Dixie – Anemic – Low B-12

[Roger]

Dixie, our Aussie Mix 6-8 years old (we rescued her 4 years ago) began losing weight about 3 month ago, she was never overweight, actually a little thin at 46 lbs. Then she lost her appetite and we struggled with finding her a food she liked. We took he to the vet about 3 months ago and she was about 40 lbs. The vet explored SIBO, EPI, a Bad Tooth through a series of tests and treatments. CBC, Urine, Fecal, Cobalmin/Folate/TLI/PLI. At this poit she was losing about 1 ½ lbs per week and reached a low of about 35 lbs when the combination of B-12 injections, Trinfac-B, Livaplex, Prednisone (30mg a day now tapered to 10mg every other day) and she is up to about 38 lbs. With the prednisone tapered now to 10 every other day there is a very noticeable reduction in appetite. Below are the numbers that were out of range at first and last Thursday. We are very concerned with how much the CBC numbers have swung toward the worse even though she is gaining weight and is better than she was 4 weeks ago when the B-12 injections began. I got her numbers from the vets office Saturday so we could look through them. I think the vet will want to do an endoscopy but I don’t know what that will do in terms of finding an actionable treatment. We are getting very worried for our little girl.

On 24 May 2014 her out of range number were:
HGB 11.8 g/dl
HCT 34.6 %
MCV 50.5 fL
MCH 17.3 pg
Platelet Count 1111 K/uL
Potassium 5.7 mmol/L
NA/K Ratio 25.1
Calcium 8.5 mg/dL
Total Protein 4.1 g/dL
Albumin 2.0 g/dL
Globulin 2.1 g/dL

Now on July 17 her out of range numbers are:
WBC 27.4 K/ul
RBC 5.03 M/ul
HGB 8.49 g/dl
HCT 27%
MCV 53.7 fL
MCH 16.9 pg
MCHC 31.4 g/dl
Platelet Count 1160
RBC 5.03 M/ul
Retuculocyte 15%
Reticulocyte Absolute 754500 /ul
NEUT# 24112
Potassium 5.7 mmol/L
NA/K ratio 25.4
Creatinine .6 mg/dl
Calcium 8.7 mg/dl
Total Protein 4.4 g/dl
Albumin 2.3 g/dl
Globulin 2.1 g/dl
Urine pH 7.5
Protein 30

[Claire]

Hi Roger, sorry to hear that you are having such a worrying time with Dixie. I am not one of the people on this site who can interpret blood results but there are lots on here who can. The fact that they have so much detail to go on already from your post will mean they can help you more quickly. Someone knowledgable will see and respond shortly, I am sure – the support and expertise on here is amazing.

Claire

[admin]

Hi Roger

I am really sorry to hear Dixie has been so ill – it is very worrying to see them like this & we would all love to help you as much as we can. All of us have experienced this awful scenario & understand completely how upsetting this is for you.

I know Patrice has sent you some excellent information & advice already – she is an amazing person with great knowledge. I saw Dixie has B12 injections which have helped & your vet has done a lot of testing. Dixie’s PCV is not ” seriously low”, so please don’t worry too much just yet, and she’s producing baby red cells (reticulocytes) which is GREAT news. I know Patrice has also mentioned about abnormal clotting (I see Dixie’s platelets are high on both tests) & I also would urge you to speak to the vets about this as soon as possible as she may need anti-clotting medication. If you could read the following which is from our AIHA terms glossary https://www.secondchanceaihadogs.com/AIHA_Terms/abnormal-clotting/
Number 3 is relevant to Dixie.

Anything at all we can help with, you only have to ask. I have a real soft spot for rescue dogs too – my two are of unknown origin as well! She sounds like an absolute darling.

All my best wishes, Sheena, & Worzel & Ollie
PS “Our stories” are available to read on this site, but I think you’ve got enough to fill your time with at the moment.

[Vally]

Hi Roger, I’m sorry your Dixie is so sick at the moment. I know Patrice has sent a lot of information through for you to go through and Sheena has directed yo to the AIHA Terms (up the top) which has a huge amount of information written in such a way that it’s understandable to those who don’t really understand medicine.

I also really urge you to ask for the aspirin and the sucralfate that was mentioned.

Ask anything at all – we all love out mutts to pieces and will do anything we can to help.

Vally (an Aussie human) and Bingo (another rescue mixed (up))

[Roger]

Thank you all for the information, we are very grateful for your time to respond. I’m on a crash course to learn all I can. Not being a medical person there sure is a lot to comprehend. I do have some additional info that was on Dixie’s CBC paperwork that I sent via the Urgent Advice page but did not post here. I’ll place it below in case some of these items help in forming an opinion on Dixie’s situation. By the way we have a vet appointment tomorrow afternoon.
PLT Comments: Platelet numbers appear markedly increased Few macroplatelets seen.
WBC Comments: Leukocyte morphology is within limits. Neutrophil numbers appear moderately increased.
RBC Comments: No Spherocytosis seen. No RBC autoagglutination present in warm saline Target cells noted. Hypochromasia +2
Anisocytosis 2+
Polychromasia 2+

[Tamara]

Hi Roger, just wanted to say welcome to this forum, it is the best place you could be, the help here is amazing and has been such a huge assistance to me in the fight for my dear rescue dog’s fight for life. Please continue to post frequently and let us know how you and your sweet Dixie are doing, Ashki and I are sending lots of healing vibes your way.
tamara and ashki

[admin]

Hi Roger

My goodness, we’ve all had to learn fast with this disease! Just ask about anything you’re not sure on. I can assure you I knew very little about AIHA/IMHA and other types of anemia when this happened to Worzel.

Sorry to nag, but I am concerned about the clotting risks with the high platelet levels – I see you are going to the vet this afternoon – please ask them about this. The addition of sucralfate to Dixie’s medications is also very important as ulceration (leading to bleeding) of the GI tract is common with the prednisone.

Good news on “no spherocytes” & “no RBC agglutination” as these are also clotting risks and are signs of auto-immune destruction of RBCs. That’s extremely positive news. It looks like Dixie may either have iron deficiency anemia or possibly there has been some blood loss somewhere – do your vets think there may have been blood loss? Is this why they want to do an endoscopy or is it that they are concerned about malabsorption?

Polychromasia & anisocytosis are often seen in cases of anemia where immature red blood cells are being released – her body is trying hard to get the red cell levels back up.
https://www.secondchanceaihadogs.com/AIHA_Terms/anisocytosis/
Hypochromasia means paler than normal red blood cells because their haemoglobin content is lower than it should be. It is also an indicator of iron deficiency anemia.

Wishing you all the luck in the world at the vets today – please let us know how you get on. I know Patrice has given you a lot of information to discuss with them. Dixie has a great Dad &family looking after her best interests. I will be thinking of you.

All our positive thoughts & wishes
Sheena, Worzel & Ollie

[Roger]

Update on Dixie. So we went to our vet yesterday and saw a substitute Dr. since our normal vet was out. Actually we really liked him and he spent probably about 2 hours of his time studying her previous tests, doing a little research and concluding about the same as you all have. No definitive answer to where the blood, iron, albumin is going. He recommended we get either an ultrasound to look for an issue along the digestive tract or get an endoscopy from a specialist location. So after more conversation we decided to give a location near our city where we have heard very good things about and they have some affiliation with UC Davis. We were able to get Dixie in there today and decided to start with the Ultrasound (less invasive, less $$) and while it is a lower probability diagnostic tool we took the chance. The doctor spend a lot of time talking with us and performing the ultra sound with no definitive results everything looked ok though there certainly are limitations on the procedure. He suggested that we consider endoscopy with multiple mini-biopsy’s from the scope (sent to Texas A&M) and we decided that we where going to take this step to potentially treat our beloved little girl. Previously we had thought about endoscopy and thought we might not place Dixie in anymore anesthetic situations and instead make the best guess for what she had and treat it as if we knew the answer. The doctor gave us a little more confidence that with this procedure we should know with about 85% certainty what the root to her problem is. He said that not everything that is found has a great outcome but there is a pretty good chance that we could find the one or multiple causes (focused and/or dispersed) of her illness. Dixie is there now being prepped for tomorrow and for the first time in so many years I can’t remember, there is no dog in our house. The house is not the same and we do not like it. Tomorrow Dixie will get the procedure and we should be able too pick her up in the evening. We are praying everything goes well.