Anemia case lecture Flashcards
6 year old S/F boxer
History of coccidioidomycosis, takes daily fluconazole for 5+ years
Had gastric metallic wire removed endoscopically in June 15. No problems in last 5 months since procedure.
Due for vaccinations and coccidiomycosis titer.
BAR, happy dog..
Assessment
Valley fever; historical, asymptomatic
Ceruminous debris AU
Grade 1 dental disease
Low HCT (PCV) Low Hb Clumping noted Albumin low Globulin High ALP HIGH Serum electrolytes normal
Fluconazole dose for treating active fungal disease?
5-10 mg/kg PO BID
Valley Fever Profile
CBC/Chem/UA
Coccidiodes titer
If patients coccidiodides titers are stable from last year and patients CBC is normal…
Consider discontinuing fluconazole
Vaccine protocol..
Dogs
DA2PP Vax: right shoulder
Rabies: R hip
Bordetella va: intranasal
Consider flucosamine supplementation
Coccidiodies titers
IgM
IgG (positive in sadies case)
IgG titer 1:8
Anemia
Regenerative? r/o hemorrhage/loss (3rd space, GI tract) unlikely hemolysis s
Non-Regenerative: r/o ACD, decreased production (immune disease/PRCA/non-regenerative IMHA, myelofibrosis, myelodysplasia, neoplasia) - unlikely CKD.
Hypoalbuminemia
Loss 9kidney/PLN0 - unlikely GI tract due to hyperglobulinemia
Negative acute phase reactant
Decreased production- no strong suspicion for hypoadrenocorticism or liver disease.
Hyperglobulinemia
Immune stimulation (dental disease, known infection (historically valley fevere), undiagnosed infection, inflammation. Neoplasia (unlikely due to mild elevation)
Elevated ALP (normal ALT)
Drug reaction (fluconazole) Endocrinopathy (HAC, HypoT4) no associated clinical signs Other ALP isoenzyme (bone, steroid) Infiltrative hepatic disease (neoplasia) intrahepatic cholestasis Extrahepatic cholestaisis (pancreatitis, cholelith, mass, mucocele)
Diagnostics recommended with..
Anemia
Reticulocyte count
Abdominal ultrasound
Diagnostics recommended with..
Hypoalbuminemia
UA +/- UPC ratio
Diagnostics recommended with..
Hyperglobulinemia
No specific diagnostics, can consider protein electrophoresis if increases.
Diagnostics recommended with..
Elevated ALP
Abdominal ultrasound
Discontinue fluconazole.
Abdominal ultrasound can look for..
Evaluate the hepatobiliary tree
Evaluate for third space losses
Evaluate for GI masses
What is a 4DX?
Tests for (erhrlichia) E. Canis (anaplasma)A. Platys heartworm d. immitis lyme disease b. burgdorferi
Reticulocyte counts over what are considered regenertative?
60,000
Markedly anemic dog inappropriate regenerative response Classically expect reticulocyte count below 200 negative for ehrlichia major concern is decreased production undiagnosed bone marrow neoplasia. Revised diagnostics?
Chest radiographs: screen for metastatic disease or diagnosed infection/lymphadenopathy
Bone marrow aspirate/biopsy if radiographs are clear.
Pale pink, normal LN
Femoral pulses bounding, 2/6 L apical systolic murmur.
Tramadol to control discomfort.
Myelofibrosis
Proliferation (non-clonal) of fibroblasts in bone marrow- bone marrow scarring.
Primary myelofibrosis not well documented in dogs
May occur secondary to bone marrow necrosis
-likely to damage to bone marrow microvasculature
Underlying possibilities:
-Immune mediated disease
-infectious disease (septicemia, e. canis)
-drugs (estrogen, cephalosporin’s)
-neoplasia (usually hemolymphatics)
Suspct myelofibrosis secondary to immune mediated disease
Guarded prognosis and usually takes 3-4 months to respond to treatment
Treat with immunosuppressive medication
-concern for underlying coccidiomycosis and potential recrudescence)
Prednisone 30-40 mg/day
Cyclosporine 100-125 mg PO q12 hr
Discontinue fluconazole because it can be to due to chronic fluconazole treatment.
What is fluconazole?
?
