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Dr. John
Dr. John, Texas Veterinarian
Category: Dog Veterinary
Satisfied Customers: 4997
Experience:  Over 14 years of clinical veterinary experience
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I live in Kuwait and vet clinics do not have modern

Customer Question

I live in Kuwait and vet clinics do not have modern capabilities. I have a Maltese who is 11 years old. Close to a year ago he started losing his hair and getting very week. I visited several vets and they were giving me guesses about his medical problems and kept giving him types of antibiotics, non were helping. Only antirobe proved helpful but he was was not regaining his strength. Then a detailed blood test showed he was suffering from anemia. The vet was once again guessing about the reasons. She tried prednisone and it was effective. he regained his weight and hair, but he has now been on it for quite a long time. He is around 12 lb and I was giving him first 7.5mg but he was always sleeping and tired I convinced the vet to reduce to 5mg.
Recently a new blood test showed his anemia better but still lower than the normal, but his platelets are double the Normal also she told me an X-ray showed he is losing bone mass.
Do you think he has auto immune hemolytic anemia?
Is it bad to keep giving prednisone and can I reduce the dose?
Does prednisone cause bone mass loss?
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Jess K replied 1 year ago.

Hello, this is Dr. Jess. I am sorry to hear about your pup. Do you know have they been checking his red blood cell levels regularly? you say the levels are better but lower than normal- did they originally go back to normal and have dropped again since decreasing the prednisone?

Expert:  Jess K replied 1 year ago.

Also, exactly how long has she been on the prednisone? And do you know if her reticulocyte count is showing a regeneration of blood cells? Did they say anything about that?

Customer: replied 1 year ago.
His red blood count has never gone back totally to normal. Last test on nov. 11 his RBC was 4.31.
Concerning how long has he been taking prednisone I have to check with vet in records.
I have a copy of the blood test but I don't know how to check for the blood regeneration, but I remember that the vet had at one stage told me he was improving in that he shows blood regeneration. If u can tell me what should I look for in the test I can check.
The hematology shows : HCT and HGB at 27.9 and 9.8 respectively lower than normal.
While PLT and PCT at 1052 and 0.81% respectively.
mind you I read on net that some blood testing machines mix the count of platelets with other elements in the blood, giving wrong reading. Not sure how to true.
Customer: replied 1 year ago.
Another rest called blood chemistry shows that BUN/UREA at 34.3 and PHOS at 3.3. For the high PHOS she gave me maloox to give him after each meal 5mg.
Expert:  Jess K replied 1 year ago.

The value to see if he has a regenerative anemia, which is where they are making new red blood cells, is the reticulocyte count. Not sure if that is on his bloodwork or not, we check it here in the US when we are looking to tell what type of anemia we have.

So your question about bone changes, we can see bone changes with prednisone use. I have not personally ever seen this, but if you look in a drug formulary, it states that osteoporosis can be seen with the drug. As I said, I haven't seen it before, but it is possible.

It is also possible that prednisone alone isn't enough to control the anemia for your dog. Sometimes secondary medications are needed such as azathioprine and cyclophosphamide. I have only had to use these a few times, as most dogs do well on just the prednisone alone. Depending on how long your dog had been on them, it is possible that he was tapered too quickly. Most dogs require at least 4 months of treatment if not longer.

Here is an article for you on IMHA:http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1390

With the elevated phosphorus and chronic anemia, I also worry about kidney disease. The BUN looks only a little high- was the creatinine normal?

Also, with the bone loss I worry about osteoporosis due to poor diet or an endocrine disease. Has he ever had his thyroid levels checked? Hypothyroidism can cause issues with poor haircoat/hairloss, lethargy, and in some cases can cause anemia.

Also, have his calcium levels been normal? Have those been checked?

Customer: replied 1 year ago.
On the test there is an abreviation : Retics it's 17.7.
In his blood chemistry test an abbreviation Ca is 2.35. Is that the calcium.
Expert:  Jess K replied 1 year ago.

Yes, Ca is calcium. Does it give a reference range for the retics and the calcium? Some labs may have different values/measurements. Is there a Crea or something along those lines? Thatwould be creatinine.

Expert:  Jess K replied 1 year ago.

What is his normal diet?

Customer: replied 1 year ago.
As for prednisone he is still taking it now. 5mg. He has not been tapered.
Expert:  Jess K replied 1 year ago.

Ok, I thought you had said he had been on 7.5mg and it was recently dropped to 5mg

Expert:  Jess K replied 1 year ago.

I guess he was dropped to 5mg awhile back/when he first started?

Customer: replied 1 year ago.
The Ca range in the test sheet is 1.98 to 3.00
Yes Crea is 148 for a range of 44 to 159.
In the past I used to feed him pedigree cans, after his sickness I started giving him better diet of cooked chicken and beef and carrots as offen as he likes. Then before his last blood test I had returned to pedigree since he had been quite picky. For the last two weeks I have been giving him the best type of a brand natures way, chicken and beef and liver and carrots
Expert:  Jess K replied 1 year ago.

Ok, does it give a normal range for the retics?

Expert:  Jess K replied 1 year ago.

and has his thyroid ever been checked? Do you know how severe the anemia was initially?

Customer: replied 1 year ago.
the relics show as normal, not in the red zone.
As for the thyroid I have to ask my vet tomorrow. Also I will ask about the anemia.
Expert:  Jess K replied 1 year ago.

Ok. Let me know. You can also ask the vet if it is a regenerative anemia. If they can tell you this by looking at the bloodwork, it can help narrow down the possible causes. Also, find out exactly how long he has been on the prednisone.

Customer: replied 1 year ago.
Ok thanks. By the way his current food is natures gift.
Happy thanksgiving
Expert:  Jess K replied 1 year ago.

You too!