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Hi. My name is***** I'm sorry to hear about this situation with your girl. It sounds like things are getting pretty severe with her anemia. When red blood cell counts are low, it can be due to blood not being produced, bleeding, or red blood cells being destroyed. Not being produced can be from chronic renal disease or bone marrow disease such as cancer. I'll be honest and say that in cases like hers, the most common thing I'll see at my ER are where the red blood cells are being destroyed. They can have their immune system just start to destroy the red blood cells and this is called immune mediated hemolytic anemia (IMHA). It can be due to red blood cell parasites such as ehrichiae, it can be due to medications, or vaccines, or cancer, but a lot of times it is idiopathic in that no specific cause is found. Here is a good link on this.
In her situation, she may be one that needs a red blood cell transfusion to help support her till the medications have more time to kick in.
It is still absolutely possible that it is an immune issue even though she's been on the prednisone for a week. The IMHA cases are very critical cases and unfortunately there are about half of the cases that don't respond to the immune therapy. I hate to say this, but when I have a case at my ER, I tell owners that it is a 50 / 50 of the pet getting through the disease and getting into remission. Some that don't respond to the prednisone may need more time and that is where the transfusion can buy that more time to give it a chance to work. Others need to have more medication started like azathioprine which is another immune suppressing medication.
A bone marrow biopsy is a good diagnostic option that tries to determine if the problem is in the progenitor cell line of the bone marrow. It can also look for cancerous issues there. If she's not improving, it rises as far as a clinically important diagnostic test. It is a test that isn't done a lot as the identification of the IMHA is again the most common cause for the low red blood cell count. I forgot to add that other possible causes of red blood cell destruction are eating of zinc (zinc pennies are the biggest issue here) and eating of large amounts of onions / garlic which damage red blood cells. An x-ray of the stomach can be done to make sure no metal is there that could be zinc. A bone marrow biopsy is a pretty straight forward diagnostic step that can get some answers. It may be confusing though as the starting of the prednisone could make any diagnosis of cancer more challenging.
I'm in the midwest. Luckily not on the East coast. I hope you are safe where you're at and I'm hoping for the very best for your girl!
If they saw something metallic, it would have been very, very obvious. It could have been some other thing that caught there attention. If it was metal, then I'd be taking more x-rays to see if it is still in her!
Hi again. Could this still be an IMHA (immune mediated hemolytic anemia)? Yes. Again, there are some that may take a longer time to start to respond to medications or unfortunately, there are some that never really seem to respond to it. That is good that she has responded so well to the first transfusion as far as acting so happy after it was given. Some don't take to the transfusions well. It going from 22 to 19 in a week isn't surprising. There is always going to be the expectation for a drop as the transfusion red blood cells get destroyed by her immune system - this is normal. The good news is hopefully that it didn't drop more in this time frame. Could her own production be starting to catch up? The key here will be to see where things are going with her hematocrit over the next few checks. I'm sure they are wanting to at least recheck her in a week. Again, some may need to be on azathioprine to help suppress the immune system if IMHA is the overwhelming concern and things aren't responding to the steroid alone. The IMHA cases are ones that can be a marathon in duration to get them through.
At least there is a potential diagnosis now to focus on. I'll be honest and say that I've only come across one case during my career of pure red blood cell aplasia. That dog was on steroids and received a blood transfusion when needed to boost the red blood cell count. On the ER side, we just don't come across a lot of these cases. I will do some literature research to see if I can come across anything else.