Blood clots with AIHA

[Meghan]

Also, she is exhausted from the hospital. I agree, Sheena, she definitely needs lots of calm and rest. It’s a little difficult with a 3 and 5 year old, but I’m trying and keeping my focus on Gabby right now (which makes for jealous kids) ;) But they were doing well this afternoon, and I had gabby laying on her blanket on the couch, when the door bell rang!!! Gabby, out of instinct/habit, jumped off the couch barking and running to the door before I could get her. by the time we got to the door, she had fallen over on her side, her legs were twitching and she went potty on floor. It was very scary, and I though I was losing her at that moment. :( But after a minute she started to calm and just stayed laying there and started breathing normal again. It was so so scary. And unfortunately now she’s more tired than she was when we brought her home. I hope it didn’t set her back more. So upsetting…..

[admin]

Meghan,
I can imagine that was a very scary episode and you certainly don’t want to repeat that. having Gabby rest is very important now and you don’t want her to charge around. Of course with the kids in the house that becomes a real challenge. Do you maybe have an old playpen that you could put her in? She could then be close to you but still be confined. I have what is called an X-pen, something like a playpen for dogs. people going to agility or conformation shows would have them. Ask around you never know. Maybe you still have one of those gates you can put in a door or at the top of a stair case? maybe you could confine Gabby this way? I am sure you don’t want to put her in a cage or travel kennel, but try and find a solution with what I suggested.
I have no idea what caused this episode, maybe someone else has a thought. I would for sure mention it to the vet. Best wishes,
Brigitte

[admin]

I forgot to mention, this confinement should of course not be a punishment! You could feed her in there and make it very cozy and pleasant for her. Give her treats and make sure she can still see you when you are moving about.
Brigitte

[Vally]

Meghan, the collapse episode sounds very scary. I think if it were me, I’d ring the vets and run that past them. It sounds a bit like an Addisonian Crisis which can happen if there’s not enough hormone going through the body but I thought this was something that happened if steroid dosage is being reduced too quickly, which isn’t the case here.

I’ll go through the medications you emailed and put a chart together for you.

Love Vally & Bingo.
xxx

[Meghan]

Thanks! I will call the vets in the morning. They said she did have one episode while they were doing her exam on Tuesday, where she put her head down, then her front legs gave out. They said they were able to rouse her but it was concerning. They were worried about clots being in the brain or in the nervous system I think is what they said. I know unfortunately she still has lots of clotting in her system that we can hopefully get cleared out after everything else calms down. unfortunately I’m wondering if that’s what it was from. She took all of her meds tonight a while after that and has eaten some chicken at dinner time and now, right before bed. She doesn’t want to drink so we are giving her water through a medicine dropper/syringe. Hoping a good night’s sleep tonight will help. I also put a sign on our door – no knocking or ringing door bell. do not want to repeat that!

[Vally]

What they put us through!!! You have a good sleep too.

Vally
xxx

[Patrice]

Meghan,
This is something called a syncope. Basically fainting. Chance had syncopes when he developed a heart condition because he had an irregular heart beat. But this can happen to any dog that has low blood pressure.

Why would her blood pressure be low? Well Vally already mentioned that this could be an Addisonian Crisis. This arises when there is not enough cortisol in the body to help the body handle stress. In dogs we know that something simple like hearing the door bell is a stressful event. You know what you feel like when you are almost in a car accident, your heart races, your breathing increase and you feel highly focused and a little buzzed. That’s what cortisol does for us, prepares us for fight or flight.

High dose treatment of prednisone (similar to cortisol) plays a role in causing the adrenal glands to shrivel up and “go to sleep,” aware that their job function is no longer needed. When we start to decrease prednisone there is a risk that during periods of stress there may not be quite enough cortisol to help the body prepare. One of the important things that happens is that the heart is stimulated to beat faster to provide more blood in circulation.

Another cause for low blood pressure is a very low level of albumin in the blood. This protein keeps our blood very viscous and prevents fluid from leaking out of the capillaries. If it becomes low, fluid will leak into local tissues and the blood volume will drop dangerously low. This decreases the blood pressure.

Gabby also has anemia so the blood she is pumping is low in oxygen. That makes this even more complicated. The body simply wants more oxygen to body tissues and if it doesn’t get it then the brain begins to conserve blood to the core, leaving the brain out of loop. Nature built us to basically faint when this happens so we become horizontal and can distribute blood more evenly. So the fancy word is syncope.

This can often be mistakenly confused with seizures. The difference is that with syncope a dog will often recover very rapidly, while a dog that is having a seizure may experience some disorientation long before the seizure and be out of it for a much longer period of time after the seizure.

I am sorry, but they both look very frightening and I have experienced moments of terror for Chance. However, of the two, the seizure is far more serious.

So the best thing to do is enforce absolute quiet in your house. Turn off the door bell and turn down the phone. No guests etc. I wouldn’t let her get up on furniture for now so she doesn’t risk falling off the couch or bed.

Your vet may want to perform a test that measures the levels of cortisol. However a dog can’t be on prednisone before this test so it’s not often practical for dogs in treatment for AIHA. The best thing to do is control the symptoms as best as possible until there is a better red blood cell count and the blood pressure begins to return to normal. Your vet may notice a heart murmur from the anemia.
my best
patrice

[Patrice]

Meghan,
I absolutely think this blood test is not accurate, if you want my honest opinion. There is a HUGE difference between the value of the hematocrit from the CBC and the value of the PCV (hand spun test.) These two tests are essentially measuring the same thing so should be very similar (but not exactly the same), they are just accomplished in different ways, one with automated laser machines and the other is viewed visually against a chart. The PCV is very accurate and reliable. In very sick dogs the automated is more dodgy and can put out errors.

I’ve seen these kind of mistakes many many hundreds of times in the 8 years I have been helping owners. I get quite irritated that it is still happening to owners who have very sick dogs. Not only that it is very expensive.

To resolve this, always be polite, but get your way. Try to pick out the tech that seems to be the best one of the group and politely request that your appt be with her/him for the next blood draw. Use any excuse you want, be polite and perhaps a bit goofy, but you drive the bus. This is your money and you deserve the best treatment for Gabby. Her treatment protocol depends on these results. You don’t want to change her meds in response to an invalid test.

Be sure Gabby is fasted 8-10 hours before the test to avoid fat in the blood, but make sure she has lots of water. Prednisone can lead to dehydration. Try to get her fluid intake up before they draw the blood. Keep her stress level very low, get there early and find a quiet place to rest her so she is not excited. If you have to be the first appt in the morning or the last one at night, do that.
my best
patrice