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Canine Anemia
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Anemia
5 Natural Ways to Treat Canine Anemia
THE PET HEALTH LIBRARY
Anemia: Inadequate Red
Blood Cells
Red blood cells are basically little microscopic bags of hemoglobin.
They have no DNA. They have no internal structures and thus no ability
to perform complicated metabolism. Despite their simplicity, their function
is crucial: they carry hemoglobin, the iron-containing complex protein
that allows for oxygen transport to the tissues, as well as carbon dioxide
transport to the lung for removal. Inadequate red blood cell quantity means
inadequate hemoglobin, which means inadequate oxygen delivery. In the whole
patient this translates to lack of energy, poor appetite, pallor, and basically
an important reduction in life quality.
There are three important ways in which the kidney patient loses red
blood cells. The first way is bone marrow suppression. The second way
is bleeding. The third way is called hemodilution. Maintaining a stable
red blood cell quantity keeps the patient energetic and spirited and is
crucial to staying alive.
Bone Marrow Suppression
One of the functions of the kidney is to produce a hormone called erythropoietin
(pronounced “Urithro-po-eetin”). This hormone, often simply referred to
as “EPO,” represents the command to the bone marrow to make more red blood
cells. When the kidney is damaged, its ability to produce erythropoietin
is compromised. Red cells are still produced but over time the red cell
count drops.
Blood
sample in a PCV tube being read against a chart
Blood sample in a PCV tube being read against a chart
A simple measurement of red blood cell count is called the “packed
cell volume” or PCV. The packed cell volume is an expression of the percentage
of the blood’s volume that is taken up by red blood cells. It can be measured
using only a drop or two of blood and can be done while you wait in any
veterinary office. The sample is spun in a machine called a centrifuge
to separate the red cells, white cells, and serum. The blood tube is then
read against a chart to get the packed cell volume. Hematocrit or “HCT”
also measures the volume of blood present as red blood cells but uses a
measure of hemoglobin to determine it. Practically speaking, PCV and hematocrit
measure the same thing.
Normal PCV
Normal HCT
Dog
37 - 55%
43.3 - 59.3%
Cat
24 - 45%
29.3 - 49.8%
In renal patients, weakness becomes evident in dogs and cats when the
packed cell volume drops below 20.
What can we do?
Thanks to genetic engineering, human erythropoietin is commercially
available in an injectable form. This means that the hormone that the kidney
has failed to make is replaced with injections. Injections are given three
times a week at first but when the patient is more stable they can be backed
off to twice or even once a week.
Pros
The injections can easily be given at home.
Treatment with erythropoietin injections is generally extremely effective
with normal red blood cell counts achieved usually within 4 weeks.
Cons
An oral iron supplement must be given simultaneously so that the bone
marrow will have the building blocks necessary to make red blood cells.
Packed cell volume must be monitored weekly until the patient stabilizes
so the patient will need frequent veterinary visits at least at first.
If this monitoring is skipped, it is easy for the red cell count to become
too high, thickening the blood and causing high blood pressure (which in
turn creates more kidney damage in addition to other problems).
Cost of treatment is reasonable for small pets such as cats and smaller
dogs but could be prohibitive for even a medium-sized dog.
Because the product used is a human origin protein, it can induce a
cat or dog to generate antibodies against it. When the immune system is
stimulated in this way, it not only attacks the human erythropoietin but
also the patient’s own erythropoietin, creating a severe anemia. If this
happens, transfusions may be needed to manage the anemia. When the EPO injections
stop, eventually the antibody production stops and the anemia resolves
somewhat but EPO cannot be used in this patient again and periodic transfusions
become the only means of managing anemia.
In a presentation by Dr. Sheri Ross at the 2006 meeting of the American
College of Veterinary Internal Medicine, she notes that in one study of
dogs and cats with naturally occurring kidney failure, two of three dogs
treated with erythropoietin for more than 90 days and 5 of 7 cats treated
for more than 180 days developed refractory anemia that was attributed to
anti-erythropoietin antibodies. A clinically significant immunologic reaction
to erythropoietin has been reported to occur in 20-70% of treated veterinary
patients. A more commonly published statistic is that antibody production
is a problem in 30-40% of pets using human erythropoietin but this complication
poses a sobering thought. It is important not to use this hormone at the
first sign of anemia but wait until it is really and truly needed.
Is Darbepoetin better than Erythropoietin?
Darbepoetin is a synthetic hormone meant as an improvement over the
natural hormone, erythropoietin. The synthetic version lasts longer and
is less antigenic (less likely to create any erythropoietin antibodies).
Cost is similar to erythropoietin and since most veterinarians have experience
with erythropoietin, this is what tends to be prescribed. Furthermore, dosing
for animals is still being worked out though there are some guidelines
based on human conversions between darbepoetin and erythropoietin. It appears
that the changes made in the amino acid sequence have made darbepoetin less
likely to generate anti-erythropoietin antibodies but in a patient that is
already having a problem with antibodies, darbepoetin is close enough to
EPO to be inactivated as well.
Bleeding
The calcium-phosphorus imbalance that goes with renal disease is reviewed
elsewhere but the bottom line is that the excess blood phosphorus that
results in renal insufficiency leads to demineralization of bone and mineral
deposits in soft tissues. Mineralization is inflammatory and, when it occurs
in the GI tract, it leads to bleeding, ulceration, and pain. The renal
patient cannot afford appetite loss, nausea or further blood loss so special
treatment is needed while other efforts are made to control phosphorus levels.
Beyond the phosphorus level, another problem is a hormone called gastrin.
Gastrin is a hormone involved in food digestion and is a stimulus for
the stomach to release acid. Normally, when the need for gastrin has passed,
the kidney removes it from the circulation but in the kidney patient gastrin
is not efficiently removed. The prolonged presence of gastrin also prolongs
the stomach’s secretion of acid which can lead to ulceration.
How Do we Know There Is Stomach/Intestinal Ulceration?
There are several clues on the lab work an in the patient’s physical
appearance that tell us that additional therapy is needed to control this
kind of blood loss.
Horrendous inflammation in the mouth (odor, bloody or purulent drool,
sticky discharge on the lips and chin) includes ulceration. When ulceration
in the mouth is this bad, we can assume similar erosion is occurring deeper
in the tract.
A sign of GI bleeding is a BUN level that is more elevated than the
creatinine. Remember, the BUN partly depends on dietary protein. Bleeding
into the GI tract provides the intestine with blood to digest and the BUN
rises further. Some laboratories include a BUN:creatinine ratio to highlight
this phenomenon (a ratio >20 suggests intestinal bleeding).
Uncontrolled phosphorus in and of itself suggests mineralization in
the GI tract.
What can we Do?
Medications for nausea and appetite stimulation can be used. The most
important treatment, of course, is going to be control of the phosphorus
level. Other treatments include the following:
• Antibiotics
When the mouth is purulent, there is probably secondary infection and
antibiotics can help clear it. Antiseptic mouthwashes may also be of benefit.
• Antacids
Reducing stomach acid helps reduce pain and bleeding when the GI lining
is ulcerated (at least in the stomach). Omeprazole is probably the strongest
antacid for veterinary use but famotidine tends to be preferred because
of its additional ability to antagonize parathyroid hormone (which is a
uremic toxin and an elevator of blood phosphorus).
• Gastroprotection
Sucralfate is an oral medication that forms a gentle webbing, effectively
a bandage, over the ulcers, protecting them from further irritation.
Hemodilution
Pets presenting to the vet’s office in Stage IV or late Stage III
kidney failure are often dehydrated. A typical scenario is a pet that had
been drinking lots of water and eating fairly well suddenly stops eating
and is listless. Possibly it is even noticeable that the pet has lost weight
(though this is often erroneously attributed to age). The owner waits a
day or two to see if the pet will start eating again and get better on its
own and when that does not happen, the pet is brought to the vet. Once the
diagnosis of kidney failure is made, fluid therapy will be recommended,
possibly fairly aggressively to drive the toxin levels down quickly. Unfortunately,
the fluid therapy that is so helpful for driving toxin levels down, also
will dilute the blood and drive the red blood cell count down.
This is not a big problem if the patient is not particularly anemic
to begin with but if the patient is already low on red blood cells or if
fluid therapy is very aggressive, by the end of hospitalization (or even
in the middle of it), the patient may be feeling the low red cell count.
What Can be Done?
One choice is to be less aggressive with the fluid therapy, though
this means a longer time to get to a livable toxin level. Another choice
is the use of erythropoietin as above, possibly in addition to a less aggressive
fluid administration rate. Using erythropoietin helps at least increases
the red blood cell production to balance the dilution that comes with rehydration
of the patient.
Date
Published: 6/25/2007 1:22:00 PM
Copyright
2007 - 2007 by the Veterinary Information Network, Inc. All rights reserved.
This work was originally published by Veterinary Information Network,
Inc. (VIN)
and is republished with VIN's permission.
5 Natural Ways To Treat Canine Anemia Article
By gene sower
Anemia can be caused by excessive
loss of red blood cells or by inadequate production.
Nutritional iron-deficiency anemia, common in people, is uncommon in dogs
with today's commercially balanced dog foods. Chronic iron deficiency, as
described by the 'Dog Owner's Home Veterinary Handbook,' is a clear indication
that an insidious loss of blood is taking place.
Blood loss is a condition that is commonly caused by wounds or parasites
such as worms and fleas. Symptoms of anemia in dogs include white or pale
gums, weakness, and a fast pulse. Sometimes this condition indicates a more
serious illness such as toxicity that results from a drug exposure. However,
the more simple and common cause of anemia which is blood loss can be easily
treated with a view toward promoting the growth of new red blood cells.
You need to give your dog a special diet rich in iron, protein, and vitamin
B12. The following lists of foods and supplements are especially helpful
and provide the necessary nutrients that your dog needs to treat anemia.
1. Beef liver which contains iron, protein, B complex, and B12.
2. Kelp powder which contains iodine and other trace minerals.
3. Green vegetables which contains iron and other minerals.
4. Nutritional yeast along with B12 which offers the same benefits as
the liver.
5. Vitamin C, from 500 to 2,000 milligrams per day (depending on the dog?s
size) which helps with the absorption of iron from the intestinal tract.
If the condition is caused by parasites, then you will need to nip the
problem in the bud and treat the parasite infestation first before using
any other forms of treatment.
Using a many commercially available flea treatments such as shampoos and
sprays can prove effective in killing fleas. But start by combing or brushing
your dog on a white sheet or blanket so you can see any fleas fall off. And
keep in mind that fleas can jump.
And don?t forget to wash your dog?s bedding and use a good flea powder
on carpets throughout the house, especially in the areas where the dog sleeps
and has it?s bed.
According to the Dog Owner's Home Veterinary Handbook', 'Signs (of anemia)
vary considerably, depending on the cause. Often they are overshadowed by
the signs of a chronic illness, of which anemia is but one of the associated
symptoms. In general, anemic dogs lack appetite, lose weight, sleep a great
deal and show generalized waekness. '
They go on to caution, 'With severe anemia, heart murmurs are common.
The pulse is rapid and so is the breathing rate. The dog may faint when
overexerting. Most of these signs also occur with heart disease, and these
two conditions might be easily confused.'
As always, your
vet can make the final diagnosis.
About the author
Gene Sower is the publisher of the DOG BYTES newsletter and owner of http://www.naturalpetsworld.com,
a site devoted to offering a huge selection of natural pet foods at discount
prices. from http://www.bloggingstuff.com
Copyright
© BloggingStuff - All Rights Reserved -
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The above information is simply informational.
It's intent is not to replace the advice of a veterinarian nor to assist
you in making a diagnosis of your pet. Please consult with your own veterinarian
for confirmation of any diagnosis. Your pets life may depend on it.