have damaged RBC during the draw and they know if they have mishandle the sample, perhaps leaving it too long before finishing with it so that the sample actually begins to change. Red blood cells that sit like this can absorb too much water and burst, this is hemolysis. Platelets can form clumps.
This isn’t the easiest job with really sick animals, but they need to make an effort to get it right. A sample like this should be throw out and a fresh one taken.

How many times have I had my dogs in for blood tests? At this point I am sure it numbers into the hundreds. I know the difference when I see them taking it. I try to do everything I can to help them manage my dog comfortably. You will see a picture of Willie in the slide show offering his front leg for a blood draw. The techs love him because he just lets it happen, no struggle.

But since these things are really expensive, it’s now in the vet’s court to make this up to you. The vet can do the next draw so you can be sure it is done correctly. Smile and be polite about it, be gracious. But get it done. I want you to also request a simultaneous PCV test. This is a small tube of the drawn blood that is manually spun and held up to a chart that shows the packed cell volume. This is a more accurate indicator for reference since the laser analyzer can make mistakes on blood of very sick dogs because there are many more odd or different cells right now. The HCT hematocrit is going to be somewhere between 2-6 points lower than the PCV. It shouldn’t cost more than $10. When Chance was ill I had one drawn each time we walked in. The amount of blood is tiny. See the glossary item for PCV to see the tiny tube.

I have said for years to owners, the numbers are not the whole picture. When your dog acts like he is feeling a lot better, well… he IS feeling better. Dogs can’t lie. I don’t believe this lower value is correct, or at least Tiger is adjusting to it so that he feels quite good at this value. So the short of this is, don’t worry unnecessarily over the weekend. If he’s acting ok, (is he eating today?) then just enjoy him over the weekend. Spend some happy quality time together. If you worry he will pick up on this and react to it as though he had done something wrong.

I don’t like to see vets reduce both drugs at the same time but sometimes it has to happen like this. Constant vomiting, diarrhea, failure to eat and sometimes even pancreatitis or the worst I saw was a dog that had developed sudden and severe diabetes because of the prednisone. These are reasons for a quicker reduction. In this case your vet has agreed that the dosages he was originally on were very high. I agree. So letting a dog remain extremely sick because of high doses just weakens them and they can’t recover as quickly. We want to keep Tiger as healthy as possible right now.

Please let me know tomorrow how he is doing. I want to know.
my best
patrice

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