2nd transfusion Advice please

[Marie G]

Hello,

BiBi is a 6 year old Cavalier weighing 14.2 pounds. 8-8-19 diagnosed, blood transfusion performed same day. Held steady at 26 for a 3 weeks then dropped to 21 on 9/4 perhaps due to having colitis. She was 20 on 9/6 then dropped to 16 on 9/11 and today, 9/12 still 16. My vet is on vacation and the cover vet wants to perform a blood transfusion at 7:45 am tomorrow because it’s the weekend and BiBi dropped to 16. I would love to wait for her vet to return on Monday but I am also afraid to go against the advice. Any thoughts about the 2nd transfusion?

[Vally]

Marie, some dogs can cope short term with a PCV of 16 and some dogs not. How is BiBi coping? That’s the most important thing. My Bingo had a PCV of 15 but we didn’t transfuse. He did pick up on the drugs by the next test.

If the second transfusion is done – it MUST be properly matched blood. The first one can be any type of blood, but a second transfusion MUST BE MATCHED.

They should not transfuse above a PCV of 25 otherwise the dog’s own body won’t work to make more red blood.

See here for more information from our glossary
https://www.secondchanceaihadogs.com/AIHA_Terms/transfusion

[Patrice]

Marie,
I am sorry to read about Bibi.

This is a bit different than what we usually see in dogs with IMHA. Their immune system is attacking red blood cells.

If I understand correctly she is experiencing bleeding due to colitis and this is leading to anemia.

While transfusions are not benign treatments, they are very beneficial for supporting and maintaining homeostasis of the body. When a human or dog has anemia, whatever the cause, it affects the entire body. The body’s cells don’t receive enough oxygen and functionally begin failng. For a small dog, for instance, they can develop a heart murmer. Also low PCV HCT leads to hypovolemia, low blood pressure, risks of clotting. They don’t feel good.

So, medically, a transfusion can help maintain stability, and make us feel better.

There is no one single criteria for when a transfusion is necessary. The medical community calls this a transfusion trigger. Dr’s evaluate a number of things before determining if one is necessary or just a good idea.

After evaluating all the lab work, the vet evaluates the patient. Are they really suffering because of low O2 to the body? Have they become weak and unwilling or unable to eat, can no longer stand to potty, are disinterested in visits from you or her caregivers?

I’ve seen dogs on this forum who could not tolerate a PCV HCT of 20%. I’ve seen dogs at 13% that were spunky and happy to see family. First dog needs a transfusion, second dog may not.

Serious colitis can be a medical emergency. It can quickly decondition a dog, leaving them febile. A transfusion can help with other things than just replace red blood cells. It can provide many other cellular elements that help.

So, I’m not sure of all the details about Bibi, what her lab work ups look like, what diagnostics have been done. If the attending vet is urging you to do this ask them why they feel this way. You don’t need to feel like this might seem a combative to them. They are professionals and should respond to you positively.

Another transfusion has some risks. Your dog needs to be typed and matched. Transfusions should be performed slowly and carefully to avoid transfusion reactions. Ask if the staff doing this does it routinely and understands the risks. Weekend staff should be as capable as regular weekday staff.

The cost can be normal or high, depending on whether it’s considered an emergency or routine. Find out first.

I have no doubt this will make Bibi feel better. Will it treat the other problems, probably not directly. I suspect they have her on prednisone in order to quiet down the colitis. Ask what other treatments they are considering for that.

Do you have more questions?
My best Patrice

[Marie G]

Hello Vally, What do you consider short term? She is not 100% but not doing poorly. If it wasn’t the weekend I would not do the transfusion until her vet returned. They do have Saturday morning hours so I could have them get a count then as well. On Wednesday when her count dropped to 16 they increased her prednisone from 7.5 to 10 twice a day. She is struggling with this a bit as she just had an increase last week from 5 mg to 7.5 mg twice a day. But her foster mom stated that her red blood cell count was lower (not like this at all) after an infection and at the foster mom’s request, they kept her on an antibiotic longer and the count bounced back up. A specialist consulted on BiBi’s case and suggested a regime of doxycycline for 28 days. My regular vet has not seen this report yet because of his vacation.

They did take blood yesterday and matched her as you described so I think we are good on that end but at your warning, I would confirm if I moved forward with the transfusion.

[Vally]

Marie, have you read Patrice’s response? Maybe ask the vet why they think it should be done rather than waiting.

[Marie G]

Hello Patrice,

I’m sorry, I was not clear. BiBi was diagnosed with AIHA on 8-8-19 and had her first transfusion on that day. She was holding her own at 26 for 3 weeks until she developed colitis and that’s when her count dropped so, in my opinion, I think colitis was the cause of the drop and had she not had colitis I wonder if her count would have held or gotten better.

But honestly you answered my question. BiBi is eating, drinking, she is still following me everywhere I go in the house, tail wagging and other than a reaction to the increased dose of prednisone on Wednesday (even more panting and drinking!), she is not displaying any of the signs you mentioned. Her gums are pale but that is the only symptom she has as far as the low count.

Much, much appreciation! I will feel better waiting for her regular vet to return on Monday.

Thank you,
Marie

[Marie G]

Yes I did Vally! How amazing!

The covering vet did not examine BiBi, we had a vet tech visit so she only saw the 16 count. Vet tech visit yesterday afternoon, covering vet said BiBi may need a transfusion so she wanted to get more blood to do the match as a precaution only, I agreed. Then the whole day went by without contact and at 5pm I got a call telling me the covering vet decided she wanted to do the transfusion could I come tonight or in the morning. I said I at least wanted to see her count before deciding that so I ran her up for another count. The covering vet was not even there. When it held at 16 I asked if we could wait until Monday for my vet to come back the vet tech said no, the covering vet wanted to do it tomorrow.

My gut was telling me to wait until Monday but my fear kicked in. I was afraid of making the wrong decision.