One of my little yorkies has been in emergency care since saturday
late evening. She has Immune-Mediated Thrombocytopenia. She
has had 2 blood transfusions...1 monday morning and 1 about 3:00am
today. I am really scared. Do you have any advice?
Traci,
Re: Traci,
Oh dear, Mou, I'm so sorry for your baby!
How old is she? What tests is the vet running? Blood smear? Clotting factor test? PCV? Rule out cancer? (xrays, etc) Did he send blood off to a lab for tick-borne disease? (if not, send blood off for a full immunological profile, including Coombs, tick-borne, all other immune-mediated - ask vet to ask lab to expedite results)
If your girl has required 2 transfusions already, I am at a loss what to advise at this point, the vet must get to the root of the problem via rule-outs, unfortunately, this can take time and frustration, especially when sending off blood to a lab. What is the vet's suspicion?
What meds is your girl on? Is she a candidate for doxycycline and/or prednisone? Sometimes one or both are started (depending on severity of illness and pending lab results).
How old is she? What tests is the vet running? Blood smear? Clotting factor test? PCV? Rule out cancer? (xrays, etc) Did he send blood off to a lab for tick-borne disease? (if not, send blood off for a full immunological profile, including Coombs, tick-borne, all other immune-mediated - ask vet to ask lab to expedite results)
If your girl has required 2 transfusions already, I am at a loss what to advise at this point, the vet must get to the root of the problem via rule-outs, unfortunately, this can take time and frustration, especially when sending off blood to a lab. What is the vet's suspicion?
What meds is your girl on? Is she a candidate for doxycycline and/or prednisone? Sometimes one or both are started (depending on severity of illness and pending lab results).
..........Traci
Re: Traci,
Traci,
They have done numerous blood profiles, but not for a tick-borne illness.
I can ask about that. I don't think that is what it is, but who knows??
We have very few ticks around where I live, and I haven't been to the
area where they are. They are really afraid to do any venopucture if
it isn't absolutely necessary because she bleeds out and under the skin.
I went to see her again today and she looks so good....BUT she did
yesterday when I was there, and then crashed at 2:30am. I will ask
about the tick-borne illness.
Thank you Traci.
They have done numerous blood profiles, but not for a tick-borne illness.
I can ask about that. I don't think that is what it is, but who knows??
We have very few ticks around where I live, and I haven't been to the
area where they are. They are really afraid to do any venopucture if
it isn't absolutely necessary because she bleeds out and under the skin.
I went to see her again today and she looks so good....BUT she did
yesterday when I was there, and then crashed at 2:30am. I will ask
about the tick-borne illness.
Thank you Traci.
Hugs for everyone, and prayers for those who want them.
Re: Traci,
Traci,
I asked about the tick -borne aspect of her illness and they
said they could do that, and would if I wanted, but they didn't
think that was the cause because her platelet count is soooo
low. They say the count is usually not this low in that case.
What do you thin??
I asked about the tick -borne aspect of her illness and they
said they could do that, and would if I wanted, but they didn't
think that was the cause because her platelet count is soooo
low. They say the count is usually not this low in that case.
What do you thin??
Hugs for everyone, and prayers for those who want them.
Re: Traci,
Whatever immunological profile the vet doesn't have at the clinic then it is prudent to send out to an outside lab, most vets don't have pcr or tests for anti-body titers in their labs (particularly for tick-borne, parasitic and infectious disease, i.e., ehrlichiosis, canine hemobartonella) and have to rely on CBC's, blood smears, etc, which often does not tell the vet enough if there is something underlying going on. Sometimes it is the liver or spleen that is the problem, other times it is certain drugs, cancer, lupus, bone marrow problems. At the time of the first diagnostic workup in cases like this, as much blood drawn as possible the first time to facilitate extra testing is prudent. Having said that, the vet is right, you do not want to perform venipuncture unless the platelets are adequate and unless there is no hemorrhage.
Were xrays done in the initial diagnostics? These can be helpful to rule out masses, enlarged organs, hemorrhage. Ultrasound can be helpful to pinpoint location of suspicion, but unless your little girl is is feeling better and not in severe condition, I'd hold off on ultrasound at this point, unless the vet feels it's warranted. These cases have to be handled very carefully to prevent bruising, bleeding etc.
If the vet feels this is primary immune-mediated thrombocytopenia, that is, not a secondary problem that can be ruled out with additional testing, then he should ultimately be treating this agressively AS IF severe thrombocytopenia, there are various immunosuppressive medications that can be used in combination (ask about starting with prednisone or prednisolone and doxycycline or dexamethazone), sometimes these have to be high starting doses until the platelets rise to normal levels - then they are decreased slowly. Some dogs must remain on pred for life (usually intermittently). There are other immunosuppressive drugs available that can be added or substituted if the dog has side effects to one or the other. An agressive treatment approach (whether or not additional testing is pending) is usually the best course of action because the majority of these cases are idiopathic and it is crucial to do what is necessary to get the platelets to normal, functioning levels. Id the vet is suspicious of hemorrhage, that has to be addressed as well, agressively. Sometimes it requires surgery but this option must be reserved for those dogs who are good candidates for surgery - it doesn't sound like your girl is a good candidate at this point.
The bottom line, in my opinion, at this point is to start treating agressively with immunosuppressive therapy, watch the platelets, add additional meds if necessary. If she responds favorably to the blood transfusions and the platelets rise with immunosuppressive therapy, then it would be prudent later on to possibly put some focus on any secondary problems that might have been missed this time.
If your vet has access to VIN, ask him to consult the specialists, particularly due to her size and breed and for medication doses.
Were xrays done in the initial diagnostics? These can be helpful to rule out masses, enlarged organs, hemorrhage. Ultrasound can be helpful to pinpoint location of suspicion, but unless your little girl is is feeling better and not in severe condition, I'd hold off on ultrasound at this point, unless the vet feels it's warranted. These cases have to be handled very carefully to prevent bruising, bleeding etc.
If the vet feels this is primary immune-mediated thrombocytopenia, that is, not a secondary problem that can be ruled out with additional testing, then he should ultimately be treating this agressively AS IF severe thrombocytopenia, there are various immunosuppressive medications that can be used in combination (ask about starting with prednisone or prednisolone and doxycycline or dexamethazone), sometimes these have to be high starting doses until the platelets rise to normal levels - then they are decreased slowly. Some dogs must remain on pred for life (usually intermittently). There are other immunosuppressive drugs available that can be added or substituted if the dog has side effects to one or the other. An agressive treatment approach (whether or not additional testing is pending) is usually the best course of action because the majority of these cases are idiopathic and it is crucial to do what is necessary to get the platelets to normal, functioning levels. Id the vet is suspicious of hemorrhage, that has to be addressed as well, agressively. Sometimes it requires surgery but this option must be reserved for those dogs who are good candidates for surgery - it doesn't sound like your girl is a good candidate at this point.
The bottom line, in my opinion, at this point is to start treating agressively with immunosuppressive therapy, watch the platelets, add additional meds if necessary. If she responds favorably to the blood transfusions and the platelets rise with immunosuppressive therapy, then it would be prudent later on to possibly put some focus on any secondary problems that might have been missed this time.
If your vet has access to VIN, ask him to consult the specialists, particularly due to her size and breed and for medication doses.
..........Traci
Re: Traci,
She had bled into her abdomen in a great quanity. She didn't want
her bedtime treat and so I put her in her little kennel instead of on
the bed knowing I might wake up to many vomit puddles. About 2:30a
she whined so I got up and she had vomited a LARGE amount of blood.It was black and tarry. I took her outside and she had a BM that was 7/8
blood-black tar again. I then took her to the emergency vet clinic and
they saw the bruising on her tummy and such. This is a real emergency
clinic and they can do most testing there, but not the tick-borne. They
are very reluctant to "stick" her because it causes a huge bruise. He
said if they have to do another stick he can draw some for the tick-borne
test if I want.
I have not gotten a call through the night or so far today so she must
not have had to have another transfusion. YAY!
her bedtime treat and so I put her in her little kennel instead of on
the bed knowing I might wake up to many vomit puddles. About 2:30a
she whined so I got up and she had vomited a LARGE amount of blood.It was black and tarry. I took her outside and she had a BM that was 7/8
blood-black tar again. I then took her to the emergency vet clinic and
they saw the bruising on her tummy and such. This is a real emergency
clinic and they can do most testing there, but not the tick-borne. They
are very reluctant to "stick" her because it causes a huge bruise. He
said if they have to do another stick he can draw some for the tick-borne
test if I want.
I have not gotten a call through the night or so far today so she must
not have had to have another transfusion. YAY!
Hugs for everyone, and prayers for those who want them.
Re: Traci,
Just to rule it out, any chance she got into any rodenticides?
Based on the urgency, I would think it ok to skip the prc/titer/immunological sent to the lab, at this point in time, but in the future, I hope the vet takes that into account with ALL cases of this type. (I know that money can be an issue for some owners)
The thing is, you still need to know where the bleeding is occuring, so it can be stopped, (again, surgery is sometimes required for this). If the symptoms are the least bit improving, and if she responds to the transfusions and meds, surgery may not be required. Time will tell, the next several hours/days will tell.
Again, agressive immunosuppressive therapy is usually the treatment of choice, talk to your vet at great length about that, call them and get an update and discuss meds etc.
Based on the urgency, I would think it ok to skip the prc/titer/immunological sent to the lab, at this point in time, but in the future, I hope the vet takes that into account with ALL cases of this type. (I know that money can be an issue for some owners)
The thing is, you still need to know where the bleeding is occuring, so it can be stopped, (again, surgery is sometimes required for this). If the symptoms are the least bit improving, and if she responds to the transfusions and meds, surgery may not be required. Time will tell, the next several hours/days will tell.
Again, agressive immunosuppressive therapy is usually the treatment of choice, talk to your vet at great length about that, call them and get an update and discuss meds etc.
..........Traci
Re: Traci,
I don't think it is possible that she got into rodenticides. I don't have
any around the house or outside even. I have racked my brain on
that and I just cannot think of anywhere she would have gotten any.
When we are away from the place we always take them potty in a
place where there are no people and I watch them like a hawk. I take
them out one at a time so I can watch close.
any around the house or outside even. I have racked my brain on
that and I just cannot think of anywhere she would have gotten any.
When we are away from the place we always take them potty in a
place where there are no people and I watch them like a hawk. I take
them out one at a time so I can watch close.
Hugs for everyone, and prayers for those who want them.
Re: Traci,
Traci,
What do you know about using HUMAN INTRAVENOUS IMMUNOGLOBULIN
to treat this? Her platelets are less than 1000.
What do you know about using HUMAN INTRAVENOUS IMMUNOGLOBULIN
to treat this? Her platelets are less than 1000.
Hugs for everyone, and prayers for those who want them.
Re: Traci,
Just a suggestion - any chance she's taken a fall, been in an accident, or been kicked? I'm thinking maybe something with the liver or spleen. Could she have gotten into any medication (aspirin or other NSAID)? Garbage can? Lawn chemicals? Have they done any cultures to rule out bacterial infection and sepsis?
Also, if you do get the blood testing done, try to have it done on any blood they have saved from what was drawn before the transfusions. The transfusion will dilute out any antibodies and may make diagnosis more difficult.
Also, if you do get the blood testing done, try to have it done on any blood they have saved from what was drawn before the transfusions. The transfusion will dilute out any antibodies and may make diagnosis more difficult.
"A dog is the only thing on earth that loves you more than he loves himself." ~ Josh Billings.