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Thread: Non-regenerative anemia

  1. #1
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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.
    Joyce - Proudly owned & loved by

    BellaMia (Aug. 30, 2012) My Beautiful Red Headed Baby Girl
    Sydney (
    April 16, 2000~April 4, 2012) Always and Forever In My Heart

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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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    In that case I would ask about the pros and cons of possibly changing from pepcid to omeprazole (prilosec). They both do the same thing, but by different methods. Research suggests omeprazole may be a better choice for dogs.

    http://veterinarymedicine.dvm360.com.../detail/731454.

    Research article: http://www.ncbi.nlm.nih.gov/pubmed/15822586.
    Oz probably isn't running 300 miles, but this study found similar conclusions:
    http://www.ncbi.nlm.nih.gov/pubmed/20102495

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    What do his actual numbers look like? What are his hematocrit, hemoglobin and RBC count? What are his exact kidney values, and was a urinalysis done? What was the value for the reticulocyte count? He has no symptoms, right - and this was just an incidental finding? Symptoms include lethargy, weakness, collapse, and rapid breathing and heart rate.

    I've dealt with nonregenerative anemia in dogs with kidney disease, but this usually becomes a problem after a period of time of chronic kidney disease. The hematocrit will gradually drop, and when it gets down to the low 20's or so, it becomes a problem. Unfortunately, simply supplementing with iron or B vitamins doesn't work very well and will not reverse the trend. It can get to the point where the vet will treat with EPO (human erythropoietin) but that's not a good answer either (expensive and dog will form antibodies because it is a human blood product). I had one boy with HCT stabilized around 20 for a long time, and he did okay. But that was a very chronic drop over time from normal of 36 or so; which is tolerated better than an acute drop. I did infuse his subq fluids with B vitamins. I had another girl with acute IMHA, HCT about 15, and that was a tragedy. The IMHA was likely caused by a blood cancer, but she was a teenager.

    I presume that his numbers are not critical, or you wouldn't have to wait so long to see the internist. Nonregenerative anemia can be caused by chronic systemic disease, inflammatory disease, or immune-mediated disease. (PRCA - pure red cell aplasia - is from a problem with the bone marrow and is severe. Bone marrow evaluation is needed for diagnosis.) "Anemia of inflammatory disease does not require treatment and often improves with treatment of underlying cause......Anemia of inflammatory disease usually is mild (PCV not less than 25%), except in end-stage kidney disease."**

    Nonregenerative anemia can also be caused by tick borne diseases - particularly Ehrlichiosis - so if they can't find obvious reasons they will likely run a tick panel. Tick panels are not created equal - I always use:

    http://www.protatek.com/reflab.html

    Dr. Cynthia Holland is amazing and readily spoke with me on the phone when I had a lot of questions about tick titers (a confusing subject, not at all black and white). Even though my vet did not have an account with them, I was given instructions on how to prepare sample and ship to them and just sent a personal check for the testing fees. It was inexpensive and more accurate than I could get from my local Antech lab. Dr. Holland is quite an expert on TBD.

    **Clinical Veterinary Advisor - Dogs and Cats - Second Edition - 2011, page 76.

    Pat
    Pat B
    Atlanta, GA

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    I'll see if I can get a copy of his lab results on Monday. He did not have a urinalysis. This was an incidental finding on blood work for a routine teeth cleaning. Do they regularly check kidney values on that? Whatever lab work I get, I'll post. Yikes - so many possibilities!
    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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