Our immune systems are amazing. They recognise infections and attack germs often before we even know they’re there. It is a very complicated and intricate system which unfortunately can sometimes go wrong. Dear Rusty found out how catastrophic it can be when that happens…
Rusty is a happy go lucky red Collie in the prime of life (see him playing in the grass in the photo on the right). He began to feel unwell on the Sunday before the May bank holiday last year. His humans brought him to see Cath, one of our vets, who found as well as being lethargic his gums were rather pale and he seemed to be feeling a little sick. She took some bloods which showed his white blood cells were high but his red blood cells were low (anaemic). When blood is spun in a special tube, it will separate into its different parts. We can then calculate the percentage of the red blood cells in the blood. While the blood machine can tell us roughly, the manual reading is more reliable and helps to rule out mistakes the machine might make. This is called the packed cell volume or PCV. If the PCV is high it shows there isn’t enough fluid so the animal is likely to be dehydrated. A normal PCV for a dog is between 35% – 55%, (interestingly sight hounds like greyhounds have a higher PCV than other dogs because they are bred to sprint and so have more red blood cells to transport the oxygen around the body). Rusty’s was low at 26%.
Cath was suspicious of a condition called immune mediated haemolytic anaemia (IMHA). This condition occurs when the body’s immune system gets confused and attacks the red blood cells as though they are germs. The body can’t make enough red cells fast enough to replace the ones being destroyed. The dog will suffer also because of the by products from the destroyed cells. Some cases are mild and the animal can cope but others get very sick very quickly. They can get to the point that they don’t have enough red cells to transport oxygen properly around the body so they collapse. The treatment is to use steroids to suppress the immune system to give the animal time to reset; if the condition is severe they may also need blood transfusions to give them enough cells while the steroids take effect.
So Rusty was in trouble. We didn’t know how bad it would be yet though. As Rusty didn’t like to be away from his owners, he went home with some medications to treat the symptoms as we couldn’t confirm the diagnosis until the external lab opened again. We don’t like to start immune system-busting steroids until we are completely sure they need it! However Rusty deteriorated and came back the next day and saw Amanda; his PCV had dropped to 13%, very low indeed. He was getting worse so it was felt we couldn’t wait and started the steroid therapy. He went home again under strict observation. He seemed a little better that evening but the next morning he vomited up his tiny breakfast and collapsed. His owners returned him to the surgery and he was admitted. Rusty was feeling really weak and sick at this point, we and his humans were very worried about him. His PCV had dropped again to just 9%. This is dangerously low, the steroids weren’t working quickly enough, Rusty needed blood – now!
Blood is a tricky product to stock, it goes out of date quickly and besides that you often need the right type. So when we need blood we order it from the Pet Blood Bank but unfortunately this can take 24 hours to arrive, it wouldn’t be here in time for Rusty. Dogs can receive one blood transfusion without type matching; it isn’t ideal but as long as any subsequent blood is type matched it is ok. But blood doesn’t grow on trees! We needed a donor.
An ideal donor dog is a young healthy well behaved dog over 25kg, receiving no medication and has not travelled. In the past we have called on staff pets. However all of us have small dogs! But our brand new recruit Helen piped up then. Her parents own two slightly older golden retrievers. She kindly offered up Dylan as a donor. She went home and collected him. He was so well behaved, sat beautifully still and gave what we needed to save Rusty.
By now Rusty was fully collapsed, he could barely lift his head, though still tried to wag his tail whenever we were with him. We administered the blood to Rusty, still warm! And he started to improve. We hoped this would be enough to give the steroids time to work.
Rusty did improve, his PCV rose to 17%, but this was not enough. By the next morning it had decreased to 13% and not only was he collapsed but he had also started to get a yellow tinge to his gums. This is the by-product of the rapid cell break down. It was just another thing to add to his worries. The blood from the Pet Blood Bank arrived so he was given that too. By now the vets had been in discussion with a specialist vets in Wellington. They could see Rusty the following day. It was decided that given how severe his condition was he would be better off going there, though it was a risk transporting such a sick boy. His devastated owners wanted to give him the best chance so transported him to Cave Veterinary Specialists. We worked very hard on Rusty while he was in, we all hoped he would be ok but also knew he had quite a battle on his paws. Throughout his stay Rusty was so sweet; he tried so hard to do what was asked of him. He got very fed up with blood tests (who wouldn’t!) but still was good as gold.
Rusty received a further five transfusions at Cave Veterinary Specialists, as well as a barrage of medications. Rusty finally started to respond and was discharged, though we were unaware of this.
We next saw Rusty by chance; our vet walked past a consult room and saw a familiar face. She took a double take, and had to check the screen. She was so happy to see him as she had lost track of his progress and assumed he hadn’t survived – he was THAT sick! She made sure to have cuddles while we took another PCV to check his progress. Poor Rusty resembles a pin cushion and is quite fed up with having blood taken, but aside from this he always seems happy to see us. He also arranged for his humans to bring in a hamper of toys and treats for Dylan, his donor, to enjoy.
Rusty is still in often and it has taken a while to stabilise him on his medications we are currently trying to wean his steroids down, it has taken months of dedication from his owners to get him to this point. We love seeing him, his happy face and wagging tail. He and his owners were so brave through this, they are all worthy of Braveheart status.
Rusty has finished steroids and is being weaned of the other meds shortly. If all carries on as it presently is Rusty will be in remission and off all meds in just a couple more weeks! Keep all your fingers crossed for Rusty, we all are!
Photograph – Rusty on the left, and Dylan his blood donor with his present from Rusty!