Stella – Page 2 – Second Chance AIHA Dogs

Keymaster

PJ,
Good to see you back!

First, Stella no longer is considered anemic. Her HCT hematocrit, 42.2% is well within normal limits (wnl.) The reference range is 37.3-61.7.

Since there is no anemia at this point, the body has basically slowed down the regenerative process in the bone marrow to a normal level of about 1% and 50,700 absolute reticulocytes. All humans and dogs have this normal level of reticulocytes. There is no reason to continue to suppress the immune system with the higher doses of immunosuppressive drugs (prednisone, azathioprine, or cyclosporine). If you are still using high dose prednisone it is ok to start reducing that very slowly. See this page:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction

There is one value that relates to the red blood cells that is somewhat high, called MCV mean corpuscle volume, the size of the RBC, and this case the cells are larger than normal. Because of these larger cells, this has caused the HGB hemoglobin amount to look a bit low, 12.6. HGB reference range 13.1-20.5.

The HCT hematocrit is fine and the lower hemoglobin is negligible. Sometimes when a dog has had AIHA IMHA, replacement RBC’s made in a hurry are a bit too large when they are new and I suspect that another CBC in the future will not look the same.

However, the WBC white blood cells count is a bit high, 19.29. The reference range is 5.05-16.76. This is a combined count of all 5 types of WBC and these are your defensive cells of the immune system. Each type has a different job.

Neutrophils NEU are in the greatest quantity in the body and when they become high we usually suspect infection of some kind. On this test, NEU is 16.10 with a reference range of 2.95-11.64.

Monocytes MONO are called macrophages, WBC that vacuum up unwelcome things in the body. They become very active when other WBC attack bacteria etc, cleaning up the “mess.” The value on your test 1.21 is slightly high, reference range 0.16-1.12. Not a really high value, but indicative of some kind of inflammation or infection that has occurred.

Finally the basophils BASO are high 0.42, reference range 0.00-0.10. It is rare to see basophils at all and any amount above normal should be noted. Their job is usually related to allergies and if you see higher eosinophils EOS also, this is a good indicator that a dog may have an allergic reaction. However in this case the EOS values are normal. So a vet might think along the lines of something amiss with the bone marrow. I would want to see previous CBC’s to see what has been happening up to this point. One test doesn’t tell a very good story, multiple tests show changes and trends.

On the chem screen there are number of values that are high.

BUN blood urea nitrogen is a kidney function value and this indicates the amount of wastes that the kidneys were not able to process properly that remain the blood. In this case the value is 28 reference range 7-27. So it’s not very high. In a case like this we would also look at another value called creatinine to see if it is high also, in this case it is normal. So then we would look at their ratio. In this case the ratio might appear to be normal. Since the kidneys are so critical and BUN can indicated damage it would be important to check with the vet to see how they feel about this slightly high value. Viewing multiple chem screens might show a trend.

ALT Alanine transaminase and ALKP Alkaline phosphatase are liver enzymes that usually indicated that liver cells are being damaged. The ALT is high, 534, reference range 10-125. ALKP is high 296, reference range 23-212. When your dog is on prednisone, the liver processes this drug and during this liver cells will die. So it is pretty clear that these levels are high because of the use of high dose prednisone. This is a very normal and usual consequence of treating any dog with AIHA IMHA. There should be no cause for alarm, if there was no organic liver disease prior to now, once the prednisone dose is reduced these values will return to normal. But we can help the liver with a supplement. In this case they used what I always recommend, Denamarin. This is a high quality liver supplement dosed appropriately for dogs. You should continue this supplement for the whole period of time you are also giving prednisone. While these values appear high, many dogs will have extraordinarily higher values when on prednisone and they do recover as the liver is regenerative.

GGT Gamma-glutamyltransferase is also an indicator, usually, of liver problems. It is high, 58 reference range 0-11. In this case I think the vet would agree this is another indicator that the prednisone is the source of the liver injury and once reduced this value will decrease.

Finally the CHOL cholesterol value is high 386 reference range 110-320. Dogs do NOT have the same kind of cholesterol problems that humans do, it is a very different species when it comes to blood levels of CHOL! Dogs are capable of handling fats very differently than humans and they are every efficient at converting fat to blood glucose, their main source of energy fuel. They can survive quite well without added carbohydrates to their diet, producing their blood sugars with converted fat. So why is the high CHOL value of concern? Well the first reason is simply that the dog was not fasted properly before the blood was drawn, there should be a fast of at least 8-10 hours before this, and there is a lot of fat remaining in the blood, called lipids, which can interfere with many values on a blood test. If we could look at other previous tests and see the CHOL is consistently high then I would suggest that there may be hypothyroidism and would recommend a full thyroid panel be done, Hemopet can do this. In dogs, the CHOL is a very accurate indicator that the dog has hypothyroidism, nearly 75% of dogs that are hypothyroid will have elevated CHOL. See this page and select the Thyroid Profile 4 (T4, free T4, T3, free T3). When you select this test, it will give you instructions how to draw and mail the serum sample to Hempet.

https://labordatenbank.com/cake/hemopet/samples/hemopet_form

So first, please get me some early test results. I would recommend a slow reduction of prednisone and if the cyclosporine is dosed higher than a regular maintenance dose then reduce it to a maintenance dose for now and then once the prednisone is reduced you can begin to reduce the cyclo at a slow rate. It is more important to reduce the pred now so as to reduce the load on the liver.

Do not add any supplements like this to the regimen. If anything the diet and supplements should be carefully monitored to optimize liver support and anything new should not be added since we do not know how it could affect the liver. I suggest that you use Dr. Dodds Liver Sparing Diet. see
https://www.secondchanceaihadogs.com/wp-content/uploads/2015/08/Cleansing-Diets.pdf
my best, patrice

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