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Hi - so Boone had his second round of carboplatin, and we had his 14 day follow up bloodwork completed (full CBC). We do this via my primary vet to avoid having to travel to the oncology clinic, and they provide the results to us/the oncologist. Here's the conundrum: his platelet count is at 14k; where reference values for chemo are above 100k. His neutrophil count is better this time (3.5, v. 2.3 following the first round), but the instructions sent by the oncologist to my vet for what to do in case of low counts doesn't stipulate ANYTHING for low platelets, only low neutrophils. To top it off, our oncologist isn't in today, and they don't have another on staff, and there's literally 3 others in the province (so they have no on-call consults available).
WHAT DO I DOOOOO? My vet doesn't know (transfusion? panic?) and all treatments and interventions are supposed to be approved by our oncologist.
Clinically Boone seems in pretty good spirits? Appetite is normal, stool is loose but not diarrhea, he doesn't have any bleeding from the gums and I'm not seeing any burst capillaries in his mouth or on his belly (my old dog, rest her soul, had immune mediated thrombocytopenia).
Tell me this has happened to other people and what they did, and please talk me off my ledge because at this point I'm just sitting here staring at him.
Yes, it's happened to other people and their dogs, really!
Every situation is different though, and resolution takes different forms. Boone is his own dog. You say he's pretty much himself right now? That's awesome! Run with it! Breathe, relax. If he is doing fine there is no need to panic. Let him do what he does, and wait to talk to the oncologist about the low platelets.
If it makes you feel better, do a capillary refill test occasionally to ease your mind. If he starts showing signs of anything different let your vet know immediately. But otherwise, I can tell you that for sure we've seen this before and it usually is just a matter of time and a more fine-tuned regimen to get counts back to normal. Just stay in touch with your vet and let us know what's going on when you get a chance. You can do this!
Jerry, I appreciate you. Still panicked.
I'm again in the terrible position where I'm acting as Boone's clinical coordinator; pet healthcare access in BC is wild.
Here's what they said to us re: CBC values "A neutropenia is common following chemotherapy, but generally there is no need for concern unless the neutrophil count is <1,000/uL: prophylactic antibiotics are recommended any time the neutrophil count is less than 1,000/uL due to increased risk of infection. Clavamox, cephalexin, and trimethoprim sulfa are all reasonable choices. Hospitalization and intravenous antibiotics are indicated if the pet is febrile and not feeling well (regardless of neutrophil count) or is profoundly neutropenic and ill. More aggressive, and perhaps combination antibiotic therapy, may be needed if there are signs of sepsis. If severely neutropenic (<1,000/uL), the CBC should be rechecked in 3-7 days. Please fax or email these results to us."
But his neutrophils are at 3500 (awesome), his platelets are 14000. Are neutrophils a precursor to platelet creation, following which we can anticipate his platelet counts will rebound in the days to follow? URGGH. Everything is so frustrating, and google is not my friend.
Not knowledgable enough to offer any insight other than to ditto Jerry.
One thing uou might do to give yourself some reassurance is post this under ASK A VET. Our volunteer Bet may be able to help you. Just cooy and paste what the Vet sent you. And definately stay off fake Doctor Google!
Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!
Thank you, just posted the question there as well!!
benny55 said
Not knowledgable enough to offer any insight other than to ditto Jerry.One thing uou might do to give yourself some reassurance is post this under ASK A VET. Our volunteer Bet may be able to help you. Just cooy and paste what the Vet sent you. And definately stay off fake Doctor Google!
Platelets have nothing to do with neutrophils and many times chemo lowers the total platelet count quite a bit. My dog Tazzie had carboplatin after her amputation and she routinely went under 20,000. This is a transient issue and typically the counts come up as the bone marrow recovers. There is no need to delay chemo and my oncologist did not recommend cutting back the chemo dose.
The reason a low neutrophil count is a big deal is because these are white blood cells that work to fight infection so if very low your dog can get a fever or sepsis so the chemo dose will often be delayed or reduced and your oncologist may put the dog on a broad spectrum antibiotic.
Pam
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