Jan 2010 Case of the Month: Lethargy & malaise in 12 yo collie x

Re: Jan 2010 Case of the Month: Lethargy & malaise in 12 yo collie x

Clive Elwood — Thu, 04 Feb 2010 19:13:38 GMT

There was hyperaemia and excess mucous production in the duodenum. No overt bleeding was seen. Gastroscopy was unremarkable:

Histopathology of an intestinal biopsy showed a moderate lymphoplasmacytic enteritis:

So, final questions.

1) Is this sufficient to explain Mick's iron deficiency anaemia.

2) How would you manage Mick now?

Clive Elwood — Mon, 01 Feb 2010 15:06:59 GMT

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Iron status

Serum iron 5.6 (21-37 µmol/l )

Total iron binding capacity 52.1 (51-103 µmol/l)

Transferrin saturation 10.8 (>26%)

Faecal occult blood

Positive

So we did an abdominal ultrasound:

Wall thickness was 5.1 mm (<4.7). No other abnormalities were detected.

Thoracic and abdominal radiographs were obtained and revealed no abnormalities.

So:

How do you wish to manage Mick now?

Clive Elwood — Mon, 01 Feb 2010 09:32:46 GMT

Urine sediment analysis was unremarkable; no cells seen. That's all you get

Clive

Clive Elwood — Fri, 29 Jan 2010 17:33:08 GMT

So here are some more details:

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Haematology	Result	Reference range
Red blood cell count	4.55	5.8-7.7 x 1012/l
Haemoglobin	3.83	14.5-19.6 g/dl
Haematocrit	0.16	0.42-0.56 l/l
Mean cell volume	35.1	67.2-75.5 fl
Mean cell haemoglobin	8.39	23.3-26.3 pg
Mean cell haemoglobin concentration	23.9	34.0-34.9 %
Red cell distribution width	23.1	12.1-14.1 %
Platelets	560	150-400 x109/l
White blood cell count	16.61	4.7-18.7 x109/l
Neutrophils	12.8	1.6-11.7 x109/l
Bands	0.9	0-0.5 x109/l
Monocytes	2.3	0.2-1.7 x109/l
Lymphocytes	0.51	1.9-5.5 x109/l
Eosinophils	0.1	0-0.8 x109/l
Reticulocytes	18.4%
Smear examination: Red cells show excessive central pallor, anisocytosis +++, polychromasia +++, marked microcytosis. Occasional nucleated red blood cells are seen. Leucocytes appear normal.
Biochemistry
Sodium	145	145-149 mmol/l
Potassium	4.2	3.5-5.5 mmol/l
Chloride	113	110-115 mmol/l
Urea	8.5	3.8-7.0 mmol/l
Creatinine	95	70-130 µmol/l
Calcium	2.45	2.0-3.0 mmol/l
Phosphate	1.28	1.0-2.0 mmol/l
Glucose	5.1	3.0-5.5 mmol/l
Total protein	52.5	50-65 g/l
Albumin	27.9	25-35 g/l
Globulin	25	25-35 g/l
Bilirubin	9	7-15 µmol/l
ALKP	154	10-100 IU/l
ALT	116	15-50 IU/l
Cholesterol	6.27	3.5-6.5 mmol/l
HCO3-	-	mmol/l

Urine (Cystocentesis)
Specific gravity	1.025
pH	6.0
Nitrite	-
Bilirubin	-
Blood	-
Protein	-
Ketones	-
Glucose	-
Microscopy	-

What further tests would you wish to perform to further classify the anaemia?

What is your interpretation of the findings so far?

Arlo Guthrie — Thu, 28 Jan 2010 17:21:33 GMT

Please, nobody reply to this thread, and instead reply on this one here.

This thread is just for Clive to add diagnostic info as we go along.

I've shifted three posts from here to there, so if you are one of the authors, that's where your post has gone!