ITP in dogs can be a scary diagnosis but it doesn’t have to keep your dog from living a great life. Take it from Dr. Laura Garlow, veterinarian and mom to Fletcher, a Goldendoodle who lived with ITP for nine years. On the invitation of integrative veterinarian Dr. Julie Buzby, Dr. Garlow takes a comprehensive look at ITP in dogs and shares her experience walking this path with Fletcher.
I think that everyone’s first dog as a “grown-up” holds an extra special place in their heart. That was the case for me and Fletcher. I like to affectionately call Fletcher the “best bad dog” in the world. No other dog will ever be able to fill the Goldendoodle-sized hole he left in my heart when he passed away a little over a year ago at the respectable age of 11. He had a long happy life, nine years of which he lived with immune-mediated thrombocytopenia, but it still never feels like long enough.
My now-husband (who was my fiancée at the time) and I picked Fletcher up as a rambunctious ball of fluff the summer before I started veterinary school. I wanted to make sure I did everything right. So I spent that summer reading all the puppy training manuals I could and hiding everything chewable in our little apartment.
Fast forward a couple of years and Fletcher had turned into a pretty great dog. Maybe the puppy training manuals I poured over so carefully had worked. Or maybe he was just destined to have a wonderful temperament. Regardless, he was a good boy and he brought us so much joy.
Tiny signs of an issue with blood clotting
My husband and I got married during the summer between my second and third year of veterinary school. While on our honeymoon, we boarded Fletcher at a doggy daycare that he loved. He had a blast playing with his doggy friends but had gotten a little scruffy. So when we got home, I gave him a bath, dried him off, and brushed him out. He was his normal self at that point. But just a couple of hours later, I noticed that the insides of both of his ears were covered with tiny pin-prick red dots where I had brushed him.
While I was only halfway through my veterinary education, I knew enough to know that this was not normal. With a bad feeling in the pit of my stomach, I quickly texted a picture to a close friend and mentor. He confirmed my fear that the tiny pin pricks looked like petechia, or very small bruises. Then he gently reminded me that petechia are evidence of an issue with blood clotting. This meant we needed to have some lab work performed ASAP to try to pinpoint the problem.
Since Fletcher was otherwise feeling well with no other evidence of bleeding or bruising, we decided that it was okay for me to wait to take him into the clinic until first thing the following morning. I didn’t sleep a wink that night.
A diagnosis of ITP, immune mediated thrombocytopenia
We went into the clinic the next day. A couple of blood tests later and just like that, Fletcher had been diagnosed with immune mediated thrombocytopenia, or ITP.
This diagnosis had a profound impact on our family, and on my career. I developed a special interest in internal medicine and immune-mediated diseases. This interest led me to complete an intensive one-year internship at a specialty and emergency veterinary hospital after graduation. I found that I enjoyed the challenge of complicated medical cases, and I especially enjoyed helping pet parents understand and navigate the challenging situation of having a hospitalized pet.
After my internship, I spent many years at the same specialty hospital caring for sick hospitalized patients. In that time, I treated many wonderful dogs with immune-mediated thrombocytopenia. Through the years, I have learned so much about this condition, both from our experience with Fletcher, and from my experience caring for my patients. I want to share some of my knowledge with you.
If your beloved dog has been diagnosed with ITP, I hope you finish this article feeling empowered with the knowledge you need to face this challenge head-on.
What is ITP in dogs?
Immune mediated thrombocytopenia (ITP) is one of several autoimmune diseases in dogs. In ITP, the dog’s own immune system attacks and destroys his or her platelets. As a result, the dog has thrombocytopenia, which is the fancy medical term for a low platelet count.
Platelets 101
Platelets are tiny cell fragments within the blood. They are made in the bone marrow and are vital to blood clotting. You may think about platelets helping stop bleeding from a large cut or wound, but platelets aren’t just there for the primetime trauma. They also prevent life-threatening bleeding from normal daily microscopic wear and tear to blood vessels. When these tiny tears occur, platelets clump together at the site of the damage to form a blood clot. This stops any bleeding before you would even be able to notice there was an issue.
Normal platelet counts vary depending on the laboratory equipment being used to measure their levels. Generally speaking, a normal platelet count is anywhere from about 180,000 to 500,000 platelets per microliter of blood. Most of the time, there are no signs of ITP until the platelet count dips below about 40,000 platelets per microliter of blood. At that point, the risk of spontaneous bleeding sets in.
Occasionally, dogs are diagnosed with ITP due to a moderately low platelet count found by accident on routine yearly bloodwork. However, it is much more common for dog parents to have no idea there is a problem until the platelet count is less than 10,000 platelets per microliter and their beloved companion starts showing obvious signs of bleeding.
What are the symptoms of ITP?
The clinical signs of ITP can be broken into three main categories:
1. Direct signs of bleeding or bruising
- Small pinpoint bruises on the skin or mucous membranes (i.e. petechia)
- Larger bruises on the skin or mucous membranes (i.e. ecchymosis)
- Blood in the urine (i.e. hematuria)
- Dark, black, or tarry stool (i.e. melena)
- Fresh red blood in the stool (i.e. hematochezia)
- Blood in vomit that can appear like coffee grounds ( i.e. hematemesis)
- Nose bleeds in dogs (i.e. epistaxis)
- Bleeding into the whites of the eyes (i.e. scleral hemorrhage)
2. Signs related to anemia in dogs (i.e. low red blood cell count) from losing too much blood
- Pale or white gums
- A lethargic dog
- Decreased appetite
- Exercise intolerance
- Rapid heart rate
- A dog who is breathing fast
- Collapse
3. Signs related to the body system where bleeding has occurred
- Blindness from bleeding into the back of the eye (retinal hemorrhage)
- Dog seizures or other neurologic signs from bleeding in the brain
- Difficulty breathing from bleeding into the lungs
If you notice any of these signs, please make an appointment with your vet immediately. In some cases, severely affected dogs may need an emergency vet visit .
How does the vet reach an ITP diagnosis in dogs?
At the appointment, your veterinarian can check your dog’s number of platelets on the in-house laboratory equipment as part of a complete blood count (CBC). Since low platelets are the primary characteristic of ITP, a platelet count is the diagnostic tool of choice.
The CBC will also allow your veterinarian to check your dog’s red cell count. This is important as anemia can be present due to bleeding from ITP. Or sometimes ITP is combined with immune-mediated hemolytic anemia (IMHA in dogs). Evan’s Syndrome is the name for ITP and IMHA in dogs.
Occasionally platelets can clump together and read as falsely low with in-house machines. This means that in most cases, your veterinarian will want to confirm the low platelet count by looking at a blood smear underneath a microscope.
The vet will also take into consideration your dog’s age, gender, and breed when diagnosing ITP. Any dog can have immune-mediated thrombocytopenia, but like most conditions there are some dogs who might be more predisposed. Many auto-immune conditions are more common in females, and ITP follows that trend too. Middle-aged dogs are the age group most likely to have ITP. Some breeds have a higher risk as well. These include Poodles, Cocker Spaniels, and Old English Sheepdogs.
Once the vet has determined your dog has ITP, he or she will start looking for the underlying cause, if there is one.
What causes ITP in dogs?
When veterinarians think about ITP, they break it into two classifications—primary and secondary. Primary ITP (i.e. idiopathic ITP) is a diagnosis of exclusion. This means the vet will use additional diagnostic testing to rule out the presence of a trigger. If the vet doesn’t find a clear cause, he or she will categorize it as primary ITP.
Secondary ITP occurs when another medical condition triggers the immune system to run amok within the body, attacking its own cells. Common triggers of secondary ITP include:
Infections
Almost any infection can over-stimulate the immune system and trigger autoimmune disease. However, there are some infections where this is a much more common occurrence than others. Fleas and ticks spread many, but not all, of these infections.
Some of the more common infectious triggers of ITP include:
- Tick-borne disease in dogs such as Ehrlichia, Rocky Mountain Spotted Fever, or Babesia
- Bartonella
- Mycoplasma
- Leishmania
- Leptospirosis
- Heartworm disease in dogs
- Systemic fungal infections
Drugs or vaccines
- Sulfa drugs
- Cephalosporins
Note: While vaccines were once thought to be a common trigger for immune-mediated diseases like ITP, more recent studies have not supported this link. In general, vaccines are safe and do a great job of protecting your pet from preventable illness. If you are wondering which dog vaccines are absolutely necessary, I recommend having an open conversation about your concerns with your veterinarian.
Cancers
- Lymphoma in dogs
- Leukemia
- Multiple Myeloma
- Histiocytic Sarcoma
- Hemangiosarcoma in dogs
How do you find the underlying cause?
To look for these triggers, your veterinarian will study your pup’s medication and vaccine history, ask you questions about preventative medications and lifestyle, and run additional diagnostic tests.
Your vet may perform a more limited in-house test for some common tick-borne infections. Alternatively, more comprehensive tick panels are available through outside veterinary diagnostic laboratories. In some cases the vet may decide to start a course of the antibiotic doxycycline while awaiting these results because doxycycline is effective against many tick-borne diseases.
To look for any underlying evidence of cancer, your veterinarian will likely recommend full lab work. He or she may also recommend chest and abdominal radiographs or even an abdominal ultrasound.
Fletcher’s ITP trigger
In Fletcher’s case, he had not been on any recent medications and we were diligent about giving him his flea, tick, and heartworm preventative medications. His chest radiographs were normal. Since I had access to internal medicine specialists at my veterinary school, we also performed an ultrasound and a more comprehensive infectious disease panel a few days later. Thankfully, Fletcher’s ultrasound did not show any evidence of cancer.
When the infectious disease panel came back, we were surprised to discover that Fletcher was positive for Bartonella, an infection that is spread via fleas and can sometimes trigger ITP. We treated Fletcher’s Bartonella infection with a course of antibiotics and crossed our fingers.
Many times, if you treat the underlying trigger, the ITP can resolve. However, this was unfortunately not the case for Fletcher. His ITP did not go away, but with the help of daily medications, he managed to have a wonderful life.
What is the treatment for ITP?
After reaching a diagnosis of ITP, the veterinarian will propose a treatment plan. It may involve:
Immunosuppressive medications
An out-of-control immune system is the root problem with ITP. So you would be correct if you guessed that medications to suppress the immune system are the mainstay of treatment. Steroids like prednisone for dogs are almost always part of the arsenal. However, the vet may also add on other secondary immunosuppressive medications like cyclosporine, mycophenolate, or azathioprine.
Vincristine
If your furry friend ends up needing to be hospitalized for ITP, your veterinarian may talk to you about a medication called vincristine. This is an injectable chemotherapy medication. Since it is given at a lower dose for dogs with ITP, side effects are rare. Vincristine functions to push any leftover tiny platelet fragments out of the bone marrow and into circulation. Studies have shown that dogs who receive vincristine have slightly shorter hospital stays due to a more rapid increase in their platelet count.
IVIG
Intravenous Immunoglobulin (IVIG) is a more intensive treatment option that veterinarians usually reach for in severe cases or if a patient is not responding to more standard therapy. It is a human product and can be quite expensive, making it cost prohibitive for many pet parents.
IVIG essentially works by neutralizing the immune system cells by clogging up the site where they would bind to the platelets they were planning to inappropriately destroy. It is an injectable medication that must be given in the hospital as an infusion. IVIG can be a good option for some situations, and is generally well-tolerated. However, it is not a common day-to-day medication in the arsenal against ITP.
If you are interested in learning more about vincristine and IVIG, a study published in the Journal of Veterinary Internal Medicine compared these two options in dogs with ITP.
Blood products
Some dogs with ITP experience significant blood loss since they cannot mount an effective clotting response. If dogs lose enough blood that they are experiencing clinical signs from their anemia, they may need a blood transfusion. Packed red blood cell transfusions are the most common type of blood transfusions performed in veterinary medicine. These transfusions don’t provide any platelets or stop the bleeding, but they do stabilize the patient to buy more time for the medications to stop platelet destruction.
In some cases, veterinarians may reach for a whole blood transfusion to help with anemia and ongoing life-threatening bleeding. Whole blood contains both red blood cells and platelets, but unfortunately the platelets in the transfusion last for an incredibly short time inside the body. They may very temporarily help with severe bleeding, but this effect is short-lived. Unfortunately, a whole blood transfusion will not lead to an increase in platelet count.
Since ITP destroys platelets, it would seem like giving the dog more platelets would be a good treatment option. However, while platelet transfusions are relatively common in human medicine, they aren’t that useful in dogs with ITP. Two issues are at play in this situation. The first is that canine platelet products have somewhat limited availability. The second and more significant issue is that the platelets, once transfused, will be destroyed within hours by the same abnormal immune response that is destroying the dog’s own platelets.
Other supportive care
If your beloved pup is diagnosed with ITP, your veterinarian may add in other supportive medications to help treat specific symptoms. These may include:
- Antacids or stomach coating medications if your dog is experiencing gastrointestinal bleeding.
- Antinausea medications if your dog is nauseous.
- Appetite stimulants for dogs if your dog is not eating.
Your veterinarian will work closely with you to tailor the medication and treatment plan to your furry family member’s specific situation.
What is the prognosis and survival rate for dogs with ITP?
Using the treatment options we just discussed, the short-term prognosis for ITP Is good. The overall survival rate is roughly 80 to 85%. Unfortunately, though, this does mean that 15 to 20% of dogs pass away or are euthanized due to ITP.
There are a couple of factors that have been linked to a lower survival rate for some dogs with ITP. These include bleeding from the GI tract and an elevation in a blood marker known as BUN. If your pup falls into one of these categories, instead of losing hope, I recommend specifically talking to your veterinarian about your worries and discussing ways to tailor your dog’s treatment to his or her specific clinical situation.
The ups and downs of ITP treatment
One of the harder things to counsel clients on during treatment for ITP is the very normal, but understandably anxiety-inducing waiting game. It can take anywhere from four to seven days on average for immunosuppressive medications to kick in. During that time, we often check the platelet count and red cell count on a daily basis.
It can be very disheartening for dog parents to see that platelet count go from 8,000 to 5,000 to 5,000 again, especially if their dog is showing signs of bleeding. However, it is important to understand that just because a dog hasn’t responded over the first few days, doesn’t mean they still don’t have a good chance of responding positively to their medications.
Indications of improvement
You can breathe a sigh of relief when your dog’s platelet count increases above about 40,000 platelets per microliter. This is generally when your veterinarian will consider your dog to be out of the woods. At this level, life-threatening spontaneous bleeding is much less likely. Even so, you will want to treat your dog as if he or she is quite fragile until the platelet count increases back into the normal range.
This means no running or jumping or boisterous play. I even tend to recommend soft or canned food to decrease the risk of bleeding from the gums while waiting for the platelet count to normalize.
Happily, once the platelet count begins to rise, it normally continues to do so very quickly. Your veterinarian will likely want to monitor the platelet count every several days until it is normal. Once the platelet count has been in the normal range for three to four weeks, then the first step is to gradually reduce the dose of the steroid medication (often prednisone).
The vet typically decreases the dose by about 25% every three to four weeks while continuing to monitor to ensure the platelet count does not start to drop back down. If a secondary immunosuppressive agent was part of the treatment regimen, the vet will decide whether or not to stop or wean that medication once he or she is able to get the dog off steroids.
Medication side effects
Vets aim to taper the steroid dose first because while steroids are potent and effective medications to suppress the immune system, they do come with a number of side effects. Being able to use lower doses of steroids can be one of the advantages of adding in a secondary immunosuppressive medication.
All dogs are susceptible to experiencing steroid side effects, but large and giant breed dogs tend to be most sensitive. Some of the side effects you might see with chronic, high-dose steroid administration include:
- Increased thirst in dogs and increased urination
- Increased panting
- Lethargy or listlessness
- Weight gain, especially for small to medium-sized dogs
- Weight loss and significant loss of muscle mass, especially for medium to larger breed dogs
- Pot-bellied dog appearance
- Increased appetite
- Increased risk of other infections (skin infections, UTIs in dogs, etc.)
- Thinning of the skin
- A thin or dull haircoat
- Insulin resistance, which may increase the chances of diabetes mellitus or cause issues in an already diabetic dog
- Iatrogenic Cushing’s disease in dogs
If you think your dog’s steroid side effects are becoming problematic, speak to your veterinarian. He or she may be able to adjust your dog’s medications to reduce or eliminate some of the side effects.
What to expect long-term
Because of these side effects, vets always hope that we will be able to wean our ITP patients off all of their medications. That is possible in many cases. However, approximately one-third of dogs will have a relapse of their ITP either during their medication tapering or at a later date.
Sometimes it can be harder to get these dogs back into remission, but often they do still respond well to immunosuppressive medications. In some cases, dogs end up on life-long immunosuppressive medications to keep their ITP at bay. The vet will always try to get them on the lowest doses of medications that both control their disease and minimize their side effects.
Fletcher’s long and happy life with ITP
I can’t end this article without telling you what happened to Fletcher. He responded well to his medications and went into remission quickly. Happily, he never ended up needing a stay in the hospital or any blood transfusions.
A couple of months after weaning off his medications, a routine recheck revealed a significantly decreased platelet count. This indicated a relapse, which of course we felt disappointed about. He responded well again but his platelets dropped once more as we got him on the lowest doses of medications. This meant that he fell into the camp of dogs who need lifelong immunosuppressive medications to keep their disease at bay.
We bought a pill organizer, and we were diligent about giving his medications every day and keeping up with his routine rechecks. He experienced some side effects of the long-term steroid use including having to pee more often and losing a lot of his muscle mass. Luckily, at this point I was working at a specialty hospital. The internal medicine specialists were great about giving me lots of advice on his care.
We switched up his medication cocktail and found the right combination of medications that kept him in remission but also minimized his side effects. He lived a very happy life on those medications for more than six years.
Fletcher’s legacy lives on
Fletcher’s happy-go-lucky nature was both a blessing and a curse because by the time he started to act sick from cancer (unrelated to his ITP), it was already in his liver, spleen, and bones. We kept him as comfortable as we could and fed him lots of tasty, previously off-limits foods. Then we let him go when he told us it was time.
We still miss him very much, but we have so many wonderful memories with him. I am grateful for all the lessons he taught me, both about navigating a diagnosis of ITP and about how to empathize with dog parents when they are dealing with a complicated medical condition in their beloved companions. I hope that if you are facing a diagnosis of immune-mediated thrombocytopenia with your beloved dog, this article and Fletcher’s story give you the knowledge and the hope you need to make it through to the other side.
Has your dog been diagnosed with ITP?
What words of advice do you have for other dog parents who find themselves in a similar situation?
Hi! My 6 year-old male Yorkie was limping, lethargic, and had a fever. The vet diagnosed him with ITP (platelets 47 with a normal range of 148-484) and possible acute Lyme disease. A 4DX test showed he is positive for Lyme (however, he was already found to be positive for Lyme a year ago, but was asymptomatic at the time). He put him on a 30-day course of Doxycycline as well as a month’s worth of Prednisone. I’m to recheck his platelets in 5 days. Information about Lyme disease and thrombocytopenia is scarce, especially how to treat these conditions concurrently. Since there is no definitive test for acute Lyme infection, the doctor wanted to err on the side of caution and therefore put him on the steroids instead of just treating him with the antibiotics. Does treating with Prednisone and Doxycycline simultaneously seem like the right course of action?
Hi Alexandra,
I am sorry your little guy is so sick, and I understand why you are concerned. From what you describe, your dog’s case is complicated. In these instances, it can be tricky to know exactly how to proceed. It sounds like your vet is delivering the standard of care that would be expected and trying hard to turn things around quickly for your pup. How is the treatment going? Is your dog feeling better? If you have any lingering questions or concerns, you can always schedule a consult with a specialist. I hope your sweet boy is on the mend and back to living his best life. Best wishes.
Hi Dr. Buzby, thank you so much for writing back. I just got off the phone with my regular vet. My dog has been on the prednisone and Doxycycline and has been doing well. He is back to his normal self. However, as we’ve been decreasing the prednisone, his platelets have started dropping again. They are still in the normal range, but the doctor suspects that this has not been caused by Lyme disease after all. She suspects that ITP itself is the primary cause. She recommends finishing off the antibiotic anyway, continuing the prednisone for now, but also adding on Mycophenolate while continuing to wean off the prednisone. I am going to have him undergo an ultrasound and x-rays to rule out cancer. I am beside myself with worry that it is not “just” ITP. He’s having those tests done on Monday. I’ll write back when I know more.
Hi Alexandra,
I am glad your vet is not suspecting Lyme Disease anymore, but I know that does not take away your worry for your pup. Hoping this extra testing will produce some answers with a positive outcome. I think it is great you are adding Mycophenolate to the treatment protocol. You should see some good results soon. Praying for your vet visit today. Thank you for the update and I look forward to the next!
Good news! The ultrasound and x-ray came back all clear! I’m so relieved! So now that any underlying condition has been ruled out, the doctor says to keep him on the same dose of Prednisone for now and have another blood test done in a week. When those results come back we’ll decide whether to keep weaning him off the Preds or switch him to Mycophenolate.
Hi Alexandra,
YAY! This is such great news! I am very excited for your little guy and hoping his lab work will show the positive results we are praying for. Thank you for the update and I look forward to the next. ♥
The ultrasound sound came back today. The abcess is gone. They want her off the shots as her urine test is showing a strain on her kidneys. Her blood test for her kidneys is fine. She is also going back to every three days of pred at 1.25mg. They believe where the abcess was, was making her sick. We hope to remove the Prednisone in a week. The only thing I didn’t get an answer on was the Lipase. I kept getting the number wrong. It was 2350 then was 2210. Her platelets were great, white blood cells etc. I’m hoping her kidneys were not damaged beyond repair.
Hi Randy,
This is great news! If the kidney values on lab work look good, then I would not think you would need to worry about kidney damage. It sounds like everything is going the right direction and the abscess has resolved as hoped. The pancreas (responsible for lipase) may have gotten a bit aggravated with everything going on. I am glad your vet is keeping an eye on it and feel like it will calm down now that the abscess is under control. So glad to hear this positive update on Holly. Have a great week!
Hello Dr. Buzby,
Holly had a follow-up ultrasound and the mass is still gone. She is also off prednisone and has not gotten sick. I’m hoping she can catch a break for a little while. gallbladder removal, ITP, Mass on liver. She keeps fighting. She now goes for two walks a day and runs and plays with her friends. She will be 14 in eight days
Hi Randy,
What a great report from the recheck! Maybe things are finally under control and will remain stable for a long time. I am so happy Holly is feeling good and enjoying her daily walks. She definitely doesn’t look 14!!! Thank you for letting me know and allowing me to be a part of Holly’s life. All my best to you both. ♥
Thank you for listening and responding. It was very helpful through these hard times. Holly, Joey and I thank you.
Holly went for a recheck. She has something small on her liver in a different spot and her liver enzymes are up a little. it’s very small they said and can’t tell what it is. They will needle express it. It could be Ecoli again or Inflammation which she has had. She’s been off prednisone for about three weeks with no issues. It’s possible she has to go back on 2.5mg. If it’s the ecoli that’s going to kill her kidneys. I don’t know what she has done to deserve this.
It looks like the ecoli might be back. With her only being on it 10 days because of her kidneys they think it didn’t kill it all. There is another antibiotic that was shown to kill it. It requires two shots a day but is not harmful on the kidneys. I don’t know the name of it. Waiting for the cytology to come back. The biopsy really showed nothing of importance. I’ll have to learn how to give shots. I feel so bad. I don’t want to hurt her. She went on three walks today.
Dear Randy,
I am still praying for Holly and hoping she can overcome all this adversity. Giving injections can be intimidating but I assure you they are easy, and you can do this! A bit of food is a great distraction, and your girl may not even realize she received her treatment. Keep fighting the good fight. I am certain Holly knows how much she is loved and is living a life full of joy because of you and your steadfastness to her care. Bless you and your sweet girl. ♥
Hi Alexandra,
I hope that your Yorkie is responding well to treatment. Your comment caught my attention because of the symptoms that you reported prior to ITP Dx. I have a 2 y/o Doberman who presented w/fever, lethargy, confusion, and literally stumbling/unsteady on his feet. He does not present any bleeding/blood issues. Most of the ITP information that I have found discusses the “blood issues” (bruising, petechiae on eyes, ears, etc). Did your pup have any blood related symptoms? My concern is that I do not want to miss something that could potentially be worse while we are treating the ITP.
Any feedback you can provide is sincerely appreciated. Thank you I’m advance.
Sorry in advance for the super long comment!
This article was do informative and uplifting. Our dog Bentley was diagnosed with primary ITP in July of this year when he was only 1.5 years old, after getting his yearly vaccinations. Fortunately he responded well to Prednisone and his platelets went from basically zero up to normal fairly quickly and have been perfect ever since. We have been very slowly tapering him off over the last few months and everything has stayed stable, and we are hoping to have him completely off of Prednisone and his liver supplement in the next few months, fingers crossed! I’m really hoping after that his platelets will stay up on their own, but we will do whatever we have to do to keep him healthy and happy.
I know in your article you said that there is no real support saying that vaccines can trigger ITP, however this is the only thing that Bentley’s team has been able to find that could have triggered his ITP as it happened so quickly after his shots. We have decided to be very cautious about vaccinating him in the future, but I am worried because I believe by this coming June, he will be out of date on his Parvo and Distemper vaccines, and that worries me. Especially because he loves to be around other dogs and go to public dog events and classes that require these vaccines, and we can’t afford a titer test to prove he’s clear before each of these events. Do you know of any ways to help prevent an immune response when admistering vaccines in a dog with ITP? Thank you for your time, and for writing this article and devoting your career to this!
Hi Becky,
I am so glad Bentley was able to make a full recovery from his scary ITP diagnosis. I understand your concern with the idea of repeating vaccines in the future. I am not aware of any treatments that could lessen the possibility of a relapse. This would be a great question for an internal medicine specialist. Your vet can always consult with a specialist if needed to determine the best course of action. Checking titers is a great option and it is generally done once to twice a year. Most classes and establishments in my area will honor this testing if done yearly (similar to the frequency of vaccination). You can also make sure to get your pup a 3-year Rabies and distemper/parvo vaccine. This way you only have to worry about revaccination every 3 years. Talk to your vet to see which type of vaccine they carry and try and eliminate vaccines that are not completely necessary. I hope this helps a bit and I am wishing you and Bentley the best for a bright future!
Our 2yr old Great Dane is in remission, but has now torn ccl. I am unable to find any info on the internet about a surgery after remission. I am worried the stress and actual surgery will spark imtp again. Your thoughts on this?
Hi Jenn,
I understand your concerns with surgery, and you are right to be cautious. I honestly don’t know if knee surgery would be a potential trigger or not. This would be a great question for a specialist. Your vet should be able to reach out to an internist or schedule you a consultation if needed. I am praying you find the answers you need to make the best choice for your big guy. Please leave an update with what you find out. I am curious to know what the expert recommendation is for your sweet boy’s situation. Wishing you both the best.
Our Boy was diagnosed just today. He is almost 10 years old and on medication for his hip pain. Our choices are either to keep him on his pain meds to keep him comfortable or go with the treatment for this….we chose to keep him comfortable.
He has cancer masses on his body so we guess they can be related.
We know we’re going to have to say our good-byes at some point soon, but we are just trying to keep him comfortable right now.
He still eats well and occasionally wants to play with his brothers, otherwise he sleeps all day.
Dear Danielle,
I am sorry your boy is facing so many difficulties and nearing the end of his days. I am glad you are able to keep him comfortable and enjoy some additional quality time together. My thoughts are with you as you face some tough choices ahead. Praying for strength to face each new day.
Our 4 year old Maggie (4 on Tuesday 11/22) corgi, our first dog….was diagnosed with this last night. She was running agility no problems one night and the next lethargic and not our dog. Her platelet count was near 0 and now at the last lab level she is at 5,000. We opted to bring her home and make her comfortable. We are doing medications with steroids and antibiotics. The next few days are critical, it’s near physically impossible to get in anyplace. Fingers crossed things go in the right direction. She loves dog sports she loves agility and fast cat do you recommend her to no longer do that ever?
Hi Jenny,
I am sorry Maggie is struggling with ITP but glad she was able to come home and be with you while trying to recover. How are things today? I am not sure what the original trigger was for this condition in your pup, but I would not think exercise would have a negative impact once in remission. Of course, it would be a good idea to discuss these concerns with your vet. You may even want to schedule a consult with an internal medicine specialist. I hope Maggie is on the road to a full recovery. Praying all is well and wishing you both the best.
Thank you so much for sharing your experience, and your guidance about this disorder! Our beloved Indy, and 8.5 year old Frenchie, was diagnosed with metastatic adrenal cancer in early October. We began treatment with Palladia and she felt great! They said she was a candidate for stereotactic radiation, so we thought what the heck, let’s do this too! She received SRT from 10/25 to 10/27, and from the moment of her first treatment, she’s been sick. She had hemorrhagic diarrhea and melena, and was hospitalized due to mild anemia. She was released from the hospital but continued to have issues with bleeding until we were able to start her on sulcrafate. But at that point too, they found dangerously low platelets and a raised MPV, along with worse anemia. It wasn’t until yesterday that we learned that the platelets were 100% not a mistake, and Indy’s been put on prednisone. Thank you for sharing, this helped us feel less scared and alone.
Hi El,
I am sorry your little guy has had so many setbacks over the last few weeks. I am glad the platelet issue was found rather quickly and am hopeful the prednisone will help Indy stabilize. How are things going today? Praying you are seeing some improvement and your sweet boy can achieve remission. Wishing you better days ahead.
These are amazing stories.. My Mia 10 Years old was perfect one day and by the evening she was bleeding from her gums and had bruising on her belly. We took her to the ER and she was diagnosed with ITP. Her Platelet count was 24,000 and she was bleeding at a rapid speed. She got meds and we took her home but she kept getting worse. By the forth day she had not eaten or drank water for about 36 hours. I carried her to her bowl and she collapsed. Her gums were white and I knew it was time to let her rest. The meds did not work fast enough to fix the damage. I knew from the beginning it was a race for time.
My heart just wants to explode with the hurt I’m feeling. Should I have waited longer could I have fought harder did I do enough. Its been horrible. Bless those that have pulled through this horrible disease
Dear Liz,
I am sorry for your loss of sweet Mia. It is normal to grieve and ponder all the “what ifs” when you lose a beloved pup, especially under these tragic circumstances. Take comfort in knowing you did everything you could and definitely did not fail your girl. You made the right decision to free her from her suffering and give her peace and rest. I have no doubt she knew how much she was loved. I pray Mia’s memory will stay with you forever and be a blessing. ♥
Hi – our almost 11 month old Frenchie puppy Ruby was just diagnosed with suspected ITP. She stayed overnight at the ER and we just brought her home. Her symptoms were lethargy and fever only. No bleeding. The platelet count was 20,000 upon admission to ER and she had a high fever. She responded quickly to treatment and her ultrasound was clear so she was discharged. We are waiting for the more advanced blood work results to come back. She seems herself and we are being very careful she doesn’t overexert. This has been so shocking as she was fine one day and lethargic and feverish the next with no explanation. The doctors still don’t know the reason. We are praying she recovers – she’s practically a baby. Thank you for your wonderful article and its also very helpful reading thought the comments. Barbara
Hi Barbara,
I am sorry you are dealing with this scary situation in your young pup. What a blessing that Ruby hasn’t had any bleeding issues and seems to be responding well to the treatment. I am hopeful that she can achieve remission and continue to thrive. Praying for good results from the pending lab work. Wishing you both the best!
It’s great to hear positive outcome stories for a dog with ITP. We’ve been treating ours for about 6 months. She had an early relapse but has been in the 450-500 range since that relapse. She now is down to 3 MG a day (mycophenalate and melatonin as well). Her recent blood work came back as 148. Starting to worry it’s the beginning of another relapse. Our vet hasn’t been able to give a clear answer if we slightly increase the dose that it could increase the platelet count or reverse a relapse. We’re just hoping to not have a full relapse and start the process over at 20 mg again.
Hi Eliot,
I am glad your dog has continued to fight and stay strong through so many trials over the past 6 months. I understand your concern with the recent mild changes noted on lab work. I am hopeful that this is just a blip on the radar and not signs of something more serious. Praying your pup can remain stable and continue to thrive. How are things today? Feel free to leave an update if you have a chance.
Thank you for the prayers! She’s been stable since the drop in platelets hovering around 148k which is great. We decided to keep her on the 3 mg of prednisone for a couple more weeks to see if there’s any movement on the platelet count before attempting to drop it anymore. Fingers crossed it stays stable/positive so we can lower the dose!
Hi Eliot,
Thank you for the update! Glad to hear things are stable and you may be able to decrease the prednisone in the near future. I am still praying for your girl and hopeful good things are ahead for both of you. Best wishes!
So she’s currently developed a nasty UTI and did a 7 day course of nitrofurantonin. Unfortunately it didn’t resolve so we’re going to do another round of it (3 weeks). She’s down to 1.5 mg of prednisone a day. How often does Nitrofurantonin tend to interferes with ITP or blood platelets?
Hi Eliot,
I am sorry to hear your girl has developed a UTI. I am not very familiar with the side effects of nitrofurantoin as this is not a medication I use commonly. I did some research and looked through the veterinary drug formularies. There was no mention of this medication affecting platelets or causing ITP to relapse. With that being said, there is always a slight risk of an unexpected complication, but I don’t think there is cause for concern at this point. I am so glad you were able to decrease the prednisone to 1.5mg!!! That is a big win! Hopefully the UTI will respond to this longer course of treatment. How are things today?
Thank you for.such an articulate recount of this disorder. my girl, Channing, was diagnosed August 2022. At this moment, I am sitting in the parking lot of Channing’s ER Veterinary Hospital, Sage Redwood City, south of San Francisco. we have been unable to titrate her off prednisone. coupled with Mycophenolate, and after a severe gastric bleed initially out of ICU early August due to too much pred (she’s a giant Bluetick coonhound at 120 lb), she’s on 10 mg 2 x bid, 500 Mycophenolate bid, omeprazole, and she was diagnosed with idiopathic epilepsy at 1 yr old. After another blood check this past Tues, she was stable only after we had to increase pred again after trying to lower from 10 mg in am and 5 in pm. Twice we’ve reduced pred to this and both times, evidence of bleeding happened. Tonight when I for home from work, I noticed a bleed in her mouth. The right side of what looked like her tongue was bleeding significantly. I tried to pack it with gauze and apply pressure to no avail so I loaded her in the car and drove 45 min again …one of many drives we’ve made over the past 3 months. After sedating her. the ER Dr found a small laceration near her 1st re molar. She packed the area and cauterized as best she could and stopped the bleeding. I asked if … Channing’s platelets are “normal” Tonight, why didn’t the wound stop bleeding. the Dr wasn’t sure and felt Channing would be ok to take home. Channing is a hound and the pred is making her drive for food nearly uncontrollable. I have to watch her constantly on walks as she will dive for anything remotely edible. I’m exhausted. I hope I can get her to at least 10 years in age. she turns 6 this next February. wish me luck. Thank you. Fletcher looks like he would be a heart breaker. Aren’t they all? Cheers
Hi Terri,
I am sorry it’s been such a tough road with Channing these past few months. It sounds like you have a good partnership with the veterinary staff, and they are working hard to make sure your big girl remains stable. I hope with time your girl will be able to wean off of the prednisone without relapsing again. Praying for remission and a bright future for the both of you. Best wishes. ♥
We’re back. Dr Buzby. after a good 6 week run of titrating off pred ( from 10mg am/10 pm to 10mg/am 5/pm), we relapsed Thanksgiving eve when I was in LA with family. I had gained enough courage to leave Channing with my awesome dog walker after detailed instructions on how to watch for any signs of bleeding or lethargy. Chan was doing great. she had a bleed after a morning walk. I keep white sheets on her bed and sofa so we can spot bleeds quickly. since I was in LA and Chan was home in San Francisco, I instructed my dog care giver to raise the pred to 10/10. Chan’s bleeds occur while she’s asleep presenting in blood tinged saliva so it looks alarming on a white sheet. I was super concerned being out of town but managed things while contacting her internist over the holiday. the raised pred has stopped the bleed again and I now am beginning to feel your beloved fletcher and Chan have something in common … maybe a life long pred life. this marks the 3rd attempt to lower her slowly and to no avail. I will never give up on my baby girl so if that is our fate, we will carry on. Thank you for responding. I wasn’t notified but would sure like to know when posts are available to read from you and other dog parents who need support. I really like your pursuit of giving us hope through all you’ve experienced. happy holidays from the city by the bay. Terri. Channing, and Mac
Dear Terri,
I am so sorry the prednisone weaning did not go well again. Poor Channing can’t catch a break! I am glad you have been able to entrust her care to your dog walker and resume some normal activities for the holidays. The white sheet over her bedding is a genius idea. Thank you for the update and I will continue to look forward to any comments you leave in the future! Wishing you all the best. ♥
greetings, Dr.
We’re still in the game. lots has happened. Today, Channing is completely off pred. it took a village but 5 months on pred, and weaning like my life depended on it, she’s finally off. still on Mycophenolate and pregabalin (seizure fix) … we ran into the dreaded calsinosis cutis … Channing can’t catch a break as you said earlier. that has been a 2 month battle. horrific sores on top of her neck, between her front 2 toes, and on her rear end which has been especially challenging to fight bacteria. We’re on the other side of that but now, a new challenge… (fyi I am alone with this fight for her life) … we were walking on the beach as she’s been feeling strong and her rowdy self which has made my heart melt. she chased her ball a couple times as I’ve been conservative with rebuilding her strength (.she’s 125 lb coonhound) … born to run. she suddenly stopped on the beach as we walking lifting her hind leg up. I thought she stepped on something so checked her paw. nothing. kept walking. same behavior. I took her to the suv and by that evening she could barely walk. I was sure she tore a ccl. er visit next morning and it appears she experienced a hyper flex event ( tarsal hyperextension). the surgeon tried lots if leg maneuvers so the trauma seems to be in both hind paws. after 2 days she seemed better. last night I walked her and she was frisky with another dog and after a couple hours she could barely walk again. I couldn’t believe the extent of this injury that literally happened out of the blue. rest is the program. she developed trmors on tramadol so no go. we lost ground from last Sunday after last night’s friskiness so now we pay the price. she’s 6 and giant so m not going the surgical route. Shea been thru so much these past 6 months … I can’t now put her thru major surgery and recovery its just too much to ask of her so I’m going the holistic route of icing as tonight there is swelling on one paw, confinement, tlc and I ordered bracing to support her ankles below ans above the hock. they bear so much weight so I thought it I wouldn’t hurt. her internist said today while doing a recheck on blood for itp to lock in remission confirmation, let’s.give her a break and not put her thru surgery. shes nearing weight on both legs with some visable lameness for sure. at least she can still walk. thoughts?
thank you for hanging with us. Terri and Channing
Hi Terri,
Goodness, what a whirlwind! Bless you for staying strong and continuing to advocate for Channing’s health and wellbeing. I am sorry these new mobility issues have popped up, but so glad to hear the prednisone has been discontinued. That’s a HUGE WIN!!! I agree with your vet, your big girl has been through so much. A holistic approach to her injury/pain seems better than surgery for now. There are several ways to help decrease pain and inflammation without the use of “drugs”. Here is a link to an article with more information: Natural Pain Relief for Dogs: 13 Methods
You may also want to think about discussing Channing’s case with a veterinary rehabilitation professional. They may have additional ideas about therapies or treatments to try. I am still hopeful that your sweet girl can live a long a happy life. I am pulling for her every step of the way. Thank you for this update and please keep in touch!
I found this article very helpful! My 7 yr old terrier mix was diagnosed with primary ITP in June of 2020. He was prescribed Prednisone, and after 6 months of treatment he was in full remission. He has stopped all medication and has not relapsed since. He is going to be due for his updated rabies vaccine soon. Our vet said it was up to us if we decide to get it. What do you recommend? We know the rabies vaccine didn’t trigger it, but will he relapse if he gets it? I’m in CA, and I honestly don’t even know how to excuse him from the vaccine.
Hi Samantha,
I understand your concern with this tricky situation you are facing with your pup. While I am glad he was able to achieve remission, the thought of having to vaccinate him again makes me uneasy. Rabies is required by law, and I am not aware of any instances that an exemption has been made. With that being said, your vet is correct that the decision is ultimately yours. This might be a good topic to discuss with an internal medicine specialist. They probably have experience navigating this exact path with other dogs and could have ideas of ways to help prevent a reaction. I hope you can find the best way to keep your sweet boy safe and living his best life. Praying for a positive outcome!
My Morkie was diagnosed with IMT in May and is slowly being tapered off her meds. She had a very bad case and had to have vincristine and iVIG. Her internal medicine doctor has recommended no vaccines and we have an exemption. So it is possible.
Hi Melissa,
Thank you so much for this reply! I am glad to know that some states are willing to grant exemptions. Hoping your little pup will continue to remain stable and be able to keep living life to its fullest. ♥
hello. Channing’s internist has written an exemption for any vaccines required and we’re in SF, CA. I haven’t researched if it could be contested but I’m sure not allowing any vacs to enter her body again. I feel it is possible with internal medicine recommendation. wishing you the best of luck. we’re still fighting this horrible disease. not giving up. Terri and
Channing
Hi Terri,
I am so glad you were able to get the internist to write Channing a vaccine exemption! I will keep you and your sweet girl in my thoughts and prayers. Please keep in touch from time to time! ♥
Its been a bit, Dr! Channing is still in the fight. We’ve been thru an ITP war and it is not.winning. However the effects of prednisone have literally blown Channing’s hind paws so they are completely flat due to soft tissue/tendons rupturing. Her toes … all of them are completely flat. We’re ok because she’s still alive, happy and even though her running days are over, she is living her best life. After so many trials getting her off prednisone, it is abundantly clear she is a life.long candidate at 20 mg / day. It is simply remarkable that when I begin to wean her off just 5 mg less, within 36 hours, she has a bleed from her gums while sleeping. That is how close I’ve dialed her in on dosage.. I’m sure her platelets are consistently low, ….ranging from 15-30,000 ?? the numbers swing dramatically I’ve noticed …
… after the dozens of blood tests taken, it’s a moving target so I just watch her like a hawk and together we are grateful for each day. she turned 6 February and if I can be lucky enough to get her to 10, that will be my luckiest day ever. She may just make it❤️ thanks for tracking along with our very special life journey, Dr. Hoping all is well on your own journey! Cheers, Terri
Hi Terri,
Thank you for the update on Channing! You are doing a great job at staying on top of her symptoms and finding the right dosage of prednisone. Hoping your sweet girl can keep on fighting and wishing her many happy years ahead. Keep up the good work and stay in touch!
Holly ended up having a minor case of pancreatitis. She’s on boiled chicken, Flaygl. Not sure if that could have caused her liver enzymes to go high
Hi Randy,
It definitely could. We will hope that is the case!
Her numbers went from 360 to 154 ALT. And 2600 to 1100 ALTP.
Hi Randy,
YAY! Will continue to keep you and Holly in my thoughts. Celebrating this small yet wonderful victory!
Hello,
I am in CA with an 11 year old black lab mix. In response to the above question, we have filled out paperwork with our Vet’s help that allows us to get a dog license from CA with no Rabies vaccine. Ask your Vet to provide you with this paperwork. Unfortunately it has to be filled out every year but it is worth it to avoid the vaccine.
This blog is so very helpful for us to see everyone’s stories and various off-label treatments. Buddy was 10 1/2 when he was diagnosed with ITP last November. We were lucky to have found this out after he became lethargic and an x-Ray showed rocks in his stomach (labs do eat anything!). Anyway, the rocks weren’t the issue but his blood tests showed us the ITP. He was in remission briefly and is now on 60 mg pred plus an immunosuppressant. We are lucky to have a great Vet and are hoping for the best. Our Buddy is such a lovely chill guy, he is very pliable and wonderful with all the people who are helping us through this medical challenge.
Hi Teresa,
I am glad Buddy is responding well to treatment and is loving life. I think it is great that the state of California will allow your vet to submit paperwork for Buddy to forgo his annual rabies vaccine. Thank you for sharing your experience. Wishing you and your sweet boy the best. Keep up the good work!
Julie,
Thank you. Unfortunately Buddy has not responded to 2 immunosuppressants and his liver levels are elevated. We are meeting with an internist to see what makes sense at this point. I don’t think we want him on any more immunosuppressants so we plan to ask what would happen if we take him off all medications and just let him enjoy the rest of his time on earth as the happy dog he as before we pumped him full of medication. What is the downside of allowing ITP to run its course, do we have to go straight to euthanasia? My friend is a human doctor and seems to think he would just pass quietly from an internal bleed. He isn’t super physical and doesn’t go to dog parks r really interact with other dogs.
So the risk of a broken bone or being hurt by another dog is slim.
Anyway, I’m glad you are here and would love to know your perspective.
Thank you
Teresa
Dear Teresa,
I am so sorry Buddy’s condition is deteriorating and you are facing some difficult decisions ahead. I am a bit concerned about just allowing the ITP to run its course. While a peaceful passing is a possibility, it is not common. You have to make the choice you are comfortable with, but I just want you to be fully informed. As a dog’s platelet count drops to zero, there are many possible symptoms you could see. These include bruising, bleeding from the nose, gums, eyes, or rectum, struggling to breathe, and seizures. This is not an exhaustive list but just the more common possibilities. It is possible to provide hospice care and still offer a humane euthanasia when the time comes. I always think it is better to say goodbye one day too early rather than one day too late and allow unnecessary suffering. I will attach links to other articles that have great information and good advice from other readers. I hope you can find the answers you need to choose the best path for everyone involved. Wishing you and Buddy comfort and peace. Bless you both. ♥
1. Using a Quality of Life Scale for Dogs
2. Dog Hospice Care Can Bring Peace and Dignity to Your Dog’s Final Days
3. Preparing for Your Dog’s Euthanasia: 10 Thoughts for Peace
4. Dog Euthanasia: Knowing When to Say Goodbye
Dr Buzby,
I sent a response to this message yesterday but it may be in your box pending approval. Anyway, I will summarize here. Buddy is not doing well and is on a 3rd immunosuppresant. My husband really wants to remove all meds and let Buddy enjoy what few good days he may have left (he is 11 year old Black Lab). We have recently weaned him from 60 to 40 mg of pred and will work with our Vet to keep reducing it appropriately. My question is, what can happen with ITP if it is untreated and does the dog feel pain? We don’t want to put him down any earlier than needed and would like to be realistic about what can happen if he is un-medicated and what we should look for to know it is time. Thank you.
Hi Teresa,
I just finished typing a reply to your comment from Saturday. I hope it will offer some advice and the guidance you are looking for. Praying for you all to have the strength and courage to face this unknown path ahead. Give your sweet pup a hug for me. ♥