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Thread: Non-regenerative anemia

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    Default Non-regenerative anemia

    Does anyone know anything any non-regenerative anemia? Oz had his teeth cleaned earlier this week and they did a regular pre-op blood panel and found some irregularities in his RBCs so they sent them off to a specialty lab. They came back today with the diagnosis of non-regenerative anemia. I have an appointment with an internist on July 2. He will be 6 on July 1 and was diagnosed with Inflammatory bowel disease about a year ago, but has had it for much longer. He has also lost weight recently despite no diet change. His gums look a little bit paler than my other dogs, but not much. All I know about it is what I have read on the internet (PetMd, etc).
    Bev
    Oliver (blenheim, born 3/2001), Riley (black & tan, born 8/2002,), Madison (ruby, born 9/2003), and Oz (tri-color, born 7/2007)

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    I had to look it up, so definitely not an expert. Basically what is going on is that for some reason his body isn't making as many Red Blood Cells (called RBC) as it used to. Since RBC have an average lifespan of 4 months if there aren't enough new cells being made you'll end up with not enough as the old cells die off. Note: RBC are not actually alive (they aren't technically cells, even), and they don't really "die", but everyone talks about them like they are living cells, so don't worry about that detail.

    Given his IBD I would thinking that maybe he isn't absorbing iron as well as he should, a chronically irritated gut has tremendously reduced ability to absorb nutrients. Apparently kidney failure is a concern, lead poisoning is a possibility as well, problems with the bone marrow. But I would be focusing on his gut problems as a first guess.

    What are you feeding? Giving a vitamin C source at the same time as iron can improve absorption.
    Do you use a dewormer regularly?
    What about pre- or pro-biotics?
    Has he been on antibiotics recently?

    I'm always paranoid that my dog will be one of the "cases" that starts a dog food recall, so when in doubt I will switch to home cooked meals, and then transition to a totally new brand of food. But I know that is mostly just a nagging fear, and not very likely.

    Your internist will be able to give you more information about Oz's specific case, so keep us updated.

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    Thanks for your answer. He's on a high quality limited ingredient single protein dog food. He gets pre- and pro-biotics daily. He has not been on antibiotics, but he is on Reglan and Pepcid for his IBD. His vet has suggested that his IBD may be at the root of this problem. I read also that it may be low B12 - which then I could give injections for. How would he get lead poisoning?
    Bev
    Oliver (blenheim, born 3/2001), Riley (black & tan, born 8/2002,), Madison (ruby, born 9/2003), and Oz (tri-color, born 7/2007)

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    Gosh Bev, this sounds serious. I have nothing helpful to add, just wanted you to know I was thinking about you. Sounds like diagnosis may be another juggling act in trying to figure it all out. Maybe try to get an appointment sooner with the inter nest.
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    I mentioned lead poisoning because I don't know anything about your life, or his "eating" habits. For all I know you live in a house with flaking 100 year old paint peeling off the walls, and Oz is a sneak who eats anything that hits the floor. It may not apply to your situation, but I have no way of knowing that.

    Are there grains in his diet? Given that it is a specialized diet it may not. Wheat is of course the one most people blame, oats can also be problematic, rice should be fine. Anecdotally, the pathologist where I got my PhD said ~80% of the animals at our facility showed signs of celiac's, this represents a sample size of several thousand animals (over his decades long tenure at the facility), our animals were on a diet that contained wheat, and was provided by Purina (they make most lab animals' food). These weren't dogs, but 80% is a huge number.

    http://marycoordt.com/wp-content/upl...se-800x311.jpg

    This isn't about celiac's per se, but the illustration shows what the progression from a healthy to a damaged intestine looks like. The difference in nutrient absorption can be huge.

    I am by no means an expert on pro-biotics, but if possible you might want to use a rotation through a few different bacteria options, staying with the same choice could hypothetically lead to a gut that doesn't have a good balance of bacteria. Maybe switch a few times a year, if variety exists in the market.

    You may also want to consider adding supplements to his diet. If this is caused by malabsorption, remember this is the first deficiency that is showing up, but not necessarily the only one. So while B12 or iron might solve this one facet, if he is struggling to get the nutrients from his food you want to address the large problem as well as the immediate issue. Smaller more frequent meals may also help.

    Be sure to ask the internist about Reglan and Pepcid, I don't know enough to comment on the use of these drugs, but the specialist certainly will. I do see online that Reglan is not recommended for long-term use, and is to be used cautiously in kidney failure patients. Since kidney failure is one of the causes of non-regenerative anemia it's worth bearing in mind. Both drugs are working to decrease how much digestion occurs in the stomach (Reglan by shortening how long the food is there, and Pepcid by reducing acid which breakdown food), so it's possible these are making nutrients less available downstream, although I really am not qualified to make these judgements. The internist, on the hand, will definitely know. You may even be able to use these drugs, and see a benefit by giving them at specific times in relation to his meals. Reglan is also used to treat anemia (internet says so), so definitely do not change his medication without a vet's approval.

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    You have a wealth of knowledge. Interestingly we started the Reglan because when he went for his diagnostic endoscopy he was fasted overnight and really hadn't had anything since about mid afternoon of the day before, but an ultrasound the next day at 2 pm (when they were ready to do the procedure) showed a belly still full of food! Talk about slow emptying. Obviously they cancelled that endoscopy and had me fast him for two days before trying again. He's on the Pepcid because he has a reflux issue too, so the Pepcid is to protect his esophagus from erosion. It's all a tangled web though because he didn't start to lose weight until he started on the Reglan. Thanks for giving me lots of questions to ask. Oh, and yes there is rice and sweet potatoes in his diet.
    Bev
    Oliver (blenheim, born 3/2001), Riley (black & tan, born 8/2002,), Madison (ruby, born 9/2003), and Oz (tri-color, born 7/2007)

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    Quote Originally Posted by Love my Cavaliers View Post
    ... He's on a high quality limited ingredient single protein dog food. He gets pre- and pro-biotics daily. He has not been on antibiotics, but he is on Reglan and Pepcid for his IBD. His vet has suggested that his IBD may be at the root of this problem. ...
    What exactly is his food? I've been told that dogs on raw protein diets sometimes show up as slightly anemic in blood tests. Also, dogs that have been victims of tick infestations can show slight anemia on blood tests, as Pat pointed out.
    Rod Russell

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    Here are Oz's lab values from the specialty lab: RBC: 4.74 (L); HGB: 11.1 (L); HCT: 32.4 (L); recticulocyte: 52; % reticulocyte: 1.1; BUN: 15; Creat: 0.8. So kidney values are in the normal range. This lab considers a reticulocyte count < 110 as indication of inadequate bone marrow response. His other results are just slightly below the reference range, although when the vet ran them they were lower (RBC: 2.84; HCT: 20.3; HGB: 11.0 and reticulocytes: 46.7). His food is Wellness kibble. He was just groomed and no signs of ticks - doesn't mean he hasn't gotten bit in the past, even though he gets monthly tick and flea applications. Would you think the most likely culprit is his IBD?
    Bev
    Oliver (blenheim, born 3/2001), Riley (black & tan, born 8/2002,), Madison (ruby, born 9/2003), and Oz (tri-color, born 7/2007)

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    Quote Originally Posted by RodRussell View Post
    What exactly is his food? I've been told that dogs on raw protein diets sometimes show up as slightly anemic in blood tests. Also, dogs that have been victims of tick infestations can show slight anemia on blood tests, as Pat pointed out.
    Actually, I am not concerned about tick infestation blood loss (which would have been obvious) but rather tick borne infectious diseases like ehrlichiosis and babesia which could be from a long-ago single tick bite that was never noticed. Non-regenerative anemia is different from anemia that would show up from blood loss, etc. This is a problem caused by inadequate red blood cell production rather than loss of red blood cells from bleeding, tick infestation, etc. Different still is immune-mediated hemolytic anemia where the body attacks and destroys its own red blood cells. It is a sign of a good vet clinic that they followed up with a reticulocyte count without being asked.

    This link is about IMHA, but there is a good description of non-regenerative anemia versus responsive anemias:

    http://www.veterinarypartner.com/Content.plx?A=1390

    "Anemia due to poor red blood cell production by the bone marrow is called a non-responsive anemia. Such anemias are caused by chronic inflammatory diseases (like inflamed skin, infected teeth, or other long standing irritations), kidney failure, cancers of various types, or certain drugs (especially agents of chemotherapy).

    Normally when red blood cells are lost, the drop in blood oxygen that results causes hormonal changes leading to increased production of red blood cells by the bone marrow. These are called responsive anemias because the bone marrow is responding. Bleeding and immune mediated red blood cell destruction are both responsive anemias.

    There are several ways to determine if the anemia is responsive or not from the blood panel results. Most blood panels run by reference laboratories include a portion called a complete blood count, or CBC, which reviews red blood cell count, size, shape, and maturity as well as white blood cell types and ratios. A patient with a responsive anemia will have an active bone marrow. Red blood cells will be released early leading to a variety of sizes and redness of red blood cells circulating in the blood (less mature red blood cells are larger and paler than mature cells). Further, red blood cell precursors called reticulocytes are released. (These may be thought of as red blood cells so immature they canít truly be called red blood cells yet.) If the bone marrow stimulus is especially strong, red blood cells may be released still containing cell nuclei."

    Non-regenerative anemia is one of the symptoms of a couple of tick-borne diseases.

    Pat
    Pat B
    Atlanta, GA

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    Quote Originally Posted by Love my Cavaliers View Post
    Here are Oz's lab values from the specialty lab: RBC: 4.74 (L); HGB: 11.1 (L); HCT: 32.4 (L); recticulocyte: 52; % reticulocyte: 1.1; BUN: 15; Creat: 0.8. So kidney values are in the normal range. This lab considers a reticulocyte count < 110 as indication of inadequate bone marrow response. His other results are just slightly below the reference range, although when the vet ran them they were lower (RBC: 2.84; HCT: 20.3; HGB: 11.0 and reticulocytes: 46.7). His food is Wellness kibble. He was just groomed and no signs of ticks - doesn't mean he hasn't gotten bit in the past, even though he gets monthly tick and flea applications. Would you think the most likely culprit is his IBD?

    You didn't give normal values for either lab, so I'll assume Antech Lab normals. Those second CBC numbers are not scary-dangerous. The HCT that the vet ran (20.3) and the RBC at 2.84 ARE scary-dangerous; you would have seen symptoms at those values. (My girl who died of IMHA had an acute drop to an HCT of 15, and she collapsed and was taken to ER.) Was that an inhouse profile? FWIW, I alway use an outside lab like Antech. I never get inhouse labs unless the dog is hospitalized at an emergency 24 hour clinic. Get copies of all lab work and keep them at home in a folder so you have a historical reference. It is good that this was found on routine blood chemistry at a more early stage.

    I have never heard of non-regenerative anemia caused by IBD, but that certainly does not mean that this is not the cause. I'll try to do a little research. I think it is highly unlikely that this is related to diet or lack of supplements or medications, and it also appears that there is no kidney disease. I would definitely talk with internist about tick titers. And, again, I would use Protatek and I would talk on the phone with Dr. Holland who is a real expert on TBD. Tick titer results are not "black and white," so I'd want an expert to interpret and to recommend specific tests - even more of an expert than an internist. (I went down this road with two old Cavalier rescues who were Lyme positive.)

    Here is an interesting link:

    http://www.justanswer.com/dog-health...ick-borne.html

    I'll post again if I find anything more about IBD causing this.

    Pat
    Pat B
    Atlanta, GA

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