# My dog has almost no platelets!



## Orye74 (Apr 15, 2014)

My 7.5 year old lab/hound mix two weeks ago had bleeding gums for a few days straight I think it started on a Tuesday or Wednesday. Come saturday I noticed one eye was red, like it had blood in it. So made appointment with vet for that coming Tuesday and her blood work came back and the vet said she could find no blood platelets on most of the fields and some only 1 or 2 in other fields. Now at this point, other then the bleeding gums and eye she seemed normal. So some meds were prescribed and things seemed to go down a bit after the med like she is lethargic, hardly eats and lays around a lot. Yesterday was the first day it seemed I didn't find any blood and the eye is clearing up. Also took her into vet again yesterday and she still could t not find blood platelets so she sent the blood work out, also her feet seem swollen now and having trouble walking, has anyone else been through this before???


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## [email protected] (Nov 18, 2013)

To quote Tom Hanks in Toy Story, "This is the perfect time to panic!" This is a life-threatening problem, and I am more than a little concerned when you said that your vet "prescribed meds" but waited several days to send out labwork. Yikes! This is not the sort of case that should be treated conservatively, or treated empirically (i.e. without a diagnosis), since your dog is at risk of bleeding to death at any time.
There are a number of potential causes for such a severe platelet shortage. The most likely would be an immune disease (immune mediated thrombocytopenia), some of the tick borne diseases (Ehrlichia, Rocky Mountain Spotted Fever, etc.), or destruction of the bone marrow (myelophthisis, often caused by cancers). Obviously these various problems are treated very differently and the treatment is specific to the problem. So...you need a diagnosis ASAP and you need really aggressive treatment...a week ago! Most patients whose platelets are this low require hospitalization. There is a medication called Vincristine (a chemotherapy drug) which can be used to create a short-term release of platelets from the bone marrow, but it shouldn't be given until other definitive treatment is in place. Platelet infusions (for blood transfusion) are sometimes available from the various blood banks. 
If your vet can't (or won't) provide you with the sort of aggressive workup and treatment that this case requires, I strongly suggest that you see a different vet immediately.


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## Orye74 (Apr 15, 2014)

The blood work sent out is not for diagnosis but for examining further for blood platelets. She is currently on Doxycycline, Prednisone, Famotidine, Azathioprine, and Sucralfate


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## InkedMarie (Mar 11, 2009)

I agree with ^^^. Run to another vet, probably ER vet, now.

(I hope this is not one of those instances where we never hear from the OP again)


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## Amaryllis (Dec 28, 2011)

Doesn't rat poison cause this? Vitamin K shots can save the dog's life in that situation. I know a man who almost lost his dog that way.

Either way, new vet, now.


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## Orye74 (Apr 15, 2014)

Rat poison did come back negative


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## Amaryllis (Dec 28, 2011)

Orye74 said:


> Rat poison did come back negative


At least they checked for that. 

Your dog is a hemophiliac now. Even a bruise could kill him. He needs help, fast.


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## Orye74 (Apr 15, 2014)

What about all the meds I have her on?


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## [email protected] (Nov 18, 2013)

Orye74 said:


> The blood work sent out is not for diagnosis but for examining further for blood platelets. She is currently on Doxycycline, Prednisone, Famotidine, Azathioprine, and Sucralfate


Um...yes. But why is your vet treating without a diagnosis? And what is the mechanism for the "feet seeming swollen?" (This is not normal if the platelet shortage is your dog's only problem. And if there are other, concurrent problems going on, you need to know about them immediately, particularly if you are giving the sort of high-risk medications that have been prescribed in this case.) I would hope that your vet has already performed full general labwork (CBC, chemistry panel, urinalysis) and they certainly should have performed an anti-megakaryocyte antibody test (for immune mediated thrombocytopenia) and a panel for tick borne diseases. They should also have discussed with you performing chest X-rays, abdominal ultrasound, and a bone marrow aspirate. Given the severity of what you are describing, there is a high probability of your dog dying while your vet is treating symptomatically. 
It appears that your vet is treating using a "shotgun approach" (all kinds of medications for all kinds of potential problems). But if your dog has ITP, the antibiotic (Doxycycline) is redundant and potentially harmful. (There is a concern with needlessly using antibiotics in the face of autoimmune disease, since this has the potential to trigger further problems.). Similarly if your dog has an infectious disease problem, immunosuppressing them with Prednisone and Azathioprine will slow recovery and potentially can be very dangerous. In addition, as I mentioned, your dog is currently being treated as an outpatient in the face of a life-threatening problem. The sort of accurate platelet count that you are describing ("The bloodwork sent out...for examining further for blood platelets..") should have been performed earlier, and should be performed daily until the platelet count is back into a safe range (say 70,000 or higher). Examining a blood smear non-quantitatively is fine as a backup to confirm an actual platelet count, but is is no substitute for knowing how many platelets your dog actually has, or if they are going up/down. How else is your vet going to know if the medications are working? The vast majority of vets in the U.S. have the ability to perform in-house complete blood counts (including quantitative platelet counts) and this technology has been commonly available for at least the last 20 years. Where do you live that your vet doesn't have in-house bloodwork capabilities?
Without putting too fine a point on it, unless your have left out a lot of other details, your vet is managing your case with the sort of casual disregard for safety that is only appropriate if an owner has declined more aggressive care, or if they are simply trying to keep your dog alive during the 1-3 days it might take to reach a diagnosis! If you have elected to manage the case very conservatively (and some owners do, for a variety of reasons), it would be helpful if you could provide that information to us. If not, I strongly recommend a second opinion.


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## sassafras (Jun 22, 2010)

Yes, it's a reasonable idea to trash the OPs vet based on a couple of internet posts when we have no idea what tests were run, what conversations were had, or what diagnostics the OP did/didn't agree to. :/


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## [email protected] (Nov 18, 2013)

Orye74 said:


> Rat poison did come back negative


There is no test specifically for rat poison. (Most, but not all of the rodentacides work by inhibiting Vitamin K1 activity. At one time there was a test called PIVKA--proteins induced by vitamin K antagonism--but is proved inaccurate and hasn't been available for some time.) I would assume that what your vet tested was your dog's coagulation times. While this is a reasonable thing to do in any bleeding patient, the rodentacide poisons don't produce low platelets; their mechanism of action is by a completely different part of the coagulation cascade. Curiously, coagulation times are expensive to measure and are a fairly sophisticated test to run...one that wouldn't be performed until more general labwork has been done. Could you please go back and fill in some of the blanks: Exactly what testing has been performed thus far?


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## Orye74 (Apr 15, 2014)

Ok this is what I have so far as per written on my invoice. Blood parasite test, chem 17 blood work, CBC in house and HCT, Electrolytes-in house, Coag PT Test, Coag PTT test


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## [email protected] (Nov 18, 2013)

sassafras said:


> Yes, it's a reasonable idea to trash the OPs vet based on a couple of internet posts when we have no idea what tests were run, what conversations were had, or what diagnostics the OP did/didn't agree to. :/


With all due respect Sassafras, since I am well aware that you are also a vet, if Orye74's vet is handling the case well, their medicine should stand up to scrutiny and some questions. And this is exactly what this forum is for: to help owners know what questions they should be asking. And if the case is being handled as Orye74 has suggested, you know as well as I do that this dog could die at any time...while the other vet manages (or mismanages) it. Many owners choose a lower standard of medicine owing to constraints of time, money, personal beliefs, etc. That is fine, so long as everyone is on board that there are other options available, and it is the owner's choice not to pursue them.


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## [email protected] (Nov 18, 2013)

Orye74 said:


> Ok this is what I have so far as per written on my invoice. Blood parasite test, chem 17 blood work, CBC in house and HCT, Electrolytes-in house, Coag PT Test, Coag PTT test


Good, so your vet does have in-house bloodwork. So if you have paid for a CBC, your vet should be able to tell you exactly what the platelet count was. That would be helpful information. You may also want to ask what the "blood parasite test" was measuring. Since your vet performed a chemistry panel, do you know what the total protein and albumin levels were (important given the swelling of the feet)?


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## sassafras (Jun 22, 2010)

[email protected] said:


> With all due respect Sassafras, since I am well aware that you are also a vet, if Orye74's vet is handling the case well, their medicine should stand up to scrutiny and some questions. And this is exactly what this forum is for: to help owners know what questions they should be asking. And if the case is being handled as Orye74 has suggested, you know as well as I do that this dog could die at any time...while the other vet manages (or mismanages) it. Many owners choose a lower standard of medicine owing to constraints of time, money, personal beliefs, etc. That is fine, so long as everyone is on board that there are other options available, and it is the owner's choice not to pursue them.


You don't know what the medicine even IS. You have second-hand posts on an internet message board. Honestly I think it's pretty poor to pick apart how another veterinarian is handling a case and suggest that s/he is practicing with "a casual disregard for safety" via information obtained on an online dog forum. This is not your patient nor your client you should not be trying to interpret lab work and give treatment recommendations about such a serious problem here beyond recommending the OP ask their veterinarian to clarify what the lab results mean and what the drugs are for.

Maybe one day YOU may be the subject of "my vet said xyz" when xyz is at best a total misunderstanding and at worst an outright lie about what you actually said, and then you won't be so quick to throw accusations like that around.


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## [email protected] (Nov 18, 2013)

sassafras said:


> You don't know what the medicine even IS. You have second-hand posts on an internet message board. Honestly I think it's pretty poor to pick apart how another veterinarian is handling a case and suggest that s/he is practicing with "a casual disregard for safety" via information obtained on an online dog forum.


Again, as this forum exists, we have only the information provided by the poster. I am well aware (as are you) that this is often incomplete or possibly wrong. Even so, it is all that we have to go on when offering an opinion. Perhaps Orye74 doesn't understand the case, or perhaps, as you suggest, they are lying. In any of these situations, they need to go back to their vet and start asking questions--that is the essence of being a patient advocate. Once again, if their vet is doing a good job, they will re-explain the case to Orye74, and all will be well. If not, second opinions are always a good idea and may be critical in such a high-risk case. I have no problem with my clients asking for clarification, with questioning my medicine, or with seeking a second opinion. Infact, if this were my case I would already have referred the patient to an internal medicine specialist specifically to have a second set of eyes look at the case. Encouraging Orye74 to do so isn't "throwing accusations around;" it is helping them to make an informed decision.


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## Orye74 (Apr 15, 2014)

As far as the CBC goes, they took more blood from her yesterday and that is what was sent out, I never got an exact Number, but yesterday was a separate visite then the first and was only charged an office visit. The reason why Thursday is I suspect this particular vet is off work today and tomorrow


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## sassafras (Jun 22, 2010)

Until you have access to this patient's medical records, you shouldn't even HAVE an opinion of a case this complicated. 

Seriously, if it is really ok to make assessments of a patient we have very, very little information about based on a couple of second-hand posts about a complicated case on a dog forum, then I weep for our profession.

And yes, saying a veterinarian is displaying a "casual regard for safety" IS throwing accusations around.


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## [email protected] (Nov 18, 2013)

Orye74 said:


> As far as the CBC goes, they took more blood from her yesterday and that is what was sent out


The invoice that you referenced specifically said "CBC in house." I understand that your vet submitted a CBC to an outside lab yesterday, but do you know if your vet originally performed an in-house CBC, and if so what the actual platelet count was?


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## Orye74 (Apr 15, 2014)

We she said she looked at various "fields" and on many she saw none and claiming the ones she saw on other fields were hard to find. Maybe u know what that means.


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## Orye74 (Apr 15, 2014)

Actually I'm going to call right now and see if there is an actual platelet count


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## [email protected] (Nov 18, 2013)

sassafras said:


> Until you have access to this patient's medical records, you shouldn't even HAVE an opinion of a case this complicated.


As you may have noticed, I have not suggested a specific diagnosis; I have told Orye74 what is likely and what they should be looking for. I have not made specific treatment recommendations; I have told Orye74 about treatments that are available (such as Vincristine) and advised that such a treatment should be withheld until definitive treatment has been provided. I have recommended they discuss hospitalization, which is rather a "no-brainer" discussion to have when they are describing hemorrhage. I have provided Orye74 with some ideas for tests which could (or should) be done to achieve a diagnosis. I have discussed some of the medications they have said that their pet was receiving and suggested some potential contraindications to using them. 

To put this case in perspective, Sassafras, here in my local area both of the large (human) hospitals offer "ask a nurse" services. If you call them, they will provide you with just such information as I have provided Orye74. This is generally considered good medicine. They will then tell you that based upon the symptoms that you are describing (such as hemorrhage within the eyeball, swelling of the limbs, and bleeding at the gums) that you should seek emergency treatment immediately. I believe that is exactly what I told Orye74. I don't think I would weep if I were to receive such advice from someone competent in medicine; I would be glad that someone was looking out for my health. Nor, I suspect, would my (human) doctor feel threatened if I were to go to an emergency hospital and receive diagnostics/treatment with such severe symptoms.


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## [email protected] (Nov 18, 2013)

Orye74 said:


> We she said she looked at various "fields" and on many she saw none and claiming the ones she saw on other fields were hard to find. Maybe u know what that means.


So usually when a CBC is performed now, it is done by a machine which provides specific counts for the various types of cells (red blood cells, platelets, specific types of white blood cells). Often a vet will go back and check a blood smear my hand to ensure that the machine is providing accurate results. (This is called a "hand differential."). Years previously such CBC's were performed entirely by hand (using glass slides that would only allow a very specific amount of blood to enter beneath them). Using these hemacytometer slides it was possible to measure cell numbers rather accurately, although often not with the precision that the modern machines can provide.
I'm not sure from your description if your vet performed a hand CBC, or if they were merely trying to estimate the platelet numbers based upon a blood smear. (That is what it usually means when you are looking at "fields."). Basing a platelet count on the number of cells seen per field will give you a ballpark estimate of platelets but not a very accurate platelet count. 
My point earlier is that often it is critical to measure (and keep measuring) an actual platelet count. Thus if a dog has 2,000 platelets on day 1, 4,000 on day 2, and 10,000 on day 3, you can be reasonably sure that they are improving. While this patient still has a life-threatening problem, I would worry much less about this dog than the one whose platelets are staying the same or getting lower. Also, a dog with 2,000 platelets is at risk of dying. A dog at 20,000 is still very low, but isn't likely to hemorrhage to death immediately. So measuring actual platelet counts on an ongoing basis can be a very useful thing to do in a case like this.


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## sassafras (Jun 22, 2010)

> To put this case in perspective, Sassafras, here in my local area both of the large (human) hospitals offer "ask a nurse" services. If you call them, they will provide you with just such information as I have provided Orye74. This is generally considered good medicine.


If you called and described a serious, life-threatening problem that you had already seen a physician for, said some diagnostics were done - including a test that doesn't exist, and listed several medications you had started but you weren't sure why, it would be good medicine for them to say ANYTHING other than "you need to call your doctor back and talk to him/her about this" ? Really? 



[email protected] said:


> Nor, I suspect, would my (human) doctor feel threatened if I were to go to an emergency hospital and receive diagnostics/treatment with such severe symptoms.


I wonder how s/he would feel about you wasting your time on an internet message board instead of actually calling him/her with your questions or going to the emergency room?


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## LittleFr0g (Jun 11, 2007)

While this forum is here for the discussion of diagnosed health issues, it is not intended as a vehicle for members to give out veterinary advice on a dog they have never seen. Since that is becoming an issue here, I am closing this thread, and I would encourage the OP to seek out a second opinion immediately if you are not comfortable with your current vets handling of the situation, and to please post an update thread in this forum.


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