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?
I have a 12 year old Shih Tzu that was first diagnosed with ITP in December 2020. He started prednisone and after several months, we were able to taper off. A few days ago, after a visit with his vet, his bloodwork showed his platelet count at 0 and the vet saw 4 platelets on the smear. We were sent home with prednisone and cyclosporine. My vet is very concerned, and I may be naive, but Bentley handled treatment so well last time, so I have less worries.
My mom did some research (googling) and suggested I try feeding Bentley small amounts of liver hoping that can help. Besides soft food, do you have any other diet suggestions for dogs with ITP?
Hi Maggie,
I am sorry Bentley experienced a relapse of his ITP. Hoping he is doing better, and things have stabilized. I am not sure I have any specific recommendations for dietary changes to help with this condition. It may be a good idea to reach out to a holistic veterinarian or one that practices Traditional Chinese Medicine for options. Wishing you and your sweet boy the best!
I am so frightened right now. My beloved 9 year Cockapoo had a totally normal yearly physical in April , 2023 with all labs being WNL. On 7/29 I noticed petechiae and bruising on his abdomen. The next day melanotic stools. He was seen the following morning and diagnosed with anaplasmosis (was negative 4/23) and had been on monthly flea and tick preventatives. His PLT count on first appointment was 8,000, 48 hours later dropped to 5,000, HCT 20. He is hospitalized and has received high dose steroids, azathioprine and a whole blood transfusion. He is not improving and today receiving vincristine. PLTs this AM are 1,000. He is not eating. I did say DNR if he arrests as his poor little body could not handle CPR. I don’t know when to say enough is enough and if he can recover from this. Any thoughts would be appreciated.
Hi Carla,
What a scary few days you had with your Cockapoo. It sounds like your veterinary team is doing an amazing job taking care of him and trying all the right treatments to get his platelet counts to come up. Hopefully he starts to respond soon! However, if he continues to decline, it probably does make sense to have that hard conversation with the veterinary team about when it is time to stop. Since I’m not involved in his care, I can’t really speak to when that point would be, but I’m sure that his veterinary team would be able to provide some guidance. Fingers crossed for a good outcome for him!
Hi Dr. Buzby
Thanks for sharing Fletcher’s story. I have a rottweiler who is 12. She was brought to the hospital showing signs of non-stop bleeding from the gum, lethargic and eventually collapse. She has been in care for six days now, having a few blood transfusion as well as given the drug Vincristine and steroids. We are on to day 5 of Vincristine, however, her platelets remain 0. The doctor also suspect gastrointestinal cancer as ulcers are being found in the area and she has bloody diarrhea . However, there seems to be no way to test it because of her ITP (risk of bleeding obtaining biopsy). We seems to be really at a cross road here. Our doctor suggest IVIG next, but we are unsure because of the cost and we were told that it will likely not change the prognosis as well. What is your opinion on IVIG and the chances of it working? This is our family’s first dog, we are really at a loss about how to proceed. We have a good team working on her, but of course they are reluctant to give some straight answers at time. I am hoping to get an insight from a different viewpoint into the situation if possible. Thank you so much.
Dear Melody,
I am so sorry you were faced with this tragic situation. I wish I could tell you what was best, but with these uncertain circumstances, no one really knows what to expect. I am sure your veterinary team is giving you the most straight forward answers available. IVIG does sometimes make the difference for some dogs but not for every case. If you are prepared to do anything and everything (including cost) it is worth a try. It is also never wrong to forgo further procedures and elect to do palliative/hospice care. I am sorry for the delay in responding. Praying your sweet girl was able to turn things around and make a full recovery. Feel free to leave an update if you would like. Bless you.
Hi Dr, thank you so much for sharing your story about Fletcher. I am currently going through this with a seven-year-old German Shepherd, who just recently received the rabies vaccination. Although it’s not conclusive, it’s thought that the rabies vaccination could have possibly started ITP to my Una . I’m curious how many other scenarios have played out for other owners? Una had the telltale sign of the hematoma in her eye, which resulted in nerve damage, killed her platelets and now is trying recover. Am I honest opinion that has to be an outcry about these vaccines being necessary for animals in some instances yes but I think in my opinion as a money grab for all the pharmaceutical companies just like they did with Covid. Can you direct me to any national firm that can help Spread the word the possible Issue with administering certain vaccinations. I mean, there hasn’t been a rabies outbreak in forever thank you.
Hi Charlie,
I am so sorry you are battling this nasty disease with your beloved Shepherd. While most vets try to only administer vaccinations based on the pet’s risk and lifestyle, rabies is a bit different. Many states have strict rabies laws which limit veterinarians as to what we can and can’t recommend for our patients. While this sounds like an overreach of government, the laws are put in place to protect the general public. Rabies vaccinations are truly meant to keep dogs and cats from spreading the virus to humans (not merely to protect the animal). Rabies has less than a 1% survival rate and there is no treatment. So, while there has not been a rabies outbreak in many years, we definitely want to keep it that way! I understand how this complicates things for dogs that deal with any number of immune mediated diseases. Ultimately you have to do what you feel is best for you and your pup. Hoping Una can continue to improve and praying for a full recovery.
For a dog with immune-mediated thrombocytopenia (on maintenance prednisone) is there a standard of care with respect to managing heartworm & flea preventative use? I know these things are different from vaccines (& their potential issues), but dogs with IMTP seem “fragile” & I worry about “disordered” reactions to these preventatives that other dogs seem to tolerate well. Vets have said it’s no big deal, but some of the same ones have said vaccinating a dog with (chronic) IMTP isn’t a big deal either. Any thoughts? Thank you.
Hi Karen,
I understand your concern about giving your dog anything that could potentially cause an ITP relapse. Unfortunately, I don’t think there is a standard recommendation when it comes to monthly preventatives. Most of my patients have continued to receive their monthly prevention with no issues but I know we can’t make definite conclusions about what could trigger ITP in different dogs. I think you have to trust your gut and rely on your veterinarian’s experience. I am not sure there is a clear right or wrong answer. Wishing you and your pup the best of luck.
Hi Dr Buzby,
Here a message on the progress of Mowgli,Monday August 7 i went back to the clinique again and unfortunately his platelet count was almost 0 again.So. the vet and i decided to start with the Romiplostime also known as Nplate and i menaged to get my hands on a dose of 125 micrograms and the next day we started with 50.3 microgram and last tuesday i went in again for platelet count and he had a major rise up to 648! We gave another dose of 5.3 and upcoming tuesday he will get his 3th dose and count his platelets..I already purchased a 2nd dose for him and my vet and i are trying to figure out now where to go from here My vet had never heard of Romiplostime used in dogs but since Mowgli was diagnosed with itp i went on a relentless search out on the internet and i found a medical journey that had been done in Germany where it had been tested on 5 dogs and 4 of them went in remission.I am so glad that my vet was open for trying it and i urge any other owner with a dog with itp that doesnt respond on the prednisone and immune supressors to try it out.
https://bmcvetres.biomedcentral.com/articles/10.1186/s12917-016-0718-4
Here is the article and i will keep you posted on how things will go further for my little ewok.
Greetings,Chomissa
Hi Chomissa,
WOW! This is amazing! Thank you for the update and for sharing this valuable information. I hope others can use this and have an informed discussion with their vet to see if this could be an option for their dogs. What great progress you are seeing with Mowgli. This post has made my day. ♥
Hi Dr Buzby,
I wanted to give you an update on Mowgli so yesterday he had his 3th dose of Romiplostime.The veterinarian gave him 40.1 mcg.Three weeks ago his platelets were 648 and she decided to pause with giving him a dose,then one week later his platelets dropped to 110.So last week she gave him a dose of 40.1 mcg and his platelets yesterday were 865! She was thrilled to see again how effective the romiplostime is but she also realises that the trigger causing the ITP isnt addressed so she still thinks that a splenectomy might be necesary in the near future.She is tapering the dose of prednisone now,we went from 15 mg to 5 mg..and the profit of the Romiplostime is that no platelet transfusion will be needed before surgery..In a few months there will be a veterinarian congress in Barcelona and Mowgli’s case will be mentioned there as we are the first ones here in The Netherlands that have used Romiplostime with ITP in dogs..They have also started the Romiplostime now with another dog,this dog is bigger though and needs the whole dose wich is costly.125 mcg is 416 Euro..Did you know that a British and Dutch hospital have created a milt and liver scan in order to predict wich of the two is destroying the platelets for humans? It would be so helpfull if this could work with dogs to!
.https://www.ntvh.nl/journal-article/de-itp-lever-miltscan-een-mogelijke-voorspeller-van-de-kans-op-remissie-na-splenectomie-bij-itp-patienten/
perhaps you can translate this article.
Greets,Chomissa
Hi Chomissa,
WOW! This is amazing! What a blessing for Mowgli and I am so excited you have shared this breakthrough information with us! I know you are still concerned for your boy with such a big surgery coming up. I am praying for him that things will go smoothly, and this will be the turning point in getting him on the road to recovery. Please let me know how things go after his surgery and know we are all wishing you both the best. ♥
Hi Dr Buzby
Here another update on Mowgli,today i went for platelet counting and his count is now 881! The veterinarian gave him a dose of 20 mcg today and the prednison has been tapered to 2.5 mg now and Mowgli is still doing well.Words cannot express how happy i am that he is doing so well on the Romiplostime.I can strongly recommend it to anyone having a dog with itp that is persistent,it’s a life saver! Next week the convention in Barcelona will begin and my vet will be there and tell about Mowgli’s case. i will keep you updated on his progress😃
Greets,Chomissa
Hi Chomissa,
Awesome! So happy for you and Mowgli. He is nothing short of a celebrity and I am honored to follow his journey!
Hi Dr Buzby,
Yesterday i went in for another bloodcheck and Mowgli’s platelets were 763 so still above the norm! Mowgli’s prednisone will be tapered down to 2 days 1.25 mg and then one day no prednisone.He is still on the mycophenolate and the romiplostime he gets is 0.06 now instead of 0.07.. I am so happy that he is still doing well.I will keep you posted!🙋🏻♀️
Greets,Chomissa
Hi Chomissa,
Yay! So happy for you and Mowgli! As always, keeping you both in my thoughts and looking forward to the next update. ♥
Hi Dr Buzby,
Here an update on Mowgli,He is still doing well,2 weeks ago his platelets were 691 after not having Romiplostime for 3.5 weeks.Before that his platelets were 931 so that was quite high so we decided to taper the frequency of the injections.Now he didn’t have Romiplostime for 2 weeks and we have stopped with the prednisone also for 2 weeks now.He started licking his paws,not to bad but i did notice it so i have him on horse milk to now since this works well on itches and allergies.So yeah,tomorrow i will visit the clinique again where they first diagnosed him and they will manually count his platelets and give him a check up and ofcourse i will give you an update on how he is doing!
Greets,Chomissa
Hi Chomissa,
So glad Mowgli is still thriving and feeling well. How was the checkup? Hoping you received good news. Thank you for the update and I look forward to your next post!
Hi dr Buzby,
Last week i went to the clinique and Mowgli’s platelets were 691 so still good! My vet told me that the control values of a dog with ITP should be around 180 so his are way above that.She told me that she had spoken to a few veterinarians from America and Australia and some told her that they had used Romiplostime but usually one dose to get the platelets up and then further treatment with prednison.None of them had never used it as a treatment being used more often so noone had any data on what the Romiplostime will do longterm in dogs but so far so good.Last week he had a dose of 0.05 ml and the plan is depending on his platelets will do to taper of the Romiplostime eventually.Mowgli is still on mycophenolate as well. twice a day every 12 hours he gets 0.04 ml.Next week i wil have his platelets checked at my local vet and at the end of this month back to the clinique.We also discussed to make a thirth echo of his splene,just to see if there is any change in the nodus now that he is off prednisone.I will keep you updated and thank you so much for your interest in Mowgli’s case.
PS, If you would like to have a direct line with my veterinarian for more specific information i could send you her info through email.
Greets,Chomissa
Hi Chomissa,
I am just fascinated by how well Mowgli has done with this experimental treatment. Thank you for allowing me to keep up with how things progress and for the regular updates. The team here tries to keep our articles updated with the latest information and routinely will go through and add new items as more research emerges. We may be reaching out at some point in the future when it comes time to update the ITP article. As always, best wishes to you and your sweet boy!
Hi dr Buzby,
So today i went for another platelet count check and after reducing the dose of Romiplostim to 0.05 his platelets are 591 after 2 weeks so still above average.Today we gave him a dose of 0.04 ml and on November 28 i will go to the clinique again.So far so good so i am really thankfull and happy😀
Greets,Chomissa
Hi Chomissa,
So glad Mowgli is still thriving and responding well to the Romiplostim. Hoping you get a good report at the checkup today!
Hi Doctor Julie,
Here’s another update on Mowgli,i had many distractions going on in my personal life so i didn’t find the time to message you🥴Mowgli is still doing well.On November 28 his platelets were 551 and the dose of N plate was 0.03 mland on December 12 591 we gave him another dose of 0.03 ml.His veterinarian wants to taper the dose with 0.01 with every good blood result and he is still on mycophenolate o.o4 ml every 12 hours.Since we stopped with the prednisone he started to get itchy but nothing really serious.I give him Omega 3 and fatty acids supplements now for that.I have still reason to be optimistic and to be happy about his health progress.My vet went to the convention in Barcelona and also in Sweden and she spoke with collegues from Australia and America.Some of them were familiar with N plate but none of them had given it to a dog for such a long period of time like Mowgli has had it.Some told her that they had given it to a dog to boost the platelets and then to go further with cyclosporine or prednisone There will be a follow up because they are curious to know about Mowgli’s outcome eventually.I must say that he is doing really well though as he is playfull and active again.On January 9 i will go back to the clinique and in 2 weeks i will have a check up at my own local vet.I will keep you informed!
Greets,Chomissa
Hi Chomissa,
I always love your positive updates on Mowgli! Thanks for keeping me in the loop. Give your sweet boy a hug for me and I wish you both a Merry Christmas!
Hi Doctor Buzby,
Today i went for another platelet check to my local veterinarian and Mowgli’s platelet count is 600 so still above average! I could not have wished for anything better then this.We have been tapering the dose of Romiplostim and his platelet count is still going up.My hope is that his condition is slowly going into remission,Only time will tell.The dose next time will be 0.02 of the Romiplostim.His eye lid was a bit inflamed and i’ve treated this with vitamin A potion and it is healed now.His next check will be on January 10.I want to wish you a happy new year and i will message you again in the new year.
Greets,Chomissa
Hi Chomissa,
Happy New Year! Thanks for the update and give Mowgli a hug for me!
We did split the dose of 125 microgram and stored it in the fridge at the clinique. as it is somewhere mentioned that the veterinarians that did the test concluded that this could be done safely allthough it is normally used on humans just one time.Romiplostime is a humane medication used on people with Thrombocytopenia.
Thanks for the article and I saw you mentioned melatonin to one of the commenters. We lost our pup recently to cancer, but I figured to share her experience with ITP in hopes this helps others in her honor.
Similarly to others, my pup was suspected of ITP during her routine checkup. Our vet noticed petechiae around her belly and immediately did bloodwork for CBC. Platelet count was very low… can’t remember the numbers as this was years ago. So we immediately started treatment regimen of suppressing her immune system to allow her body to produce platelets along with anti-nausea and antacids. Perform CBC and monitor, then taper treatment when levels are normal. But every time we taper or remove, platelets drop. We went through multiple cycles of this for more than a year and ending up having to keep her on these meds. My poor pup was miserable, lethargic, and lost muscle mass. Our vet – God bless him – had reached out for options and alternatives and there was some chatter on melatonin in combo with other meds she was already taking. When CBC is up in normal range, then start lowering dose of the meds while keeping her on melatonin. We kept her on melatonin even after the other meds, one by one, were removed. After a year of just melatonin, our vet felt it safe to taper and then eventually stop melatonin treatment. We monitored her CBC, and it remained normal throughout her life. She was ITP-free for 8 years, but sadly cancer took over her last 2 years.
I’m still grieving and I miss her so much. And I hope her story encourages further research and can help others.
If this helps further (and I don’t like to advertise), we were using Nature’s Bounty 5 mg melatonin tablets per our vet’s recommendation.
Hi Jessie,
Thank you so much for sharing your knowledge and experience with us! It seems like melatonin was the miracle your pup needed and offered her a good quality of life. What a blessing to have gained 8 extra years with your sweet girl. I appreciate your willingness to give this valuable information to others and spreading some hope to those in a similar situation. Wishing you the best as you continue life’s journey. Bless you!
Thank you for all the information in this article. Our almost 2 year old female was just recently diagnosed with Evans syndrome. She did end up needing a hospital stay, and we were fortunate enough to be able to bring her home 2 weeks ago. The first day was pretty tough, but she stopped peeing blood within a couple days of her being home. A few days ago her RBC went up by 2, and she appeared to be getting some color back (in her gums and around her nose and belly). Yesterday we were told to give her half the amount of prednisone she was previously taking. I noticed she is starting to have rapid breathing today. Do you happen to know if this is a normal side effect of the decrease in medication or if it could be because her body is attacking her red blood cells again? I am worried about her but also worried I may be over analyzing every minor detail.
Hi Brittany,
You are right to be concerned about this change in your dog’s breathing. Usually panting is a side effect that can be normal for dogs taking prednisone but not usually seen in response to decreasing the dosage. I would be suspicious something may be starting up again. Please make sure your vet is aware of this new symptom and see if they need to examine your pup. Hoping all is well and your young girl is still fighting. Feel free to leave an update if you have a chance.
Dr. Buzby,
Our 8 and half year old miniature Schnauzer was lethargic and eating little of his dinner on a Sunday. I called the vet and took him in first thing Monday morning . They did a IDX – Anemia Real PCR Panel with Lab 4Dx plus test and determined he had IMT and was dehydrated. He was put on fluids and steroids. Later that evening I was told he also had Evans syndrome and she would try other meds. In the morning his platelets were zero and his RBC was down to 12 and his breathing was heavy and labored and told to get to the clinic asap. Seeing how uncomfortable he was we decided it was best to put him down. He was a sweetie and charmer and the vet and all the techs too were teary eye. The vet told us his heart and lungs were strong and goo.d. We have numerous questions but our biggest is how did this move so fast when just a month earlier he had his physical and all was good. Thanks,
Dear Ken,
My heart goes out to you with the recent loss of your Schnauzer. I can only imagine how difficult it must have been to say goodbye with so little time to truly process what was happening. ITP can be triggered at a moment’s notice and progress to a critical level in just hours. There were probably no signs of this at your boy’s physical the month before. I am certain you didn’t miss anything and did all you could to try and save him. I hope with time your heart will heal and release you from the grief you are experiencing. May the memories of the good times you shared be a blessing in your life.
Thank you for writing your experience.
We have a 4-ish-year-old mix breed female (mostly doberman but mixed with others!) who was diagnosed with ITP in May 2022. It was a dangerous situation because she ended up in the emergency with nearly zero platelets, bruising, and dark stool, it was awful. She ended up being there for 5 nights and had 2 blood transfusions, a bunch of steroids, and even a chemo drug to suppress her immune system.
The treatment finally worked. We never found out the real reason for what happened and why she got ITP. From May 2022 to April 2023, she was on prednisone and very slowly decreased from 40mg to 0 through monthly check-ups with our vet and CBC test. Throughout the year, she maintained her red blood cells and platelet levels perfectly and hasn’t relapsed. She is now completely off the medication and though I am happy she is completely off and can start to recover from the awful side effects from the steroids (including loss of muscle and weight gain), I’m nervous this is going to return.
Although she never relapsed during the past year and consistently decreased her steroids every month, I read in your post that dogs who relapse will usually do that during the weaning process of the medication, but with our experience, I am sure she is still at risk of relapsing. Thoughts?
Hi Emma,
I understand your concern about the possibility of a relapse. You are correct that a relapse can happen at any time, but it is much more common during the weaning phase. So, since your girl has been able to maintain and is stable without prednisone, her chances of staying in remission are very good! What a blessing! Thank you for sharing your experience with us. We need to hear more success stories like yours. Praying your sweet pup will have many happy years ahead. Wishing you both the best.
Hello,my 6 year old shi tzu was diagnosed a few weeks ago with idiopathic itp,when i went to an internist with him his platelets were 0 and he had petechiën and echymosis all over his body and blood in his stool,he also did vommit blood. The internist started giving him 10 mg of prednisone and his platelets went up again but last friday i had to wear off to 5 mg and yesterday i discovered echymosis again so that really scared me.Today i will go in again to have his platelets checked.Does anyone have words of advise for me?Thank you in advance and please pray for my little Mowgli.
Dear Chomissa,
My thoughts are with you as you face this difficult journey with your pup. Praying you get good news at the recheck today. Feel free to leave an update if you have a chance. ♥
Hello Julie,
Sorry for my late reply,it has been a journey indeed for the last weeks.Unfortunately ,his platelets didn’t reach the 348 after his relapse and even after increasing the prednisone to 15 mg it still didnt go up that much so the vet decided to prescribe mycophenolate and today i went in for a blood check and his platelets are around 86 now and possibly a bit more since the blood had some clots.He doesnt have any echymoses or petichea at the moment but he has gained some weight.In 2 weeks he went up from 8.4 to 9 kilo..Have you heard about the turkey tail shroom? They say it is good to use against cancer but also auto immune diseases.I would like to hear your thoughts on it.Greets from The Netherlands,
Chomissa
Hi Chomissa,
I am sorry your pup did not respond well to the prednisone alone and is requiring an additional medication to get things under control. I have heard about the turkey tail mushroom. Unfortunately, I don’t have much personal experience with this as a treatment, but several readers have mentioned it and had positive experiences using it for their dogs. I would recommend you talk to your vet about the possibility of adding on this supplement and make sure there are no causes for concern. If you decide to try the mushroom, please let me know what you think! Hoping your sweet boy can make a full recovery and you get some good news. I’ll keep you both in my thoughts. Thank you for the update! ♥
Dear Dr Buzby,
Mowgli is still on mycophenolate and prednisone and he seems ok but i will be sure on next monday where we stand.Our veterinarian is going to order Romiplostim because there has been research on 5 dogs and a few went into remission after giving this medication to them I came across a medical journal where this medication was mentioned and the veterinarian agreed with me that it is worth trying.It is a costly medicine though,393 Euro for 125 microgram and you can only use it once and the dose is 5 microgram per KG but they have another patient who’s owner is willing to try it so the plan is that both our dogs will be treated with it at the same time.I hope that it will work🌈🙏🌟
Greets,Chomissa
Hi Chomissa,
I am so glad Mowgli is hanging in there and seems to be doing ok with both medications. You have me very intrigued by the use of this experimental medication! Please let me know how things go! Praying this will be the miracle we are all hoping for. Wishing you and your sweet boy nothing but the best. Give Mowgli a hug for me. ♥
We lost our Bernedoodle on 3-15-23. ITP was suspected at the ER vet who was treating him for status epilepticus due to his epilepsy. His platelets were 32k. I got him tested 2 days later at our regular vet and they went up to 113k. No treatment for ITP just the epilepsy. The AED’s made him ver lethargic so I didn’t think of it. His neurologist had me pulse dose if he had more than 1 seizure due to clustering. On 3-15-23 he started clustering so I pulse dosed and gave nasal midazolam. He started bleeding from the mouth, rushed to the ER, they tried life saving measures to no avail, he was gone in 1 hour. I’m still traumatized from it. I don’t understand why his neuro and reg vet weren’t concerned and treat the possible ITP. They were focused on the epilepsy.
Hi Jan,
I am sorry you lost your big guy in such a tragic way. I know you are grieving his loss and running all the “what ifs” through your mind. Although the ER vet suspected ITP, it sounds like a definitive diagnosis was never made due to the complicated circumstances. Also, you mentioned your dog’s platelets had improved on recheck without ever initiating treatment. This is probably why your vet was not concerned with a platelet issue and was more focused on the seizure disorder. The fatal bleeding event you witnessed may not have been ITP related. Unfortunately, there is no way to know for sure and there are no good answers. I hope you are able to find comfort in the fact that you did everything you could for your sweet boy. I have no doubt he knew how much he was loved. May his memory be a blessing. Wishing you peace for your heart.
what did you give upurgolden doodle to keep him in remission? our dog goes off steroids and then atopic but itp always rears its head again. my vet says wait until the next time. It is always such a hard recovery for him. I would like to give him something to maintain his health platelet issue.
Hi Char,
This article was written by Dr. Garlow. I don’t know the specifics of what she did for Fletcher, but I assume it was a combination of steroids and possibly cyclosporine. I am not sure what changes were made after they switched his medications up to reduce side effects. This would be a great question for an internal medicine specialist, and you can always request a referral from your vet or ask about a consultation.
My 7 year old pitbull Winchester was diagnosed with itp last year. I noticed some purple circular bruises on his belly and called the vet. His platelet levels were so low they werent even reading. they tested him for tick borne diseases did bloodwork etc and ended up finding nothing. they put him on antibiotics just in case along with high dose steroid. he improved and got back to normal levels and slowly we tapered him off the medicine. For about 6 months he was fine but just recently he relapsed. he had dangerously low levels and had to start back on steroids. He was improving and got to 100k and then within a week had dropped 60k. The vet now has added in cyclosporine along with the prednisone. he is ravenous with hunger and manging that alone is difficult. he was 96 lbs when first diagnosed and is now 107lbs. he definatley gained weight with the steroid treatment. he goes Monday to have his blood taken to see if any increase. the vet said if this doesn’t work next thing would be to do an xray and ultrasound to see if anything else could be causing. all his other bloodwork besides platelets has been good. i am just worried should the xrays and ultrasound be done now and not wait around. he just started the cyclosporine so we will see if this helps. i am hopeful. i love him so much and just want him to feel better.
Hi Kristi,
I am sorry Winchester has had a relapse of his ITP. I am hopeful the new medications will be able to get him stabilized. How is he feeling today? Did you end up having to proceed with the x-rays and ultrasound? Praying all is well and things have calmed down a bit. Feel free to leave an update if you have a chance.
Oh how i feel you here i am going through the same with my shi tzu Mowgli,i’ve been stressing for weeks now since he got diagnosed.All we can do is to take it from day to day.Mowgli is on steroids and mycophenolate now and he has improved a bit but i am fearing the day that he has to taper of the steroids.My vet says that mycophenolate can be used for the rest of his life if necesary.Last resort option would be a splenectomy she says.Wishing you lots of luck with your dog🙏
Greets,Chomissa
My Dr called and she wants to move forward with the injectable antibiotic after speaking with my vet. I believe she once a week and two blood panels a week to check her kidneys. It can be really hard on the kidneys. She feels if this is successful the abcess will be gone in three weeks. She is worried about kidney issues. She also said it could make her lose her hearing. But stated that’s not a fact just a possibility. I feel so bad for Holly. I know everyone days she’s old. She still loves to bark run around outside. bark at me when I’m making her food and follow me everywhere. She’s not even close to ready to go. I do think doing this gives her the best chance of survival. If this is cured, she can go on for however long then.
We found that Holly could take Minocycline. The Dr was just hesitant because it can cause liver issues. She has been on it for two weeks and had her blood work again today. Her ALT went from 360ish to 166 to 164. Her ALKP went from 2760 to 1760 to 1340. Her lypase is back to normal. She has an ultrasound in two weeks to see if she can cone off the antibiotics. She hasn’t had any stomach issues. I’ve been giving her the best prescription probiotic I that is available. Or one of them. She’s doing really good. One thing I didn’t mention because I didn’t want to think about it is that Holly has focal seizures. It only happens in the car or if something is fast moving at her eyes sometimes. It lasts about 2 seconds and she’s back to normal. She typically doesn’t have them unless she is stressed out or anxious. She probably has had one in teo months. She had 6 going 5min on the car. Once she stopped looking outside they stopped. I don’t really want to think about it. I have been charting it and letting the vet and specialist know. They don’t seem to worried given the frequency.
Hi Randy,
I hate that sweet Holly’s seizure activity is triggered by riding in the car, especially with all the vet visits she has endured over the past year. I am glad they seem to be pretty low frequency and think it is great you are keeping a log of when her episodes occur. So happy to hear her blood work is improving since starting the Minocycline. Keeping my fingers crossed that her stomach issues won’t recur, and she can finally get some relief. Thanks for the update. Wishing you a peaceful holiday season ahead.
I made one mistake. It was Doxycycline. Unfortunately I didn’t get the news I was expecting. Her ALT went from 244 to 360 and her ALP went from 1350 to 2300. The ultrasound on her liver looked fine. They did not see any of the ecoli. They don’t know what is causing it now. They said possibly the 4 weeks of Doxycycline. There is a disease somewhere they can’t see. Cushings but unlikely. Pancreas issue as she has chronic pancreatitis but is not showing any clinical signs. She doesn’t drink a lot of water but always wants to eat. it’s insane. They said we are running out of options medically. Last resort would to put her back on shots for ecoli or do exploration surgery. I will not do the last one. I’m very defeated. It was bad timing because I had surgery. I have a drain coming out of my chest. It was supposed to come out but I’m bleeding about 20cc since my blood pressure is so high worrying about Holly.
Dear Randy,
I understand your feeling defeated and my heart aches for you and Holly. I am not sure what the future holds, but I am certain that you have done EVERYTHING you can to give your girl the best chance at life. Holly is dearly loved, and I am sure she knows how much you care about her. She is one lucky pup to have you advocating for her health and well-being, even to the point of putting your own health at risk. When the time comes that there are truly no other options and tough decisions have to be made, we will focus on giving Holly the peaceful goodbye that she deserves. There is no way to know if that will be months down the road or years from now, but sometimes we have to focus on quality of life rather than quantity. All I ask is that you allow yourself some grace and please take care of yourself! Praying for a miracle and still holding on to hope that Holly can make a full recovery. Wishing you comfort and healing. Bless you both. ♥
Sorry. She didn’t have a seizures in the car. She hasn’t had any since.