Hi there. I just got my dog back from the vet because he seems to have a slipped disc, 12 yr old Rat Terrier. I had the vet do xrays and also check his blood. I was surprised to find out that his platelet and white blood cell count is extremely low. He actually got scratched by a cat on his lower eyelid a couple weeks ago, it bled a lot right away but when I held pressure on it, it clotted immediately and stopped. I would think if his platelets were low this would not have been the case. The vet is sending his blood out to have it tested for tick disease. I am so confused because I have never even seen a tick on him or even in the yard. So because of that I am fearful that he may have something wrong with his bone marrow, which the vet suggested. She said if the tick test came back negative then the next step would be to take marrow from him. What bone marrow disorder could cause low white blood cells? I thought cancers caused high white blood cell counts. He is on Prednisone for his disc problem, could that cause low blood counts? He is also on Cephalexin for a lick granuloma on his paw and Gucosamine/Chondroitin. His red blood cell count was normal. He has no symptoms of illness, eating great, not lethargic, no diarrhea/vomiting. The only thing I can tell is wrong with him is his neck pain. I am so confused and would appreciate anyones help. Thanks!
::edit:: I just got a copy of his results, here are the abnormalities:
AMYL - low 265
BUN - high 38 mg
CHOL - high 368
WBC - low 1.4 x10 9/L
Grans - low 0.8 x 10 9/L
%Grans - 57%
(the next one was cut off but looks like maybe L/M - low 0.6 x10 9/L
%L/M = 43%
PLT =low 62 x10 9/L
I hope it's ok that I posted all that.
Low Platelet/Low WBC
How long has your dog been on prednisone, and what is the dosage, has it been consistent or has it recently been tapered to the lowest dose possible? Yes, to some degree, prednisone therapy can affect bloodwork, and it might be wise to consider some other pain control method, as long as it is not an NSAID at this point. What is the vet doing/recommending for the slipped disc? What originally prompted you to see the vet? Was the slipped disc a result of some sort of trauma (blunt-forced for example)?
Were the dog's lymph nodes examined, are they enlarged? Was his heart function checked?
Was the CBC repeated for accuracy within 12-24 hours? This should always be done when there is suspicion for blood loss or platelet disorders. Has the vet actually ruled out potential hemorhage somewhere? (i.e., spleen)
The results you posted were incomplete, did the vet do a complete chemical profile? The AMYL and BUN are enzymes included in a blood profile, but there are several others that need to be included in a "complete" chemical profile. Likewise, neutrophils, lymphocytes, monocytes, eosinophils etc should have been included in the CBC report.
It's good the vet sent blood to rule out tick disease, but did that profile also include coombs and ANA?
Were the dog's lymph nodes examined, are they enlarged? Was his heart function checked?
Was the CBC repeated for accuracy within 12-24 hours? This should always be done when there is suspicion for blood loss or platelet disorders. Has the vet actually ruled out potential hemorhage somewhere? (i.e., spleen)
The results you posted were incomplete, did the vet do a complete chemical profile? The AMYL and BUN are enzymes included in a blood profile, but there are several others that need to be included in a "complete" chemical profile. Likewise, neutrophils, lymphocytes, monocytes, eosinophils etc should have been included in the CBC report.
It's good the vet sent blood to rule out tick disease, but did that profile also include coombs and ANA?
..........Traci
Wow, thank you for your help. Ok let's see, this is going to be long....my dog has been on and off Prednisone for about 7 weeks, for a slipped or bulging disc. He's been on it 3 times, and is currently on it now. He always starts with 2 days of 1 1/2 - 5 mg pill, then 1 - 5 mg pill for 3 days, then 1 every other day (which is his dose now, today being an off day). He has also been on Turbutrol, most recently 1 mg for just a couple days, it did nothing for him so this is why we went back with the Pred. The vet did want me to use Deramaxx but I refuse, she did say she would fill a Tramadol script for me if I would like, to use with or w/o the Pred. He's on strict rest as well, for the disc.
The original vet visit was for the disc, he suddenly had a stiff neck/tilted to the right and was tripping on his right foot occasionally, I took him in immediately. He was fine when he woke up then about 15 minutes later this happened. The only thing "traumatic" that happened to him was a slight slip on a floor vent, so I mentioned this to the vet. After the first round of Pred/Turbutrol he was fine for a couple weeks then the problem reoccurred. At that first visit the vet didn't think it was a slipped disc since the pain was in his neck and he was still walking. The second visit, after reoccurrence, the vet flipped his back foot over and there was a slight delay in turning it back, this along with other symptoms is why he was diagnosed with a slipped or bulging disc. This time he was given Hydrocodone and Pred. Once I started tapering off the Pred he was in pain again so I got another prescription for Turbutrol a few days later, it did nothing, so then got more Pred. This is also what prompted me to get xrays and blood work on him. The only thing that prompted me to get blood work done was his being on meds, I wanted to make sure his liver wasn't elevated. His xray showed no spaces in his cervical vertebrae and a "dip" in the same area, but my dog was extremely scared and hunched up during the xray so the vet said it was hard to tell if it was showing a disc prob or him being so tense and causing it to look like it did. He was felt from head to toe, no lymph nodes seemed enlarged, his heart sounded great. CBC wasn't repeated, the vet offered to send the blood out to a lab to see if they came up with different results then she did but I decided to just go ahead with the tick titer and if that came back negative then have more blood drawn and sent out. I thought it would be better to send out a whole different batch from a different day and see what that came up with. Not sure if they ruled out blood hemorrhage, would this have shown up on an xray? He had images taken from the side as well as on his back.
I think the blood that was sent out was only to screen tick disease and not Coombs/ANA. The info included on the chemical report I got is: ALB, ALKP, ALT, AMYL, BUN Ca, CHOL, CREA, GLOB, GLU, PHOS, TBIL, TP. On the CBC there is: HCT, HGB, MCHC, WBC, GRANS, L/M, PLT. I included only the high/low amounts in my above post but can post all the results here if that would help. Should I request a better blood and chemical analysis? Thanks again so much for your help, and sorry about the length of this post.
The original vet visit was for the disc, he suddenly had a stiff neck/tilted to the right and was tripping on his right foot occasionally, I took him in immediately. He was fine when he woke up then about 15 minutes later this happened. The only thing "traumatic" that happened to him was a slight slip on a floor vent, so I mentioned this to the vet. After the first round of Pred/Turbutrol he was fine for a couple weeks then the problem reoccurred. At that first visit the vet didn't think it was a slipped disc since the pain was in his neck and he was still walking. The second visit, after reoccurrence, the vet flipped his back foot over and there was a slight delay in turning it back, this along with other symptoms is why he was diagnosed with a slipped or bulging disc. This time he was given Hydrocodone and Pred. Once I started tapering off the Pred he was in pain again so I got another prescription for Turbutrol a few days later, it did nothing, so then got more Pred. This is also what prompted me to get xrays and blood work on him. The only thing that prompted me to get blood work done was his being on meds, I wanted to make sure his liver wasn't elevated. His xray showed no spaces in his cervical vertebrae and a "dip" in the same area, but my dog was extremely scared and hunched up during the xray so the vet said it was hard to tell if it was showing a disc prob or him being so tense and causing it to look like it did. He was felt from head to toe, no lymph nodes seemed enlarged, his heart sounded great. CBC wasn't repeated, the vet offered to send the blood out to a lab to see if they came up with different results then she did but I decided to just go ahead with the tick titer and if that came back negative then have more blood drawn and sent out. I thought it would be better to send out a whole different batch from a different day and see what that came up with. Not sure if they ruled out blood hemorrhage, would this have shown up on an xray? He had images taken from the side as well as on his back.
I think the blood that was sent out was only to screen tick disease and not Coombs/ANA. The info included on the chemical report I got is: ALB, ALKP, ALT, AMYL, BUN Ca, CHOL, CREA, GLOB, GLU, PHOS, TBIL, TP. On the CBC there is: HCT, HGB, MCHC, WBC, GRANS, L/M, PLT. I included only the high/low amounts in my above post but can post all the results here if that would help. Should I request a better blood and chemical analysis? Thanks again so much for your help, and sorry about the length of this post.
Re: Low Platelet/Low WBC
No, if you posted the abnormal results, it isn't so necessary to post all of them, I just asked to be sure that a full profile was indeed done.
And, no, hemorrhage doesn't always show up on xrays (especially if it is a slow hemorrhage, or within certain organs or hidden behind another organ), but bloodwork often does, as well as a clotting factor test.
Did your vet suggest slightly sedating your dog so she could get accurate xray results? This might be a good next step. However, if your vet isn't experienced enough, perhaps a consult/exam with a veterinary orthopedic surgeon might be helpful, even your vet could consult with one on your behalf and either share the xrays already taken or one of them could take a new one. It's a bit concerning that the reflex/pain response test showed your dog was slow to respond, this too should be repeated. Are you keeping him strictly confined and limiting his movements/exercise as your vets persue the rule-outs?
Was there any chance for a toxic ingestion of some sort? (just something to rule-out)
I really am not sure how to recommend you to proceed. I think the first order should be a new xray, under slight sedation if necessary, but I think it would be wise to repeat a CBC first and check platelets/PCV before proceeding with any anesthetic, your vet can go over that with you and make an educated opinion if the above is warranted. I do worry about the platelets being low without repeating a CBC (you really need accuracy), and you might even have two un-related conditions going on. The vet has to come up with suitable pain control that is also not going to interfere with or alter bloodwork results, or worsen the platelet count, or if it does, to be efficient in taking that into consideration with the results. Also ask him/her to see if they can expedite the lab results on the blood sent out. Did she hint at the possibility of a tumor (spinal or otherwise), that too should be ruled out eventually, although it does sound more like a disc problem at this point. The prednisone is helpful to reduce inflammation that causes pain, but it isn't always so helpful as a specific pain medication. Ask your vet what the options are for your dog in particular.
And, no, hemorrhage doesn't always show up on xrays (especially if it is a slow hemorrhage, or within certain organs or hidden behind another organ), but bloodwork often does, as well as a clotting factor test.
Did your vet suggest slightly sedating your dog so she could get accurate xray results? This might be a good next step. However, if your vet isn't experienced enough, perhaps a consult/exam with a veterinary orthopedic surgeon might be helpful, even your vet could consult with one on your behalf and either share the xrays already taken or one of them could take a new one. It's a bit concerning that the reflex/pain response test showed your dog was slow to respond, this too should be repeated. Are you keeping him strictly confined and limiting his movements/exercise as your vets persue the rule-outs?
Was there any chance for a toxic ingestion of some sort? (just something to rule-out)
I really am not sure how to recommend you to proceed. I think the first order should be a new xray, under slight sedation if necessary, but I think it would be wise to repeat a CBC first and check platelets/PCV before proceeding with any anesthetic, your vet can go over that with you and make an educated opinion if the above is warranted. I do worry about the platelets being low without repeating a CBC (you really need accuracy), and you might even have two un-related conditions going on. The vet has to come up with suitable pain control that is also not going to interfere with or alter bloodwork results, or worsen the platelet count, or if it does, to be efficient in taking that into consideration with the results. Also ask him/her to see if they can expedite the lab results on the blood sent out. Did she hint at the possibility of a tumor (spinal or otherwise), that too should be ruled out eventually, although it does sound more like a disc problem at this point. The prednisone is helpful to reduce inflammation that causes pain, but it isn't always so helpful as a specific pain medication. Ask your vet what the options are for your dog in particular.
..........Traci
Re: Low Platelet/Low WBC
Thanks again. Is there a more complete blood test that should be done? I read something about a differential but not sure if that's what I had done or not.
The vet was going to sedate him if he wouldn't allow the xray, he allowed it but was difficult during it. She said she would re do it under sedation but after finding out what is wrong with his blood. The reflex in the back paw was explained as very slight delay and I just remembered that the vet said old age could also contribute to that as well. My dog is on strict rest, no playing, stairs, jumping, I even hand feed/water him so he doesn't strain his neck.
The vet is certain it is two different things going on, and since my dog is responding to the Pred, is now more concerned about the blood then about the disc. No mention of a spinal tumor and no chance of him ingesting something. Two more questions, Would a tumor have shown up on the xray? Could all the meds he's been on (Turbutrol, Hydrocodone, Pred, Primor, Cephalexin, he also had Dex and Turbogesic shot on 2 occasions) all these within about 7 weeks alter his blood? The only time he ever had to be on medications was about 3 years ago when he had a penile infection (antibiotics) and three times drops for his ears for yeast infections. I thought maybe he was just overloaded with meds and his count is going wacky. Thanks again!
The vet was going to sedate him if he wouldn't allow the xray, he allowed it but was difficult during it. She said she would re do it under sedation but after finding out what is wrong with his blood. The reflex in the back paw was explained as very slight delay and I just remembered that the vet said old age could also contribute to that as well. My dog is on strict rest, no playing, stairs, jumping, I even hand feed/water him so he doesn't strain his neck.
The vet is certain it is two different things going on, and since my dog is responding to the Pred, is now more concerned about the blood then about the disc. No mention of a spinal tumor and no chance of him ingesting something. Two more questions, Would a tumor have shown up on the xray? Could all the meds he's been on (Turbutrol, Hydrocodone, Pred, Primor, Cephalexin, he also had Dex and Turbogesic shot on 2 occasions) all these within about 7 weeks alter his blood? The only time he ever had to be on medications was about 3 years ago when he had a penile infection (antibiotics) and three times drops for his ears for yeast infections. I thought maybe he was just overloaded with meds and his count is going wacky. Thanks again!
Re: Low Platelet/Low WBC
The "differential" is an added part of the CBC, it evaluates the different WBC's and helps as a guide to rule in or out regenerative vs non-regenerative anemia, immune-mediated disorders, infection, viruses, etc. Here's a good site that helps explain what the vet is looking for when he is looking at the CBC results (including the differential). Ideally, yes, you want a CBC with Differential done anytime there is a blood disorder. Again, I would have this test repeated so that you have some indication if the last test was accurate, or if there are significant changes.
Yes, medications can affect the results, but generally not the platelets (or PCV-Packed Cell Volume). The pred is the only med I would be suspicious of at this point (maybe the Dex), ask your vet about that, but she is probably confident that it is better to use the pred as an antiinflammatory at this point rather than use nothing. However, the blood still needs to be evaluated, ANY time that pred is used in therapy. Likewise, liver and kidney function should be monitored any time lengthy courses of pain medication are used.
If a tumor were fibrous, for example, and not hidden by another organ or fluid, it would most likely show up on an xray (particularly the lungs). However, some cancers are slow to grow, making it difficult to rely soley on xrays to detect them. Xrays are a valuable tool, but more valuable when used in combination with other tests (like bloodwork). If any xrays are done, you want the film to be clear as day, and the patient must be in a gently restrained position and as relaxed as possible to achieve that. It's entirely possible the next time you're at your vet's, if an xray is done, it may not require light sedation, your dog may feel more relaxed, hopefully. I only suggest sedation when you absolutely, must, without a doubt, get a clear picture of a suspicious area and when time is of the essence or when the patient is fractious, or in pain.
Give your vet a call tomorrow (or ask her to return your call if she's busy), and ask about her opinion on repeating the CBC (with differential), if nothing else, for accuracy, and for peace of mind so that you don't miss a potential bleeding problem (not saying that's the case, but if this were my dog, I would have it repeated before waiting on the tick titer). If he's otherwise doing fine, does not look anemic (pale mucous membranes, like gums and whites of eyes or inside ears etc), is eating normally, is not cool to the touch, or any other obvious symptom, your vet may feel its more prudent (stress wise to your dog and cost-wise to you) to wait for the titer results, and discuss additional testing at that time if necessary (which is why I hope she can call the lab and ask for expediting the results if possible).
Hope this helps? Wish I could offer you more, but without more diagnostic results, it's kind of a wait and see thing. Hang in there and don't be afraid to discuss your concerns with your vet, ok?
Yes, medications can affect the results, but generally not the platelets (or PCV-Packed Cell Volume). The pred is the only med I would be suspicious of at this point (maybe the Dex), ask your vet about that, but she is probably confident that it is better to use the pred as an antiinflammatory at this point rather than use nothing. However, the blood still needs to be evaluated, ANY time that pred is used in therapy. Likewise, liver and kidney function should be monitored any time lengthy courses of pain medication are used.
If a tumor were fibrous, for example, and not hidden by another organ or fluid, it would most likely show up on an xray (particularly the lungs). However, some cancers are slow to grow, making it difficult to rely soley on xrays to detect them. Xrays are a valuable tool, but more valuable when used in combination with other tests (like bloodwork). If any xrays are done, you want the film to be clear as day, and the patient must be in a gently restrained position and as relaxed as possible to achieve that. It's entirely possible the next time you're at your vet's, if an xray is done, it may not require light sedation, your dog may feel more relaxed, hopefully. I only suggest sedation when you absolutely, must, without a doubt, get a clear picture of a suspicious area and when time is of the essence or when the patient is fractious, or in pain.
Give your vet a call tomorrow (or ask her to return your call if she's busy), and ask about her opinion on repeating the CBC (with differential), if nothing else, for accuracy, and for peace of mind so that you don't miss a potential bleeding problem (not saying that's the case, but if this were my dog, I would have it repeated before waiting on the tick titer). If he's otherwise doing fine, does not look anemic (pale mucous membranes, like gums and whites of eyes or inside ears etc), is eating normally, is not cool to the touch, or any other obvious symptom, your vet may feel its more prudent (stress wise to your dog and cost-wise to you) to wait for the titer results, and discuss additional testing at that time if necessary (which is why I hope she can call the lab and ask for expediting the results if possible).
Hope this helps? Wish I could offer you more, but without more diagnostic results, it's kind of a wait and see thing. Hang in there and don't be afraid to discuss your concerns with your vet, ok?
..........Traci
Re: Low Platelet/Low WBC
Thank you again so much, you have given me so much info and have been so helpful. I will call the vet tomorrow about the CBC, I was told the tick titer would take 2-3 days so that would be either tomorrow or Friday, I'll ask about having it back sooner though.
I hope I'm not making a pest of myself. I am totally stumped on the platelet deficiency though. The two things that are making me skeptical about it are
1) when my dog got scratched on his lower lid by the cat, it bled so much immediately, which I figured was because it is very vascular there. I held a cotton pad on it for about 10 seconds and it was like nothing even happened, couldn't even see a mark and absolutely no blood.
2) I mistakenly cut his quick when doing his nails last week (I cut them so he wouldn't slip on the floor and hurt himself more) I was expecting it to be a bloody mess but it clotted right away.
If his platelets were really this low would the bleeding have stopped so easily?
And one more question, so sorry, I keep reading that Leukemia and Lymphoma would show a very high WBC count, I haven't read anywhere yet of a low WBC count with these diseases, is this correct? I really appreciate your taking the time to help me out.
I hope I'm not making a pest of myself. I am totally stumped on the platelet deficiency though. The two things that are making me skeptical about it are
1) when my dog got scratched on his lower lid by the cat, it bled so much immediately, which I figured was because it is very vascular there. I held a cotton pad on it for about 10 seconds and it was like nothing even happened, couldn't even see a mark and absolutely no blood.
2) I mistakenly cut his quick when doing his nails last week (I cut them so he wouldn't slip on the floor and hurt himself more) I was expecting it to be a bloody mess but it clotted right away.
If his platelets were really this low would the bleeding have stopped so easily?
And one more question, so sorry, I keep reading that Leukemia and Lymphoma would show a very high WBC count, I haven't read anywhere yet of a low WBC count with these diseases, is this correct? I really appreciate your taking the time to help me out.
Re: Low Platelet/Low WBC
The scratch incident was a couple weeks ago, so no, this wouldn't have anything to do with the platelets. Bleeding elsewhere in the body however, could contribute (again, like the spleen).
Actually, a low WBC can still indicate infection or immune-mediated disease and blood disorders, so you still want to include the differential and recheck the CBC for any significant changes. To simply rely on one CBC and if it is suspicious, another one should be done for accuracy. With platelets and PCV, these are crucial markers, they can elevate and decrease within hours to days, so that's why it's crucial to retest.
For the most part, lymphomas and leukemias would most likely show high WBC's, but you'd also see changes in the RBC's as well (and clinical symptoms like anorexia, vomiting, lethargy, potential fever activity etc). Xrays and ultrasonography would be additional tools to try to locate the source (if a mass for example).
Actually, a low WBC can still indicate infection or immune-mediated disease and blood disorders, so you still want to include the differential and recheck the CBC for any significant changes. To simply rely on one CBC and if it is suspicious, another one should be done for accuracy. With platelets and PCV, these are crucial markers, they can elevate and decrease within hours to days, so that's why it's crucial to retest.
For the most part, lymphomas and leukemias would most likely show high WBC's, but you'd also see changes in the RBC's as well (and clinical symptoms like anorexia, vomiting, lethargy, potential fever activity etc). Xrays and ultrasonography would be additional tools to try to locate the source (if a mass for example).
..........Traci