Immune mediated disease.

Dr. Marie replied:

Poor Amber...it sounds like she is really having a tough fight!

I have had cases very similar to what you have described with Amber and they can indeed be tough. From what you have described, it really sounds like your vet is doing all of the same things I would. I don't think you could ask for any better care.

There are several things that could cause these problems with Amber and it is often hard to pinpoint the diagnosis in cases like these. When we see low red cells and platelets then there are ways we can interpret the blood work to determine these decreases are due to blood loss, blood cells not being created or blood cells being destroyed. It sounds like your vet has determined that something is destroying Amber's red blood cells and possibly platelets.

The most common reason for this is an autoimmune condition. Usually, when a dog has this, we don't know the reason why. Sometimes we can pinpoint it to a reaction to a vaccine or a particular drug that had just been given but most of the time it is a mystery. Several of the drugs that Amber is being given are meant to stop her immune system from destroying her blood cells. These include the dexamethasone shot, the prednisone and the cyclophosphamide.

One possible reason for platelets to be destroyed is a tick borne disease. Sometimes we can pick up these diseases on bloodwork but not always. So, when we have a dog with low platelets we usually treat with doxycycline which is good at treating most tick borne diseases.

Sometimes certain cancers can cause the body to destroy blood cells such as a spleen cancer. Often if there is spleen cancer we can see evidence of this on xray, but sometimes we need an ultrasound to determine if there is cancer inside the spleen. And even then, there is no guarantee that we'll get a diagnosis.

The weakness is concerning. It's hard to say whether it is because of the prednisone. My guess, however, is that it is because of the low level of her red blood cells. Red blood cells carry oxygen and so if the number of red blood cells is decreased then this means there is less oxygen in the blood. This can definitely cause labored breathing and lethargy.

If the breathing issue seems to be getting worse then it is possible that Amber has developed some internal bleeding. If the platelet level drops to a certain amount then we can start to see more internal bleeding issues. However, as you mentioned that the levels are improving this is probably not the case.

High doses of steroids can cause some labored breathing. But, it would not be a good idea to decrease the dose of steroids as it seems like they are working.

I have seen cases like this go either way. Sometimes we plow through and the medicines help the body get through this and stop destroying blood cells and eventually things get better and better and as the cell levels come up, we decrease the steroids. But I have had cases where we lose the battle despite using the best medicine we have available.

It really does sound like Amber is in good hands. I hope she continues to improve!

Dr. Marie.


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