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Dr. Deb
Dr. Deb, Dog Veterinarian
Category: Dog
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Experience:  I have owned, bred and shown dogs for over 40 years.
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my dogs platelet count is 13000 and she is vomitting blood

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my dogs platelet count is 13000 and she is vomitting blood and her stools are black in color.

Hi Rajesh, I'm Dr. Deb. I will do my best to assist you today.

I'm so sorry for this problem with Spinach.

With a platelet count this low, she is obviously at risk for spontaneously bleeding which is what's happening. In all honesty, she needs to be hospitalized and a blood transfusion given to her. I don't know if you have the facilities in India to have this done, however.

I assume that your vet is trying to eliminate a tick disease which is why she's on Doxycycline. In my experience, tick diseases rarely cause the platelet count to be this low. I would be more worried about an Immune Mediated Thrombocytopenia or possibly ingestion of a rodenticide when the numbers are this low.
If she has an immune mediated disease causing increased destruction of her platelets, then she needs to be on high doses of steroids (prednisone) as well as receiving a transfusion to stabilize her condition.

I've seen low platelets with cancer but, again, the numbers are not usually as low as this.

I realize that my answer may not be what you want to hear but I would be doing a disservice to both you and Spinach if I were less than truthful and honest in my response to you. I hope you understand.

I also hope that this is helpful and that she can receive the care she needs. Deb

Customer: replied 3 years ago.
We have done all that except the transfusion. She is still vomitting blood. Any other options. Any other treatment. She is not retaining any food. She is vomitting out the food followed by blood.
I was away from my computer and have just now seen your additional question.

I know this is a very difficult situation for both you and Spinach.

You may already know this but Thrombocytopenia is usually seen secondary to:

1. Increased destruction as might be seen in Rickettesial or tick diseases or auto-immune diseases such as Immune Mediated Thrombocytopenia

2. Decreased production in the bone marrow. Some sort of underlying cancerous problem might be suspected to cause this problem. It would take a bone marrow biopsy to detect such an issue.

3. Sequestration such as in the spleen. Unfortunately, this is usually associated with a cancerous process, too, such as lymphoma. An ultrasound with a needle aspirate can be helpful in making this diagnosis.

4. Rodenticide poisoning.

5. Cancer elsewhere in the boy

6. Certain drugs have triggered Immune mediated disease such as Cephalexin or some non-steroidal anti-inflammatory drugs (Carprofen).

It can sometimes be challenging to identify the cause of the low platelet count.
You don't mention if a specific diagnosis has been made or what additional testing has been done; therefore, I can only provide generalities as to treatment options that might be open to you.

1. As I mentioned above, when the platelet count is this low and there is obvious hemorrhage, then a transfusion is almost mandatory.
2. Supportive care such as anti-vomiting drugs and fluids are important.
Over the counter drugs such as Pepcid AC or Famotidine) can be given in an attempt to control nausea but since they are oral, they may not be as effective as injectable drugs would be. Famotidine is also available in an injectable form. The dose would be 1/4th mg/lb twice a day.
Other options include Ranitidine at a dose of 1 mg/lb twice a day or Omeprazole at a dose of 1 mg/lb once a day.
I don't know what drugs you have in India but if you provide me with what you have available, I can provide a dose.
Cerenia is a veterinary drug which is a very potent anti-vomiting drug but, again, I don't know if this is available to your vets. It does come in an injectable form and thus would be preferred to oral pills.
3. If a rodenticide (rat poison) is suspected, then Vitamin K should be given. In symptomatic patients (as might be the case here), a loading dose of 2.5–5 mg/kg is suggested. Then 1.25–2.5 mg/kg twice daily with a fatty meal (if the patient is eating and not vomiting). For a second-generation anticoagulant or if the anticoagulant is unknown, treatment should be instituted for at least 30 days.
This drug does come in an injectable form as well as oral tablets.
4. The human supplement, Melantonin, has been shown to increase platelet numbers. The dose would be <20 kg, 3 mg twice a day; if >20 kg, 6 mg twice a day. Nature's Bounty is a good manufacturer since quality control issues are a concern when it comes to supplements.
5. Avoid drugs that decrease platelet function. While meloxicam has minimal effect on platelet aggregation, carprofen should be avoided. Penicillins and Cephalexin may aggravate clinical hemorrhage in thrombocytopenic patients and should be avoided.
6. If Auto-immune Thrombocytopenia is suspected and steroids are not effective after 7-14 days, then other immunosuppressive drugs should be considered:

a) Azathioprine (Imuran®): 2 mg/kg q 24 h. A complete blood count (CBC) should be monitored for possible changes to all cell lines and monitor liver values for hepatotoxicity. Combination therapy with prednisone and azathioprine has been reported to have longest survival times.

b) Cyclosporine (Neoral®): 5-10 mg/kg/day divided twice daily. Neoral® is preferred over Sandimmune® (10mg/kg every12-24 h) because of more consistent absorption. However it has used on a limited basis because it is costly and requires therapeutic drug monitoring within the first 24-48 hrs then every few weeks are.
c) Leflunomide: 4mg/kg every 24h. Leflunomide has been reported in a few studies to be effective in treating immune-mediated and inflammatory diseases. Very expensive.

7. I would feed moist, gruel-type food to avoid trauma to the esophagus.
8. Avoid handling as much as possible and provide well padded areas for sleeping.

Dr. Deb and 2 other Dog Specialists are ready to help you
Customer: replied 3 years ago.
We don't get doxycycline IV injections in India. My doc wants to inject her as she is NIL by MOUTH. She is vommitting so we want to inject her. Is it possible to give me a prescription so that my friend can courier it to India. Is there any alternative to doxycycline Please advise. Any way I can import these urgently to India.

Thanks for the rating; it's greatly appreciated.

That's a real shame that you can't get injectable Doxycycline drugs in India. Unfortunately, it would be illegal for me to provide you with a prescription without a client/patient relationship...which means I would have to physically examine Spinach (which clearly I cannot do).

There are other options to Doxycycline such as Tetracycline or Minocycline which are acceptable alternatives.

As quoted from Plumbs, Veterinary DRug Handbook:
1. Oxytetracycline HCl 50 mg/mL, 100 mg/mL Injection: There are many FDA-approved oxytetracycline products marketed in these concentrations. Some trade names for these products include: Terramycin®, Liquamycin®, Biomycin® (Bio-Ceutic), Medamycin® (TechAmerica), Biocyl® (Anthony), Oxyject® (Fermenta), and Oxytet® (BIVI). Some are labeled for Rx (prescription) use only, while some are over-the-counter (OTC). Depending on the actual product, this drug may be FDA-approved for use in swine, cattle, beef cattle, chickens or turkeys.

2. Minocycline also is available as an injectable: Minocycline HCl Powder for Injection lyophilized for solution: 100 mg in vials; Minocin® (Triax); (Rx)

I will continue to wish you the best with this situation as you struggle to treat Spinach effectively. Deb

Just a clarification:
The Oxytetracycline drug is a veterinary labeled drug but the Minocycline is a human labeled least here in the States. I'm not sure if this is helpful information or not. Deb

Customer: replied 3 years ago.
For 60 hrs after my last reply she has not vommitted. She was NIL BY MOUTH for 60 hrs. But she vommitted blood now after we fed her water soaked biscuits. Her new blood test report which was done today is given below. Her platelet has increased from 13000 to 20000. Her Hg has dropped from 10.3 to 7.2. She is not able to ingest any food. She is vommitting it out. R.B.C 3.04 million/cm. P.C.V 24.8% Reticulocyte 11%, W B C 41500, stab cells 31% , neutrophils 46%, eosinophils 06% Basophils 0%, lymphocytes 12% , monocytes 5% , abnormal cells 0% PERIPHERAL SMEAR STUDY; Mild poikilocytosis (Tear drop cells, oval cells, target cells ), marked anisocytosis, microcytes and macrocytes present, Mild hypocromia in RBCs, mild polychromasia present, platelets decreased in no and morphology normal. Please let me know the diagnosis and the likely solution
She's anemic in addition to having low platelets. This level of anemia can be secondary to her blood loss or involved as part of her primary problem. If it was normal on her original complete blood count (CBC), then this may be secondary to blood loss.

Spontaneous bleeding can be seen when platelet numbers are <40,000 so it's not surprising that she still might be vomiting blood although it's certainly distressing.
The increased white blood cell count either indicates inflammation, infection or stimulation of the bone marrow in an attempt to replace her red cells and platelets.

The possible diagnoses are not too different from what I've already mentioned above:
1. Evan's syndrome which is an auto immune condition where both the red cells and platelets are being destroyed. Immune mediated Thrombocytopenia if platelets alone are being destroyed. Auto immune conditions are treated as I mentioned above.

2. Tick borne diseases such as Ehrlichia, Anaplasmosis and Babesia (LINK).
The first two are treated with Doxycycline while Babesia is treated with different drugs which are covered in the link that I provided.

3. Cancer of the bone marrow...either primary or secondary (spread from some other organ system where cancer is present).

The treatment suggestions as mentioned above are unchanged even with this mild increase in her platelet numbers. Deb

Hi Rajesh,

I'm just following up on our conversation about Spinach. How is everything going?