Case of the week

RE: Case of the week

Julie Innes — Thu, 24 Oct 2019 10:49:03 GMT

Interesting case! we had one a couple of years ago, IMTP, 10d after vaccination which of course the owner was adamant was to blame (well, initially she was convinced it was having his anal glands emptied that caused it). Never proved it and dog recovered, but she has decided not to vaccinate him again (although we are allowed now to empty his anal glands!)

RE: Case of the week

Roland Bulkyn-Rackowe — Wed, 23 Oct 2019 14:01:02 GMT

I had a similar case some years ago, slightly older (and no spherocytes); a 6 month old collapsing / anaemic pug. The owner had switched dear old Puglsy's diet to liver and onions as his dog food looked so unappetising.

RE: Case of the week

Charlotte Marshall — Tue, 22 Oct 2019 20:44:53 GMT

I did many years ago see one case I suspected, likely IMHA within a week of first vaccination

RE: Case of the week

Sarah Keir — Tue, 22 Oct 2019 19:45:13 GMT

I know the evidence is poor regarding links between vaccination and autoimmune disease but... I have used Nobivac vaccines for 17 years with no noticeable link except the past 6 months worked somewhere using Virbac vaccines and see three cases soon after vaccination - IMPA, a bizarre neck-pain/SRMA (went for referral) and a IMHA. Or perhaps it is because I am working in a different county?

RE: Case of the week

Thomas Johnson — Tue, 22 Oct 2019 19:03:53 GMT

[quote user="Joyce Whitehead"]It’s interesting the vaccine thing, I’d agree that I’ve never seen a case of autoimmune disease that I can be suspicious was related to recent vaccination.[/quote]

I've always been very suspicious of the link between vaccination and auto-immune disease. Anecdote alert: I have seen one case that did fit though. A whippet that was diagnosed with steroid responsive meningitis at 9 months old (had CSF tap at referral centre), 6 months since his last vaccination so no suspicion on that occasion. However 3 weeks after his next vaccination when he was 15 months old the signs of meningitis recurred, lethargy, pyrexia and neck pain, and responded to treatment with prednisolone. Could be coincidence, but on balance we have decided not to vaccinate him again, it's now 18 months since that second episode.

RE: Case of the week

Iain Richards — Tue, 22 Oct 2019 18:07:42 GMT

Good Case. Be interesting to run that one on Vet Voices and see what the testaholics make of it.

RE: Case of the week

Chris Milligan — Tue, 22 Oct 2019 17:53:25 GMT

[quote user="Joyce Whitehead"]

It’s interesting the vaccine thing, I’d agree that I’ve never seen a case of autoimmune disease that I can be suspicious was related to recent vaccination. Good case, thanks for posting David. I’ve seen a definite couple of IMTP over the past 35years associated with amoxiclav, both resolved after removing drug and adding steroids (one post Caesar, that was a bit of a worry).

My GP practice nurse was telling me when I was in (for a smear test, why do dog owners always assume we want to know about their dogs?) that her dog had IMHA and the vaccine company were contributing to the cost of treating it as it had been vaccinated 8 weeks before. I was rather surprised, and wouldn’t have reported that as an adverse reaction.

[/quote]

this is even worse than being trapped at the barbers, unable to move for 20 minutes while they tell you about Fluffy's bowel movements in excruciating detail

RE: Case of the week

Gillian Mostyn — Tue, 22 Oct 2019 17:47:03 GMT

[quote user="Joyce Whitehead"]as it had been vaccinated 8 weeks before.[/quote]

So IF you've got a dog with IMHA AND vaccinate yearly, you've got almost a 1 in 6 chance of getting a vaccine company to pay for treatment. Not bad odds!

RE: Case of the week

Joyce Whitehead — Tue, 22 Oct 2019 17:26:55 GMT

RE: Case of the week

David Mills — Tue, 22 Oct 2019 16:56:45 GMT

I think this is IMHA as it has all the hallmarks of such - pyrexia, anaemia, haemolysis, bilirubinuria, reticulocytosis, spherocytes on smear.

It may not be. The pup was started on preds at 1.5mg/kg/day, amoxicillin, and is now bright as a button.

I posted this to illustrate that the diagnosis (presumptive) was reached with absolute minimal testing, at very low cost, all in house, and successful treatment initiated.

Biochemistry and haematology may have helped but first line? Not for me. A Coombs test is redundant with autoagglutination.

I suspect the small amount of free fluid in the abdomen was just normal for this age of pup.

Regarding cause

[quote user="Beats"]I would say IMHA caused by the vaccine as number one [/quote]

This has been found to be false (recentish study) - there is no correlation within a month of vaccination and cases of IMHA.

I suspect in this pup some inflammatory or infectious episode (hence initial pyrexia) triggered IMHA. Amoxiclav is a candidate but would be pretty rare IME.

Also never seen it in an animal this young.

RE: Case of the week

Sarah Keir — Tue, 22 Oct 2019 11:02:59 GMT

chronic neonatal isoerytholysis?

RE: Case of the week

Joyce Whitehead — Tue, 22 Oct 2019 10:06:46 GMT

Yes I’d be thinking IMHA too, although I’ve never seen it in a pup. I’ve just lost a young dog to it recently (I mean 3yo not pup), horrible disease.

RE: Case of the week

Beats — Tue, 22 Oct 2019 09:52:12 GMT

[quote user="Clive Ansell"]Angiostrongylus Vasorum[/quote]

Does it cause pyrexia or significant anemia in the absence of obvious hemorrhage?

I would say IMHA caused by the vaccine as number one differential and IMHA caused by the amox/clav as number 2 differential and IMHA for another reason as number 3 differential.

RE: Case of the week

Clive Ansell — Tue, 22 Oct 2019 08:49:42 GMT

Other than being treated with milbemycin a week ago, has the puppy received regular anti-parasitic treatment?

Angiostrongylus Vasorum, lungworm, must be on the list of differentials (Not sure how much you see in your area, but we see cases in the Midlands). Fairly inexpensive to run a snap test, and larvae found in a faecal smear would be diagnostic.

RE: Case of the week

Lucy Fleming — Tue, 22 Oct 2019 08:15:11 GMT

[quote user="Beats"]Cheapskate[/quote]

I'm only a lowly assistant, I don't make the purchasing decisions!

RE: Case of the week

David Mills — Tue, 22 Oct 2019 07:38:24 GMT

Urine haemolysed blood 3+, bilirubin 2+

Reticulocytes increased on methylene blue staining.

Diagnosis? Cause?

RE: Case of the week

Joyce Whitehead — Tue, 22 Oct 2019 00:14:21 GMT

Urine sample? Any bilirubinuria?

RE: Case of the week

Nicola Cole — Mon, 21 Oct 2019 21:53:01 GMT

I somehow missed the smear picture.

I‘d also be starting on immunosuppressive doses of pred...

RE: Case of the week

Beats — Mon, 21 Oct 2019 20:34:17 GMT

[quote user="Lucy Fleming"]You could perform a reticulocyte count. I've been told (no personal experience) that the blue stain in a diff quik set can replace new methylene blue in a pinch[/quote]

Cheapskate ;-) https://www.clin-tech.co.uk/product/new-methylene-blue-1-in-0-9-saline-100ml/

keeps forever

2 drops in urine tube with 2 drops edta blood - let sit for 20mins then make "normal" smear

don't waste time counting 1000 rbcs (not assuming you can post the blood to someone that will for a small fee should you really wish a "retic count") - just make a subjective judgement based on level of anemia.

RE: Case of the week

Beats — Mon, 21 Oct 2019 20:22:50 GMT

clear pyrexia one week after vaccine, no response to amox/clav, PCV of 14% and an absence of foul-smelling bloody diarrhoea and I'm starting on pred 1mg/kg q12hrs and asking further questions later.

spherocytes and normal blood protein levels and positive slide agglutination seal the deal.

could have loss of rbc precursors as part of immune-mediated process, so checking reticulocytes with NMB might not necessarily demonstrate the level of regeneration expected.

RE: Case of the week

Lucy Fleming — Mon, 21 Oct 2019 20:17:34 GMT

[quote user="David Mills"]Do we know if this is regenerative or not? What inexpensive in house test could you do to determine this? [/quote]

You could perform a reticulocyte count. I've been told (no personal experience) that the blue stain in a diff quik set can replace new methylene blue in a pinch

RE: Case of the week

David Mills — Mon, 21 Oct 2019 19:23:56 GMT

No fleas. No trauma. Wormed a week ago, milbemycin.

There are spherocytes.

Do we know if this is regenerative or not? What inexpensive in house test could you do to determine this?

There's a test not done yet which pretty much clinches the dx.

RE: Case of the week

Neil Wheadon — Mon, 21 Oct 2019 18:51:46 GMT

I guess you have to go through the differentials

Trauma,

Parasites

Red blood cell breaking down

Red cells not being produced

I feel there are a number of spherocytes in that smear

There isn't a lot that would cause anaemia in a puppy aside trauma and loads of fleas (assume none seen??) so IMHA on the list

The TS is normal, whilst PCV is reduced - Chronic, so maybe I'm wrong with the spherocytes?

Neil

RE: Case of the week

David Mills — Mon, 21 Oct 2019 18:27:48 GMT

Born in the UK, normal size for age. No known toxin exposure.

Ts was 80.

Saline agglutination positive.

Any more tests or suggestions?

RE: Case of the week

Rob Davis — Mon, 21 Oct 2019 16:48:54 GMT

Was it born in the UK?