clotting disorders

Re: clotting disorders

CatherineThomas — Mon, 02 Apr 2012 20:45:40 GMT

Thanks everyone.

The pathologist did look at a smear and she said platelet morphology was normal.

I think I'll ask the owner to come in for an appointment so that I can do a BMBT, then I can also get a proper history rather than relying on incomplete notes.

Re: clotting disorders

Andrew Kent — Mon, 02 Apr 2012 19:26:21 GMT

Agree with others that this is a platelet issue - numbers are ok but I would send a smear for a pathologist to examine to look at platelet morphology, otherwise platelet function testing ( eg thromboelastography) may be needed. The other possibility would be a vasculitis rather than blood disorder causing bleeding. Andy

Re: clotting disorders

CatherineThomas — Mon, 02 Apr 2012 18:07:14 GMT

Ah, I've just checked her notes again and yes she is on metacam. But she wasn't on anything when the previous sample showed a low platelet count.

She is on synulox but no other antibiotics. She has been seen over the past week or so for a swelling near the shoulder and the notes say suspect FB. I haven't seen the dog but I've just spoken to the owner and she says that there is a hole which often bleeds over night and they wake up to the dog covered in dried blood.

Re: clotting disorders

CatherineThomas — Mon, 02 Apr 2012 17:06:19 GMT

Not that I've seen or heard of. But we aren't too far away from a port.

Re: clotting disorders

Christopher Saul — Mon, 02 Apr 2012 17:06:09 GMT

A platelet count of 150 would not normally be associated with spontaneous haemorrhage no, but you seem to have reason to be concerned based upon the history. I would probably not be confident to go to surgery just yet to be honest. Is referral an option? I would advise you consider referral to be honest if the owners can afford it. I doubt anyone would criticise you for referring because it is better to be over cautious than to be faced with a dog bleeding out during a spay.

Having said that here are a few thoughts:

I agree the low PT/APTT means you're looking at a primary haemostatic disorder if anything. I don't recall this breed being amongst the overrepresented list for VWD, though I'm not near a textbook as I write this so I'd advise you check that. Remember though VWB is independent of platelet number; it is a thrombocytoPATHIA not a thrombocytopenia.

You would need to assess both platelet number and function here; I would repeat the CBC as maybe the platelet count is waxing and waning over time.

Causes for thrombocytoenia include reduced production by the BM ( drug induced, infectious or neoplasia), increased destruction ( most importantly IMTP) or sequestration (eg DIC). Is there any history of oestrogen or suphonamide therapy? As goes infectious causes, these are most notably the intracellular bacteria and distemper virus. I would test for erhlicia/anaplasma, more likely to be a problem if the dog's been abroad, though I think some anaplasma species are present in the UK so might be worth doing a PCR. One species causes cyclic thrombocytopenia but I cant for the life of me remember which one.

As for platelet function; is there any history of NSAID therapy? A relatively simple test of platelet function is a BMBT. There are more sophisticated tests such as flow cytometry but you'd have to ask your lab about those.

In summary: most important things to do are... thorough history particularly with regard to NSAID, oestrogen or sulphonamide tx, foreign travel etc. Repeat CBC, Buccal Mucosal Bleeding Time, +/- Anaplasma PCR...

Hope this helps

Chris

Re: clotting disorders

Mark Hedberg — Mon, 02 Apr 2012 16:19:28 GMT

Any tick borne diseases in your area? (Ehrlichia, for instance?)

Re: clotting disorders

CatherineThomas — Mon, 02 Apr 2012 16:04:57 GMT

She had a "well pet screen" done in 2009 which includes biochem and haematology. It showed a low platelet level of 153.

This weeks results are:

PT 6 sec (7-10)

APTT 9 secs (11-18)

Fibrinogen 8.8 (2-4.5)

Platelets 167 (200-500)

Biochemistry has not been done this time.

She has been using advocate, she last picked up the advocate in February but I haven't checked if she has actually used it.

Re: clotting disorders

HMC — Mon, 02 Apr 2012 15:22:52 GMT

I'm sure others will quickly follow with better/more scientific answers but for what it's worth....

a normal PTT and APPT rule out secondary clotting disorders, so I would focus on primary, ie platelets, starting with a buccal mucosal bleeding time.

I would also consider lungworm- a course of panacur is rather cheap.

Was a full biochemistry done too?