Large pony, now a pasture ornament but still well loved for all that; borderline EMS, PPID on low-dose Prascend, but consistently tests with a low level of anemia. Vet just wants him on supplements, but as for me, I have to think that three tests over 18 months surely must mean something not being addressed by iron or vitamin b supplements. Vet has not suggested scoping or checking fecal for possible ulcers - just wants to continue supplements. I have read that iron supplements are contraindicated in horses with both PPID and EMS but the vet was dismissive of that when I brought it up. Not sure what to do, looking for ideas from someone who has been there and dealt with similar issues.
Have you drawn blood after working him? A “low” red count is often not really low on horses, because they store red cells in the spleen and dump them when they’re needed. If you can get him out on the longe at a brisk trot for 15 minutes prior to the blood draw (enough exercise to get him actually working), you may find nothing amiss at all.
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What @Simkie said. Also, I’m pretty sure true iron deficiency is not very common in horses. Has the horse had any eosinophils on his CBC?
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Thanks for the replies. The low numbers are for hemoglobin, red cell count, hematocrit and absolute neutrophils. Eosinophils and MCV are mid-range normal as are the other values. Blood is usually drawn first thing in the morning - vet says that’s best for monitoring the borderline EMS. He is not in work - retired show pony, pretty much a companion to my elderly miniature mare who at 30 something is in abundant great health. thank goodness.
that’s not a reliable test situation for determining anemia.
A lot of horses are low-normal, or just below normal, if tested while in a rested state.
Horses get SO MUCH iron from their forage.
If anything, I would make sure you’re supplementing copper and zinc
I would never give an iron supplement to an EMS horse. That doesn’t fix anemia anyway, even if they really are low (barring acute blood loss), the fix is almost always more copper and zinc
Hmm…eosinophils greater than one can indicate that the animal has a significant parasite load. Some horses are not high shedders, so (even with routine fecals) the horse may have a parasite load. Taken with the low RBC count, I would think about doing a power pack if you haven’t recently.
If I remember correctly, the neutropenia can be a consequence of the PPID.
Yes, thank you. I wondered why the vet is so insistent on keeping him on the product (Lixotinic). I pulled him off of it between the second and third tests (I schedule these six months apart and there have now been three) and each time the low blood numbers are identical to the previous lab results. His non-grain (no soy!) pellets do have a vitamin pack which includes copper and zinc and he has been fed the same pelleted feed in small amounts (last thing at bedcheck) for that time period, as well. As for parasites, is it possible that with a regular schedule of rotational deworming he would need a power pack? I am really leery of those for little horses as a while back one of my ponies colicked so severely from a power pack, followed by a really severe laminitis attack, that he never was able to return to his driving career. Some of the mini and pony peeps have opined that power packs for the littles are kind of a bad idea so I’m truly hesitant.
As I’m sure you know, not all dewormers kill the same parasites. Also, it is very common for a local population of parasites (as in on a whole farm) to become resistant to certain dewormers.
I could go on talking about parasite prevention for a little while, but…
To your other question, IME, when horses colic after being given a dewormer it is often because the parasite load was so high to begin with. For this reason, vets often recommend deworming with Quest plus or similar pre-power pack in horses suspected or know to have a high parasite load. That kills some of the worms and leaves the encysted strongyles for the power pack.
Also, I have never heard of any incidence of power packs being harder on ponies specially. That doesn’t mean it never happened, of course. All I can say is that I have power packed my own minis and had no issues. I did use a weight tape prior to deworming to make sure I gave them an accurate dose.
It’s astonishing how many vets don’t understand this aspect of blood work 
There you go 
Whether that’s actually enough to reasonably balance the forage, depends on the forage. How many mg of each does it have?
What’s he been dewormed with, and when, in the last year?
A Power Pack is safe for everyone, its chemical is really “mild” compared to most others. But any horse with a large enough encysted strongyle load could impact as a result, and the die-off cause laminitis.
I’ve never heard of a mini person steering away from a Power Pack. Quest, for sure, I wouldn’t use it on a mini though I know some do, especially if they have a scale weight.
Quest Plus kills almost everything, except for 1 of the encysted larval stages,and does it very effectively. It kills all but that 1 encysted stage, adult strongyles, pinworms, bots, tapeworms, neck threadworms, all of them.
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Or not, according to recent literature.
Can you post a link? Always want to learn more 
“Peripheral blood eosinophilia does not predict the severity of
helminth infection. Peripheral blood eosinophilias may be
higher in infected than na€ıve horses, as occurs with S.
vulgaris, but among affected animals, no correlation is found between PBEs and lesion severity, number of larvae or adult
worms (Bailey et al. 1984). Neither do PBEs correlate with the
adult worm burden in horses with mixed strongyle infections
(Round 1968). Isolated eosinophil counts therefore are
unreliable indicators of clinically significant parasitism (Round
1973)”
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