Hi Everyone
With Ardy's permission, I want to share with everyone, the very promising
results we have gotten with the use of Winstrol.
When Ardy first contacted me, she provided me with Tigger's lab results. As
Ardy has mentioned, the results were pretty grim. The key findings for me were:
March 12/16 Red Cells: 1.07 (RR: 5-10)
Haematocrit 6.3 (RR: 30.0 - 45.0%)
Haemoglobin 4.6 (RR: 9.0 - 15.1)
Reticulocyte 5.2%
WBC 3.3 (RR: 5.5 - 19.5)
%Neutrophils 16.4%
%Lymphocytes 64.0%
%Monocytes
NRBC None recorded
Even though there are no reference ranges listed for the percentage
distribution of neutrophils and lymphocytes, I know this distribution pattern
is abnormal. There should be more neutrophils and lymphocytes in cats, with the
ratio being something like 1.8/1, so maybe 45% neutrophils and 25% to 35%
lymphocytes would be the kind of range one would like to see. The very high
lymphocyte count here (higher than the neutrophils) suggests these are leukemic
cells - ie abnormal lymphocytes produced as a result of the viral infection.
Ardy frantically tried all kinds of places to get the Winstrol and she was
finally able to get some and start Tigger on it, on March 15 - so three days
after this blood work was drawn.
The next set of blood results showed an slight increase in red cells, a
significant increase in the haematocrit, haemoglobin, reticulocytes, and a
reversion of the neutrophil/lymphocyte distribution to what one would prefer to
see.
March 25/16 Red Cells 1.70 (RR: 5-10)
Haematocrit 14.1 (RR: 30.0 - 45%)
Haemoglobin 4.6 (RR: 9.0 - 15.1)
Reticulocyte (Not done)
WBC 3.1 (RR: 5.5 - 19.5)
%Neutrophils 43%
%Lymphocytes 20%
%Monocytes 26%
%Blasts 9%
NRBC 9/100 WBC (Normal is 0)
So we started to see a slight increase in the red cell count (which although it
still is well out of reference range, is a 70% in increase from the previous
awful result. The haematocrit more than doubled. The haemoglobin stayed about
the same. The reticulocyte level wasn't done but we started to see nucleated
red blood cells (NRBC) appearing, which are immature red cells which still have
their nuclei - mature red cells do not have nuclei. This indicates they are
being pushed out early by the bone marrow in response to the low red cell
count. The neutrophil/lymphocyte ratio has normalized, but the monocytes are
quite high (usually are low like 2% or so) and are indicative of an
inflammatory process going on. The total white cell count was still lower than
the reference range, suggesting a depression of this cell line as well.
Not surprisingly, the pathologist who reviewed this set of blood results said
(in part) the following: "This anemia appears NON-REGENERATIVE, and although I
can't confirm the exact cause based on this CBC alone, given this appearance,
and especially the macrocytosis [elevated monocytes] and metarubricytosis
[presence of lots of nucleated red blood cells] and in the face of minimal
polychromasia, FeLV is my top differential. . . . The blasts noted do appear
consistent with lymphoblasts. . . While they could be neoplastic, their overall
concentration is small, and I could not confirm neoplasia as seen here."
In the meantime, Ardy was reporting that Tigger was not needing as much pain
medication (or any at all), and began to eat on his own.
The last set of blood results showed:
April 26/16 Red Cells 1.67 (RR: 5-10)
Haematocrit 12.2 (RR 30.0 - 45%)
Haemoglobin 4.6 (RR: 9.0 - 15.1)
Reticulocyte 10.31% (Not usually seen)
WBC 4.9 (RR: 5.5 - 19.5)
%Neutrophils 45%
%Lymphocytes 40%
%Monocytes 3%
%Blasts 12%
NRBC 95/100 WBC (Normal is 0)
So, looking at these results, I was initially concerned because of the slight
slippage of the red cell count but then I realized that if you combine the red
cells with the massive increase of nucleated red blood cells (95 per 100 WBC's)
and also add the reticulocytes (an even more immature form of red cells), then
we would actually be seeing a much much increased red cell count. (See the
comments from the Pathologist, which follow, to see that he also has picked up
on this.) I was also concerned about the drop in haematocrit but then I
recognized that the red cells are becoming more normal in size (they were quite
macrocytic in the last blood sample), so it would show a drop because it is
machine calculation. I also initially could not understand why Ardy got a PCV
result of 16 (with the previous one being 14), because PCV and haematocrit are
considered the same. However, thinking it through further, I think the answer
is that the PCV is the actual manual spinning down of the blood whereas the
haematocrit is a machine calculation measuring the red cell density percentage.
I think in this case, the machine has not added in the reticulocytes and the
nucleated red blood cells in the calculation, whereas the manual spinning of
the blood sample would have included these cells in the red cell density
percentage. I therefore think that the true haematocrit is actually 16 not 12.2.
In the microscopic, it is also noted that Howell-Jolly bodies are also present.
These are remnants of nuclei in mature red cells and again supports the
conclusion that there are a lot of new red cells coming out of the bone marrow
(which frankly, is amazing given that the blood work from the end of March
suggested that (a) the bone marrow was no longer producing red cells and (b)
the red cell population in the circulating blood was dangerously depleted).
The total white cell count has also increased to the point that it is just
below the normal reference range, so that is more good news. The lymphocyte
percentage is up a bit higher than we like to see, but the dramatic monocyte
count seen in the last sample has dropped significantly (12% to 3%), so again,
more normal. The blasts are still there.
My opinion to Ardy was that she actually needed to double the Winstrol at this
point and put Tigger on Doxycycline. Ardy had discussed Doxycycline with her
vets but they talked her into Convenia instead. The great thing about Convenia
is that Tigger can get one shot which lasts several weeks, and so it is one
less thing Ardy has to stress him about in terms of giving him more medicine.
So we agreed to just keep going with the Convenia and play it by ear. However,
seeing the blasts and the slightly increased lymphocyte percentage, I think
that Doxycycline is needed here. I confirmed that while Doxycycline (being an
antibiotic) doesn't kill the FeLV virus, but it interferes with RNA replication
which is how the virus reproduces and pretty much every source I checked
recommended the use of Doxycycline when treating for FeLV. Ardy has spoken to
her vet about it.
With respect to the Winstrol, I actually had my Zander on 2mg twice daily for a
long time - until his haematocrit went above 20 or 25 I think, and then I
dropped him down to 1 mg twice a day. However, any appreciable dip in the
haematocrit, I would go back to the 2 mg twice daily dose until I was satisfied
his results were stable again. My view is that while Tigger's red cells and
anemia have responded to the Winstrol, it is a sluggish response to date
(although the immature red cells are really appearing in significant numbers),
so I suggested we try 2 mg twice daily until his red cell counts begin to
recover more satisfactorily.
Here is what the Pathologist is now saying, when looking at the CBC results:
"This anemia is MARKEDLY REGENERATIVE. While I would want to rule out
hemorrhage, given this presentation, I suspect this is secondary to hemolysis.
IMHA secondary to FIV infection is a differential to consider. . . . I do
recommend repeat CBCs with reticulocyte counts to monitor HCT levels and
regenerative status. Blasts are seen. Upon close review, they appear consistent
with large immature lymphocytes. While I couldn't rule out an early leukemic
population, they are still present in small numbers, and a definitive diagnosis
of neoplasia cannot be made here. Given their concentration, it is also
possible that they could also represent stimulated inflammatory blasts instead.
. . " Unfortunately, I think we have utterly confused the pathologist at this
point, because he has no idea what could account for the change he has seen
between the earlier blood results and this one, so you can see he is now making
other suggested diagnoses, and he doesn't even mention FeLV (though Tigger has
tested positive several times now for FeLV).
As Ardy has said, she knows that Tigger is not out of the woods yet, but we are
certainly seeing signs of moving in the right direction, though it will be a
bumpy ride for sure. We have had to adjust medications in response to his
symptoms, and Ardy has been unwavering in her commitment to her little boy. She
has had to deal with less-than-committed vets, who, as is often the case, are
ready to write off Tigger. Thankfully for Tigger, he has a tireless defender on
his side!
I am also happy to see that the Winstrol appears to be making a big difference
here. As I have posted previously, when the bone marrow shuts downs, I know of
no other product that is able to turn it back on again to produce red cells,
white cells and platelets. Moreover, it is pretty darned inexpensive compared
to all the other products offered which sometimes work but often don't.
Ideally, in my view, if a cat is confirmed to be FeLV positive, he/she should
be started on Winstrol to AVOID the almost inevitable crash in red cells, white
cells and platelets.
Amani
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