10yo ME springer spaniel with GI signs, now very high globulins....

RE: 10yo ME springer spaniel with GI signs, now very high globulins....

Jenny Harris — Thu, 30 Jul 2020 06:51:08 GMT

Hi Andy

thanks so much for your help with this case. The dog did turn out to have multiple myeloma!

best wishes

Jenny

RE: 10yo ME springer spaniel with GI signs, now very high globulins....

Andrew Kent — Sat, 25 Jul 2020 10:43:10 GMT

Hi Jenny,

Apologies for the delay in getting back to you.

So the results seem to suggest your results were real - thats a pretty speedy change! And I agree lymphoid vs myeloid neoplasia has to be at the top of our list.

I think you could go either way with this so no right answer. I tend to start with the easier things so imaging + FNA liver/spleen and see what you get in those.

Do keep us posted - interesting case!

Andy

RE: 10yo ME springer spaniel with GI signs, now very high globulins....

Jenny Harris — Thu, 16 Jul 2020 13:15:27 GMT

So we have the results back :

FINAL RESULTS:

SPE

Fraction Result (g/l) Reference interval

Total protein 140.0 54.0 - 77.0

Albumin 18.70 20.0 - 40.0

Alpha 1 2.36 2.0 - 5.0

Alpha 2 3.52 3.5 - 11.5

Beta 15.96 10.0 - 18.0

Gamma 99.46 5.0 - 12.0

The trace suggests a monoclonal gammopathy with associated abnormal proteins

extending the gamma fraction, rather than a monoclonal gammopathy within a

polyclonal. While neoplasia is the most prominent differential, infectious

inflammatory disease is not fully excluded and, if this pet has any travel

history an infectious diseases screen is advised.

So we could recheck globulins again I suppose, but presuming these are still high then I could offer the owner either progression of the GI work up with biopsies (endoscopic depending on albumin),

vs persuing multiple myeloma dx with radiographs of the bones, FNA liver and spleen and bone marrow biopsy?

If the travel history is not 100% certain I suppose I could offer testing for erlichia/leishmania but these don't seem likely given the rest of the picture.

And also we could monitor the UPC ...

Which way would you lean first? Biopsies or investigation for myeloma? I suppose we could try and do all in one but will make for quite a long GA in my hands as don't do endoscopy frequently....

many thanks again!

RE: 10yo ME springer spaniel with GI signs, now very high globulins....

Jenny Harris — Wed, 15 Jul 2020 12:53:31 GMT

Thanks so much for taking the time Andy!

yes I thought the result was odd so it was sent externally and in house. I can always recheck it again now, but if not real would the electrophoresis run properly? I will recheck globulins regardless before making a further plan for the case.

The haematology was ok other than the non regen anaemia as far as I remember.

I will keep you posted and thanks again

Jenny

RE: 10yo ME springer spaniel with GI signs, now very high globulins....

Andrew Kent — Tue, 14 Jul 2020 21:34:55 GMT

Hi Jenny,

Are you sure the globulin result is real? Seems unusual to go from low to that high. Agree that malignancy would be a potential cause of that but would repeat it first if you haven't done so as just seems odd. Its more marked than we usually see with inflammation so lymphoid malignancy or myeloma more likely.

[quote userid="15443" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29227/10yo-me-springer-spaniel-with-gi-signs-now-very-high-globulins"]Is there anything else I should be considering? If this comes back as a monoclonal gammopathy would next steps be radiographs to look for lytic lesions +/- bone marrow biopsy?[/quote]

Presumably a haematology is normal? No lymphocytosis?

You could indeed look at radiographs or FNA the liver/spleen.

[quote userid="15443" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29227/10yo-me-springer-spaniel-with-gi-signs-now-very-high-globulins"]Or should I pursue the GI angle first with either endoscopic or full thickness biopsies?[/quote]

that would certainly be another potential place to sample.

[quote userid="15443" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29227/10yo-me-springer-spaniel-with-gi-signs-now-very-high-globulins"]Would you be concerned about full thickness with an albumin of 17 (has been 13)[/quote]

A little - I guess we need to see what it is at the time we are thinking about sampling. Endoscopic would certainly be preferable at that level.

[quote userid="15443" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29227/10yo-me-springer-spaniel-with-gi-signs-now-very-high-globulins"]I was also going to do a course of erythromycin with regards the campy even though this seems likely a secondary problem[/quote]

I would ignore this. Campylobacter is commonly found in dogs with and without diarrhoea but when significant is more associated with acute disease.

This does sound unusual so let us know how things progress!

Andy