Very Low Platelets

[JoJo207]

A few weeks ago my boy Rex was due to have a growth over his eye removed. During the presurgery bloodwork it was discovered his platelets were very low, especially compared to records they had from a few years ago. We're talking going from 147 to 56. (Side note, he had a dental at another location about a year ago and his numbers were 131.) Since platelets help with clotting, the surgery was not performed. Originally they thought they saw one of the tick borne bacteria in his blood so a CDC panel was done. It didn't show any. We decided to treat with antibiotics, doxycycline, and a steroid, prednisone. This was about 2.5 weeks ago. During the weekend I discovered a rash on his left side below the hair line. Which brought us back to the vet yesterday where they ran blood again and his platelets went down a little more to 51. We are stopping the doxy for a week, to see if it's causing the rash. My question is has anyone else had such low platelets in their dog? Does anyone have any thoughts?

 

Google is not your friend in these situations, so I know there are some big L words no one wants to hear that can be associated with low platelets. If it helps Rex is 9 yrs old and I've had him for almost 7 years.

[tbhounds]

I would run a full tick panel-NC State would be the gold standard. Your hound may have an auto immune condition but, honestly the tick panel should be run first before starting corticosteroids. The steriods will suppress the immune system and if there's an underlying tick borne disease that could be very, very bad. There are other tests that should be run too (ANA, Coombs....)

I highly suggest you see an internal medicine veterinarian ASAP.

Edited September 1, 2016 by tbhounds

[MaryJane]

You might also want to redo the test and make do a manual count and see if that is different.

 

It could be (but not likely) that if they used a syringe for the blood vials that by the time they filled the lavender tube with the anticoagulent for the platelet blood work that there were some microclots already starting. Again, not likely but something that I would watch for on the next blood draw.

[Burpdog]

You can have an negative panel and still have a TBD. If they platelets are dropping, not sure I would stop the doxy, probably add pred.

 

They results between NC State and Protatek are the same, and those who do many, many tick panels use Protatek.

 

I think you need a specialist or a greyhound vet that has been around a long time ASAP. He is almost at transfusion levels.

[XTRAWLD]

Kasey's absolutely tanked when he was on chemo, 50s like you are having, but agree that's in transfusion territory. Is there any bruising around his belly, or sheath or inside of legs? If you press his gums, how long do they stay white/pink? Usually, we waited about a week for the platelets to rebound. I tried to help it come around as best as I could with food, how is his appetite? While feeding something today won't increase levels tomorrow, I started feeding him Vitamin K or B9 rich foods and high caloric foods; lentils were a big deal as was spinach. The platelets need time to recreate themselves.

Edited September 2, 2016 by XTRAWLD

[tbhounds]

I disagree that it's transfusion time but, it needs to be addressed quickly. Regarding running a manual count to rule out platelet clumping I didn't suggest it because the levels in the 50's were already repeated twice.

[JoJo207]

We were doing the antibiotics because of the possibility of a false negative with TBD, so we were treating like we did the tests and they came back possitive. Using what has in the past been successful for my vet in other dogs. Aside from the growth above his eye and the rash on his side/belly, he's the picture of health. No bruising, appetite is great, clotted fine when they took blood the other day, no change in energy levels. Thanks for your thoughts and advice everyone. I'll keep you posted as things progress. Going to get a hold of our local greyhound guy to see what he says.

[tbhounds]

Glad you had a positive return-now you know what you're dealing with. No more pred now.

[JoJo207]

We had a vet visit yesterday. After switching antibiotics and focusing on the mystery rash, the rash is almost completely cleared up. We have halved his amount of doxy starting a few days ago. They did blood work, and his platelet numbers have gone up. From 51 to 75 in about 2 weeks. Yay!! Hoping this trend continues.

[EllenEveBaz]

Keep it on the up and up, Rex!

[Burpdog]

According to Ohio State, he is close to tranfusion time for a greyhound. If they have dropped so quickly, they can go to 40 in a heart beat. I see they are coming up, but if you are not correctly dosing for a TBD, it's just going to go backwards.

 

5mg per # of body weight twice a day for 8 weeks.

[JoJo207]

Well, platelet level took a nose dive again back to the 50s. We were referred to a place to get an ultrasound and other testing done and did that yesterday. Xrays were clean, yay, good news! Ultrasound showed an enlarged and mottled looking spleen. The Dr biopsied the spleen and sent samples to a pathologist. I should hear this afternoon what the pathology report says. May have to go back for a bone marrow test today, but won't know 'till results are in and read. No idea what the best case scenario is at this point. It all seems sort of bleak. Really I need to stop reading articles online about different way this could be going. Rex's is still eating and seems to have lots of energy, so it doesn't seem totally hopeless yet. Just so bummed it isn't something easy like a TBD.

[Remolacha]

[carronstar]

Prayers and good thoughts.

[JoJo207]

Vet just called. No red flags with the spleen biopsy. So no real answers aside from there doesn't appear to be some form of cancer in the spleen. Next step is a bone marrow test to see if something is happening there. Good news I think...

[XTRAWLD]

Does he have a good appetite? Load him up on some high caloric stuff and see if that will help.

[tbhounds]

Are only the platelets decreased?? I would pursue the bone marrow biospy at this time. They will harvest a tiny amount from his shoulder-they typically only need a mild pain medication (like rimadyl and Tramadol) post procedure.

Also--has a clinical pathology test been run on the CBC??

[JoJo207]

We did bone marrow yesterday and she took more biopsy cells from the spleen for another look and extra blood in case a more thorough CBC is needed. His white blood cells have also been down slightly, but not enough to be a worry or a definite sign of something else. His appetite is fine and will eat anything presented to him. Though he has loss weight @ 5 lbs since the beginning of August and is now back down to racing weight. Not a big issue, there is some argument that anything over racing weight is too much. IMHO it depends on the dog. Man I forgot how boney his back feels! Energy levels are good as well. Today I work and wait to hear the results from yesterday's testing.

[XTRAWLD]

Appetite is good, and I would use that to your advantage to help him rebuild his red blood cells naturally and as much as possible and get some weight back. It takes 6 weeks for the count to increase naturally so the sooner you start adding some iron rich foods, the better. They loose weight so much so quickly when they get sick.

[Remolacha]

Frustrating not to know, but so far you haven't gotten any bad news! Also good that he seems to feel ok. Hoping you gets some good answers soon.

[tbhounds]

We did bone marrow yesterday and she took more biopsy cells from the spleen for another look and extra blood in case a more thorough CBC is needed. His white blood cells have also been down slightly, but not enough to be a worry or a definite sign of something else. His appetite is fine and will eat anything presented to him. Though he has loss weight @ 5 lbs since the beginning of August and is now back down to racing weight. Not a big issue, there is some argument that anything over racing weight is too much. IMHO it depends on the dog. Man I forgot how boney his back feels! Energy levels are good as well. Today I work and wait to hear the results from yesterday's testing.

 

Keep in mind that these guys loss muscle mass while in pred--it can turn out to be pretty significant.