Small Animal Veterinary Information Network: grillied!

Vikram Dave lab male senile DOB
not known, HB-6, RBC- 2.5, wbc-8000, PCV-16.3,

thrombocytopenia, hypochromic microcytic anemia, n-60, l-36,

e-04, bun-80 , creat-3.5,tot. bili-0.2 direct&indirect both 0.1,

sgot-52.8,sgpt-70 TP-8, A-4.2, G-3.8H/o losse motions , anorexia,

blood in stools, dehydrated,suspeted ARF...inj dns 500 ml +

cef + salbactum 375 mg bid + conciplex 2ml + neohepatex 1ml im

+ vitcofol 1 ml imbifilac and aparacid syp p/one sugesstions are welcome

August 7 at 6:03pm · Comment · · Flag

- Premal Darji
  lots of fluids. + wud change antibiotic to amoxyrum (whenever renal failure suspected)..babesia is the possibility for hemolysis.as no rise in neuto..canu send us total wbc count..is it a puppy or adult...check out urine colour..urine test if possible..
  
  this r my assumptions..not diagnosis..
  August 7 at 6:09pm · ·
- Gagan Gaudi temp??
  was there any history of ticks?
  August 7 at 6:33pm · ·
- Premal Darji i wud never rely on history of ticks sumhow..hav seen the clenest of all dogs getting tick fever...
  August 7 at 6:37pm · ·
- Vikram Dave no h/o ticks the DOB is nt knwn by the owner say the owner is ignorant so hardly has ne history as the dog is wih watchman which change quite often but the dog looks old even initited with catract, i ve already given wbc count above, temp is 101.5 F
  August 7 at 6:37pm · ·
- Premal Darji ok sorry didnt c that.but didnt c platlet count either.8000 wbc ..so quiet normal..
  August 7 at 6:40pm · ·
- Vikram Dave its 5100 which i dnt believe coz they clumpse to the sides of the vials and flase results are achieved generally but there is thrombocytopenia which i ve already mentioned
  August 7 at 6:44pm · ·
- Premal Darji ya sorry i wanted number..so u knw what it is...
  August 7 at 6:46pm · ·
- Vikram Dave no re will send it again for conirmation
  August 7 at 6:49pm · ·
- Premal Darji
  had similar case 4 yrs back.sgpt, bilirubin was 10 times higher, severe jaundice..creat rising day by day...v all were like tensed..and changing antibiotics from one to another..thn sum wise dr came in..just gave 1 shot of OTC..dog was normal nxt day..started eating the next day..thn was maintained on doxy....
  
  no comparison to this case...no cases r same
  August 7 at 7:05pm · ·
- Swarupmay Majumdar looks like leptospirosis! penicillin, fluids, becomplex...lolts of fluids
  August 7 at 7:46pm · ·
- Swarupmay Majumdar need transfusion! low HB and PCV
  August 7 at 7:47pm · ·
- Premal Darji how to confirm???
  August 7 at 7:47pm · ·
- Premal Darji HB -6..y to rush for transfusion..??
  August 7 at 7:48pm · ·
- Vikram Dave leptospirosis!!! i think the wbc count sud shoot uo in those cases were as in here it is normal, transfusion again is a problem, to find a donor, and as i said the owner is ignorant so will nt go for it
  August 7 at 7:50pm · ·
- Vikram Dave ya exactly i think its not high time for transfussion
  August 7 at 7:51pm · ·
- Premal Darji ya in case of infection wbc shoot shoot..
  August 7 at 7:51pm · ·
- Premal Darji i think u still maintain him on doxy..if not vomiting..along with other antibitic whch is not required..but just to avoid other inf..
  August 7 at 7:52pm · ·
- Gagan Gaudi i would go with oxy in this case along with fluids and other symptomatic treatment
  August 7 at 7:59pm · ·
- Swarupmay Majumdar
  more than Hb being less pcv values is also low! its requires blood soon or late! in any cases of thromocytopenia, there is 2 good options : tick fever or lepto! both will be blood losing condition!! So soon or late boold is a must! becoz even if u want to take it to a level of 9 , perhaps with iron injections and all...it may take more than 1 months to rach 9! I will not much worry about the cReatinine lebel! as fluids can manage it alot!
  Doxy is a good medicine but need to go with penicillin innitially if vomiting is not there!
  Case is having gaured prognosis. plz let us know about its course in ur hospital
  August 7 at 8:04pm · ·
- Rajshankar Tony Sarma
  Blood film - reticulocyte count, platelet count. Is this regenerative? Don't know reference ranges, but is TBil normal? Haemolysis? Blood loss? Failure of erythropoiesis? Are WBCs normal or reduced (pancytopaenia is bad...)
  
  Anaemia of renal failure - possible, but this is severe. IF it is related, then bear in mind that the patient will have compensatory mechanisms in action so should not be collapsed etc. due to low RBCs and in that case, while transfusion is always good when PCV is under 20, if animal is compensating ok, can often get by without. However, care with fluids. Severe azotaemia (is this patient in shock??) dictates high-rate fluids; that may push PCV down further though and cause decompensation...
  
  Questions - do you have a urinalysis / USG? Is there any sign of blood loss (e.g. melaena)? And, as said, blood smear time...
  August 7 at 8:18pm · · 3 people ·
- Swarupmay Majumdar yes..in such cases , would preferably be given D25 . I had a simmilar case! posted in SAVIN! which we lost becoz we could not arrange blood! Raj, can we use Hemacel in such cases where creatinine is high? and since HB is low, preferably he is put to complete rest.
  August 7 at 8:21pm · ·
- Premal Darji is this case chronic or acute??? if acute thn anemia due to renal problm i dont think so..but if chronic i will think on renal failure aspect..
  August 7 at 8:28pm · · 2 people ·
- Rajshankar Tony Sarma
  Colloids. Another can of worms ;o)
  
  They can be given to support intravascular volume, and by doing so will support blood pressure and therefore renal perfusion. However, renal toxicity, along with coagulation problems and anaphylaxis, are recognised side-effects of colloidal administrations.
  
  Also, benefits of colloids are theoretical... No-one has ever proven that they are better than crystalloids in shock (or vice versa) so human A&E doctors continually shout about their choice (colloid or crystalloid) at each other without any actual evidence to back up their claims...
  
  Haemaccel datasheet link below. Includes Haemaccel as "indicated" for certain renal problems... Others say "caution" in renal disease.
  
  http://www.noahcompendium.co.uk/Intervet_Schering-Plough/Haemaccel_Solution_for_Infusion_3_5_ACU-_(Veterinary)/-35965.html
  
  Euthanasia? Don't know without seeing dog / knowing more about case, but this patient clearly has big problems that either require full workup (without guarantee that cure is possible) or drastic action.
  August 7 at 8:29pm · · 1 person ·
- Swarupmay Majumdar raj, I was telling about putting down or euthenesia! I was saying the HB is so less , so its better not to make him walk around
  August 7 at 8:31pm · ·
- Rajshankar Tony Sarma Agree with Premal - anaemia would be related to renal issues in chronic renal disease only (and hence body has time to compensate). Such anaemias are normally milder, however.
  August 7 at 8:31pm · ·
- Premal Darji doc what is normosol.. is it available..
  August 7 at 8:31pm · ·
- Swarupmay Majumdar more over chronic renal failures has some suggestive clincal findings like uremic smells, anuria to dysuria, oral ulcerations, voimiting, encephalopathy..although varies in severity
  August 7 at 8:33pm · ·
- Rajshankar Tony Sarma
  Normosol - alternative to Lactated Ringers (Hartmann's). Higher in Magnesium, so can cause V / twitchiness in high doses.
  
  Sometimes preferred for patients with high Ca / liver problems. Lactated Ringers has better effects vs. acidosis (if liver functioning ok).
  
  http://www.drugs.com/pro/normosol-r-injection.html
  August 7 at 8:35pm · · 1 person ·
- Swarupmay Majumdar Raj, can this case be a case of Some Neoplastic origin , if so can u tell me more?
  August 7 at 8:37pm · ·
- Rajshankar Tony Sarma Compare to Hartmann's...
  
  http://www.noahcompendium.co.uk/Animalcare_Limited/Aqupharm_11_Hartmann's/-33363.html
  August 7 at 8:38pm · ·
- Vikram Dave this is not my case it has come to me as a 2 nd opinion. i have no proper history and the owner is least bothered, i mean hes paying but not givin history as its like a guard dog
  August 7 at 8:38pm · ·
- Premal Darji ‎????????...but if u dont mind 1 question??? how will u give second opinion whn u dont hav history..or evn tretment history what the vet has given..
  August 7 at 8:46pm · ·
- Vikram Dave i mean nt exactly second opinion they have changed the vet and want me to continue the treatment and give prognosis
  August 7 at 8:51pm · ·
- Rajshankar Tony Sarma
  Swarup - when I was at college, if a Prof asked me what could be causing a patient's disease, and I didn't have a clue, I knew I could always answer "neoplasia", "autoimmune disease" or "drug reaction" - because these things can present any way they like!!!
  
  As such, yes neoplasia is possible. There can be close links between anaemia and neoplasia - anaemia can be a paraneoplastic syndrome; neoplasia can lead to immune-mediate haemolysis; and bone marrow neoplasia (primary or secondary) can "crowd-out" normal bone marrow, thereby causing primary bone marrow failure.
  
  Euthanasia? Can't tell without seeing/knowing more about patient; however, significant perturbations on bloods which suggest that he either needs full workup or drastic action.
  
  The eternal problem - we can't treat properly, or even prognose accurately, without subjecting the patient to a whole load of tests - and the owner to a big bill - without any guarantee that what we find will can be treated. However, if we don't, we simply treat blindly, which for a complex problem is a suboptimal position too.
  August 7 at 8:52pm · · 1 person ·
- Swarupmay Majumdar Raj! I agree with u, u said paraneoplastic condition! can u specify something more?
  August 7 at 9:05pm · ·
- Swarupmay Majumdar
  ‎@Vikram dave: Dude ,we understand ur point, but I will sincerely request you not to treat a case when u are not knowing the history or such things or if u r asked to do the follow up! at the end of the day, the vet who wrote the prescription for it for ur follow up will either take the credit of the good work of urs or the owner take the blame onto u!
  I never do a fllow up case as a attending vet! thats not done, in my hand I want to treat in my own way!
  August 7 at 9:09pm · ·
- Vikram Dave sir im treating it and not folllowing up, if i had to do follow up i would have no queies regarding the case, they were not satisfied with the Rx of previous doc and so have shifted the case, i hope u understand
  August 7 at 9:14pm · · 1 person ·
- Premal Darji
  yes v all understand..only 1 more question??? how do u treat it thn..???
  
  if no proper history of disease and prvious treatment given by XYZ doc..i will take a consent from owner 1st..bcoz whn owner cums to u as second opinion that means he trusts u a lot..
  
  but owners cannot b trusted..specially whn dog serious..a non concerned dog owner also suudnly gets concerned of everything..especially his money..
  August 7 at 9:24pm · ·
- Rajshankar Tony Sarma Normally over here I'd call the other vet and ask for their notes. Owners constantly seek other vets - it's not (usually!) personal, just as each of us wants different things from our doctor, each owner wants different things from their vet and sometimes they just want to see if the terrible/expensive outlook given by the first vet is confirmed by the second. Therefore there should be no animosity involved in this.
  August 7 at 9:33pm · · 1 person ·
- Rajshankar Tony Sarma
  From WSAVA notes, Eric Teske of Utrecht uni...
  
  There are several causes for anaemia in cancer patients.
  
  1. Anaemia of chronic disorders. This type of anaemia is caused by a shortened erythrocyte life-span and is characterized by a mild, normocytic-normochromic, nonregenerative anaemia. The erythrocyte life-span is shortened from 120 days to 60-90 days. The exact cause of this anaemia is not known. Damage to the erythrocyte by abnormal vascular structures, inflammation, or immune complexes may result in increased phagocytosis in the reticuloendothelial system. Abnormal iron metabolism may also contribute to the anaemia.
  2. Anaemia caused by myelophthisis. Bone marrow infiltration by tumour cells may suppress the normal bone marrow cells. This is called myelophthisis and is usually only seen in a late stage of the neoplastic disease.
  3. Immune-mediated hemolytic anaemia. Immune-mediated hemolytic anaemia is usually associated in the dog and cat with haematopoietic tumours.
  4. Microangiopathic hemolytic anaemia. This type of anaemia is usually associated with microvascular tumours. Fragmentation of erythrocytes can occur. Both abnormal erythrocytes, resulting in anaemia, and fragmented platelets are the result of intravascular damage by fibrin threads formed in the course of DIC, or by abnormal vascular structures with fibrin deposits, or by proliferation of the intima in the pulmonary vessels after tumour embolism. Hemangiosarcoma is the most frequent tumour in the dog associated with this type of anaemia.
  August 7 at 9:50pm · · 1 person ·
- Premal Darji what kind of sympotms wud dog show clinically other thn anemia..in such cases
  August 7 at 10:18pm · ·
- Rajshankar Tony Sarma Depends on the tumour and other paraneoplastic signs. There's a million and one different possible presentations, so can't really be specific!
  August 8 at 2:51am · · 1 person ·
- Gautam Unny my 2 pennies worth, sulbactam and oxytetracycline are best avoided in renal cases. secondly the tlc is just 8k, why the need for such a strong antibiotic. just support the dog with ringers, vitamins, some steroids to increase the platelets , if very low, and wait. give some iron dextran and some medicines for the gut. avoid irrational use of antibiotics
  August 8 at 9:30am · · 1 person ·