thrombocytopenia

Re: thrombocytopenia

scatty — Fri, 20 Dec 2013 17:50:47 GMT

Hi,

I actually put the dog to sleep today at the owners request which is fair enough all things considered. However we did a bit more work up for those of you who are interested:

Radiographs - unremarkable although spleen was large in size. Ultrasound - definite pockets of fluid around the spleen - we did an u/s guided aspirate of the fluid which was a clear transudate. APTT was prolonged, the hypoproteinaemia and anaemia were both progressing. Fasting bile acids were normal. I didn't really complete the work up to get a definitive diagnosis before we made the decision was made to put him to sleep. Thanks to all of you for your help.

Re: thrombocytopenia

scatty — Thu, 19 Dec 2013 19:05:25 GMT

Thanks very much for all of your replies. The dog is booked for tomorrow to do PT/APTT etc and also for imaging. Will let you know how I get on!

Re: thrombocytopenia

Kate Richardson — Wed, 18 Dec 2013 14:47:58 GMT

That's quite a significant anaemia for a Lurcher so with low platelets and low proteins may suggest blood loss. Would be good to know if there are signs of regeneration on the blood smear or a retic count. Check faeces for melaena, but I would be heading to some imaging especially of abdomen. Spleen always comes to mind in an older dog

Re: thrombocytopenia

Rory Bell — Wed, 18 Dec 2013 14:45:03 GMT

I agree with what Martin, Andy and Dagmar have said; all good points. Definitely recommend coagulation profiles, imaging of the chest and abdomen is a good idea as well. Primary immune thrombocytopenia would usually, as Andy pointed out, be associated with much lower platelet counts then this case, and would not be expected to cause such a dramatic weight loss or decrease in appetite, so even if there was an immune mediated component to this dog's illness, its much more likely to be secondary to some other underlying illness.

Keep us posted!

rory

Re: thrombocytopenia

Dagmar Steele — Wed, 18 Dec 2013 13:49:20 GMT

I know for you guys this is a long shot but with people traveling abroad with their pets nowadays you might want to start considering diseases like Ehrlichiosis and Anaplasmosis as well. They do cause thrombocytopenia as well.

Re: thrombocytopenia

Andrew Kent — Wed, 18 Dec 2013 12:58:05 GMT

I agree with Martin on this one.

You have a low platelet count but many of the ITP's will have much lower levels that this (<50000/ul). So a consumption or loss of platelets seems more likely (unless this falls further so keep an eye on it.)

I would measure secondary coagulation times (PT/aPTT) and D-Dimers to try to exclude a consumptive coagulopathy/DIC and then image to look for a source of bleeding.

Andy

Re: thrombocytopenia

Martin Atkinson — Wed, 18 Dec 2013 12:39:50 GMT

You have to ask yourself if this is an unrelated auto-immune thrombocytopaenia or if it is an iatrogenic drug reaction to the thyroxine, or is there something else suppressing the bone marrow. So go looking for evidence of bleeding, any petechiae or melaena, how about looking for faecal occult blood. That low glucose, albumin and cholesterol interest me possible pancreatic disease, insulinoma with liver involvement, bleeding into abdomen?? So some imaging X-ray/ultrasound before I'd even think about corticosteroids or azothiaprine.