pyrexic collie

Re: pyrexic collie

Bob Russell — Tue, 07 Dec 2010 11:22:44 GMT

We provisionally diagnose pancreatitis for almost all vaguely unwell dogs until proved otherwise. The in house test works well generally but does miss some!

A case I was getting nowhere with went for referral and they eventually made a provisional diagnosis of pancreatitis but did not manage to proveit!

If the test is positive you have an answer but if negative still warn the owners that it may be pancreatitis and treat symptomatically any way!!!

Is pancreatitis on the increase or are we just getting better at diagnosing it?

Re: pyrexic collie

Richard Fox — Tue, 07 Dec 2010 10:22:40 GMT

I am no expert in cPLI however the test is quoted as 98% specific but only 85% sensitive so you will miss 15% of cases with pancreatitis - no test is 100% reliable in my experience :) That's not to say you are def. dealing with pancreatitis :)

Re: pyrexic collie

emma o'connor — Mon, 06 Dec 2010 22:57:12 GMT

I would have to agree about the pancreatitis Richard, it is still my hunch as well, even though the in house snap test kit was normal, I am beginning to wonder whether it is worth having these or not, i would be interested in your opinion of their usefulness.

Re: pyrexic collie

Richard Fox — Fri, 03 Dec 2010 09:29:32 GMT

Thanks for the update - I would monitor liver enzymes and see if they are falling (ALP half live of about 3 days). I still wonder about pancreatitis myself :)

Re: pyrexic collie

emma o'connor — Thu, 02 Dec 2010 20:46:37 GMT

Seen the dog again today....the owners braved the snow which is more than some of our staff did!....... He is doing well, currently no further pyrexia, eating better, no vomiting, passing normal faeces and urinating and wanting to go for walks. So we have decided at present to allow the antibiotics to run their course and recheck blood work next week.

Just a point, the haematology we sent to the laboratory was actually blood drawn on the monday, when even according to our in house analyser, all wbc counts were now wnl, the initial low wbc readings were obtained over the weekend, and i deemed that blood too old to send to the lab monday afternoon. I was really looking for comment on rbc morphology and white blood cells as my own cytology is rather limited! But i do agree we must always take care with results from in house analysers, accepting they are not without fault!

Re: pyrexic collie

Richard Fox — Thu, 02 Dec 2010 09:54:13 GMT

It is :)

"Alkaline Phosphatases are a group of enzymes found primarily the liver (isoenzyme ALP-1) and bone (isoenzyme ALP-2). There are also small amounts produced by cells lining the intestines (isoenzyme ALP-3), the placenta, and the kidney (in the proximal convoluted tubules). What is measured in the blood is the total amount of alkaline phosphatases released from these tissues into the blood. As the name implies, this enzyme works best at an alkaline pH (a pH of 10), and thus the enzyme itself is inactive in the blood. Alkaline phosphatases act by splitting off phosphorus (an acidic mineral) creating an alkaline pH.

The primary importance of measuring alkaline phosphatase is to check the possibility of bone disease or liver disease. Since the mucosal cells that line the bile system of the liver are the source of alkaline phosphatase, the free flow of bile through the liver and down into the biliary tract and gallbladder are responsible for maintaining the proper level of this enzyme in the blood. When the liver, bile ducts or gallbladder system are not functioning properly or are blocked, this enzyme is not excreted through the bile and alkaline phosphatase is released into the blood stream. Thus the serum alkaline phosphatase is a measure of the integrity of the hepatobiliary system and the flow of bile into the small intestine.

In addition to liver, bile duct, or gallbladder dysfunction, an elevated serum alkaline phosphatase can be due to rapid growth of bone since it is produced by bone-forming cells called osteoblasts."

Sorry a bit of plagiarism there My english is not that good

Re: pyrexic collie

Michael Woodhouse — Wed, 01 Dec 2010 22:22:10 GMT

[quote user="Richard Fox"]if ALT not raised then active liver disease is unlikely although if TBil is normal then cholestasis is also unlikely ? So maybe look at other causes of raised ALKP i.e pancreatic disease/intestinal disease. Pancreatitis (acute or chronic) may result in increased ALP levels from swelling and/or fibrosis around the bile duct. Also HAC but if cholesterol not raised then also unlikely?[/quote]

Isn't Alk Phos also produced from bone?

Re: pyrexic collie

Christopher Saul — Wed, 01 Dec 2010 17:53:44 GMT

haematology unremarkable, bit different from what the in-house result said huh? I never know how much to trust the in-house analysers. The main thing with this case is it's clinically improving. I'd def repeat the liver enzymes in a few days though....

Re: pyrexic collie

Richard Fox — Wed, 01 Dec 2010 10:38:31 GMT

Cool. if ALT not raised then active liver disease is unlikely although if TBil is normal then cholestasis is also unlikely ? So maybe look at other causes of raised ALKP i.e pancreatic disease/intestinal disease. Pancreatitis (acute or chronic) may result in increased ALP levels from swelling and/or fibrosis around the bile duct. Also HAC but if cholesterol not raised then also unlikely?

ALP(ALKP) half life in dogs is about 3 days :)

Blister cells are erythrocytes containing one or more vacuoles. The texts suggest cell membrane damage (physical) d.t. interaction with fibrin deposits or microangiopathic haemolytic anaemia (pre-shistocytes).

Re: pyrexic collie

emma o'connor — Wed, 01 Dec 2010 10:22:05 GMT

ionised calcium 1.18, within normal limits according to our ranges. Haematology comments unremarkable, apparently giant platelets, scattered polychromatic cell, occasional blister cells (not sure what these are?) no mention band neutrophils. Dog doing ok at home, bright and eating on antibiotics still, due to see him again tomorrow for another check. Alp is still high, at 1108, so perhaps next step will be an abdominal ultrasound.

Re: pyrexic collie

Christopher Saul — Mon, 29 Nov 2010 22:01:36 GMT

[quote user="emma o'connor"]CBC and urine in the post today, hopefully some results tomorrow[/quote]

All good, keep us posted on results. We REALLY need to know what the calcium is doing though, have you requested an ionised from the lab? If you haven't sent off to the lab for this, can you at least repeat the calcium in house to see if the hypercalcaemia is repeatable? Sorry if I'm sounding a bit anal but it'll help to decide if we're going down the neoplastic or the consumptive routes....

Re: pyrexic collie

Michael Woodhouse — Mon, 29 Nov 2010 20:37:45 GMT

[quote user="emma o'connor"] did repeat haematology this morning and found wbc now increased to just over 6 , but pcv now dropped slightly to 36%.[/quote]

So WBC went from 1.87 (6-17) to six which is now WNL? Looking very much like a consumptive issue to me. If dog wasn't drinking and was mildly dehydrated then the fluids could easily drop the PCV by that order of magnitude.

Did you look at a smear with the new cell count? Any sign of band [non segmented] neuts? More cells about?

Re: pyrexic collie

emma o'connor — Mon, 29 Nov 2010 20:07:30 GMT

thanks, CBC and urine in the post today, hopefully some results tomorrow. I did repeat haematology this morning and found wbc now increased to just over 6 , but pcv now dropped slightly to 36%. I possibly convinced myself of some mild slide agglutination, but have requested coombes test as well from the lab.

This forum is great, so many helpful people out there

Re: pyrexic collie

Richard Fox — Mon, 29 Nov 2010 17:04:10 GMT

Sorry I should have added some smileys so here goes :

Re: pyrexic collie

Christopher Saul — Mon, 29 Nov 2010 16:19:12 GMT

yeah you're poss right Richard, I was really tired and just about to go to bed when I saw the post, may not have read it as thoroughly as I might.

I think we really need the results of the path lab's CBC, and a repeat and/or ionised calcium before we can help with this one

Re: pyrexic collie

Richard Fox — Mon, 29 Nov 2010 11:52:55 GMT

Hmm - Would an aleukaemic leukaemia not produce pan-cytopaenia? - would RBC morph be abnormal unless it was releasing immature erythrocytes. Also is pyrexia a consistent finding in neoplasia? Is there any anaemia after the weekend? I would also repeat the Ca - is this a total or ionised calcium?

Neoplastic/AI diseases seem to be a default Dx when the disease process is unknown in my experience like toxin induced death is default when the death is unexplained. Common things are common and pyrexia with leukopeania would smell of infection/inflammation to me ?

Not sure you could still rule out pancreatitis entirely and the leukopaenia and neutropaenia could be consumptive? Are there any band NL in the circulation?

Re: pyrexic collie

Christopher Saul — Sun, 28 Nov 2010 23:28:07 GMT

Hi Emma,

Sorry for my rushed reply, only just seen your posts and I'm on an early start tomorrow.

I think you need to clarify whether the hypercalcaemia is 'real' and not a spurious/lab error - simplest way would be to reapeat, though ideally would be by requesting an ionised sample. Def need to get a full CBC/smear from a path lab, I see you've decided to do this already so all good .

Might be useful to get a urine culture and cytology too given the haematuria. I'd prob send them some serum too -, though I wouln't request it at this stage, the lab will be able to run a serum protein electrophoresis if you request it at a later stage (mutliple myeloma not that likely given the total protein normal, but have it in the back of your mind).

Assuming the hypercalcaemia is significant, I think your musings about poss neoplasitc causes are prob right. Any signs of anal tumours? Also part of the work up for hypercalcaemia should include skeletal radiography to look for osteolytic lesions. Any skeletal pain? Remeber ALP can come from bone....

Re: pyrexic collie

emma o'connor — Sun, 28 Nov 2010 22:16:17 GMT

steroids will certainly be the next step if the other option is pts. Will be sending haematology tomorrow asap, and looking at an abdominal scan hopefully. Seems brighter today but not eating, pyrexia under control at present. Thanks for all the advice so far.

Re: pyrexic collie

Vikki Halliday LLB — Sun, 28 Nov 2010 20:16:02 GMT

[quote user="Heather Toft"]

Vikki, you didn't let it die without steroids did you?

[/quote]

Yep, fraid so peeps! They were offered as the next line of "last chance saloon" that we seemed to be playing, but the owners did not want any further treament or investigation as the dog by this point was quite frankly, bu88ered!

Re: pyrexic collie

Heather Toft — Sun, 28 Nov 2010 19:15:03 GMT

[quote user="Alan Tevendale"]

[quote user="Michael Woodhouse"]

[quote user="Vikki Halliday"]3 days of antibiosis, NSAIDS, Fluids and other tricks, the owners elected to PTS[/quote]

Vikki, you didn't let it die without steroids did you?

[/quote]

Better pred than dead

[/quote]

It never fails to amaze me how many of those cases get better!

Re: pyrexic collie

Alan Tevendale — Sun, 28 Nov 2010 18:13:18 GMT

[quote user="Michael Woodhouse"]

[quote user="Vikki Halliday"]3 days of antibiosis, NSAIDS, Fluids and other tricks, the owners elected to PTS[/quote]

Vikki, you didn't let it die without steroids did you?

[/quote]

Better pred than dead

Re: pyrexic collie

Michael Woodhouse — Sun, 28 Nov 2010 17:45:00 GMT

[quote user="Vikki Halliday"]3 days of antibiosis, NSAIDS, Fluids and other tricks, the owners elected to PTS[/quote]

Vikki, you didn't let it die without steroids did you?

Re: pyrexic collie

Vikki Halliday LLB — Sun, 28 Nov 2010 16:16:06 GMT

[quote user="emma o'connor"]

I do worry this could be an acute aleukemic leukemia, especially as he is a lovely dog with lovely owners the other possibility i guess is an infectious hepatitis given the alp increases, with wbc consumption???

[/quote]

This case almost exactly mirrors one I had two weeks ago in a 3 year old MN collie, with almost identical clinical signs and blood findings.

'Fraid I won't be much help though as after 3 days of antibiosis, NSAIDS, Fluids and other tricks, the owners elected to PTS the dog as we could not reduce the pyrexia, the dog was getting worse, and they could not afford referral. Blood smear was done in house and looked remarkably normal, but I suspect some leukaemic or autoimmune problem.

Re: pyrexic collie

Laurence Webb — Sun, 28 Nov 2010 10:23:45 GMT

Have you looked at the urine sediment to determine if it is rbc in the urine or haemaglobin? Also if it's got lots of white cells in it or not.

Although the prostate feels normal a raised ALKP and active urine sediment would make me want to look at the prostate a bit further (ultrasound). If there are no red cells in the urine sediment, just haemaglobin then you could be looking at prerenal haemolysis or myolysis (myoglobin will make the dipstick change too). Checking for slide agglutination is quick and easy to do.

Recheck the haematology to see if the white cells are recovering and get some off to a lab to look at white cell morphology too re leukaemia

Re: pyrexic collie

Mark Hedberg — Sun, 28 Nov 2010 07:58:29 GMT

If he hasn't changed significantly by tomorrow, add enrofloxacin into the mix. Amox/clav + enro is a very potent synergistic combination, and some bugs just aren't bothered by amox/clav.