# Immune-Mediated Thrombocytopenia (IMT)



## Manxcat (May 6, 2013)

Last week we had a blood screen done on Pushkin, including his blood clotting, as we (and our vet) were concerned about how easily he bruises.

Anyway, the results are in and sadly he has got Immune-Mediated Thrombocytopenia or IMT (easier to spell and say after a glass of wine!).

Basically, this means he has a really low platelet count (around 5 instead of between 150 and 450!!) and his immune system is battling itself. This is a condition kind of like haemophilia and results in really easy bruising, either in spots (petichae) or larger patches. At its most serious (which he isn't) it can lead to internal bleeding and worse.

Apparently poodles have a pre-disposition to this illness. Bummer...

The vet is starting him on medication tomorrow (I think steroids of some sort) which he will have in a large dose, fortnightly blood tests and then hopefully a reducing dose over time. It is likely he will have to be medicated for life though. 

The good news was that his other results were all good, so he is healthy otherwise, and this hopefully means that his condition is manageable.

So, my obvious question is whether any of you have come across this condition before, have you had a poodle with it, and how easy/difficult it is to manage and generally anything you know about it. We realise that it has huge significance for any surgery or accidents, and that the meds will lead to increased thirst/peeing and larger appetite. I've googled the condition and will ask the docs at work tomorrow for the human version, and we have good vets but would appreciate any insights you guys may have.

Still a bit in shock, but having had two cats, one with hypothyroidism and one diabetic on insulin shots, we know we can cope but we've Pippin to think of too and how to manage one delicate dog and one... errrr... thug!

Cheers
Manxcat
x


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## ArreauStandardPoodle (Sep 1, 2009)

One of my co-owners, Trillium here on the Forum, had a lovely rescue Standard who developed this and the outcome was not good. She would be a good person to speak with. She did learn how to save a considerable amount of money on some of the meds by buying over the counter. She is not one very often, but I can alert her that you have had this diagnosis, so she will come on and speak with you. I am sorry this is happening to you and your beloved dog.


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## Manxcat (May 6, 2013)

Thank you so much.

We're cut up about it, but also a bit relieved that we know what's causing the bruising, and also I guess feeling a bit pleased that at least he's our dog now as we are pretty sure his previous owners would not have bothered with this, and certainly wouldn't be able to afford meds.

Thank goodness for insurance! 

If Trillium could give me any insights I'd be truly grateful. The over the counter meds may be a problem as we have much tighter regulations about what you can buy and what you have to have prescribed, but who knows? 

Whatever we can do to give our lovely new boy a good life will be done 

Cheers
Manxcat
x


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## Carley's Mom (Oct 30, 2011)

Just wanted to say how sorry I am and thankful that he is in great hands. (((((hugs))))


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## Manxcat (May 6, 2013)

Thank you, appreciate the support - and the hugs!


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## ItzaClip (Dec 1, 2010)

As a groomer, if we see instant bruising of any kind we tell owner to get to vet in case it is what you said. I have not personally delt with it but lots groomers have clients with it. I will try to get any info for you...

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## Manxcat (May 6, 2013)

Thanks - I kind of know about the techno-medical side of it, as I work in healthcare, but it is the living with it and managing it in dogs that is an unknown quantity, and a bit scary! 

All info gratefully received though!


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## Tiny Poodles (Jun 20, 2013)

I don't know anything about this disease, but just wanted to say how sorry I am to hear this.
What incredible good fortune he had to land in such a loving and caring home as yours - I know that you will do the absolute best for him, and that every single day that he has with you is an amazing gift to him.


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## Manxcat (May 6, 2013)

Tiny Poodles said:


> I don't know anything about this disease, but just wanted to say how sorry I am to hear this.
> What incredible good fortune he had to land in such a loving and caring home as yours - I know that you will do the absolute best for him, and that every single day that he has with you is an amazing gift to him.


Thank you, that's so sweet of you to say. He's a gift to us too, love him to bits!


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## Carrie-e (Oct 23, 2012)

Oh manxcat,I am so sorry. Poor little Pushkin,that's awful. He seems such a lovely little happy guy,it's not fair. Am so glad he is with you where he will get all the love and medical care he needs and I hope he isn't too seriously affected. Love and poodle hugs to you and little Pushkin. Xx


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## Manxcat (May 6, 2013)

Carrie-e said:


> Oh manxcat,I am so sorry. Poor little Pushkin,that's awful. He seems such a lovely little happy guy,it's not fair. Am so glad he is with you where he will get all the love and medical care he needs and I hope he isn't too seriously affected. Love and poodle hugs to you and little Pushkin. Xx


Thanks Carrie, he seems to be coping with the steroids okay so far (early days) and goes back for another blood test on the 13th November to see if it has helped his platelet levels, and it will give us a chance to have a good chat with the vet - although I'm not sure how familiar with it our current vet is! I will be glad when our regular one is back from maternity leave - although it was her doing a locum shift as a favour who suggested that we had the tests done in the first place! She is soooo good, and we really trust her.

He's still a very happy chappy though! Apart from all the doorbell ringing that has been going off tonight! We don't do Halloween as such, we have Hop-tu-naa which is an older Manx version of All Hallows Eve and involves Ginny the Witch!


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## ItzaClip (Dec 1, 2010)

This is the response I got when asking groomers if they have any experience living with it. The quote from below is long time cocker spaniel breeder/shower/groomer

"I do, have a dog battling it right now as a matter of fact. It's been nearly two months since she was diagnosed. IMT is a lot easier to overcome than IMHA and thank Dog, she didn't get both, which frequently happens. That is called Evans syndrome. Anyway, I draw blood on her weekly and take it to my vet who sends it in for her platelet count. Fortunately I can do that and don't have to haul her to the vet every week. She is down to 5mg of prednisone every day as of last night, down from her initial dose of 20 mg three times a day. She's done just fine, and unlike IMHA where dogs get very weak, the bruising is often the only sign of IMT. The difference between those two diseases by the way, is IMT the body attacks the platelets, and IMHA the body attacks it's red blood cells causing anemia.
So, other than the awful side affect of the pred, she's done really well. We had one dip in the platelets two weeks ago, but this week she rebounded to almost the very high normal. "

Hope this helps


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## MollyMuiMa (Oct 13, 2012)

Poor little Pushkin! He is sooo lucky to have landed in your care! I know by your posts you have grown to love the little guy and my hopes and prayers are with you!


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## BorderKelpie (Dec 3, 2011)

I wish you all the best. I had a BC with IMHA, it was dreadful. 

I hope and pray you have much better success with your experience with IMT. 

Remember, with auto-immune syndromes, stress triggers flair ups. I know it's hard, but try to minimize stressors as best you can. (Yours and his lol)

Again - Best Wishes!


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## Manxcat (May 6, 2013)

ItzaClip said:


> This is the response I got when asking groomers if they have any experience living with it. The quote from below is long time cocker spaniel breeder/shower/groomer
> 
> "I do, have a dog battling it right now as a matter of fact. It's been nearly two months since she was diagnosed. IMT is a lot easier to overcome than IMHA and thank Dog, she didn't get both, which frequently happens. That is called Evans syndrome. Anyway, I draw blood on her weekly and take it to my vet who sends it in for her platelet count. Fortunately I can do that and don't have to haul her to the vet every week. She is down to 5mg of prednisone every day as of last night, down from her initial dose of 20 mg three times a day. She's done just fine, and unlike IMHA where dogs get very weak, the bruising is often the only sign of IMT. The difference between those two diseases by the way, is IMT the body attacks the platelets, and IMHA the body attacks it's red blood cells causing anemia.
> So, other than the awful side affect of the pred, she's done really well. We had one dip in the platelets two weeks ago, but this week she rebounded to almost the very high normal. "
> ...


Thank you so much! 

He does not have IMHA, thank goodness, and he is certainly still bouncy and active. He is on 5mg of prednisone at the moment, I guess done by body weight, but the vet has said she will see how that dose affects his platelet count at the next test and alter it upwards as necessary. He only weighs just under 4kg at the moment. Fortunately his other blood readings were okay at present.

Only side effect so far is increased urination, but we are keeping a really close eye on him.

Thank you all for your kind wishes.


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## Servicepoodlemomma (Jun 22, 2013)

Sadly all to familiar with this horrible disease. Never had it with a poodle, but I lost my first service dog, an Italian Greyhound name Hannah, in May this year. She was diagnosed 11 months earlier with ITP. Initially she responded well with just prednisolone (I prefer it to pred, easier on the liver and easier for the dog to utilize since the body doesn't have to convert it to use it (prednisone is turned into prednisolone in the liver before it can be used, which is also why it is easier on the liver). My vet also told me many of his patients remain stable easier if you also give melatonin (you can get this at any health food store or even in the pharmacy section near the sleep aids in stores with a pharmacy). I would also be giving milk thistle on an empty stomach twice a day to help protect the liver. 

Anyway - back to ITP, after her initial good response when her blood work was stable for 2 weeks we tried a very slight reduction - Hannah relapsed and also developed IMHA, so then we where fighting Evan's. Again we got her in remission, but she relapsed again and we added Cyclosporine, and when her blood work just wasn't improving much we had to add in Azothioprine (may be spelling that wrong) to get her in remission. She did well and after a month of her being stable we very slowly tapered the Azo first since she was having a hard time with side effects from it, and she was stable for about 6 months before she relapsed again, and we had an even harder time getting her into remission again. Sadly 11 months after her diagnosis she developed canine lupus, and was relapsing again, without us reducing her meds at all, and at the highest dose she could tolerate, so I had to make the hardest decision of my life and end her suffering. It was a hard ugly battle with her - she was always extremely healthy before, I never imagined she would be the one I would loose that way. 

Feel free to message me, I am always happy to share my knowledge with others. Hannah shattered my heart - part of her ashes are in a small pendant I always keep around my neck, auto immune diseases are ugly, but some dogs can go into remission and never have another problem again. 

One HUGE thing is to NEVER vaccinate this dog again. That is a very common trigger for ITP, and can easily send a dog out of remission. Get your vet to write you an exemption letter for rabies, most that understand auto immune disorders will have no problem doing that. Getting an internal medicine specialist involved early on is also a very good idea - A good specialist is your best tool, and should be willing to work with your regular vet to monitor blood work and recommend the proper schedule to reduce meds when that time comes. Most general practice vets just don't have alot of experience with AI disorders. 

I will never get over losing Hannah to this monster - but if what we went through can save another dog or help someone like you, it makes it a little easier. 

Good luck! Will keep you and your baby in my prayers!!! If you want my phone number so we can talk in more details about this just send me a message and I will give it to you


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## Manxcat (May 6, 2013)

Wow, thanks Servicepoodlemomma for all the info.

I actually should have said he is on Prednisolone, not prednisone, darned arthritic finger typos!

I've been doing lots of research online, and the vaccine thing really stood out. Coincidentally, we were just about to make a booking for his vaccine boosters as he hasn't been done since he was a puppy as far as we can tell, so obviously we aren't going to do that!

Our vet is working with a speciality lab over in the UK, so all his blood work is being done there rather than on the Island, and if it comes to it we will face the sea journey to get over there if necessary. We don't have any specialists for anything on the Island really, just some vets that are more clued in than others... Our regular vet should be back off maternity leave just after Christmas, which will be great - not saying the others are no good, just that we have such a lot of faith in Louisa and she is so reassuring and sensible which is good for us as well as the dogs.

I've also been getting all the science info that I'm not sure about "translated" for me by one of the doctors I work with - he has also got a dog and is really interested in canine diseases as well as being an incredible clinician for human types! Very useful!

Seems, like all illnesses, that some get it worse than others and I'm so sorry to hear about what happened with your Hannah. We are of course hoping that this will be manageable for a long time, but are realistic enough to realise it may turn out quite differently - but not going there yet!


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## Servicepoodlemomma (Jun 22, 2013)

Manxcat said:


> Wow, thanks Servicepoodlemomma for all the info.
> 
> I actually should have said he is on Prednisolone, not prednisone, darned arthritic finger typos!
> 
> ...


Sounds like you have the bull by the horns! So glad to hear you have been doing so much research!!!

As far as vaccines go - If the get them as a puppy and their booster a year later, often that is enough to keep them covered for life anyway. You can always ask your vet to do some vaccine titer tests if you are worried. 

Good luck, I am only inbox away if you need me 

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## Trillium (Sep 1, 2009)

I am so very very sorry. I had the sweetest rescue boy named Sport that I lost to Immune-Mediated Thrombocytopenia a few years ago. It broke my and my family's hearts

Here are some links to some threads on it that I posted a few years back. I hope they can be of some use to you. Also please feel free to pm me anytime. Sport's story didn't end well. The med started to destroy his liver. and he was becoming a different dog. 

The process is like living on a roller coaster, you live and worry from one blood test to another and hope for the best. My thoughts and prayers are with you. 

http://www.poodleforum.com/9-poodle-grooming/4292-groomer-problems-my-poor-sport-3.html

http://www.poodleforum.com/5-poodle-talk/4472-sport-update.html?highlight=trillium

http://www.poodleforum.com/5-poodle-talk/4819-sports-test-results-week.html?highlight=trillium

http://www.poodleforum.com/5-poodle-talk/4934-sports-health-issues.html?highlight=trillium

http://www.poodleforum.com/5-poodle...-you-we-will-miss-you.html?highlight=trillium


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## pandj (Jun 12, 2013)

I am so sorry to hear about sweet little Pushkin ! I had an Eskie that had IMT at 13. He had one horrific episode but survived . I can't remember how long he was on Pred but he never had another crisis and left us at 17 from cancer.

All of you are in my thoughts. I am so glad that special little boy is with you so he is loved and cared for.

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## Manxcat (May 6, 2013)

Thank you Trillium and pandj,

I will go through the threads later (when I'm at home, not at work!). It's early days yet with Pushkin, but it is sad to think that he is only 3 and has already had lots of issues since we got him.

His mood seems to have gone off over the weekend - definitely doesn't want to play so much and had a snarl at Pippin when she came too close yesterday, and doesn't seem to want to roughhouse with her or chase in the garden the same and appears to get tired more quickly. He's also doing more blanket sucking, so I don't know if he is stressed or just miserable - wish they could talk!! 

The vet has us keeping her updated with any changes in him, so that will be next on the list!

Thanks for all the support, you guys are the best


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## Servicepoodlemomma (Jun 22, 2013)

Manxcat said:


> Thank you Trillium and pandj,
> 
> I will go through the threads later (when I'm at home, not at work!). It's early days yet with Pushkin, but it is sad to think that he is only 3 and has already had lots of issues since we got him.
> 
> ...


Keep a close eye for bruising, pale gums, or dark stools, all could be signs of he is crashing. 

It is common for them to act like that at first - but the good news is once they are stable and you can slowly reduce meds, he should return to his old self. 

Continued prayers for you both!!!

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## Tiny Poodles (Jun 20, 2013)

Manxcat said:


> Thank you Trillium and pandj,
> 
> I will go through the threads later (when I'm at home, not at work!). It's early days yet with Pushkin, but it is sad to think that he is only 3 and has already had lots of issues since we got him.
> 
> ...


Oh, just so you know, back when my incompetent old Vet put Taylee on steroids for allergies, she began to seriously and randomly attack Tangee - and I mean seriously, like one 4 pound dog might have killed the other 4 pound dog if I had not been there when it happened. The Vet insisted that there was no such thing as roid rage in dogs, but she came off of them, and it never happened again for the next decade, so if he is being snarky with her, I would not leave them unsupervised for a second, because the aggression was not something that you could see coming - it was completely out of the blue...


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## Servicepoodlemomma (Jun 22, 2013)

Tiny Poodles said:


> Oh, just so you know, back when my incompetent old Vet put Taylee on steroids for allergies, she began to seriously and randomly attack Tangee - and I mean seriously, like one 4 pound dog might have killed the other 4 pound dog if I had not been there when it happened. The Vet insisted that there was no such thing as roid rage in dogs, but she came off of them, and it never happened again for the next decade, so if he is being snarky with her, I would not leave them unsupervised for a second, because the aggression was not something that you could see coming - it was completely out of the blue...


I agree here. I had the same problem with Hannah when she was on high doses of steroids. She never anything but grump at the other dogs are while in a was in the room, but she did go after a couple of my foster addressed. 

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## pandj (Jun 12, 2013)

Dogs like people have different tolerance levels for drugs. Pushkin is on high levels and I am not surprised that he is not his usual self. I cannot take Pred at all. Even a child's dose causes all kinds of problems for me . My dogs have had from typical reactions to being extremely sensitive and really grumpy.
Hugs 

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## Manxcat (May 6, 2013)

Well, I've just sat and pretty much bawled all the way through Sport's story, and thanks to Trillium for sharing.

It was interesting to see the pictures of Sport's bruising - very similar to Pushkin's but more of it. Pushkin has had the petechial bruising and just a couple of larger ones caused by his first harness and where he had been scratching in his armpits. He is still getting some little ones, but the ones on his soft belly seem to be clearing (or not happening) for the moment.

Behaviour-wise, he is quieter and poor old Pippin is getting quite distressed because he doesn't want to play so much - just when she'd started really enjoying having a play-mate! It's just not fair! We've not had a repetition of the growling at her, but she's learning to stay away from him when he's blanket-sucking.

I will be glad to get the next round of blood work done next week. Hopefully his platelet count will be higher than 5...

Will keep you posted.


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## Chagall's mom (Jan 9, 2010)

*Manxcat*: When I popped in on the Forum today and read about Pushkin, my heart sank like a stone in the river! No doubt about it, "Life isn't fair!" But drat, must it be _so _unfair to a mini who's overcome a tough go of things in his first home?! Must it be _so_ tough on a good soul like you who's opened her heart, home and wallet to a poodle in need?! Must it upend the fun of little Pippin having an ever-ready "sibling" playmate?! I don't begin to know why bad things happen to good poodles and good people. But I know you will handle this adversity with much grit and determination because you are truly Pushkin's champion. _That_ is his great fortune! 

I remember when Pippin was struck by a car and the anguish you (both) endured then. And now this! It's just so heartbreaking. Whatever is to come, you can know deep in your soul the best days of Puskhin's life are all those he spends as yours. I hope he's stabilized and feels better and peppier soon. I hope his condition will be well managed, that he goes into remission and will be a success story for all to cheer. In the meantime, I cheer you and him on with all my might. Hoping for the best with fingers and paws crossed. :hug:


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## Carrie-e (Oct 23, 2012)

Give him a big kiss from me manxcat,I do hope he starts feeling better soon. Have you thought of doing t touch on him? I know you tried it on Pippin,wonder if it may help.
Lots of love to you all.


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## Manxcat (May 6, 2013)

*@ Chagall's Mom *- thank you for the good wishes, we're doing our best to stay positive! It's been a bit of a blow, but hoping he gets stabilised and he's around for a goodly time yet ). And LOVE the new signature pic of Chagall... he's sooo handsome!

*@ Carrie-e *- yes we're doing some light finger work on him, and last night he was relaxing on hubby's knee for most of the evening, until he bounced up to play... He seems to need "time outs" regularly, preferably on a lap, so we just let him have his little chill time but always with hand contact from us. Not looking forward to this evening though, with the fireworks! Pippin is fine, but him...? Mr Bark At Anything? Not so good I think!


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## Carrie-e (Oct 23, 2012)

My other lovely standard boy Harley never liked fireworks. As a puppy he used to hide in the settee cushions,wasn't quite so bad as he got older but was never comfortable with them. Billy barks a bit especially at the loud bangs,but Tia amazingly doesn't seem bothered and she is scared of lots of things! Wierd! Trouble is manxcat that our fireworks don't just happen on 5th November do they,they seem to be let off for a couple of weeks around bonfire night. I do feel sorry for dogs who are petrified. I hope Pushkin will be ok.


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## Manxcat (May 6, 2013)

Ah, we're luckier than you Carrie, as they are only permitted here for a limited period, think one week max, only official displays pretty much, and there are strict regulations about the selling of them. It's one thing I really don't miss about the UK! And let's not mention New Year... it used to be like Armageddon where we lived in Nottingham! Only official displays here 

Of course, we are very sparsely populated too, which is why the town displays are popular anyway.

Have already apologised to the next door neighbour for the anticipated barking tonight! Might go and drive out to a hill top somewhere and wait it all out!!


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## Carrie-e (Oct 23, 2012)

Perhaps you could play some music to drown it out! Some nice relaxation stuff and you could all chill out! I'm reading a book at the moment about Dr Bachs flower remedies for dogs. There is a bit in there about anxiety over noises. They recommend the rescue remedy 5 flower formula. It's a really interesting book,Tia is a nervous little girl and I'm going to try her on mimulus,which addresses everyday ongoing mild fears and anxieties. As I'm sure you've gathered by now I am a big fan of alternative medicine and there seems to be a lot of different flower essences you can try for different problems in dogs,very interesting.
Hope it's not too stressful for dear little Pushkin tonight. Let us know tomorrow how it went.


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