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Dr. K
Dr. K, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 7529
Experience:  13 years experience as Veterinarian
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my dog was diagnosed with non-regenerative anemia. Tick borne

Customer Question

my dog was diagnosed with non-regenerative anemia. Tick borne diseases were ruled out, also she is not responding to prednisone which they tried for various other possibilities. Bone marrow biopsy is very expensive. Is there anything that would test positive on a bone marrow biopsy that is cureable and treatable with anything else besides steroids?
Submitted: 5 years ago.
Category: Dog Veterinary
Expert:  Dr. K replied 5 years ago.
HiCustomer

How severe is your dog's anemia (what is the HCT or PCV)?

Dr. K
Customer: replied 5 years ago.
It is very severe. Her HCT count is 26.6 after being on prednisone for 3 weeks. Before she started the prednisone, it was 26.4
Expert:  Dr. K replied 5 years ago.
Nonregenerative anemia this low is certainly indicative of a severe problem. Nonregenerative anemia can be caused by many different problems. They include:

Chronic kidney failure
Chronic liver disease
Immune-mediated destruction of red blood cell precursors
Iron deficiency (which is usually caused by chronic blood loss)
Infections--ehrlichiosis, babesiosis
Bone marrow infiltrative diseases--myelodysplasia, neoplasia (cancer), myelofibrosis, etc..

If your dog had chronic kidney failure or liver disease, this really should have been evident on the general blood and urine tests that the vet likely already ran (CBC/Chemistry Panel/Urinalysis). If your dog is having chronic bleeding, this is usually into the gastrointestinal tract, and thus there are often other signs of this like dark tarry stool and sometimes vomiting and diarrhea. Also, there would be other signs of this on the bloodwork that would have suggested an iron deficiency problem. You mentioned that your vet ruled out tick-borne illnesses. I am assuming that means tick titers were run, so ehrlichiosis would have been ruled out. This would not rule out babesia infection (although this is not very common in the U.S.).

If a bone marrow biopsy is done, this could tell you exactly what is causing this problem (whether it is immune-mediated, cancer, or some type of myeloproliferative disease). If this is an immune-mediated disease, it may just be that the pred isn't enough. Often, dogs with this type of problem need to aslo be on a drug called Azothiaprine. You may want to discuss this with your vet.

If it is not immune-mediated, the bone marrow biopsy will not likely diagnose something that is easily treated. Some cancers do respond to treatment and others do not. If there were pancytopenia present (other blood cells are also low—like white cells or platelets), then there is an extremely guarded prognosis.

I hope that this information is of help to you, and I wish you the best of luck with your dog. Please let me know if I can be of further assistance.

Dr. K
Dr. K, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 7529
Experience: 13 years experience as Veterinarian
Dr. K and 3 other Dog Veterinary Specialists are ready to help you
Customer: replied 5 years ago.

Her white blood cell count was very low when she was initially tested. After 3 weeks on the prednisone, which I am told is a very high dose, her white cell count went into the normal range, but her red count remained virtually unchanged.

 

FYI, she is a Rottweiler, 4 years old 102 lbs. Her prednisone dose initally was 30mg twice daily, which was cut down to 20mg twice daily because she is developing iatrogenic cushings. Her muscle mass has been deteriorating, she can no longer jump or climb stairs, she isn't sleeping, she wakes us up twice during the night to go outside and she is having accidents in the house when we are away for as little as 2 or 3 hours. She is going through about 4 bowls of water per day and is constantly hungry. When she started the prednisone, I thought at first she was getting better because she became more sociable and her energy seemed to improve. However, looking back on this behavior, I believe it was hunger-driven...always looking for food.

I will accept your answer after you read this information so you get paid...I guess I just want to know what you opinion is on her "quality of life" and what it would be if I kept trying new treatments and putting her through this. She was a working dog...she lived for being outside and going for walks and pullig carts and playing rough and if her life can't be like this anymore, I don't want to prolong her suffering.

Immune related illnesses have also been ruled out by all the tests that have been done

Expert:  Dr. K replied 5 years ago.
If she is pancytopenic (more than just red blood cells have been affected) then her prognosis is grave. Pancytopenia is not a disease in and of itself, but rather can occur with many different causes. Unless you have the bone biopsy done, you cannot really rule out immune-mediated destruction of the marrow stem cells. Blood tests that are done to look for signs of immune-mediated disease (like ANA titers and Coombs titers) can support a diagnosis of immune-mediated disease when they are positive, but when they are negative, and animal can still be suffering from immune disorders (and the tests are false negatives). So, unfortunately, a negative test does not rule it out. Also, as I explained before, many animals need to also be on a drug called Azathioprine when they have this problem, as the prednisone often does not do enough to get rid of the problem. I would not give up on your dog, until you have tried the azathioprine. The reason I would not rule out immune-mediated yet, is because azathiprine has not been tried, and because she is only 4 years old. If she were older, I would find cancer more likely.

As far as doing the bone biopsy goes....this I would skip. If she has a myeloproliferative disorder like leukemia or myelofibrosis, the success rate on treatments for these problems is terrible....and I would not put my own dog through treatment for this type of problem since the chances of success are so low.

I am attaching a client information handout that I use in my practice that discusses pancytopenia in more detail. I hope that you find it useful.

Click Here

Please let me know if I can help in any other way.

Dr. K

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