Aplastic anemia – time to remission

[Vally]

Ask Dr Dodds about using Epogen.

[Tharin]

Hi, Vally,

thank you for your reply.

This is just the result from a blood draw last week before her second transfusion. So I don’t have to panic right now about 15% HCT – I did last week amply…
It just took so long to get it, because the fax machine of my vet is broken and the labratory used the fax transmission, not email as expected. We discovered that just yesterday. ;)

I emailed Dr. Dodds and she wrote back instantly minus the time zone shift ;), that EPO has a big variation.
I also found a study about hemolytic anemia in dog, where they tested EPO and also had a huge range of EPO (and no correlation EPO-reticulocytes interestingly, but statistically significant anti-correlation EPO-HCT with wide range of values). Also found that higher viscosity of blood is suspected to give lower EPO values in humans. As well as a lot of inflammation proteins might give lower value. So I guess, it’s nice to now and keep in mind, but not leading anywhere right now.

Kidney parameters have been unexpectedly good in the same blood draw – we were flashed.

Thyroid I have NO idea, where she is at now. She is on substitution since the age of 2,5 years. Was very stable before this year. Then too high (but maybe just dehydrated sample, was very little serum from a normal amount of whole blood and SDMA also elevated – both low/ok in next blood draw), but too low, then normal again. With all the high dose cortison, I have no clue, where she is at. I (blindly) went up from her standard dose 250 to 300. That’s why I will do a full thyroid profile tomorrow (results next week).

I will also order coagulation tests tomorrow.
What is your experience here with the anticoagulation agents? Clopridogrel preferred? Or others?

Many greetings and thank you for your replies and the side in general.
Katharina

[Vally]

Katharina, please DO check about clotting. This is very serious in this disease. My boy, Bingo, did not need anticlotting medication, however many dogs do, and Clopridogrel is commonly used.

When you have the thyroid results, send them to Dr Dodds. Send a reply to her email to you. There is no need to do a further consult. She will answer your email.

I’m so glad the results were older. I worried when I saw the 15%.

Take care.

[Tharin]

Hi, Vally.

I should get the clotting test results this evening.
Allready took a Clopridogel recipe with me from my vet – in case.

T4 came out _high_ at my vet’s machine (5,8 for range 1-4). I usually test in a lab (also do TSH, maybe fT4), which I will do next week, because the evening pill yesterday was a bit late, so not perfect for meassurements. But this is way high…

The good news: kidney, liver perfectly fine values. Amylase a bit low, but the machine tends to meassure low, my vet says. WBC in range, lymphocytes in low third, platelets normalising -means fallen to very close to high end of range and normal (!) size. (They were evelated after transfusion and have been way to big all the past weeks.)

The bad news: RBC/HCT/HB falling. And not just the amount I would calculated by cell death.
On the other hand only blood draw to compere yet is the one from Monday after transfusion on Friday evening. And this one came out higher then excepted. Quite a bit. Calculated HCT would have been 31%, meassured was 34%.
So compared to the calculated, Milki would be wonderfull with meassured HCT of 30% today. But compared to the meassured HCT last time not so wonderful.
So I am puzzled and torn back and forth between cautious hope for some ongoing steadyness and despair of increased drop.

How often would you check? I heard and read eveything from each day to just once every one or two (!) weeks – or of course, when the dogs starts to show signs of hypoxia.

Greetings,
Katharina

[Vally]

If they do a PCV test, they only take a minute amount of blood, so ask for a PCV test.

Remember too that if they are hydrated, they will always have a lower result and if dehydrated a higher result. Stress affects results too.

Constant drops are more of a worry than an up and down result.

I’m so glad to read about the other results.

Vally.

[Tharin]

Hi, Vally.

HCT only tests are totally unusual here at vets. But: I can buy capillars and own a centrifuge. :)
Also I found a quite inexpensive tester.
So time for shopping. ;)

Clotting: Fibrinogen came normal, plasmothrombin came a bit too low for human (human lab – had not found a vet lab, but now I did, so will do next week again with vet lab), but probably ok for dogs. They unfortunately did no Quick and PTT – the telefone lady said, the filling wasn’t correct. But I suspect her to have just read my very own note to the blood draw as I gave _two_ tubes – was was definitelly 100% correct. So maybe the resulst will come, maybe not. But as I found a vet lab now, that does all three, I will sent it there next week.

It also turned out, that nower days the human labs seem to use species specific immuno assays for ferritin and transferrin (I think it wasn’t allways like that, if I remeber right). The levels were superduper low – that’s too odd.
I wasn’t able to find a vet lab yet. I would be quite interessted in that or even more the sTfR, cause this might indicate iron transport to bone marrow.
Iron was high – well 2 transfusions? It was allready elevatedright before the first transfusion, when HCT was dropping more quickly then all the weeks before.
Then copper was also elevated slightly – might have been through hemolysis? Now copper came nice in middle range.

Since the second transfusion and especially liver diet and vit b supplement and sylimarin (or maybe just Dr. Dodd consultation magic), Milki isn’t more sleepy any more then usual. She wasn’t suffering anyway, but was just tired. But maybe the frequent vet trips had quite an influence on that, too.
She did not start nagging for walks yet – her focus is a bit more shifted to food. ;) (the predni I’d say) And maybe she just sttled with no walk since we did none for weeks now. But she is defintelly quite active – coming closer to as she used to be.

It’s so nice to see and enjoy. There’s just allways that anxiousness, that the treatment will not sufficient to help her hold a acceptable red blood cell level. But that’s a well known thing here in the forum, I’d guess.
And we are so lucky, that she has *toitoitoi* no conceirning side effects.

Many greetings,
Katharina

[Tharin]

Hi,

in case somebody else is searching:

Ferritin etc. is indead species-specific test. So no use to have it done in human lab.

University of Kansas Vet Lab does ferritin and even haptoglobin tests. No sTfR available yet for animals, what I found:
http://www.ksvdl.org/laboratories/comparative-hematology/sample-submission.html
No Transferrin, but TIBC instead.

There also are ELISA kits avaibable, so every lab with photometer could perform, if willing. But those ELISAs are claimed for research only. I guess, that’s what all the studies used… For just one single tests, that probably isn’t changing therapy, it’s quite expensive to buy a kit even if you have access to photometer and lab etc. (around 500EUR).

Many greetings,
Katharina

[Tharin]

Hello!

Some questions to blood typing:
We’ve got the DEA1 test strip, so DEA 1 no prob. Also cross match before transfusion can be done.

But there seems to be no test available for DEA7 or DEA3. Is it different in the US?
(4 and 5 might be – found one publication, which states that, but did not find the tests themselves).

The typing is the only way to avoid delayed erythocyte destruction – correct?

Do you have _any_ resources in Europe for typing these blood types, too?

Or any sources of only DEA4 pos. typed blood in EU?
Or sources, that might deliver to Europe?

I was not able to find one yet. Just in the states.
Dr. Dodds said, they do not deliver here. Abrint said they don’t deliver to EU because of regulation (well, I could try to find a Swiss vet for exsample).
Also I cannot travel to US with her until stabilisation or so, because of Corona virus regulations of the US at the moment.

Best regards,
Katharina