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  Discussion on Increased Total Bilirubin low hematocrit
Author Message
New Member:
smrp777

Posted on Wednesday, Apr 11, 2012 - 9:07 pm:

Dear Dr. O-
My 6 year old rescued QH mare, Princess Buttercup, is a little off and I am trying to figure out what is going on.

Butter has had what we think is a mild case of the heaves for the past year (coughing on and off when exposed to dust or eating dusty hay).

I had my vet examine her and she felt that the coughing was not severe enough to treat. However, we now feel she has reached that point where treatment is necessary so we will begin that this week.

Other than her intermittent coughing she has been "okay." By that I mean that there is nothing obvious: normal temperature, respiration rate normal and lungs clear, heart rate normal, good weight.

But-she does not seem like herself to me.

She will have periods of feeling great and running and bucking and being normal but she also has longer bouts of seeming more mellow than she should for her age and personality. Her weight is good but her winter coat has never seemed really thick or full or healthy and in the spring it looks thin and "thrifty" for lack of a better word.

I run fecal egg counts twice a year on the whole herd. She is a low shedder so I deworm her with ivermectin twice a year. I muck runs and stalls 2-3 times/day so I am hoping parasites are not the issue.

Basically-I get the feeling that something is wrong but my vet and I cannot find anything actually wrong other than her coughing.

I finally had blood work run this week in the hopes it would help us understand what is going on with her. Of course-the day my vet came she did not cough once during the 2 hours she was here-even while eating her normal hay.

The blood work results are below.

Total and Direct/conjugated are shown in the results and I think the difference between those gives me the indirect/unconjugated?

If my assumption is correct then the increase in total bilirubin (3.2mg/dL) is mostly due to indirect/unconjugated (2.7mg/dL) and the direct/conjugated is .5mg/dL.

Her hematocrit is just below normal which surprised me because we live at 8400 feet so I would expect her hematocrit to be elevated.

Her RBC's are in the normal range but at the very edge of the lower level.

My vet suggested that her bilirubin could be a result of fasting but she had eaten an hour before the blood draw and a previous meal 6 hours prior.

We drew blood when I adopted her in 2008 (a different vet) - I am waiting for the full results but I was able to have the vet read these values off to me. I should mention she had been neglected and starved at her previous home so these values were not taken during her healthiest moments:

Total bilirubin 1.4 (0.1-2.5)
Direct-0.1 (0.0-0.5)
RBC-6.5 (6.5-10.5)
Hematocrit 27% (35-52)

Does anything jump out at you? One more thing: today Buttercup was cantering up and down her run for about 5 minutes at the most. When she stopped I could hear her rasping breath from across the barn. I video'd it and have it on my youtube account.

https://www.youtube.com/watch?v=JkyY75Cq0-Y&feature=youtu.be

I would be so appreciative for any insights you might have.
Thank you very much,
Sue

Total Protein 6.0 5.6-8.0 g/dL
Albumin 3.3 2.2-3.9 g/dL
Globulin 2.7 2.6-5.6 g/dL
A/G Ratio 1.2 0.5-2.4
AST (SGOT) 243 180-570 IU/L
Alk Phosphatase 115 50-300 IU/L
GGT 11 2-30 IU/L

Total Bilirubin 3.2 0.1-2.5 mg/dL HIGH
Direct Bilirubin 0.5 0.0-0.5 mg/dL

BUN 16 10-25 mg/dL
Creatinine 1.3 1.2-2.0 mg/dL
BUN/Creatinine Ratio 12 5-21
Phosphorus 3.2 2.0-5.6 mg/dL
Glucose 68 70-120 mg/dL LOW
Calcium 10.8 10.0-13.7 mg/dL
Sodium 135 130-146 mEq/L
Potassium 4.7 3-5 mEq/L
Na/K Ratio 29 24-58
Chloride 100 95-110 mEq/L
Cholesterol 97 70-150 mg/dL
CPK 276 20-500 IU/L
LDH 336 150-450 IU/L

Comment
Icterus 1+. AST may be increased by 20%. See online reports for specific comments regarding this interference. No other
significant analyte interference.

CBC
WBC 6.3 5.5-12.5 103/μL
RBC 6.7 6.5-10.5 106/μL
HGB 11.6 11.0-19.0 g/dL

HCT 34 35-52 % LOW
MCV 51 34-58 fL
MCH 17.4 12.3-19.7 pg
MCHC 34 31-37 g/dL
Platelet Count 136 100-400 103/μL
Platelet Est Adequate

Neutrophils 3528 56 2700-6700 /μL
Lymphocytes 2268 36 1500-5500 /μL
Monocytes 315 5 0-800 /μL
Eosinophils 126 2 0-925 /μL
Basophils 63 1 0-170 /μL
Moderator:
DrO

Posted on Saturday, Apr 14, 2012 - 8:39 am:

Hello Sue,
You are right in your assumptions about the types of bilirubin present. The elevation in the level is the indirect or uncongugated bilirubin. This is the unprocessed form resulting from RBC destruction. So there may be a relation here if there is some increase in the rate of destruction of the RBC's (see below). On the other hand the information you provide and the lab values above are not diagnostic of any particular problem and may just be artifact. Was the horse exercised before the blood was taken? Many horses will appear mildly anemic if they are not excited by the procedure or not exercised before taking the blood because of the spleenic reserve of RBC's. For more on the diagnosis of anemia see HorseAdvice.com » Diseases of Horses » Cardiovascular, Blood, and Immune System » The Diagnosis of Anemia.

For more on bilirubin and RBC metabolism you should see HorseAdvice.com » Diseases of Horses » Colic, Diarrhea, GI Tract » Mouth, Esophagus, and Liver » Icterus & Jaundice in Horses. Also you should follow the links in the article to discussions on increased RBC breakdown. This should give you some ideas to rule in or out hemolytic anemias.
DrO
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