Need help on a CBC

[jaimebaker]

Ok, vet says the bloodwork is normal but I have some questions (got a call into the vet).

Picked up a CBC today that I had run last Friday.

The RBC (I assume red blood count) is low. The range should be 6.8 - 12.9 and it's 6.17

The WBC is low (I assume white blood count). Range should be 5.40-14.30 and it's 4.91

The MCH is high. I was told it means 'Mean corpuscular hemoglobin'. Range should be 12.3 - 19.9 and it's 20.09

Now, certainly none of this is off the charts to where it alarms me. However, I have a hard time understanding why both the RBC and WBC are low. Wouldn't one be high and one be low? Or rather, one be normal and the other be low or high?

I had a CBC and a Chem panel both pulled. The only thing off on the Chem panel is ALB (I assume Albumin) and the range should be 1.9-3.2 and it's 3.3

Only reason I had them pulled was due to horse's extreme laziness. I was just wondering if something was 'off' causing his mellow, slow demeanor. Anything look suspect out of those things?

[Riley0522]

WBC and RBC don't really need to react together.

RBC are the hemoglobin, they carry oxygen. If a horse (or human) has a low RBC, they are anemic of sorts and will be slightly to very fatigued, labored breathing, just not feeling so hot. This could explain your horse's laziness.

WBC are part of the immune system. They respond to "invaders" in the body, aka infection. If the WBC are low, that means they are not fighting anything. If there was an infection, you should in most cases see an increased WBC count.

Sorry that's all I got!

[jaimebaker]

WBC and RBC don't really need to react together.

RBC are the hemoglobin, they carry oxygen. If a horse (or human) has a low RBC, they are anemic of sorts and will be slightly to very fatigued, labored breathing, just not feeling so hot. This could explain your horse's laziness.

WBC are part of the immune system. They respond to "invaders" in the body, aka infection. If the WBC are low, that means they are not fighting anything. If there was an infection, you should in most cases see an increased WBC count.

Sorry that's all I got!

Thanks for the further explanation. I specifically wanted to see if this horse was anemic and the vet says no based on the blood work. But if it was the case, it would explain a lot about this horse.

Now, how does one correct that?

[rizzodm]

If horse is anemic the hgb(hemoglobin)would be low.
You could have the cbc rechecked in a few months to see if there are any changes but these results are nothing to be concerned about.

Dawn

[jaimebaker]

If horse is anemic the hgb(hemoglobin)would be low.
You could have the cbc rechecked in a few months to see if there are any changes but these results are nothing to be concerned about.

Dawn

Ok, the HGB is normal. Range is 11.0-19.0 and it's at 12.4 Thank you for bringing that up:)

I wish I knew more about the CBCs and chem panels. It would be nice to know what all corresponds to what. The vet says normal but when I see stuff marked 'HIGH' or 'LOW' (always in scary caps:lol:) I tend to get nervous, regardless of what the vet says.

[Riley0522]

I should have clarified that the RBC carry the hemoglobin, which is what "binds" the oxygen to the RBC. I don't think any of your numbers are alarming, and if the hemoglobin is normal, that is good, but the horse could still be slightly anemic due to low RBC, which in turn causes a low number of "hemoglobin carriers."

I think you can supplement a horse that is anemic with Red Cell (which is just iron), but I don't know if that is appropriate in your horse's case because if your hemoglobin is fine, it doesn't seem like the slight anemia is an iron-deficiency. I'm not vet, just a nurse and that is my simple translation of the RBC/hemoglobin. I know the guy who winters his racers at my barn always supplements them with Red Cell when he's getting them back into work.

[deltawave]

Nothing seems all that far out of whack. As Riley noted, RBC and WBC counts have absolutely nothing to do with one another.

Anemia, if it's present and profound, is FAR more likely to cause breathlessness and poor tolerance to exertion than "laziness" or a change in demeanor/temperament.

[JB]

Thanks for the further explanation. I specifically wanted to see if this horse was anemic and the vet says no based on the blood work.
Especially if the horse had been resting prior to the blood draw. To adequately check for anemia, the horse needs to be exercised immediately prior to drawing blood, in order to get the stored RBCs out of the spleen and into circulation

But if it was the case, it would explain a lot about this horse.

Now, how does one correct that?
What's the deal that would make anemia a good cause?

[jaimebaker]

What's the deal that would make anemia a good cause?

The lack of energy and the tiring easily. The horse won't be out of breath or even have an elevated pulse but after 10 minutes of lunging he is just done. Doesn't want to do a damn thing. He's overweight and I'm trying to get weight off of him. I lose more weight than him by chasing his fat butt around the round pen. Certainly the overweight problem might make him lethargic, that I understand, but it's just a real lack of energy. Could be nothing, might be something. That's why I spent the money on the blood work. According to the vet, he's just fat and lazy.

[jaimebaker]

poor tolerance to exertion than "laziness" or a change in demeanor/temperament.

What's the difference?

[JB]

Can you ride him? If so, get on and walk. And walk, and walk, and walk.

Round penning/lunging is boring ;)

Not to mention the issue of the excess weight on legs going 'round and 'round :)

[jaimebaker]

Can you ride him? If so, get on and walk. And walk, and walk, and walk.

Round penning/lunging is boring ;)

Not to mention the issue of the excess weight on legs going 'round and 'round :)

Nope, not ridable...yet. But I'm with you, I think he's just burned out on the lunging. If I get a shaker bucket after him (a bucket of rocks) he plays and plays. Put the halter on him to take him in the roundpen or just lunge in the pasture and he suddenly acts like he just wants to go to sleep.

[JB]

Ok, sounds like you have some sensitization training to do then ;) Take your lunge whip, and if he ignores polite requests to move out, then "bite" him with the lunge whip, on his hiney. Mean it. Every time.

This may mean your sessions are only 5 minutes for a few days, so that you stop on a good note with him going "yes MA'AM!!!" at your requests. Over time, increase the amount of work you ask him to do.

[deltawave]

What's the difference?

Of course I haven't seen your horse, but when I hear "lazy, mellow" I think more of an animal (or person!) who's just unwilling to put forth the effort, or resisting somehow the demand to DO MORE. By "effort intolerance" I mean an animal (or person) who is willing, but UNABLE due to physiological limitations. In other words, the spirit is willing, but the flesh is weak. :)

Anemia won't change demeanor or temperament or make an animal lazy as an isolated symptom, but it CAN make them "poop out" much more quickly, breathe harder, and be less able to tolerate normal work without physical fatigue. This would be manifest by higher respiratory and pulse rates during and immediately after exertion, slower recovery times, and "hitting the wall" much sooner than would normally be expected. A horse can be perfectly willing, attitude-wise, but physically limited by things like anemia, heart failure, etc. OTOH, a horse that's perfectly healthy can be resistant, lazy, unwilling to try, etc. but have perfectly normal TPRs, etc. with work--if you can convince them to put forth the effort. ;)

Hope that makes sense? It's probably not that easy to declare "fish" or "fowl" in a scenario like this, but generally speaking PHYSICAL causes of low energy/supply-demand mismatch are MOST noticeable with exertion.

[jaimebaker]

Ok, sounds like you have some sensitization training to do then ;) Take your lunge whip, and if he ignores polite requests to move out, then "bite" him with the lunge whip, on his hiney. Mean it. Every time.

This may mean your sessions are only 5 minutes for a few days, so that you stop on a good note with him going "yes MA'AM!!!" at your requests. Over time, increase the amount of work you ask him to do.

That's what I've been doing to get him to canter:D I am polite when I ask twice...the third time he gets bit. But by golly, it's been working. And like you said, I keep the sessions shorter. After a couple of ' bites' all I have to do is say 'canter' and he gets right into it. I want him to know if he WORKS, as in canters and doesn't stop until I ask him to then he gets done faster. If he does this cloppity clop trot crap where he barely picks up his feet he's going to work a whole lot longer.

BUT, another reason for the blood work is, if he's lazy I can deal with that. But if there was some underlying reason that he might possibly not feel good, I certainly didn't want to be cruel by asking him to work.

[jaimebaker]

Deltawave, thank you for the further explanation. After I posted, I thought about it and figured you probably meant something like fatigue, out of breath, high pulse rate, that sort of thing as opposed to 'But moooooom, I don't waaannnaa'. So, it's not that he can't, he just don't wanna.:D

That's definitely not the case. I have worked this horse at a good trot/canter for longer lengths of time and he won't get out of breath. I guess he's a 'fit fat':lol: My other horses get in there and WORK. Get excited about it and do everything I ask. This guy will find any way to put forth the least amount of effort. His trot is like a fast walk. His walk is slow as molasses. But I watch him out in the pasture with my stallion and there isn't anything lazy or lethargic about him. Guess I need to find something more exciting for us to do on the ground.

[deltawave]

Be polite when you ask ONCE, then unleash the wrath of jaimebaker. :D

[Percheron X]

The only thing that comes to mind from your cbc numbers with the low red blood cell count with a high MCH result would be a small possibility of a slight B12 and folate deficiency.

You'd need to have the results for the "Mean corpuscular volume" (MCV) and the "Mean cell hemoglobin concentration" (MCHC) to see if the results are truly "leaning" in that direction.

If all the results were pointing towards the possibility of a slight anemia. I would then be inclined to consider asking the vet if it would be ok to put the horse on a product made by Farnam called "Red Cell".

When putting a horse on red cell be sure to do a calculation for the horses total intake of selenium, because red cell does contain selenium and other nutrients in addition to the B12 and folate.

[jaimebaker]

Be polite when you ask ONCE, then unleash the wrath of jaimebaker. :D

Ok, we'll do. I've got wrath:lol: I was just being nice and all. No more Mrs. Nice Gal....especially now that I know nothing is wrong with him:lol:

[jaimebaker]

The only thing that comes to mind from your cbc numbers with the low red blood cell count with a high MCH result would be a small possibility of a slight B12 and folate deficiency.

You'd need to have the results for the "Mean corpuscular volume" (MCV) and the "Mean cell hemoglobin concentration" (MCHC) to see if the results are truly "leaning" in that direction.

If all the results were pointing towards the possibility of a slight anemia. I would then be inclined to consider asking the vet if it would be ok to put the horse on a product made by Farnam called "Red Cell".

When putting a horse on red cell be sure to do a calculation for the horses total intake of selenium, because red cell does contain selenium and other nutrients in addition to the B12 and folate.

The MCV is 53.2 fL with the normal range being 37.0-58.0
His MCHC is 37.7 g/dL with normal being between 31.0 - 38.6

Does that give any more info?

I don't want to add iron without being positive he needs it. And I have yet to see a horse actually eat Red Cell. I can't add anything with extra selenium in it due to the amount in his feed (ADM Metabolic pellets). Smartpak has what's called 'Smart Energy' that is B12 and some other stuff without the iron. I would go that route before doing iron. Especially since the vet said he wasn't anemic. I'd rather be safe than sorry but then again, maybe he's just that dang lazy.

[jaimebaker]

Oh, one other thing. On the sheet I have at the bottom is something that says PCT. On the left column where his results are it says 0.1% On the far right there is another column with different numbers (doesn't say what those numbers are for) and it has 0.2% Below that there is something typed that says 'Differential algorithm issues. Confirm with Blood film'.

I've got no clue what that means but it's not something that has a 'normal range' or anything typed next to it. It's separate from the actual chart.

[deltawave]

He's not macrocytic. I would sincerely doubt B12/folate deficiency.

[JB]

I'd look to a Copper deficiency as a nutritional cause of low iron, before adding an iron supplement. Horses just are so rarely actually Fe-deficient.

Beyond that, true anemia is more likely to be caused by ulcers, or a heavy parasite load, than a lack of sufficient iron.

[deltawave]

Beyond that, true anemia is more likely to be caused by ulcers, or a heavy parasite load, than a lack of sufficient iron.

Not arguing the point that horses rarely need iron, but anemia caused by ulcers or worms IS largely an iron-deficiency anemia, from blood loss, and in those cases supplemental iron CAN help, in addition to correcting the underlying problem.

[JB]

Not arguing the point that horses rarely need iron, but anemia caused by ulcers or worms IS largely an iron-deficiency anemia, from blood loss, and in those cases supplemental iron CAN help, in addition to correcting the underlying problem.

Yes, you're right, I should have qualified that. My mind was on the "but horses get enough iron in their diets" tract :)

[Percheron X]

The MCV is 53.2 fL with the normal range being 37.0-58.0
His MCHC is 37.7 g/dL with normal being between 31.0 - 38.6

Does that give any more info?

I don't want to add iron without being positive he needs it. And I have yet to see a horse actually eat Red Cell. I can't add anything with extra selenium in it due to the amount in his feed (ADM Metabolic pellets). Smartpak has what's called 'Smart Energy' that is B12 and some other stuff without the iron. I would go that route before doing iron. Especially since the vet said he wasn't anemic. I'd rather be safe than sorry but then again, maybe he's just that dang lazy.

The MCV is the most important indicator, if it was right at the top of the range I would start to think about B12 and folate deficiency.

The MCHC is at the high end and suggests a good hemoglobin concentration. When it goes low you start to think about iron deficiency. But you do look for it to be normal or at the high side of the range, together with high MCV and MCH when considering the possibility of B12 and folate deficiency.

I agree with your vet that the blood work looks normal.

[Pancakes]

Yeah, to me, those "abnormal" results are just barely outside of the parameters that it really is unremarkable for a CBC.

Keep in mind the "normals" are formed by taking a sampling of horses, and the results are distributed in a normal distribution (bell-shaped curve), meaning MOST (the vast majority) of horses fall within that range. However, there are still some "outliers" that will be outside of that range on the curve yet completely normal for themselves.
Confused yet? LOL.

Unremarkable bloodwork, nothing to get excited over.

[jaimebaker]

Yeah, to me, those "abnormal" results are just barely outside of the parameters that it really is unremarkable for a CBC.

Keep in mind the "normals" are formed by taking a sampling of horses, and the results are distributed in a normal distribution (bell-shaped curve), meaning MOST (the vast majority) of horses fall within that range. However, there are still some "outliers" that will be outside of that range on the curve yet completely normal for themselves.
Confused yet? LOL.

Unremarkable bloodwork, nothing to get excited over.

After I started looking more into it and doing some research I found that out (about the sampling of horses). Actually, according to some of the larger blood testing labs out there, the low end of RBC would be 5.5 which puts him right in range. This was done 'in house' at my vets, so I'm not sure where their curve is...if it's there own sampling or something taken from other labs.

I appreciate everyone's help. I think I learned quite a bit today:)

[foggybok]

After I started looking more into it and doing some research I found that out (about the sampling of horses). Actually, according to some of the larger blood testing labs out there, the low end of RBC would be 5.5 which puts him right in range. This was done 'in house' at my vets, so I'm not sure where their curve is...if it's there own sampling or something taken from other labs.

I appreciate everyone's help. I think I learned quite a bit today:)

That is a good point. Labs should use their own reference values as each machine is a little different. I have seen good analyzers differ by a fair amount. But that said your horses values are on the low end of the scale, but nothing to be alarmed about.

[Equilibrate]

I agree with your thinking of not giving iron and with those posters who are saying iron is rarely needed when anemic unless the horse is bleeding. The way to know for sure if an anemia is due to iron is to test ferritin levels by sending a sample off to Kansas State. They developed the test and are the only lab who can do the test.

This will tell you whole body iron status and whether an anemia is actually caused by iron or not. I never recommend giving additional iron without first assessing the bodies current iron status.

Clair

Independent Equine Nutritionist
www.equilibrateequine.com
info@equilibrateeuqine.com

[Movin Artfully]

Ok, vet says the bloodwork is normal but I have some questions (got a call into the vet).

Picked up a CBC today that I had run last Friday.

The RBC (I assume red blood count) is low. The range should be 6.8 - 12.9 and it's 6.17

The WBC is low (I assume white blood count). Range should be 5.40-14.30 and it's 4.91

The MCH is high. I was told it means 'Mean corpuscular hemoglobin'. Range should be 12.3 - 19.9 and it's 20.09



Talk to your vet. When we see a decline in WBC/RBC with humans- we wonder if the sample was too dilute. Can happen due to pathology or due to lab/draw error. If the vet says it's normal...I would trust that. In humans there are also differences for male and female...I have no idea if the same would apply to horses. Good luck!

[KayBee]

Randomly...

I half-lease a horse that the vet said had "borderline" anemia almost a year ago (but horse had not been exercised prior to blood being drawn).

Well, horse was breathing heavily/exertion intolerant this summer and owner had blood drawn to see whether anemia was the problem. (Different) vet must have had some reason to suspect because she tested for anemia and also did a Lyme titer. It was... high. VERY high.

But that probably isn't the case with you as the WBC is not elevated as (I assume?) it would be if your guy was infected with Lyme.

BTW: anyone have a citation for the "exercise horse before drawing blood to test for anemia"?

I've found one online article that references it:

http://www.horses-and-horse-information.com/articles/1002blood.shtml

and a vet's website (http://www.horseadvice.com/horse/messages/4/7860.html), but his reference is page 274 of the Current Equine Vet Therapy 4. When I google that title I get the following two results:

Current Therapy in Equine Medicine
Current Therapy in Equine Reproduction

Does he mean one of the two above or something different?

[deltawave]

WBC elevation with Lyme disease would be more of an exception than a rule, in general.

[foggybok]

I agree with your thinking of not giving iron and with those posters who are saying iron is rarely needed when anemic unless the horse is bleeding. The way to know for sure if an anemia is due to iron is to test ferritin levels by sending a sample off to Kansas State. They developed the test and are the only lab who can do the test.

This will tell you whole body iron status and whether an anemia is actually caused by iron or not. I never recommend giving additional iron without first assessing the bodies current iron status.

Clair

Independent Equine Nutritionist
www.equilibrateequine.com
info@equilibrateeuqine.com

Ferritin levels can also be misleading. Ferritin goes up during inflammation, so a horse might have high ferritin and still have low iron stores. Add to this, a horse with chronic inflammation can not use the iron it has (However in this case supplememting doesn't help either since it all goes into storage)

[foggybok]

Randomly...

I half-lease a horse that the vet said had "borderline" anemia almost a year ago (but horse had not been exercised prior to blood being drawn).

Well, horse was breathing heavily/exertion intolerant this summer and owner had blood drawn to see whether anemia was the problem. (Different) vet must have had some reason to suspect because she tested for anemia and also did a Lyme titer. It was... high. VERY high.

But that probably isn't the case with you as the WBC is not elevated as (I assume?) it would be if your guy was infected with Lyme.

BTW: anyone have a citation for the "exercise horse before drawing blood to test for anemia"?

I've found one online article that references it:

http://www.horses-and-horse-information.com/articles/1002blood.shtml

and a vet's website (http://www.horseadvice.com/horse/messages/4/7860.html), but his reference is page 274 of the Current Equine Vet Therapy 4. When I google that title I get the following two results:

Current Therapy in Equine Medicine
Current Therapy in Equine Reproduction

Does he mean one of the two above or something different?

I think there is a lot of controversy on this. It is true, that horses store red cells in their spleen and release them during exercise or excitement. Unfortunately unless you have an absolute standard way of determining the excitement level, you will still get mixed results. And even with a standard protocol, 10 minutes of trotting for one horse is not the same as another. As the horses excitement level increases, so does the HCT. A horse that is nervous with the vet might have a higher HCT just because of that at rest.

We used to measure HCT levels approaching 70 during severe exercise and they covered the whole range in between....

Probably the most accurate way to determine the status of a horse would be to sample during maximal exercise so you could see the total reserve available to the horse, but that's not possible in field conditions.... And the level goes down immediately after exercise, so that gives variability too.....