Low Platelet Count For Lacy - And Getting Lower

[Guest OurLacyandJax]

Hi all, first off loving thoughts to all the pups, healthy and sick.

 

Lacy, our 10 year old brindle, is as fiery and playful and alpha as ever. Her age might have slowed down just a tad. She still runs circles around the couch, and put our boy Jax in his place anytime she wants to in spite of his 15 lbs weight advantage.

 

Around mid July, we had some blood tests done on Lacy as part of her annual, and also to check on her Thyroid.. We noticed her WBC was 3.5 which is within the range as specified by Dr. Stack. Her platelet count though was 128. Low, but not terrible. Note indicated "Few small platelet clumps observed. This may falsely lower the platelet count and estimate." Neutrophils count was 2065. T4 was .8 and normal.

 

Fast forward to Nov 3rd. We had another blood work done. Platelet count was 36! Note from the lab said "Fibrin clumps present;micro-clotting in the sample may spuriously lower the platelet count and estimate." The number had my vet - she's very sweet, btw - worried, even knowing the low values are typical. But not this low, and I agreed for another test.

 

The third test came back - bigger shock - platelet count at 26! Note said "Giant platelets present may indicate active thrombopoiesis.", in addition to the above notes about Fibrin clumps etc. She had immediately ordered some tick borne disease testing - no results on that yet. And another test was ordered today just to make sure the lab is not messing this up.

 

Those numbers are freakishly low - and we worry. Lacy seems as normal as a healthy 10 year old. Some senior stuff, but mostly alert, has a health appetite, etc etc.

 

Any insight from anyone?

 

Thanks!

Anil.

[Wonder]

I dont have any advice except I would ask OSU. Fill out a consult form. It's still free but they will be charging at some point.

https://greyhound.osu.edu/consultationservice/

[tbhounds]

The Dr can order a manual platelet count. No mention of spherocytes?

[Guest OurLacyandJax]

The Dr can order a manual platelet count. No mention of spherocytes?

 

I didn't know, probably what she ordered. I will confirm. No mention of spherocytes - should I look that up?

[JJNg]

Even if the tick panel comes back negative, it wouldn't hurt to treat with a course of doxycycline and then recheck the platelet count. And definitely monitor for any unusual bruising or bleeding, including blood in the stool or urine, as such a low platelet count puts her at risk of spontaneous bleeding.

[Burpdog]

I'd start treating asap with doxy Platelets need to be checked almost daily because that platlete count is in transfusion range.

[kikibean]

Sorry to hear about your girl! I'm in St. Louis as well. Which vet are you using?

[Guest OurLacyandJax]

Thanks for all the replies. My vet is at Millis Animal Hospital,kikibean, and I am not saying they are experts on greys, but what they do not know, they seem to make up with a willingness to listen and learn, and an abundance of care.

 

Also, my vet was telling me she wants her to go on Doxy just this Monday - and I said I'd feel better if she is 100% positive those test results were valid before she goes on it. But now that you all say it, I am tempted to start it sooner.

 

I have been paying lots of attention about her every movement this last couple weeks, and have not seen anything unusual. She looks just a little more winded than usual after her high speed racing around the couch..But even that is subjective - probably something I am dreaming up because I am looking too hard.

[kikibean]

I'd probably start on the Doxy if I was you. Did you adopt from Greyhound Companions? I know they use Barrett Station Vet off of Manchester. You could always talk to the group to see if they have any ideas. Or, I can give you Leann's number w/ Rescued Racers. She keeps all sorts of vet information.

 

It would also be worth it to do a consult w/ OSU and send them her test results so far.

[Guest OurLacyandJax]

Yes, she came to us from GCMO. Long time back we used to go to the Barrett Station. I can always ping GCMO members and see what they think. I will call the vet and ask for Doxy tomorrow first thing.

[Rickiesmom]

Based on an experience I had with my Jaynie I completely support starting the doxy, and, if there is a specialty facility near you, I would seriously consider asking for a referral to the best internal med vet available in your area.

 

What I was told was:

 

- a bone marrow problem (not producing enough),

- consumptive (body consuming too many) or

- an immune disease.

 

In Jaynie's case he wondered about the marrow because her WBC was also low. He mentioned a bone biopsy, but that was a technical possibility at that point. Apparently the most common cause is auto-immune.

 

That said, do not lose hope - AI may be most common but it wasn't in Jaynie's case and it might not be in yours.

 

My thoughts and prayers are with you.

[cometdust1]

I'd start the doxy too. My grey's initial tbd test was negative,found out the hard way 3 mos later that he was ehrichiosis positive but the antibiotics didn't work at that point.

[tbhounds]

There are many things to look at while reading a CBC to help to rule out immune mediated thrombocytopenia. One thing to look for as already mentioned is spherocytes, another is for reticulocytes (will help the vet determine if the bone marrow is functioning). A 26,000 platelet count can be very dangerous. My girl started bruising at 35,000. Watch your hound very carefully. Check for petechia, bruising-check the gum line, tummy, sclera.

IMO it will not hurt to start the doxy ASAP.

Edited November 15, 2012 by tbhounds

[Guest OurLacyandJax]

I'd start the doxy too. My grey's initial tbd test was negative,found out the hard way 3 mos later that he was ehrichiosis positive but the antibiotics didn't work at that point.

 

I fear to ask this - but what happened to him? Any symptoms?

 

There are many things to look at while reading a CBC to help to rule out immune mediated thrombocytopenia. One thing to look for as already mentioned is spherocytes, another is for reticulocytes (will help the vet determine if the bone marrow is functioning). A 26,000 platelet count can be very dangerous. My girl started bruising at 35,000. Watch your hound very carefully. Check for petechia, bruising-check the gum line, tummy, sclera.

IMO it will not hurt to start the doxy ASAP.

 

Thank you, I will ask my vet about all you mentioned here tomorrow. Did your girl show any other symptoms? Like lethargic or labored breathing, things like that? And also, how did she do with the treatment?

[tbhounds]

After a long battle and many trips to Ohio State I lost my girl to immune mediated pancytopenia-a rather rare condition. Pancytopenia is where the red, white cells and the platelets become decreased--my poor little girl basically ran out of blood, her body destroyed her blood as fast as her bone marrow made produced it--still pains me to even write about it. Sounds like in your hounds case just the platelets are decreased-yes?

Anemia is a creepy bastard---dogs can compensate if the anemia happens chronically-an acute case if a different game. Sadly, you might not notice a difference in your hound clinically with just low platelets--that's why you need to check for bruising etc...

If your vet does suspect thrombocytopenia then, there are other tests that should be run--Ana & Coombs test are two.

Fingers crossed your hound will respond to treatment-keep us posted ok?

[Guest OurLacyandJax]

After a long battle and many trips to Ohio State I lost my girl to immune mediated pancytopenia-a rather rare condition. Pancytopenia is where the red, white cells and the platelets become decreased--my poor little girl basically ran out of blood, her body destroyed her blood as fast as her bone marrow made produced it--still pains me to even write about it.

 

So sorry about your loss. That sounds like the worst time.

 

You did give me food for thought and concern here though. Although her WBC counts went slightly up (from 3.5 to 3.7), I see that her RBC counts has dropped from 7.4 to 5.9 in four months. Same drops can be seen in HGB (18 to 14.9), HCT (56 to 44). To me - especially if these lab numbers are accurate - they indicate something is off.

 

Other difference is Neutrophils count (2065 - 1517) and Lymphocytes went up (1190-1961)

 

I will bring this up to my vet. I am just antsy to get the new lab results. In a way, I am wondering how does anyone catch this in a relatively healthy dog like Lacy if not for the blood work, you know. We only found this quite by accident with her annual work,

Edited November 15, 2012 by OurLacyandJax

[tbhounds]

With the numbers that you posted your greyhound is anemic. You might want to consult with Ohio State at this point.

[Guest OurLacyandJax]

The tick titres turned up negative. We are still waiting on the manual platelet count. She started on Doxy yesterday. Still playful, alert. A bit tired may be - but she's still happy to go for walks, and ready to eat, etc. Gumlines look fine, no splotchiness, and I do not see a single bruise etc, anywhere.

 

We'll see how the weekend goes. I will start the consult process with OSU right away.

[KF_in_Georgia]

At the first sign of lethargy from Lacy--a time when she doesn't want to get up unless you insist, a time when she's not remotely interested in food--please head to the ER. I had a dog's platelet count go from 200,000 on a Tuesday (a well-dog visit to her vet, and she was fine) to 18,000 (or less) on that Friday.

 

It was immune mediated thrombocytopenia. We never found the cause, and we lost her on that Monday. Nothing turned her blood counts around. She was 8.

 

I hate to scare you--after all, immune mediated thrombocytopenia actually has a better than 50 percent survival rate--but I wanted you to know that things can go very bad very fast, and you shouldn't decide on "vet first thing in the morning" or "vet first thing on Monday" if Lacy becomes lethargic.

 

(But please take what I say with a grain of salt. Between your Lacy (like my Jacey) and Zoe in Remembrance (like my Oreo, whose gotcha day would have been the 17th), I'm getting a whole lot of deja vu from two different directions, and I'm not sure I'm sensible just now.)

Edited November 17, 2012 by KF_in_Georgia

[Guest OurLacyandJax]

Thank you KF In Georgia, no, I do not mind the note from you, in fact I welcome it. I'd rather deal with bad news ahead of time than hide. So I am glad you mentioned this to me, as I it would be hard for me to even think that would happen.And I am sorry for your loss.

 

We will keep and eye on her for sure. I have consulted with OSU already this afternoon and evening, and they have been nothing but wonderful. I sent them all the information including the latest video of her playing around. And their advice was to sent her through a prophylactic deworming as it should not hurt at all. And then do a CBC and see if it helped.. They suggested further steps after that, like a PCR tick panel at NCSU, and down the road, a spleen ultrasound, etc.

 

Will keep you posted. Hoping this will turn out to be an anomaly of a test. Although I am almost sure, along with OSU, that she is mildly anemic.(Hence the deworming, etc).

[Guest OurLacyandJax]

Status: Lacy is still doing pretty much the same. On the advice from OSU and my vet, she is on her last day of deworming today, she is still on Doxy, and since she was on Doxy before I heard about the PCR tick panel, I will have to wait for 2 weeks after her Doxy stops before I can send in a EDTA tube of her blood to NCSU's VBDDL. (I am getting good at acronym spitting now.)

 

(OSU - of course you know that, but for newbies in here, Ohio State University

Doxy - Doxycycline

PCR - Polymerase Chain Reaction test for tick, extremely sensitive.

EDTA - EthyleneDiameneTetraAceticacid filled tube that prevents the blood from clotting.

NCSU - North Carolina State University

VBDDL - Vector Borne Disease Diagnostic Laboratory - apparently great place for tick testing/full PCR panel

http://www.cvm.ncsu.edu/vhc/csds/ticklab.html

)

 

Anyway, today, she is going to a specialist at 11:00AM who will be doing an ultrasound of the spleen etc. Hopefully we will come out of it with reasonably good news.

[MP_the4pack]

Fingers crossed.

 

PS. Everyone in the business calls the test tubes by their color. So, you can say "purple top tube" instead of EDTA.

Edited November 19, 2012 by MP_the4pack

[Guest OurLacyandJax]

See I learned something new. Thanks MP_the4Pack. Anyway, here's the update again after the visit.

 

We did a manual count of platelets, and they were indeed low - the number was a range, from 20-60. The reason was that the platelets were abnormally large, meaning they were being released as a reaction to something. The diagnosis from the specialist (in conjunction with a consult from another out of town specialist who deals with greys and whippets) was Immune related Thrombocytopenia. :-(

 

It is what it is, so the next step we did was to do an ultrasound to check on the spleen etc. Good news there, everything is normal and healthy, and no mass or anything detected. So the vet said lets put her on prednisone and see if that improves the numbers in a week. Continuing Doxy for the full 28 day cycle. If no improvements, we will look into the next step - possibly a bone marrow biopsy.

 

So that's where we are right now. Lacy looks and acts fine certainly - she was all playful this morning.

[tbhounds]

Well crap. Pred is so tuff on our hounds-it just melts muscle mass off of them. Please inquire about using carafate and Pepcid or Prilosec while on the pred. Did they mention if this is regenerative anemia?

[Guest OurLacyandJax]

I have been giving her some pepcid (a half pill every 12 hours) along with her antibiotics, btw. Just to help with her stomach.

 

And no, I don't know about regenerative anemia at all. No one mentioned it. Guess I will ask.