Slaton – IMHA slow to respond – Page 2

Keymaster

Matt,
These results show a relatively severe non-regenerative anemia. The reticulocyte value, at 27,800 (which has not appreciably changed since July), indicates that the bone marrow is not producing new red blood cells in response to anemia. This value should be in the neighborhood of 150,000 to as high as 350,000 with a HCT as low as Slaton’s. A normal healthy dog (and human) maintains a value of about 60,000 or 1% at all times. This is the gold standard for evaluating anemia.

Each day our bodies destroy old worn out blood cells and replace them with new red blood cells. These new cells will live approx. 120 days when they will be destroyed and replaced. This does not happen all at once, but rather a little over time. What you are seeing then, is the gradual decline of these older RBC in circulation and thus thus the slowly decreasing HCT / PCV. These cells are most likely normal in every way, there is just not enough of them. This is called normocytic normochromic anemia. Normal shaped and normal amount of hemoglobin inside. This is exactly what Chance had. You can read his story here.

There can be a few reasons for this. However, working with Dr. Dodds for a year to save Chance’s life I learned that many dogs develop this as an autoimmune destruction of the precursor cells in the bone marrow. There are many steps from a stem cell to a fully developed red blood cell. You can see a very simplistic diagram of those steps here.

I say this is simplistic because there are many stages for the red blood cells that are not shown in this diagram. At one of those stages Chance’s red blood cell production was being “arrested.” He also had “arrest” of the white blood cell line. While a bone marrow biopsy will show this in detail, I actually don’t recommend performing this test until after an aggressive protocol has been attempted. We already know that Slaton is not making red blood cells. This test is very invasive, requires anesthesia, and would essentially tell you exactly what I have just observed by looking at your CBC. The specialist is going to offer this test to you. Talk with me again before deciding to do this.

There is a specific lymphocyte line called the T-cell lymphocytes that is responsible for the protective / warrior element of our immune protection. However this cell, that moves from the bone marrow to the thymus gland to get “programmed,” can go rogue and forget what its job was supposed to be. It generally is the lineage of WBC that is responsible for the autoimmune destruction of cells. In this case, however, it isn’t happening while the RBC are in circulation (AIHA IMHA) it is happening to the precursor cells in the bone marrow. This makes it more difficult to treat and requires a more aggressive protocol.

On the other hand the other white blood cell lines are all very high (with the exception of lymphocytes and eosinophils.)

Why are the other WBC so high? Well, each type of WBC has a specific role in the body. We can tell a lot about the possible reasons by the particular WBC lines that are in excess of normal.

In short, looking at the WBCs I can see that there is most likely an infection of some kind, but more importantly there is an inflammatory condition going on as well. I believe, from your description, that Slaton has SIBO small intestinal bacterial overgrowth. In dogs this can be a quite destructive condition, causing serious illness. The major outcome of this condition is a failure to absorb nutrition properly. It also can lead to further serious bowel disease, for instance colitis. I believe that both of these things are occurring right now.

In addition to Chance’s destruction of the precursor cells he was also experiencing digestive issues as well. Some of the malabsorption that occurs with SIBO is the inability to process and digest vitamin B12 and folic acid. These important nutrients, along with iron stored in the liver, are critical to the manufacture of new red blood cells. With low levels of them the cells that are made are fragile and this is called “maturation arrest.” Add this to the complex problem of autoimmune destruction and it like the new red blood cells must attempt to go through a “land mine” of problems to reach maturity. All this is happening “within” the bone marrow.

And finally, Chance had been diagnosed with hypothyroidism a few years prior to his illness. We started treating him for it with Soloxine but then Cassie came along, life got hectic and I got sloppy giving him his pills. This hypothyroidism was directly related to his inability to make new red blood cells. The body was slowing down the production due to the extremely slow metabolism. Dr. Dodds insisted I get him back on his therapy.

So you can see that there is not necessarily one element involved in these complicated conditions and that the best results for treatment must involve a multipronged protocol.
1. A very aggressive treatment protocol of immunosuppressives, preferably using cyclosporine in conjunction with prednisone.
2. Aggressively address digestive problems with diet, medications (tylan powder or low dose, long duration metrondiazole) and probiotic therapy (human refridgerated grade, at least 45 million per capsule). Include testing levels of B12 and folic acid (and possibly iron as well.) Give B12 shots at home on a therapeutic schedule.
3. Implement thyroid supplementation to provide a stimulus to the bone marrow.
4. Address any identifiable infections with drugs.
5. Utilize a diet that is anti-inflammatory, adding antioxidants such as blueberries, fish oil and vitamin E. No grains, soy, sugars. High quality low fat proteins are essential. Best to consider making food at home.
6. Plan that additional transfusions may be needed before this protocol begins to work. Remember, dogs whose PCV drops slowly tend to be ok with lower PCV’s than dogs with AIHA whose PCV drop suddenly in a fews days. Chance’s uncomfortable level was 18%. Slaton’s could be higher or lower.

I am very confident that you will be successful. Remember that this could take a long time. Be patient with your vet and with yourself. I can tell you are a good Dad. You have the willingness to do the long haul.
my best
patrice

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