The hb+++ indicates a significant amount of hemoglobin in the urine (hemoglobinuria) but shouldn't be interpreted without respect to other findings in Truffle's urine and blood. Can you upload a copy of Truffle's test results to our conversation? I understand that you might not have a copy at home but Truffle's vet can give you one which you can scan into your computer and then give me the file link or you can photograph the pages and upload them by using the paperclip icon (if you can see that icon) or by using an external app such as dropbox.com/
For instance, hemoglobinuria in association with intravascular hemolysis (breakdown of red blood cells inside vessels) indicates very severe, often peracute (sudden) hemolytic anemia.
Thank you for the additional information. Please note that the ALT needs to be elevated 2-3X over high normal before it's considered a significant elevation. If a sediment exam reveals no bacteria or elevated numbers of either red or white blood cells (the leukocyte pads are notoriously unreliable when evaluating canine urine), a complete blood count and visual exam of a blood smear (at least) needs to be performed in an attempt to clarify why so much hemoglobin is in Truffle's urine. Specific causes include Heinz body anemias, complement-fixing immune-mediated anemias, and zinc toxicity.
Please continue our conversation if you wish.
Pardale-V contains paracetamol and dogs can be susceptible to methemoglobinemia when given high doses of paracetamol. This would be unlikely if dosing remained below 15 mg/kg thrice daily. I see no reason to incriminate the codeine in that product but an NSAID-induced hemolytic anemia has been seen in dogs; hence the need for a complete CBC.
It's not unreasonable but I would expect elevated numbers of RBCs in the urine rather than hemoglobinuria. You're quite welcome.
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