High globulin low albumin + low RBC - 6 yr old healthy horse

[Haliburton]

I’ll be honest, purchasing a horse for the first time as an AA literally weeks before the pandemic has been an absolute nightmare. I feel like I’m a black pit of bad luck, and my poor horse is at the mercy of whatever mirror I broke or crack I stepped on or ladder I went under or misdeeds I did in a past life.

I feel like my vet isn’t being too helpful, despite being a large clinic it doesn’t sound like they have much experience with further diagnosing this kind of issue? The echocardiogram vet said she had treated 1 other horse with similar blood work results. I don’t know, maybe I’m being picky? But I feel like there are a lot of unknowns in this equation and it’s stressing me out.

Anyway, my gelding has had on and off swollen legs the last two months so I called the vet in. Vet found a heart murmur & ran blood work. Blood work came back bad, high globulin low albumin + low RBC. I’ll see if I can post a picture of the results below. We did an echocardiogram for the heart murmur, heart looked good besides the murmur, major organs looked good as well (liver, lungs & I believe intestines). Breathing & lung capacity was good, no obvious issues there. Vets next step is to test blood again and either do antibiotics (which they’d prefer not to do…) or more invasive testing at the hospital (sampling fluids & tissue + x-ray?/better imaging).

Horse in question is 6 yrs old & in good health. Chronic issues pre-this happening have been allergies (has gotten hives twice before), loose/watery stool, brittle mane & tail (coat is health), and of course he locks his stifles. He has not had dramatic weight loss and no change in energy level/behaviour. Temp has been normal, although unfortunately I didn’t get a temp during the swollen legs episode.

Any guidance/information/anecdotes/paths I should pursue with further diagnosing (or not) would be greatly appreciated

From my research I’m thinking that an SPEP test will give us a direction to go in at least, am I off base here with this? Also thinking there has to be something we can do to narrow down our options here. The vet made it sound like we’d be throwing darts at any and every possible cause? I’m not very confident in what to do next exactly.

This all feels very very bad & like it won’t end well, am I over reacting here?

ETA; also what can I be doing to keep him comfortable? I’ve been keeping him in work because of the stifle & thinking I should probably feed electrolytes to help him retain fluids? What else should I be doing?

[No1]

Currently, it seems like you are overreacting a bit. I understand, it’s stressful to think something could be seriously wrong with your new horse.

Repeat the blood work. That’s simple and if it’s normal now, you can skip the more invasive tests. If it’s not normal you could do a urinalysis to tell you more about the state of his kidneys. That is not invasive and super easy to do.

[Simkie]

I agree that I’d not get worked up about this until repeating the labwork.

[JB]

Repeating the blood work is a good next step.

Bleeding ulcers? Heavy parasite infection?

It’s a newer thing, but there is credibility to the idea that horses can have Leaky Gut Syndrome. Triple Crown and Blue Bonnet both have good articles on this

Dang - in TC’s web redesign they left off their article section and the archives is a broken link. But here’s the Blue Bonnet article

[Sdel]

@JB

Bleeding ulcers? Heavy parasite infection?

My vote is ulcers. My horse had a low albumin from ulcers due to a huge bute overdose. She was swollen everywhere.

Electrolytes won’t fix the swelling from a low albumin. The albumin is what keeps the serum in the blood vessels and not in the surrounding tissues. I fed a high protein ration balancer for a while that seemed to help.

[RAyers]

In humans this is indicative of multiple myeloma.

[Haliburton]

Thanks everyone, we pulled blood again today, will update with the results.

[J-Lu]

Thanks, please do!

The swollen legs look to be due to vascular fluid escape or vascular pooling. Could this be related to the murmur? Swollen legs can be indicative of heart problems, including murmurs, in humans. Blood can not be properly moved forward in the large vein that returns the blood to the heart, and blood can get backed up on the venus system causing swollen legs (due to gravity). Low hemoglobin can suggest that your horse might have poor oxygenation of blood and this can fit the murmur story. The vet pulled the blood from a vein.

The low RBC suggests bleeding somewhere OR that your horse isn’t producing enough RBCs. Talk to your vet about ulcers or a high parasite load (both of which can be easily detected and treated). That eosinophils are in a normal range (you didn’t highlight it) suggests that parasites may not be the problem here. If the low RBC count doesn’t rebound, look carefully at your horse’s diet and maybe pull blood for a more extensive CBC that includes iron and trace minerals. Low iron reduces RBC production and hematocrit. I know this because I personally tested my own hematocrit regularly back in the day and it was low - 32% ish. Iron supplementation really help boost it to a more normal value. I don’t know your feeding regime but it might be worth examining more closely. Consider a balancer if he does not get his daily vitamin/mineral intake from grain. If he has the same pasture and gets a significant proportion of his calories from pasture, you can send the grass off to EquiAnalytica for analysis (I’ve done this) and you can likely get the soil tested for free by your local Ag Extension (I’ve done this too).

The sodium is just below the low end of normal. I use electrolytes in the summer (I’m in NC and it gets hot here) and at a lower dose year round. My horse has a Himalayan salt block and a regular salt block year round (he uses both to greater or lesser extents. He prefers the taste of the Himalayan (it’s good, I’ve tasted it out of the wrapper) but likes to chew on the regular block). In any event, I note in the summer that this promotes kidney function because he pees a lot and drinks a lot. That’s a good thing. You might want to offer different salt blocks to learn his preference and/ or just add a low dose of electrolytes to his feed. Blood sodium levels change quickly. And, if he’s not been drinking enough, that can artificially elevate the Total Protein level because he’s a bit dehydrated on blood draw. Not enough to be problematic, but maybe enough that his Total Proteins went up. This might be helped by providing salt sources so he drinks more. Other reasons for high TPs involve liver or kidney disease but your panel shows this isn’t a problem.

The low Albumen:Globulin ratio is the most concerning. It is usually indicative of of liver or kidney disease. which the other tests don’t show. Consider assaying GLDH (for acute liver disease), Insulin for metabolic syndrome, High Globulin is associated with fighting an infection with those liver enzyme values and consider assaying for inflammatory proteins. I’m thinking SAA (serum amlyloid A and fibrinogen). I do research on kidney disease and fibrosis is a large factor in many types of kidney disease. Ask your vet.

Also, is he out with other horses who are new or did his herd dynamic change? Our barn has a trainer who brings in horses and we noticed once that one horse ran the other horses off the water. We obviously fixed that is was quite unexpected and is something I’m throwing out there.

IDEXX SDMA… I send my mouse blood to the same lab your vet uses! They can tack on individual tests and a sales rep might be willing to work on pricing if your vet uses them regularly. Our sales rep works with us.

There are very many potential issues going on with these results and most seem easy to diagnose and address. Oh, I hope it is a simple situation for you and your horse and that you can get things under wraps quickly.

Please, report back!!

[blob99]

I had a low RBC for years. For me, it ended up being corrected through b12 injections. I"m not saying that is the same for your horse. I’m only sharing to say sometimes blood test results being less than ideal can also be a result of a vitamin or mineral imbalance.

One thing I will say is that it sounds like you are not having a great experience with your vet clinic at the moment. Is there another vet you can either work with or even someone further out you can call do a consultation with based on bloodwork results?