Anaemia in 13 yr old Chinese Crested

[yellowgirl]

I'd really appreciate some input on my Madeline's situation if anyone has had a similar issue or has some idea about what might be going on here. She's 13 and a half years old.

 

On July 6 we went to the emergency vet because, while out at a playdate, Maddie had a bad 'wobble' episode where she was staggering and had trouble standing up. She's had head wobbles for about a year now and sometime has wobbles and minor staggering when walking around the house but this episode was more extreme than usual and her gums were completely white. The emergency vet did a PCV and TP test, the results were PCV- 28% TP-72g/L.

 

I took her to my own vet on Monday July 8 for a full blood panel, most of which came back pretty good for a senior girl, apart from the obvious anaemia. I have a copy of the results if specific info would help. She also had the new Cardiopet heart test which came back normal. Oh.. she now has a grade 3 heart murmur which she didn't have a couple of months ago at her last check. 

 

On July 10 Maddie had an abdominal ultrasound to check for tumours and/or internal bleeding. The vet  didn't find anything obvious in the abdomen, but he did find that the liver appeared 'patchy' and her adrenal glands were very enlarged.

 

On July 17 she had a follow-up test. PCV was 31% and TP was 75g/L. She'd been much happier in herself during this time as the vet put her on Gabapentin after our visit on the 8th. He said it wasn't related to the anaemia issue, there's a good chance that it's reducing pain from another issue like arthritis, IBD, etc. Either way, she seems happier so we're keeping her on that. 

 

She had a third PCV/TP test yesterday and the vet is more concerned now as the PCV has decreased again to 28%. TP is 88g/L.  

We have another test on 7th August and if it's still decreasing the next step would be to try to locate the problem which involves more tests, xrays,  etc, some involving sedation/anaesthetic - we're pretty much looking for a needle in a haystack, maybe a brain bleed, maybe something in the chest, maybe cancer or something else somewhere, who knows what or where. I don't know what to do, I don't know what we're looking for, and apart from the obvious issues indicated by the PCV results and the fact that her gums that are still very pale, Maddie is happy in herself (moreso since being on the Gabapentin), she's eating well (in fact she's put ON some weight!), no problem with toileting, and her poohs are great. She hasn't had any major excitement or playdates since she had the episode on the 6th and she's only had a few minor (usual) wobble episodes which resolved very quickly as they usually do. I'm hesitant to take her on another playdate because I think she overdid it at my friend's house and that contributed to the 'big episode' ... she only potters around the large yard but she does cover a fair amount of ground during the hour or two that we're there with the younger dogs.   

 

I think I just need some DOLer input here. 

 

... Extra info I have is that that this is a 'Regenerative' anaemia, the causes of which are by haemorrhage and haemolysis. It is not a result of iron, glucose or Vit B deficiency.  

 

[persephone]

Absolutely no help, but I just wanted to say "hi" to you ..& pass on a   & a      What a worry . Take care of YOU too  .

[yellowgirl]

10 minutes ago, persephone said:

Absolutely no help, but I just wanted to say "hi" to you ..& pass on a   & a      What a worry . Take care of YOU too  .

Hi Persephone! Thank you 

[Boronia]

No help here either YG but it's lovely to see you back after (it seems) a long while

Maddie is such a cutie ❤

[tdierikx]

Has the vet tested for Addison's Disease? The symptoms appear to match unfortunately...

 

T.

[yellowgirl]

5 hours ago, Boronia said:

No help here either YG but it's lovely to see you back after (it seems) a long while

Maddie is such a cutie ❤

Hi Boronia, it has been a while! Maddie was my first crestie - 10 years ago!  

[yellowgirl]

5 hours ago, tdierikx said:

Has the vet tested for Addison's Disease? The symptoms appear to match unfortunately...

 

T.

The vet mentioned Addison's as one of the things to look into but apparently the overall symptoms don't match with it. I'm going to google it though and have a proper look xx

[tdierikx]

I went with the search for enlarged adrenal glands @yellowgirl... and anaemia... Addisons can have the anaemia, while Cushings doesn't tend to. Addisons is also more likely to be diagnosed in older dogs, and Cushings more in younger dogs. Both are the main diseases that result in enlarged adrenals.

 

The "patchy" liver is a worry though... and could be the cause of the anaemia if the "patches" are nasty things. Fingers crossed it's something relatively easily treatable, and Madeline is with us for a long time yet...

 

Please give the sweet old thing a soft cuddle and kiss from me... and tell her to stop worrying her mumma...

 

T.

[yellowgirl]

6 minutes ago, tdierikx said:

I went with the search for enlarged adrenal glands @yellowgirl... and anaemia... Addisons can have the anaemia, while Cushings doesn't tend to. Addisons is also more likely to be diagnosed in older dogs, and Cushings more in younger dogs. Both are the main diseases that result in enlarged adrenals.

 

The "patchy" liver is a worry though... and could be the cause of the anaemia if the "patches" are nasty things. Fingers crossed it's something relatively easily treatable, and Madeline is with us for a long time yet...

 

Please give the sweet old thing a soft cuddle and kiss from me... and tell her to stop worrying her mumma...

 

T.

That's so sweet of you to google it tdierikx    My info says that it's more prevalent in younger dogs, around 4 to 6 years, but can certainly occur in older dogs too. But yes,  the enlarged adrenals and anaemia do fit. Most of the other associated symptoms aren't there though, certainly not lack of appetite, vomiting or diarrhoea, in fact she's actually put ON weight since being on the pain meds! Her weight loss was becoming a bit of a worry with everything else going on, which is why we went ahead with the abdominal ultrasound. Oh, her T4 (thyroid) test also came back in the normal range. 

The vet didn't seem overly  concerned about the patchy liver as the results of her liver and kidney tests were all really good. 

[tdierikx]

I've always been very interested in animal health @yellowgirl... and am currently studying vet nursing at TAFE (vet science is a bit out of my price range unfortunately).

 

My reckoning is that the anaemia is going to be the definitive symptom that leads to diagnosis of whatever is going on with Madeline, plus the new onset heart murmur (which may be a result of said anaemia).

 

I look at symptom lists as being a sort of multiple choice list of things that can be a result of any particular disease - the more symptoms from the list that are displayed, the more obvious the diagnosis - but certainly not all symptoms are required for the disease/condition to be the cause. Does that make sense?

 

Hopefully the vet will have a diagnosis and a treatment plan for sweet Madeline soon...

 

T.

[yellowgirl]

3 hours ago, tdierikx said:

I've always been very interested in animal health @yellowgirl... and am currently studying vet nursing at TAFE (vet science is a bit out of my price range unfortunately).

 

My reckoning is that the anaemia is going to be the definitive symptom that leads to diagnosis of whatever is going on with Madeline, plus the new onset heart murmur (which may be a result of said anaemia).

 

I look at symptom lists as being a sort of multiple choice list of things that can be a result of any particular disease - the more symptoms from the list that are displayed, the more obvious the diagnosis - but certainly not all symptoms are required for the disease/condition to be the cause. Does that make sense?

 

Hopefully the vet will have a diagnosis and a treatment plan for sweet Madeline soon...

 

T.

Yes, that makes complete sense @tdierikx! Here's some of the possibilities my vet has mentioned - internal blood loss, underlying coagulating problem, polyaromatic cells, possible brain bleed, neoplasia,  immune mediated haemolytic anaemia, abdominal cancer. 

 

Well done on continuing your education! That's awesome. If you want to break your brain a little bit more, here's Maddie's  blood results... 

 

RBC - 3.8 -low (4.9-8.2)

Haemoglobin - 89g/L -low (100-206)

Haematocrit - 0.30L/L -low (0.35-0.58)

Reticulocyte % - 1.8% -high (0.0-1.5)

Reticulocyte ABS - 68 -in normal range (10-110)

MCV 79fl -high (64-76)

MCH 23pg -in normal range (21-26)

MCHC 279g/L -low (310-360)

Platelets - clumped and adequate

 

 

 

[tdierikx]

Hmmm... what meds has the vet given Madeline @yellowgirl? Prednisolone?

 

Was she on any other medications prior to this episode? Has the vet tested for pituitary gland function?

 

Immune mediated haemolytic anaemia doesn't normally present with enlarged adrenals from what I'm reading... but different presentations can be indicative of underlying causes. ie: the adrenal enlargement could be the primary cause for the other symptoms and test results

 

I'll do some more investigations after work, OK? Can't have too many heads working on getting Madeline better, can we?

 

T.

[yellowgirl]

6 hours ago, tdierikx said:

Hmmm... what meds has the vet given Madeline @yellowgirl? Prednisolone?

 

Was she on any other medications prior to this episode? Has the vet tested for pituitary gland function?

 

Immune mediated haemolytic anaemia doesn't normally present with enlarged adrenals from what I'm reading... but different presentations can be indicative of underlying causes. ie: the adrenal enlargement could be the primary cause for the other symptoms and test results

 

I'll do some more investigations after work, OK? Can't have too many heads working on getting Madeline better, can we?

 

T.

You're awesome @tdierikx! Thanks so much, I really appreciate seeing if you can come up with anything else here! 

 

Maddie is on Gabapentin 100mg. She wasn't on any medication prior. I'm not sure about a pituitary test, would those results have come up in the full blood panel?  Her T4 was normal - 25nmol/L (13-52) 

 

[tdierikx]

T4 will be elevated most times if there is a pituitary issue... if the thyroid itself is normal (as I found out with my own... errr!) My own thyroid was on the way out, but blood tests kept saying all hormone levels (TSH and T4 specifically) were within normal ranges - because my silly pituitary gland was taking up the slack and doing the work for the ailing thyroid... lol!

 

So far all my looking up stuff is trying to point to Addison's Disease (hypoadrenocorticism) ... can't really get past the enlarged adrenals... *sigh*... and the liver spots may be a part of the same package there...

 

Anyways - if you promise to not get scared or go off the beaten path... here is the website that I primarily use to look up animal related medical test results... it's also very reputable, OK?

 

http://eclinpath.com/chemistry/chemistry-quick-guide/

 

Just remember to look at the results for whatever type of test that has been run, or you'll get sidetracked... errr!

 

Please give Miss Madeline a cuddle and kiss from me, OK?

 

T.

[yellowgirl]

I hear you on the thyroid issues @tdierikx! I have Hashimotos Disease and also had a pituitary tumour removed in 2016. Surgery and recovery was pretty intense, including a few cortisol crashes. Very similar to Addison's disease symptoms actually. I really think Maddie's symptoms would be much, much worse by now if it was Addison's... but I'm going to bring it up with my vet again at our next appointment. 

 

Thanks for the link! I currently have 7 tabs open... so much for not getting sidetracked lol! 

And thank you so much for your input here, it's a pretty tricky one isn't it?! 

 

Cuddles and kisses given  

[Tassie]

Hope you can get some answers for your Maddie.  If it's any help .. having had a dog with IMHA, my experience was that they go downhill very quickly ..so finger crossed that's not the answer.

[yellowgirl]

1 hour ago, Tassie said:

Hope you can get some answers for your Maddie.  If it's any help .. having had a dog with IMHA, my experience was that they go downhill very quickly ..so finger crossed that's not the answer.

Thank you @Tassie 

It doesn't seem to be IMHA... the symptoms don't all seem to fit and her lab results are normal apart from the blood issues that I posted above for Tdierikx. 

 

From what I understand, only the Anaemia came up out of whack in the results, not the other issues mentioned here...

http://scvsec.com/wp-content/uploads/2014/04/Immune-Mediated-Hemolytic-Anemia-Canine.pdf

 

From what I've read it's a very rapidly progressing disease with often fatal outcomes. I'm so sorry that you've been through that heartbreaking experience with your own dog 

[Tassie]

Quote

From what I've read it's a very rapidly progressing disease with often fatal outcomes. I'm so sorry that you've been through that heartbreaking experience with your own dog @

Thanks @yellowgirl   Yes it is horrible .. he was a 12 and a half year old apparently very fit BC .. he'd competed in a double obedience trial (in UD) on the Sunday, was a little bit off on the Wednesday ..didn't do bloods then .. in retrospect should have.. although it may not have made a difference, since there were no provisions down here for transfusion in those days.  He  became very poorly on the Thursday .. vet suspected IMHA, but wanted to get the lab tests to confirm before starting the aggressive immunosuppressive meds which were the only option, so I had him home for the night, but he died on the Friday morning.  On balance, it might have been a good thing  .. at his age, I don't know whether the aggressive therapy would have been the right thing to do.

 

Fingers and paws crossed for finding the answer to your girl's issues.

[yellowgirl]

Oh @Tassie, that's just heartwrenching. How helpless you must have felt.    Since Maddie's been unwell, I've heard of so many cases of IMHA from friends and on forums. It's just an awful thing and something that needs immediate intervention. 

[teddybeans]

I hope you are able to get to the bottom of this.  I hate it when your pet is not well and you feel so helpless.  All the best and give Maddie a cuddle from all of us!