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Old October 12th, 2010, 10:51 AM
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Idiopathic thrombocytopenia in dogs

I have a 10 year old husky cross who was having some weakness in her back due to discospondylosis but her appetite was low so we took her for x-rays and blood work. The x-rays showed that her spine condition had progressed and her blood work showed a low platelet count. We were given metacam to help her back but two days later her nose started to bleed and so we rushed her to the emergency clinic. At that time her platelets were only 1 per oil field and they stared her on 50 mg prednisone alternating with 2.5ml sulcrate to prevent an ulcer. The next day her platelets were up to 3 per oil field (around 54 when put through the counter) we had a few more x-rays done and they were normal, a ultrasound which was normal -- no tumors in spleen, liver, no noticeable ulcers or bleeding. We tried a vincristine treatment to hopefully boost her platelet counts but that has not resulted in a higher count which remains steady at 2-3 per oil field. She was on no medication before this which apparently can trigger this condition and suspect it is immune mediated. Our vet is putting her case onto some North American e-mail to see if a specialist somewhere has any more suggestions with regards to medication. I was reading about this condition in humans and not sure if this is a shot in the dark but new research has shown that when Heliobacter pylori present in digestive tract is treated with antibiotics that some had a dramatic increase in platelets. Not sure if this would be something to try in dogs? I know they have different species of Heliobacter in their guts but thought it wouldn't hurt to try? Sounds like this is most often a immune mediated problem but can possibly result from pathogens like Heliobacter, blood parasites from ticks or possibly a virus however I think there is little information on what the cause may be.

Just wondering if anyone else has information about this condition -- I know that if her platelets drop further she is at risk for a catastrophic bleed.
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Old October 12th, 2010, 06:27 PM
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SuperWanda, this is one of the two conditions that afflicted a sheltie I bred and sold 7 years ago or more. Combined with immune- mediated hemolytic anaemia it's called Evan's syndrome, which is what Arie had. Very sick dog with a wonderful owner, it has cost him over $7,000 but they have finally nearly weaned her off all drugs. I'm sure if you Google it you'll find there are a lot of possible causes.
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Old October 15th, 2010, 02:58 PM
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How is Timber doing?

Did your vet find any more answers for you? I have sent a pm to Dr Lee with a link to your thread and he will add his expertise next time he logs on.
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Old October 16th, 2010, 12:34 AM
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I am sorry to hear about everything that your pet has been going through. This is always so difficult and low platelets can be so scary.

I assume that we have suspended metacam use while on prednisone? Other pain medications like tramadol may be safer with concurrent use of prednisone, if we need pain medications.

Autoimmune disorders can lead to low platelets - ITP Immune Thrombocytopenia is not uncommon. Steroids or other immune suppressives like azothioprine are often used. Other tests like radiographs and ultrasounds are important to rule out other underlying diseases. Also blood tests if indicated may also be helpful to rule out diseases like Ehrlichia which can also lead to ITP. So far I have not heard that helicobacter is a causative agent for thrombocytopenia in dogs.

I would recommend regular platelet checks until we are 1) out of a danger zone and 2) are on an upward trend.

I hope that this helps.
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Old October 17th, 2010, 08:40 PM
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Thank you Goldsfield, Rainbow and Dr. Lee for your concern!

Yes -- no more metacam. Her platelets were low and they gave her metacam for her back. She was only on it for two days and then the nose bleed happened. My vet thinks maybe her platelets were already low and the metacam just pushed it down further.

Basically we have had 2 abdominal and 2 chest x-rays. Both showed nothing. We went for an abdominal ultrasound and there were no tumors, bleeding or any ulcers that he could see. All looked good so we continue with the prednisone and have platelet smears (# per oil field) done almost every day with no noticeable change (2-3 per oil field). The vet put her case on an e-mail database and some internal medicine vet replied and he said to stay on prednisone that it can take 3-7 days and to get an actual platelet count because a smear is not as accurate so her count was 73, I think, on Friday 15th. Still low so we are to keep giving the prednisone and my vet recommends trying the Imuran or azothioprine, that you mentioned Dr. Lee. I am starting tomorrow but am a little worried about it and the side effects but hopefully all will be okay.

Ticks were addressed as well. Here in Manitoba we have Lyme and Anaplasmosis. Less than 5% of the deer ticks here test positive for Anaplasma phagocytophilum. !0-12% for Borrelia burgdorferi so very rare chance but that was ruled out.

Blood tests also showed her to be slightly anemic so hopefully she is not developing the hemolytic anemia as well?

I have no idea what has caused this but it sounds like it can be a multitude of things from viruses, bacteria, toxins, medication genetics etc. I guess we'll never know.

Right now she is at home and seems to be improving slowly but her blood tests don't show any significant change for the better.

Thank you for your posts! I am very worried and just hope that her counts rise and she will get through this. I know she is 10 years old but hope that her age does not prevent her from recovering!
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Old October 18th, 2010, 02:32 PM
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Glad to hear the ultrasound showed no tumours, bleeding or ulcers.

Is Timber eating well? Ask your vet about giving her supplements to help her immune system.

I hope the pred and Imuran are able to bring her blood count back up soon.
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Old October 19th, 2010, 09:51 AM
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Thank you -- I am just confused about the Imuran. Basically I have two groups of vets with different opinions about using it for just the low platelets.

My regular vet and the vet that did the ultasound are recommending it. They have also asked other vet's opinions and they agree.

The emergency clinic where we took her is not recommending it. They said there is nothing in the literature that says you should use it for treating just the low platelets. They said they would e-mail the internal medicine vet and see what he thinks.

So, this is really confusing me and I don't know if I am doing the right thing now???

Yes -- she is eating very well -- I think they said that the prednisone increases your appetite so no problem with that. I also have some vitamins called vi-sorbits which I am adding to the beef and chicken stews that I am cooking. She is back to eating the Orijen dog food as well.
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Old October 19th, 2010, 11:20 AM
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Just thought I would mention something I just found out. Last week her platelet count was 54 but the machine was calibrated that 150 is normal so the second test her count was 73 but that was a different machine where 200 is normal so basically her platelet count is about the same if you look at the ratio.

Let's just make this a little more confusing
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Old October 19th, 2010, 12:49 PM
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It is so frustrating when you get two different opinions about what you should do.

Did you ask the emerg vet if her prednisone dosage would be higher if she was not taking the Imuran? I have never had a dog that required steroids but it is my understanding that if Imuran is given then they can give lower doses of prednisone.

Hopefully, Dr Lee will reply soon with his opinion.

Glad her appetite is good and sending you lots of as well.
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Old October 20th, 2010, 02:04 PM
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Yes -- I guess if the Imuran works they can start slowly lowering the Prednisone. Right now she drinks so much (no accidents yet) and pants from the prednisone. She is also lethargic -- not sure if that is a symptom of her illness or the prednisone?

I worry when I have to take any kind of minor drug myself so having to give her this stuff really makes me nervous. Because the Imuran is such a strong immunosuppressive, they recommend not even touching it with your bare hands and here I am giving this to her and hoping for the best.

Thanks for all your well wishes!
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Old October 22nd, 2010, 12:09 AM
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How is Timber doing?
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Old October 25th, 2010, 08:36 PM
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Have been on the Imuran now for 7 days and just got the blood results back. Unfortunately it wasn't great news. Her platelets were down to 66, red cells down a little more (4.82) and white blood cells now up from 6 to 17.2.

My regular vet is trying to contact our only internal medicine vet in the city who is on holidays so is trying another vet to see what he thinks.

All I know is when the white cell count is going up that has me concerned. And why is it just starting to go up now?

She had a little fresh blood in her stool today so I just picked up some antibiotics and zantac. My regular vet is concerned about the high level of prednisone if it is not an immune mediated problem.

I'm worried about a bone marrow cancer but this is all speculation from what I have been reading online.

Otherwise -- she still doesn't seem to be any worse -- still lethargic but eating well and drinking excessively due to the prednisone more than anything. I guess we'll just take this one day at a time.

Thanks for asking about her! I was really feeling positive about today so the results have left me feeling anxious again. Remind myself to just take it one day at a time.
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Old October 25th, 2010, 11:28 PM
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I am so sorry to hear that Timber's blood count has not improved.

I'll be keeping you in my thoughts and prayers and hope that the vets can find some answers for you soon.
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Old October 26th, 2010, 12:31 PM
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Thank you. I was really hoping for some improvement.

I also hope it isn't the anemia problem (IMHA) that sometimes goes with the ITP.

Gosh, I followed the story posted by SwaysBodyguard a few years back that I'm sure you remember as well. Sway had IMHA and that was so difficult and heartbreaking. I have been reading about these diseases and it's just more than I can handle right now.

I am also sleep deprived so that doesn't help. Feeling very discouraged with the unknown
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Old October 26th, 2010, 01:52 PM
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My heart goes out to you but try not to do so much reading until you get a diagnosis. I know it's hard when it's one of our furbabies but we always tend to think the worst and sometimes there is no need to.

Hopefully Dr Lee will have some further input when he logs on again and your vet finds some answers for you soon.
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Old October 26th, 2010, 06:50 PM
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No advice for you, SuperWanda, but I wanted you to know that I'm thinking of you and Timber and sending ! I hope you get a diagnosis soon!
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Old October 26th, 2010, 10:14 PM
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Quote:
Originally Posted by SuperWanda View Post
I'm worried about a bone marrow cancer but this is all speculation from what I have been reading online.
With the high doses of pred and not seeing a positive response, I would agree that this would be a concern. A bone marrow sample might help further evaluate this. In general immune mediated diseases (such as IMHA and ITP (when combined they are often called Evan's Syndrome)), respond fairly well to aggressive immunosuppresives.

I am glad that so far she is not getting worse.

A note on IMHA. When you have an immune mediated destruction of platelets (ITP), and there is also a dramatic anemia, then IMHA is also assumed unless another clear cause of anemia can be determined (such as a dramatic blood loss from the ITP, such as a GI bleed). However ITP and IMHA are diseases that involve destruction of platelets and RBC. If they are not being made from a bone marrow disease, then ITP and IMHA are not accurate terms.

I hope that this helps. I wish I could help more.
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Old October 26th, 2010, 10:46 PM
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I also have no advice, but want you to know I am also following Timber's progress, and thinking about her everyday.

and
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Old October 27th, 2010, 10:39 AM
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Thank you hazelrunpack, Dr. Lee and Myka for your thoughts and advice,

She has been on the prednisone since Oct 1 and the Imuran for a second week now (but I give the Imuran every other day now). I think my regular vet is concerned so she is the one that is trying to get more information.

She's also the one who gave us the prescription for the antibiotic and zantac so this morning her stool was more formed with no mucous or blood that I could see so that is good.

Not sure what is going on but it worries me have her on these immune suppressing drugs if it is something else.

As far as the numbers for the anemia, her last RBC was 4.82 so would that be considered dramatic anemia or only slight?

I will ask more questions but it seems to me that a diagnosis of ITP is basically a guess as other things are ruled out. We had x-rays and ultrasounds and blood work for tick pathogens but not a bone marrow test -- although when this all began her white cell count was not at all elevated. Perhaps the Imuran is stimulating that or a possible infection? Who knows but I hope my vet finds some more information soon!

Thanks again for your support and I'll keep you posted on what happens.
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Old October 27th, 2010, 02:15 PM
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Still thinking of you and Timber and hoping for a good outcome.
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Old October 27th, 2010, 03:03 PM
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I really hope your precious Timber is doing better. My 5 year old Sheltie "Bobby" had a G.I. bleed in the summer of 2009 from Metacam in combination with an antibiotic! He was hospitalized and was I SCARED. Thankfully we had a wonderful vet and staff who took the best care of him. Among other things they gave him "Diarsanyl" which is an oral paste for dogs (I'm copying it straight from the box). It is made by Vetoquinol and is a "Nutritional Supplement as an aid in coating the Inestinal Mucosa". One thing I learned from the vet during this episode is to use as little medicine/supplements/vitamins as possible. IMO you should ask your vet about the Visorbits, it might be a good idea to not give her anything other than her 'scrips, lots of TLC and
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Old October 29th, 2010, 01:20 PM
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Thank you rainbow and 2sheltiesmom,

My regular vet is working so hard to try and figure this out so I really appreciate that! She's been brainstorming with other vets and the suggestion now is to test her blood again this Monday. If there is no change we will start reducing the prednisone by half. I am fine with that because that is what is making her feel so unlike herself. She thinks that if the immune system was attacking the platelets that we should have seen improvement by now. She's been on the Prednisone for almost the entire month and the Imuran for two weeks now.

The other thing to consider is the bleeding and mucous from the rectum which has since subsided since I started antibiotics. She wonders about a growth and perhaps a colonoscopy would be the next step if we still see no improvement with the blood work. She did have an ultrasound but it sounds like it is hard to see every part of the bowel.

We could also consider a bone marrow test under sedation to determine if it is that type of cancer but I would think her white cell count would be really high and it only started to elevate after starting on the Imuran.

If there is a tumor, it would be risky to remove because her platelets are so low but I guess there are platelet transfusions available. I guess we'll cross that bridge if we get to it.

I am just glad to start reducing the meds because I want her to feel a little better. I struggle with everything that is going on -- I do want her to get well but at the same time it is difficult to drug her up and see her without much happiness if we are possibly nearing the end of her life. But, I also want to be optimistic and hope for a happy outcome (even though she is 10) although I don't want to be naive either -- I know many pets that have not made it to their 10th birthday.

I guess we'll continue to take this day by day.

Thank you all for you're kind words and advice!
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Old October 30th, 2010, 12:22 PM
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Originally Posted by SuperWanda View Post
I am just glad to start reducing the meds because I want her to feel a little better. I struggle with everything that is going on -- I do want her to get well but at the same time it is difficult to drug her up and see her without much happiness if we are possibly nearing the end of her life. But, I also want to be optimistic and hope for a happy outcome (even though she is 10) although I don't want to be naive either -- I know many pets that have not made it to their 10th birthday.
Optimism is always good, and quality of life should always take precedence over quantity of life in my opinion. It is a tough thing to think about, but you show you are a responsible and sensible pet owner by thinking about it. I have been thinking about Timber everyday, and hoping that you can find some answers. It is tough when your buddy is sick.
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Old October 30th, 2010, 04:51 PM
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Sounds like you've got a good vet there that is really trying to help Timber.

Good luck with the blood test on Monday.
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Old November 2nd, 2010, 10:29 AM
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Just an update about Timber:

Her platelets have dropped again from 66 (last week) to 55. Her red blood cells are a little lower but not much (4.5) and her white blood cells are down from 16 (last week) to 10.4. I guess the antibiotics might be helping with the white cells?

Still no idea on how to proceed.

Our only internal medicine vet returns on Monday so my regular vet is setting up an appointment to see her.

Still on the same doses of Prednisone and Imuran for now. Her liver enzymes are elevated now due to these drugs but I guess that's expected.

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Old November 2nd, 2010, 10:42 AM
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I just wanted to add some current thoughts:

Is this an immune-mediated problem? We are not sure -- because we are not seeing any improvement with the drug therapy but in some cases you don't. So wondering about trying other drugs -- vincristine shot(s) again?

Could there be bleeding somewhere else in the body. We did have normal chest and abdominal x-rays as well as an ultrasound but I guess those can miss something. She did have some blood and mucous in her poop that has since subsided on antibiotics but I guess there are different types of colitis including cancer-related types? Her nose was also bleeding when her platelets really dropped the first time so was that a symptom of the thrombocytopenia or was there another reason for that?

I never realized how difficult it would be to figure out the cause of this. I'd like to take her to a human hospital and give her an MRI or a CT Scan!
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Old November 2nd, 2010, 02:08 PM
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Has your vet consulted with Dr Dodds? She is the expert on auto-immune diseases like IMHA.

This must be so hard on you .....I'm still keeping Timber in my thoughts and sending lots of for a good outcome.
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Old November 2nd, 2010, 06:13 PM
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No -- is Dr. Dodds the one in California?

I also told my vet I would drive her to the Saskatchewan Vet Hospital if there was a test that would be better at determining the problem.


Yes, it has been stressful. I've always had a multitude of pets growing up but these are the first two where I am their Mom so haven't had to make those tough decisions you face when they get sick. I always knew it would be difficult but I never imagined it would be this complicated. For whatever reason it's really hit me hard. Just seemed like my whole life and routine has changed and I wasn't expecting it to happen so fast.

I guess when their lives are so short an illness can come on quickly. And although that's what happened, I also look back and wonder if there was anything else I could have done to anticipate it sooner. She's always been slower than my other dog (who is two years older) because of arthritis and had been lagging behind on walks. Sometimes I would worry but other times I would just think she's probably just stiff today. I feel I am fairly observant and in tune with any subtle change when it's come to their health so it really bothers me that this is happening.

I do know it's not my fault and that there are many factors that could be playing into her illness. I also know they are getting to that age where they will start having potential problems, but I think I really thought that I could somehow avoid or at least lessen the chance of them getting some terrible disease by keeping them as healthy as possible.
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Old November 2nd, 2010, 06:48 PM
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Yes, Dr Dodds is in California.

I work in Alberta, but live in Saskatoon. If you end up taking Timber to the Saskatchewan University Veterinary Center let me know if there is anything I can do to help. Do you have family/friends in Saskatoon?
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Old November 4th, 2010, 03:56 AM
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Super Wanda, don't beat yourself up because you didn't see this coming. When Arie got sick it was her groomer that noticed haemorrhages in her skin on her belly and elsewhere and fortunately for Arie's owner that woman had been a Vet in her own country. He would not have realised what was wrong, whereas she took one look and phoned him to tell him to collect her and get her to the vet immediately. Arie had been fine prior to that.
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