Low Pcv

[Guest Raelen]

Need some advice:

 

We have a 10 year old male greyhound who has been healthy after we got him 5 years ago.

 

He can be a touch of a picky eater. About once a year we end up adjusting or mixing in different foods to keep his appetite up. He’s done this since we got him.

 

3 months ago none of the add ins worked. I was cooking beef and rice and mixing it into his meal and he would turn his nose up. Needless to say his healthy weight of 80lbs began to drop. It was the end of May when I noticed that his gums were white (not pale) but white. We got him into the vet immediately who came back with a PCV of 7% - which we all know is dangerously low. He went on 10mg of prednisone twice a day. And we seriously discussed a blood transfusion but opted to wait a day or two to see how he reacted. Which was pretty well, he began eating again, his energy level increased and after a week we were up to 18%. So we kept him on the prednisone. He was having serious diarrhea in the house as well as peeing incidents. We put him on an antibiotic and a probiotic to help and he got back to normal. It’s been 2 more weeks and I could tell by how he was acting he wasn’t improving. Yesterdays’ PCV came in at 13% after 2 weeks on the prednisone. And last night was not just pee but also back to the diarrhea.

He has had a chest and abdominal x-ray and everything looks good. So far no sign of cancer but my vet wouldn’t rule it out particularly since he isn’t reacting to the prednisone anymore.

 

So my normal vet wasn’t around today for the blood work results and another one called me. He said his platelets were also low and he thought that this might be Evan’s Syndrome. Here’s the problem his platelets were at 117,000 3 weeks ago and as of yesterday 107,000 which would be low for a normal breed but falls into a normal range for greyhounds. Although we are seeing a decrease. This other doc thinks we should triple his prednisone for this weekend and give him 30mg twice a day (he's down to 66lbs right now). And that we should try a different medication. He also suggested a transfusion again.

 

My only concern with a transfusion would be the possibility of masking what is really going on.

 

Do I increase his dosage and see how it goes even though this guys wasn’t up to speed on the greyhound values? And to make it trickier I specifically asked my other vet if upping his dosage would help and he said he didn’t think so. He thought that adverse symptoms would get worse without much value add.

 

So in the normal blood values how do we know if he is producing new blood cell values?

What would you do?

 

And any thoughts and prayers would help.

Thanks!

[Batmom]

Has he had a tick- or vector-born disease panel?

[tbhounds]

Sorry to hear that your boy is ill. There could be many factors causing the illness. As already mentioned I would run a complete TBD/Vector panel--its most likely at the bottom of the list because if he was positive for a tick disease mostly after starting the pred he would have declined quickly (septis). Also, has your vet run tests to check for an immune mediated disease such as coombs, ANA....

A transfusion would increase his pcv slightly and make him feel better but, sorry to say without treating the cause his red cells would most likely decline within a few days to a week.

With his health declining i do agree with your vet about increasing the pred dosage and yes, perhaps starting an additional medication (cyclosporine, azathioprine, Cell Cept.....)

I might suggest to have a bone aspirate done along with an ultrasound. Is thre a referral near you were you can get a second opinion??

[Hawthorn]

It strikes me that 10mg prednisone twice daily is a very low dose for a dog who is thought to have two serious autoimmune diseases.

 

I don't have any experience with these particular diseases, but my boy became very ill with another autoimmune disease (IMPA) a year ago. His vet put him on the same dose of steroids as yours is on. He initially showed some improvement, but within a few days began going downhill again, at which point I requested an emergency referral to a specialist as he was extremely ill. The specialist (after doing a whole load of tests) upped his dose to 100mg per day (he weighed 88lbs at that point) and within 24 hours he was much improved.

 

Unfortunately we had further problems as he then relapsed badly when the specialist reduced the steroids too soon but improved again when put back on the higher dose for a longer period. I have no doubt that the high (immune-suppressing) dose of steroids saved his life. We tried Azathioprine with our boy in addition to the steroids, but he reacted very badly to it, so we managed him just on steroids (and gastro-protectants - these are essential).

 

I think I'd want some input from a specialist at this point, but if this is not possible I'd definitely be considering upping the dose of steroids.