[Felvtalk] Bogie's First 5 days on Stanozolol

[Amani Oakley]

Hi Sherri

Looking at the first set of results versus the second, I think there has been a good improvement.

The haematocrit went from 13 to 15.3 in just a few days on Winstrol. That is a definitive improvement.

The haemoglobin went from 4.0 to 5.3. Moving in the right direction. The haemoglobin is a molecule which sits on the red blood cells, and allows the red blood cells to carry oxygen to the organs and cells. When haemoglobin is too low, you will see symptoms of easy fatigue and being out of breath quickly. Bogie is starting to move around more because she has more ability to oxygenate her organs and tissues.

The MCH went from19.3 to above the upper limit of the reference range to 21.8. Though this is above the normal reference range, I suspect this is a temporary condition which represents the body compensating for low red cells and low haemoglobin. The MCH is the Mean Cell Haemoglobin levels. It is not measured directly by the haematology equipment, but rather, is a calculation of how much haemoglobin the average red cell is carrying so it is the haemoglobin level divided by the number of red cells. A high MCH suggests that the red cells are currently larger than normal (macrocytic anemia) and is likely the body's compensation mechanism to allow more oxygenation to occur with fewer red cells available. Another explanation is there is a significant population of reticulocytes (which the lab results confirms is correct) because this category of immature red cells is slightly larger than the mature red cells. I also think that this number may be erroneously elevated in circumstances where there are nucleated red cells in circulation. (Remember that nucleated red cells are immature red cells and are counted by the machine as white cells because the instrument is designed to count anything with a nucleus and a particular size as a white cell. Therefore, if there are a significant number of nucleated red cells, then when the machine calculates MCH, it will be dividing the amount of haemoglobin by a deceptively smaller number of red cells because the nucleated ones are not included in the denominator, and the result will be a falsely elevated MCH.) Either way, it is good news.

The first set of blood work shows that there are nucleated red cells in circulation (NRBC). The number is 7 which is quite elevated, and shows that Bogart was already trying to make new red cells and immature forms were found in the circulation. Unfortunately, the first blood work did not include a reticulocyte count (which is a different phase of immature red cells versus the nucleated ones) and the second blood work did not include a NRBC count, so we cannot see if there is an increase between first and second blood work when looking separately at the populations of the nucleated red cells and reticulocytes. However, as I mentioned in my earlier post, the reticulocyte count in the second blood work shows a strong push towards creating new red cells.

I agree with you that you must be cautious when comparing results from different labs. If you aren't running the blood on the same instrument, there will be a variation since the two machines will be calibrated differently. However, it isn't correct to say that because the reference ranges change, then the red blood cell count is lower in the second set of results. Reference ranges have nothing to do with the actual results. They are usually calculated by collecting a certain number of normal results (say 100) and establishing a high and a low number from the normal bloods. Often the manufacturer of the lab equipment will have done this work and will simply provide the range to the lab running the blood work. Just because a reference range is higher or lower in different labs doesn't mean that the actual result can be interpreted to be higher or lower in different labs. For now, I would suggest cautious optimism that there is a slight uptick in the red cell count between the first set and the second set. However, there is no question that the difference can certainly mean nothing more than lab variation. You will know more next time.

It is hard for me to tell what is happening in the white cell count because not all the white blood cell parameters are listed in either blood work. Usually, in addition to a total white cell count (WBC) the total is then broken down to the different types of white cells and numbers are given both as a count of cells seen but also as a percentage of overall white cells. In both sets of blood work, I see no neutrophil count. In neither do I see percentages either. What I do see is a rise in lymphocytes in the second blood work and that is what made me think of the Doxycycine. Often in FeLV, there is an abnormal increase of lymphocytes and the lymphocytes themselves are abnormal. (I do not see a manual assessment of the blood work, on either day, so again, I cannot tell if the lymphocytes are normal or abnormal.) Without the neutrophil counts and the percentages, I can also not tell for sure what the ratios are of the different types of cells. Normally for cats, I think that the numbers are something like 60 to 40, neutrophils to lymphocytes (I have to check this as I am speaking off the top of my head). Too many lymphocytes versus neutrophils says to me that the infection is still a significant issue and that's why I strongly suggest the Doxycycline to try to see if you can get a handle on this.

Platelets are still low and of concern, though again, they seem to be moving in the right direction.

Overall, I think there is a positive move in most of the blood work parameters from first sample to second sample, Sherri.

However, as you can tell, this is the reason I insisted on weekly bloodwork when I was dealing with my Zander. I adjusted medication according to what I was seeing, week to week. For me, I would want the Winstrol doubled until you see a more definitive budging in the red cell count and the platelets and I would add the Doxycycline and keep an eye on the neutrophil/lymphocyte absolute numbers and ratio. I would also ask for a manual assessment of the blood smear to describe the morphology of the lymphocytes, and to determine if there is platelet clumping to explain those low numbers.

Amani



From: Felvtalk [mailto:felvtalk-bounces at felineleukemia.org] On Behalf Of Sherri Godschalk
Sent: August-27-16 8:07 AM
To: felvtalk at felineleukemia.org
Subject: Re: [Felvtalk] Bogie's First 5 days on Stanozolol

Good morning all.
I replied last night to this but too many characters I guess. I talk too much...not the first time I have heard that. I will ask my vet about putting Bogey on that  antibiotic Amani. Thanks for telling me about it.
So these results are from 8/1/16
Original Test 8/1/16
WBC         9.3            3.5-16
RBC          2.1            5.92-9.93
HCT          13             29-48
HGB         4.0             9.3-15.9
MCV         61            37-61
MCH         19.3         11-21
NRBC         7               0-1                 /100 WBC
LYM        5301          1200-8000
MONO    558            0-600
EOS         465            0-1000
BASO      0.00           0.01-.26
PLT             41           200-600

>From 8/23/2016
WBC        13.46           2.87-17.02
RBC          2.43 M/ul   6.65-12.2    LOW
HCT        15.3 %         30.3-52.3      LOW
HGB         5.3 g/dL       9.8-16.2      LOW
MCV       62.6 fl        35.9-53.1     HIGH
MCH      21.8 pg      11.8-17.3      HIGH
RETIC     61.5 K/ul     3.0-50.0      HIGH
LYM        7.75 K/uL    0.92-6.88    HIGH
MONO   1.58 K/uL    0.05-0.67    HIGH
EOS         0.10 K/uL   0.17-1.57     LOW
BASO      0.00 K/uL   0.01-.26       LOW
PLT             50 K/uL   151-600       LOW

If I am reading these right and I am sure I am not...her RBC is actually down  because of the scale at the different labs.
She does have good days...and today is one. She is currently hiding behind a box and jumping out to scare my dogs when they walk by. I love this little kitten so. I hope we get many more evening like tonight.
Have a great day everyone and thanks for all the well wishes for me and  for Bogey.

Sherri
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