veterinary question

While I am not a vet, any time I see elevated white blood cell count I look towards two sources, infection and disease of the bone marrow. If there was an infection the immunosuppresents would still suppress the immune system which would actually allow the infection to grow. In this case I would look at any sort of Bone Marrow disease. I know for humans those can be detected, sometimes, via Periphreal blood smears but most often through a bone marrow biopsy.

Again I am not a vet, the above are just my thoughts. I would consider getting a second opinion with a specialty vet/clinic if at all possible.

Also, very sorry your puppy is not feeling well. Those time can be so very hard to deal with though I am glad some of his counts are improving!

Thanks, all.  My vet says it is Immune-Mediated, but does not say it is Hemolytic Anemia.   (He is still in the "ideopathic" state of mind, I guess?)   The drugs are indeed the ones you stated.  Yesterday's PCV was to 13.6%, up from a measured low of 10.8%, platelets are extremely low but rising slowly, so the trend is good.  It was just the WBC that was confusing me.

The dog is now walking a bit, and no indications of any organ failures.  It's been scary, though - my wife woke me in the very wee hours of Sunday morning because she thought the dog had died.

At any rate, it's looking better now.  I have hope for the mutt.

Thanks again,

Scott

Hi Scott - 

Glad your dog is hanging in there.  Some of these immune-mediated conditions are tough.   To clarify, I see comments about two different disease conditions above:  ITP (Immune Mediated Thrombocytopenia - a condition affecting platelets; the cells that help with blood clotting) and IMHA (Immune Mediated Hemolytic Anemia- a condition affecting red blood cells).  Dogs can become anemic with both conditions. 

With ITP, the very low platelet levels result in spontaneous bleeding.  These dogs often have unexplained skin bruising, nose bleeds, or bloody vomitus or diarrhea.   The platelet numbers are often very, very low and protein levels (albumin & TP) are often low as well due to blood loss/hemorrhage.    

In IMHA, there is destruction of red blood cells - resulting in anemia.  These dogs aren't bruising or bleeding per se, but they are can have red tinged urine due to broken down red blood cells.  These dogs usually have normal protein levels since they are not bleeding, and they can have normal platelet numbers.

We always look for an underlying cause (cancer, recent vaccines, recent new medications, infectious diseases) but I'd say many, many cases are idiopathic meaning - we don't know the cause.  Both ITP & IMHA can be considered "idiopathic" conditions.

Regarding the elevated WBC count - as others mentioned, that is very typical of IMHA and the reasons can be multifactorial.  As the bone marrow is working very hard to produce new red blood cells, the over-stimulation can increase WBC numbers.  Also, some of the elevation may be due to the inflammatory response as the body is dealing with red blood cell breakdown products.   Finally steroid (prednisone) also can contribute to the elevated WBC count.  I will say...I personally see these high WBC counts more commonly with IMHA, rather than ITP.  Regardless, I'd say the WBC elevation is the least of your concerns right now.

If there is question about whether you are dealing with primary ITP or IMHA, looking at the protein levels and a saline agglutination test can help determine that.  Also, sending a CBC (complete blood count) to a lab for pathologist review can be helpful too as there are certain characteristics of cell morphology that are typical of IMHA.  Some dogs can have both ITP & IMHA (known as Evan's syndrome) and the prognosis, unfortunately, can be worse. 

Wow!  A PCV of 10% and even 13% is incredibly low.  I start thinking about administering a blood transfusion to any pet dropping below 20-25% that is showing any clinical compromise.  There are no absolute guidelines but I pretty much transfuse any pet with a PCV as low as your dog's.  Normal PCV, FYI, is about 35-55%.  It can take days for the immunosuppressants to begin working and often pets needs the support of transfusions in the meantime.  The only way to truly give platelets (if ITP is the primary problem) is with a fresh whole blood transfusion.  If it's IMHA, stored whole blood or packed red blood cells can be helpful too.

Best wishes with your dog.  He sounds pretty sick.

SpottedCow -

Thank you for the very detailed response.  My internet searching had also indicated IMHA, but since the vet didn't use that term, my wife convinced me that I ought not to say it either.  She's a pretty smart lady, my wife, and I decided to take her advice.

His condition definitely includes destruction of red cells - PCV plunged from 29% on Tuesday last week to 10% on Saturday, and his urine was indistinguishable from blood on Thursday and Friday.  By Saturday, he could no longer stand.  We have opted not to transfuse, at least not yet, as we were cautioned by one of the more senior vets at the practice that, because his body was already destroying his own blood, any foreign blood might cause the problem to be magnified.  Platelets, by the way, were below 20 on Friday last week.  I don't know the platelet count of the most recent CBC, but we are seriously lucky this dog is still alive, I think.

All bloodwork is scary for this pooch, but as I noted previously, he is showing some signs of slow recovery.  PCV is up a bit, and his energy level is better though still far less than normal, as one might imagine.

Thanks again, both for your medical knowledge and for allowing me to have this outlet for my concerns.

Scott

Likely the final update on this topic.

First, thanks to all for the well-wishes and information.  It helped, a lot.

Second, George is recovering, it seems.  Platelets and White cells back in the normal range as of this morning, and PCV up to 26%.  He is now walking, eating everything in sight (which is unusual for him, even before he got ill.  My guess is that's the steroids talking) and seems pretty happy again.  In a couple of weeks we will try to get him back into his pre-illness routine, which included about an hour of playtime with his dog friends each morning, and a 45-minute to one hour walk each night.  Right now, he is at a single short (about 20 minutes) walk once a day.  We expect to take him off the immune suppressors, tapering off, starting in a couple of weeks, as well.  The only problem now is a bit of incontinence.  But we have learned to wear shoes in the house, and deal with it.

Thanks again,

Scott

Great to hear!!!  Dogs never cease to amaze me  Fingers crossed that he'll continue his road to full recovery!