High ALKP, Anaemia and Hypercoaguability

Hi, I have a 5 year old Golden Retriever bitch. Went in for lumpectomies (Mon 09 Feb) but pre-blood results showed: ·         High ALKP ·         Anaemia Further blood testing shows: ·         Hypercoaguability (which, I gather, is rare) Waiting on stool sample results and iron level results (urine sample came back clear) and we’re not doing the lumpectomies until we know more about what’s causing all the above. 1.      What do you think all this means?  I haven’t “Dr Googled” it… 2.      What are my, potential, options? 3.      Could the anaemia be her body's way of adjusting to the hypercoaguability and, therefore, I should think before treating or has she always had the hypercoaguability (her symptoms for anaemia (just a change in her that I've noticed but not been able to define) has been fairly recent (last few weeks).  She has a sister who had a spinal embolism last year (2025) and I’m wondering, although don’t know, if that could also have been caused by this coagulation issue (ie, it’s a genetic trait) or it’s all new and I should treat accordingly Any advice/knowledge would be greatly appreciated.

Oh no, that's a lot to have dropped on you! But it does just go to show how routine bloods can throw up stuff you don't expect...

OK, so as I see it, there are four issues here.

(1) The lumps. You haven't said much about them, but lumps needing surgical removal aren't all that common in a 5 year old, so there is a possibility that they are something to do with all this. Alternatively, they might just be incidental and unrelated: at this point, there's not enough information to say one way or the other.

(2) High ALKP. This is a cholestatic blood marker, meaning it tends to go up when the bile is moving slowly through the liver. As a result, we tend to think of it as being a marker of liver disease, but it can also be raised due to some hormonal conditions (e.g. Cushing's), some medications (steroids, for example), and bone disease, among other causes. In addition, a raised ALKP on its own can just be a "one of those things" that a dog naturally has, especially if other liver markers like AST or ALT are normal.

(3) Anaemia. There are lots of different causes of anaemia, and to help narrow them down your vet will probably need to do further tests, including a blood smear and analysis and perhaps a reticulocyte count. Common causes include underlying disease ("anaemia of chronic disease"), immune attack on red blood cells, and bleeding (e.g. from stomach ulcers, tumours, or a wound), although there are lots of other things that can cause it.

(4) Hypercoagulability. True hypercoagulability is a fairly unusual diagnosis, and it isn't something that would normally be picked up on a common routine blood test, but high platelet counts might be picked up in an assay and would have a similar clinical effect. Overall, though, I think it would be worth having a conversation with the vet as to what exactly that've found and what might be going on. In general, hypercoagulation is seen around severe trauma (which I'm guessing isn't the case here!), infectious or inflammatory conditions, and some hormonal diseases such as Cushing's.

So far, this is a very incomplete picture, so there's nothing really to say "ahah, this is the cause!". You say you are waiting on further testing, which is good, but I think the next step for you is very much to have to chat with your vet and talk through all the results (normal as well as abnormal - often the normal findings are as important as the abnormal ones!), and find out what the overall picture is suggesting.

It is quite possible that these are all isolated false-positive or non-specific findings, but you're clearly worried about them, so I really think that's a conversation to have and then decide where to go next.

Good luck, and please do let us know how she gets on!