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The Dog House => Dog Care Corner => Topic started by: cerulean.blue on March 01, 2013, 12:04:05 PM

Title: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on March 01, 2013, 12:04:05 PM
Dakota is our 10 year old, neutered Shepherd/Collie mix. He weighs about 100 lbs, and is slightly overweight. In August of 2011, we took him to the vet for a lump on his shoulder. They didn't do any testing, but told us it was lipoma, and nothing to worry about. Last Friday (2/22/13), we brought him to the vet (different vet than the first) because we had our other animals going in as well, and decided to ask about getting a dental done on him and having his lumps removed. The new vet did a FNA on the shoulder lump, and got a lot of blood and tumor cells out of it. It seems to be highly vascularized. She told us that we should have it removed, and took blood for the pre-surgery blood work.

Monday night (2/25/13), she called back with the results. There were a few troubling results on his CBC:
Quote
Platelet Count: 26 (LOW, Normal- 170-400)
Giant platelets may indicate active thrombopoiesis.
Platelet EST: Markedly Decreased
His ALKP was 209 (HIGH, Normal- 5-131), but she said that could just be due to his age, and she wasn't too worried about it. Everything else was within normal range.

She asked us to bring him in for more bloodwork. We brought him in Tuesday to have a coagulation panel done, and the vet called with the results this morning. He can clot, which is good, so she thinks whatever is causing the low platelets was caught early. She originally seemed to be thinking that the low platelets was somehow related to the mass on his shoulder, but since we brought in the record that said we first had the mass checked in 2011, she's thinking more auto-immune, since she thinks if it were related to the lump, we would've seen symptoms of the low platelet count sooner, and right now, he is asymptomatic.

On Tuesday, she started him on a 10-day course of Doxy (200 mg twice a day), just in case it was infection causing the low platelet count. We're continuing the course of Doxy, and now she's adding Prednisone (20 mg twice a day) to the mix to hopefully bring up the platelet count again, and we're going to re-evaluate in two weeks.

Any ideas what can be going on here? The vet seems a little stumped (she said I could never bring her anything easy, lol), and is mostly thinking auto-immune. My research seems to point more toward cancer, but I'm not sure I'm ready to bring that up yet. I know some of you out there are vets, and some have experience in the human medical field, so maybe you guys see something we're missing.
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on March 01, 2013, 07:20:20 PM
I got a copy of the coagulation test results today when I picked up the Pred. They found a low platelet count, but also noted "Specimen contained fibrin clots which may invalidate results." I'm not quite sure what that means. Everything else was within normal range though.

He has an appointment for the 15th to retest, and see if the Pred is helping.
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: Kati33 on March 02, 2013, 10:41:28 PM
It can be tough to get a good platelet count as the number can be dramatically changed by just a few small clots in the sample. But the giant platelets do make a low count more believable. I would also suspect immune-mediated based on the info you gave, but if they can get the mass removed and have histopath performed, that would give you a better indication of it being tied to the platelets or not. I'm interested to see how he responds to the pred. Also- good that he has enough platelets to prevent spontaneous bleeding- keep an eye out for pinpoint bruises or spots on the gums.

On on the ALKP, these results are interpreted on multiples of normal. So, the value is less than twice normal and thus not much of a concern, especially with his age like your vet said.
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on March 03, 2013, 06:13:16 PM
Thanks for your reply.

From the way our vet explained it, it sounded like a tech reviewed a slide when their lab found low platelet counts, just to see if it was machine error. If the tech saw a normal amount, the notes would say "Adequate," but Dakota's said "Markedly Decreased." Unfortunately, we don't have any other blood tests to compare this one to. Our old vet was a low cost walk-in clinic, and didn't do blood work as part of their yearly exam. I'm not even sure he got blood work done before he was neutered as a puppy. If it were auto-immune, would this be something he's had his whole life and we've just missed, or could it pop up due to normal changes in his body as he ages?

She definitely wants to remove the mass, we just have to make sure his platelet count is high enough that he'll be okay in surgery. I'll definitely have it sent out for pathology. I've been checking his gums and ears for bruises and spots. She also shaved an area on his neck where she drew blood, so we could tell if he bruised. So far, everything looks okay.

I'm hoping he responds well to the Pred. Having him on it makes me nervous about side effects (his mom is diabetic and his dad died of kidney failure after receiving steroid injections for allergies), but it seems to be the best we can do for him right now, so I'm hoping it helps, rather than causes more problems.

I trust her in not being worried about the ALKP, but it's good to know the level that would cause concern.

Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: Kati33 on March 03, 2013, 08:43:33 PM
Immune-mediated would be a recent development. There is a huge list of things that can cause it (including his mass) and often-times we never figure out what it is. It sounds like you guys are in great hands!
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on March 10, 2013, 01:11:34 PM
I really do like my vet. She was my rat vet first, and when Piper was diagnosed with diabetes, I did my research and just didn't trust the walk in clinic to take care of her the right way, so we moved the dogs over as well. She's been great with them too.

Dakota has been drinking tons of water on the prednisone. I know that's one of the side effects. I also know that prednisone can cause diabetes. I tested his blood glucose the other night, since I was testing Piper and he gets jealous sometimes. It was 121 (on an Alphatrak 2 meter), almost 12 hours after his last meal. Now I know that that's not really high, and that the meter can be off a little bit... I just want to know at what point should I worry? I'm trying not to drive myself crazy by testing him, which is why I've only done it once, but knowing the side effects of pred, and his parents' histories...
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: Kati33 on March 10, 2013, 06:28:20 PM
It may be worth a call to your vet. Polydipsia is an expected side effect of the pred, but she may want to adjust the dose with the additional information.
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on March 11, 2013, 10:58:31 AM
I called her this morning, and she's going to call me back. Yesterday and today, he's been acting like he doesn't feel good. Just sad looking and heavy sighing.
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on March 11, 2013, 02:18:45 PM
The vet called back, and we're taking him in today, instead of Friday, for his recheck.
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on March 11, 2013, 04:09:30 PM
She ran a quick test on their lab analyzer, and his platelet count has gone up, but not enough that she wants to lower the dose on the pred yet. She's going to send it out to the lab for confirmation. Her number was 66,000.
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on March 12, 2013, 06:20:03 PM
Good news from the lab! They got an even better number than the vet's machine. They had his platelet count at 157,000 and the tech commented "Adequate." Their normal is 170,000. So she said that we can lower his dose of prednisone to 10 mg twice a day, and recheck in 2-4 weeks.

I'm really glad we're lowering the pred dose. He's just not feeling good on it, and he had an accident in the house today (I don't think he even realized he was going).
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on April 23, 2013, 01:25:42 PM
Just wanted to give a quick update on this for anyone who might be wondering. :) Dakota is down to 5 mg Prednisone once a day. She is having us do that for two weeks, then 5 mg every other day for two weeks, then we go in for another recheck of his platelet count. His last blood test showed that his platelet count is up into a normal range, as defined by the lab. Hopefully, it stays that way with the reduced dose, and we can get him off the Pred, and get his tumor removed!
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: Kati33 on April 23, 2013, 07:44:33 PM
Yay! I hope the platelets keep climbing!
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on July 12, 2013, 05:31:42 PM
So at the end of May we went for another blood test. His platelets were in the normal range on the vet's machine (I think her normal is over 200,000), so we stopped the prednisone. Today we went back for another test to see if the levels were staying up without the prednisone. The vet's machine read his platelets at 146,000, which is lower than we want it. The vet is waiting for the results from the lab to see what their machine says, and then we'll decide where to go from there. I hope we get better news from the lab. She should call me back by Monday with the results.
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on July 17, 2013, 12:51:45 PM
The vet just called me back with the test results. The lab found his platelet count to be in the normal range at 175,000. That is lower than last time we checked, but like I said, still within normal range. Now we have to decide if we want to do surgery to remove his mass now, or wait to see how stable his platelet count stays. That's something that I'll have to discuss more with my family. I think that since there's a chance that the mass is causing the low platelet count, that we should remove it and see if that fixes it. However, I'm also worried that it could possibly be cancerous, and if the vet tries to remove it and can't get it all, then it could spread. I came up with some questions to ask the vet after we got off the phone, so I think I also want to talk it over more with her before we make a decision...
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: Marybelle on July 17, 2013, 03:45:10 PM
FB wouldn't let me comment on your post for some reason, so I'll post it here instead...

I don't have a lot to offer in way of advice, but good luck with whatever you decide. *hugs*
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on July 17, 2013, 05:09:43 PM
Thanks Mary. :)

When I told my Mom what the options were, she said that they didn't have the money for him to have surgery (my dad was one of the people affected by the government furloughs). So if he did get the surgery, I'm going to be the one paying for it.

Here is the list of questions I have for the vet so far:

1. Can you give me an estimate of what the surgery would cost?
2. How likely do you think it is that the mass is what is causin his low platelet count?
3. Do you think you would easily be able to remove the entire mass?
4. How likely is it to grow back or be cancerous?

Anything you guys can think of for me to add or change the wording of?
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: Dfwgolden on August 11, 2013, 03:26:32 PM
My Golden Had this.....
He didn't make it = :-[
Title: Re: Low Platelet Count and Blood Filled Tumor... Need help figuring out what's wrong
Post by: cerulean.blue on August 14, 2013, 06:15:32 PM
My Golden Had this.....
He didn't make it = :-[

Where was his tumor located, and did you attempt to have it removed?

I forgot to post after I talked to the vet, so here it is:
I'm still not sure what to do. She said she doesn't think that there would be any added risks doing the surgery (all of his other blood work, liver values, etc, looked good), and she's fairly confident that she'll be able to remove the whole mass. I asked her about what type of tumor she thought it was, and she said that the ones she's seen that present on a limb are usually benign and don't recur, but here is a link to some of the types she mentioned, which sounds scary to me: http://www.vetinfo.com/dhemangio.html#b (http://"http://www.vetinfo.com/dhemangio.html#b")

She said that it could possibly be causing his low platelet count, but usually that has something to do with the spleen, so it could just be two different conditions occurring at the same time (http://www.veterinarypartner.com/Content.plx?A=1412&S=1 (http://"http://www.veterinarypartner.com/Content.plx?A=1412&S=1")). She said if his platelet count continues to drop with no treatment, then we would do an abdominal ultrasound to find out what's going on.

The estimate she gave me was a bit more than I was thinking it would be, but I could still pay for it if I decide to go ahead with it.

I'm leaning more towards a "wait and see" approach, but part of me wants to go ahead and do it, if there's a chance that's what's making his platelets go low. To be honest, she didn't really tell me anything I hadn't already found in my own research, so I don't really have anything more to go on with my decision.  :-\