Puppy's IMHA and high WBC count?

[Nicole]

Hi all,
Our goldendoodle is about 6 months old now. She was brought in for her pre-anesthetic blood work on Dec 8th and on the 10th we were informed that her RBC count was critically low (her HCT was at 12%). She had a blood transfusion on the 10th and we went home with cyclosporine and prednisone which we’ve been giving her. She’s been going for weekly CBCs but we switched to a new vet yesterday (the old vet was charging 2x as much). The new vet told us that while her HCT is at 36% as on Dec 27 (low but on the rise!) her WBC count is extremely high and they think it’s due to an infection. They want to start her on antibiotics.

Now, the timeline for her WBC count is as follows:
Dec 8 – 17.6
Dec 13 (after blood transfusion) – 23.9
Dec 19 – 21.2
Dec 27 – still waiting for the email to see her results but this is where the new vet said we should start antibiotics.

I know there are certain antibiotics to avoid but could this WBC count be due to something else? Maybe the medications she’s on now? Is it a good idea to start a new medication now?

Or because it’s been consistently high is it likely that she’s been battling an infection this whole time and the IMHA is a result of the infection?

Is there anything specific I should ask my vet?

Thanks in advance,
Nicole & Bean

[Sara]

Hi Nicole .. I have a dog with AIHA .. I found second Chances and they have helped me tremendously here.

Just wanted to say you are in good hands with the gals that run this site. They are all very knowledgeable and will go to great lengths to help.

I am not qualified to answer your questions but just wanted to give you a heads up that this is a great place for help.

Will keep your pup in my prayers !

Sara

[Nicole]

Thanks Sara! It’s so confusing being told different things by everyone, so I hope this can be a resource for me to make sense of everything that I’m being told and hopefully I can piece things together for myself.

So I called the emergency clinic that did the transfusion to ask about what they thought about starting antibiotics and this is the email I just received from the doctor:

“…I think the elevated white blood cell count correlates with a regenerative response at the level of the bone marrow and may suggest that the treatments are working. I would consider this a normal response in the absence of any other clinical signs consistent with an infection (fever, lethargy, vomiting, diarrhea, etc). Therefore, I would not start any antibiotics and would consider this normal at this stage…”

I also spoke to the regular vet again (while waiting for an email response from the emerg.) and they want to do a stool sample to rule out the obvious stuff and the vet also mentioned that the antibiotic he would have started (don’t remember the name of it now) is not good because of the meds she’s already on.

He also pretty much said if we start (a different) antibiotic treatment that there’s not much harm to come from it – either it fixes something or it just doesn’t do anything. Is that true? Or can it possibly interfere with the meds she’s on?

Sorry for so many questions and thanks again for reading!

[Erin]

Hi Nicole and Bean! Sorry that you had to find this site, but I’m glad you did! The people on this site have great advice and support, it has been so helpful for me and my dog Murphy (diagnosed with IMHA 8 weeks ago, he’s an 8yo dachshund). Murphy was also on cyclosporine and prednisone as well, but never received a transfusion. He is also regenerative as well, so his WBC peaked at 22.8 and we did put him on antibiotics (doxycycline) to cover in case he had a tick born illness which can cause IMHA. We went ahead and gave it even though we weren’t sure of an infection, but my vet said it won’t hurt (it can cause tummy upset but we didn’t experience that) and if he does have an infection it will knock it out. Doxycycline is safe for our dogs and ok with those meds. I can only speak from my experience with Murphy, and I’m sure there are others on here with some better advice. I know there are some antibiotics they should not have, but I honestly don’t know which ones.

Best of luck to you and your pup!
Erin&Murphy

[Vally]

Hi Nicole, and welcome to the site. I’m glad to see Bean has responded so very well.

You’re right about the drugs, some drugs should not be used on our dogs, and I carry a list around with me all the time now. Here’s the item, which I suspect you may have already found.
https://www.secondchanceaihadogs.com/AIHA_Terms/drugsantibiotics-can-trigger-aiha/

I’m sorry you’re getting different answers from the vets. How frustrating.

I’m not a vet by any means, but I would choose to probably rely more on the Emergency vets advice. I know my local vet doesn’t have anywhere near the knowledge of the specialist about this disease, absolutely no offence to her.

Prednisone can increase the WBC count and so can stress. How does Bean react when at the vets? Also when there’s been a big change in the RBC, as has happened with Bean, the white cells count can be misread by the machines too. I don’t understand any of this to be honest, but I know this happens. That could be why the emergency people are talking about looking at clinical signs as well as the results. (This has been raised a few times, I’m just trying to find it in the forum and I’ll post again).

Let us know what the results are this time around and fingers are crossed that the WBC count has dropped a little again.

Vally & Bingo (diag Nov 2011, in remission)

[Vally]

This was what I was looking for. It’s come up a few times, but I found this one:

“Baby red blood cells are always bigger that adults – nRBCs or nucleated red blood cells are immature red cells & can actually skew automated blood tests if there are a lot of them – the machine thinks because of their size, that they are another type of cell -WBCs. I do think you vets have done an excellent job & have looked at smears as well as using the machine.”

So blood smears are a good way to double check this. A blood smear is a physical check of blood on a slide checked by a person.

This is the link where it came from”
https://www.secondchanceaihadogs.com/forums/topic/blood-work-help-for-maize/

Vally

[Sara]

Hey Nicole .. Oh my we were confused on what to do too with so many different thoughts on how to treat this disease. My Flossie was diagnosed on April 21st this year .. she just stopped eating one night wouldn’t even eat a beef bone and I knew something was wrong . I rolled her over to put a cold cloth on her tummy and she was yellow ( jaundice) immediately took her to ER and she had a PCV of 24 .. and by morning she had a PCV of 11 so they started Blood transfusion. And gave her a very expensive immunoglobulin shot that they could not guarantee would work but did have cases where it was shown to work ..so we opted to have the shot despite the cost. In all over 5 weeks she had 4 blood transfusions. They also gave her Doxicyclene in case it was a tick borne cause of the illness even though that test came back negative. She had the Doxicyclene for a total of 1 month as that’s what our vet said was a proper time period for killing the bacteria if indeed that was an issue. They also started her out at large doses of Prednisone. And Added in Mycophenolate in week 3 ( we call that drug the not so nice medicine) because she was non-regenerative. Week 4 came still no response from her body and they wanted to do a bone marrrow asperate which we had read wouldn’t do anything except tell us if she was making any baby RBC’s and we knew she wasn’t if her tests were coming back non-regerative. Our vet was losing hope and she was an internal medicine specialist who treated many AIHA cases.. and we asked if there was any other meds that could be tried and she said next one was cyclosporine .. so in week 5 we went for it and added it to all the other meds .. and within 10 day of starting it her blood test came back regenerative. From there she has made an uphill climb and has stayed in the mid to high 40’s for 4 months now .. this week a PCV of 47 and has been off her final med ( cyclosporine) for 18 days now. We will have another blood test in 14 days .. to make sure she’s holding. It has been a long long year. The worst part for us was the first 9 weeks. Little sleep as she needed literally round the clock care. She could barely walk on her own and had to be taken out in a wagon to go to the bathroom .. the meds made her wet the bed so late night clean ups several times a night even in between taking her to pee. We allowed her to drink as much as she wanted to keep her system cleaning out. And to avoid UTI’s. although she still ended up getting one about the 7 week mark and she was unable to tolerate the antibiotic for that so our vet put her on D’mannose and Cranberry Powder both natural supplements and they remedied the UTI in about 14 days .. so that was a blessing. Right now I have her on several natural supplement to support her immune system and clean her liver out and support her gut health. I will be glad to offer any advice I can but it would be purely advice from my own personal experience as I am not a doctor. But with this disease there are so many variables and so many ways that vets treat this disease many not agressive enough in my opinion as they don’t recognized the disease right off or if they do they are not trained in the extremes that are needed to save a dog with this disease. Anyhow there’s lots of us going through what you are so you are not alone. We’re here to help and support in any way we can ..

Look forward to finding out what your vet and you choose to do next.

Sara

[Vally]

Nicole, do you have a copy of the blood tests? Do you want to send them through? Use the Urgent Advice and you can attach them.

With white cells, if neutrophils are high, it’s probably infection so antibiotic – doxycycline – a good idea as infection is dangerous. High monocytes is usually inflammation & seen a lot with IMHA. Sometimes both are high meaning both present.

Vally & Bingo