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Dr. Taus
Dr. Taus, Veterinarian
Category: Veterinary
Satisfied Customers: 505
Experience:  Veterinarian with experience in equine and small animal medicine.
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Abnormal CBC Results? Could you please review the CBC results

Customer Question

Abnormal CBC Results?

Could you please review the CBC results from 2012 and 2013 and give me feedback on any areas for concern or possible diagnosis? I have primarily listed the “abnormal” readings but can provide any other #s from the test results.

May 2013 CBC

HGB (High) = 29.4g/dL
HCT (High Normal) = 54.4%
Neutrophil SEG (Low) = 45.3%
Lymphocytes (High) = 46.9%
Absolute Neutrophil SEG (Low) = 2627/uL
BUN (High) = 30mg/dL
Creatinine (High Normal) = 1.6mg/dL
TCO2 (Low) = 16mEq/L
NA/K Ratio (Low Normal) = 27
Auto Platelet (Low Normal) = 165

T4 (Low Normal) = 1.2ug/dL

May 2012 CBC

HGB (High) = 20.4
HCT (High) = 58.3
Neutrophil SEG (Low) = 38
Lymphocytes (High) = 55
Absolute Neutrophil SEG = 3192
BUN (High Normal) = 25
Creatinine (High Normal) = 1.6
TCO2 (Low Normal) = 18
NA/K = 32
Auto Platelet (Low) = 105

T4 (Low) = 0.7

Here is some background on why I am asking for additional feedback.

Over the last year, I have taken the my 6 year old chocolate lab mix to the vet wondered if these are all separate issues or somehow connected. I mention this because often the same symptoms will disappear soon after the Drs visit only to reappear a few months later. I have listed the most common issues below. Most occur for a few days or week and then goes away to randomly reappear.

Panting at Rest
Lagging on walks/Lethargic
Increased Thirst (currently)
Weight Gain (noticed 6 month ago but has been consistent since)
Increased Shedding/clumps of hair (currently, last noticed during hypothyroidism diag)
Skipping Meals
Dry Skin (always)
Itching (currently)
Random head tremors (noticed last about a year ago. only seen a few times)
Stiff hind leg when getting up getting up

In Aug 2012, the Dr diagnosed my dog with hypothyroidism after a 0.7 low T4. The Dr prescribed 0.6MG Thyroxine 2X/Day. After 6 weeks, our dog was showing no signs of improvement and seemed even more lethargic. We immediately took him off the medication and he to returned to his old self immediately. We’re not convinced he had hypothyroidism and another Dr in the same practice agreed after his recent 1.2 T4 results.

After the May 2013 CBC results, the Dr seemed to think our dog was now suffering from early signs of kidney disease because of the BUN/Creatinine #s and increased thirst. He found some crystals in the urine and suggested I immediately start the dog on a Royal Canine Urinary SO diet (gradually). Within 24 hours, our dog began scratching himself nonstop so stopped after 2 days and assumed it was an allergic reaction. I then put the dog back on his original (Avoderm) diet and after 4 days the itching has decreased but is still doing it. Benedryl doesn’t seem to help.
Not sure if this was related to food or a coincidence. He has been on Vectra for 2 yrs and professionally groomed over the weekend after the itching started so I don’t think it’s due to fleas or dirty coat. I am going to try the kidney diet food again but honestly not convinced of a kidney disease diagnosis either.

I am trying to figure out if there’s some diagnosis that may mimic hypothyroidism and/or kidney disease. I’ve read a little about Addisons and wondering if there are other similar conditions.

Any feedback you can provide would be greatly appreciated so I can request exact tests or take my dog somewhere else for additional treatment.
Submitted: 4 years ago.
Category: Veterinary
Expert:  Dr. Louis Gotthelf replied 4 years ago.
Hi. I'm Dr. Gotthelf. I have been a vet for 35 years and I would like to use my experience to help you with your pet's medical problem.

There are many reasons for the low t4 that are not caused by hypothyroidism. The best test to tell that is called a free t4 by equilibrium dialysis. That test eliminates all of the other factors that affect the total t4 test that your vet ran. Have they run another t4 after being on the thyroid replacement for a month to make sure that the t4 is in the normal range?

I would not consider kidney problems at this point either. The BUN and Creatinine are not that high to call it kidney problems. A urinalysis looking at the specific gravity will tell you if the kidneys are not able to concentrate urine. Is the dog drinking a lot and peeing excessively?

THe CBC's are OK except for a lower than normal neutrophil count. The ratio of neutrophils to lymphocytes in the dog should be 3:1, so I would like to see 75% neutrophils to 25% lymphocytes. When the neutrophils are down, either they are being used up by an infection, or the bone marrow is selectively depressed so it does not make neutrophils. You did not send the total white blood cell count, which would also be helpful.

With addison's disease the sodium and potassium ratio is lower that 27. That does not show up in the test results you sent.

It would appear that there is some type of skin condition going on here. Have they done any allergy testing or treatment for the skin condition like steroids? Did they run a blood test called the Alkaline Phosphatase? That can sometimes indicate a condition called Cushing's disease, which can cause many of the symptoms you described.
Expert:  Dr. Taus replied 4 years ago.
How is your dog doing at home at this point? I see it has been a couple of weeks since the previous answer.

For the most part, I agree with Dr. Gotthelf. However, I'd suggest a full thyroid panel, including TSH and free T4, to fully evaluate the thyroid.

I'm also curious if the CBC was done by machine or visually using a blood smear by a technician. If it was done by machine, it's not as accurate, since the machine only recognizes cells that fit certain parameters. Normal ranges are based on 95% of the population, and if your dog has consistently had a slightly low neutrophil count and a slightly high lymphocyte count for over a year, that may actually be normal for him (he falls outside the normal 95% even though there's nothing wrong with his blood).

The BUN and Creat with the high-normal hematocrit doesn't suggest kidney disease. Your bloodwork isn't typical for a dog with Addisons, but there is an atypical Addisons disease where the dogs don't show the typical bloodwork abnormalities, and the way to rule that out is to have your veterinarian do an ACTH stimulation test.

There are a lot of disorders out there that don't necessarily show up on bloodwork. If you have a normal ACTH stim, a normal thyroid panel, and you still feel your pet is clinically abnormal, I would suggest visiting a veterinary dermatologist to more thoroughly work up the skin and coat issue.

Since I haven't examined your pet, this is my best advice based on the information you provided. If this has been helpful, please leave positive feedback!