Page 205 - Basic Monitoring in Canine and Feline Emergency Patients

immune-mediated destruction, radiographs of the the plan was to continue Maui on mycophenolate
thorax and abdomen were taken which were largely for the remainder of her life (possibly at a slowly
VetBooks.ir unremarkable. An abdominal ultrasound did not reduced dose) as long as she continued to tolerate
the drug.
reveal any significant abnormalities and a panel
looking for underlying Rickettsial disease was nor-
mal. She was placed on doxycycline (10 mg/kg/day
by mouth for 30 days) in the event a Rickettsial Further Reading
disease that was not identified on the panel was a
causative agent for the immune-mediated destruc- Ettinger, S.J., Feldman, E.C., Cote, E. (eds) (2017)
tion. Maui also received immunosuppressive ster- Textbook of Veterinary Internal Medicine, 8th edn.
Elsevier, St. Louis, Missouri, USA.
oids (2 mg/kg/day prednisone by mouth) to control Barr, J.W., McMichael, M. (2012) Inherited disorders of
the immune-mediated destruction of her platelets. hemostasis in dogs and cats. Topics in Companion
Within 5 days, her platelet count had improved to Animal Medicine 27, 53–58.
132,000/μL on the steroids. Boudreaux, M.K. (2008) Characteristics, diagnosis, and
However, 2 weeks later, Maui’s recheck platelet treatment of inherited platelet disorders in mammals.
count (on the same prednisone dosing) had Journal of the American Veterinary Medical
dropped to 10,000/μL with a few small clumps Association 233, 1251–1259.
noted. At that time, the owners saw ecchymoses Goggs, R., Brainard, B., de Laforcade, A.M., et al. (2014)
on her ventral abdomen. She was re-admitted to Partnership on Rotational Viscoelastic test standardi-
the hospital for more aggressive immunosuppres- zation (PROVETS): Evidence-based guidelines on
rotations viscoelastic assays in veterinary medicine.
sive therapy with vincristine 0.02 mg/kg intrave- Journal of Veterinary Emergency and Critical Care,
nously once and cyclosporine 10 mg/kg by mouth 24, 1–62.
every 12 hours in addition to the continued 2 mg/ Nakamura, R.K., Tompkins, E., and Bianco, D. (2012)
kg/day of prednisone. Her platelet count initially Therapeutic options for immune-mediated thrombo-
improved to more than 500,000/μL. This exuber- cytopenia. Journal of Veterinary Emergency and
ant response was attributed to the vincristine. Critical Care 22, 59–72.
Vincristine has an undetermined mechanism, but Paniccia, R.P., Priora, R., Liotta, A.A., Abbate, R. (2015)
may either cause release of platelets from the Platelet function tests: a comparative review. Vascular
megakaryocytes in the bone marrow and/or Health and Risk Management 11, 133–148.
reduce destruction of existing platelets.
At a subsequent recheck examination 5 days Bibliography
later, her platelet count dropped to 6,000/μL. She
was also anemic (19%/6.0 g/dL; normal Blair, P., Flaumenhaft, R. (2009) Platelet α-granules:
35–45%/5.5–7 g/dL). It was suspected that she was Basic biology and clinical correlates. Blood Review
bleeding into her gastrointestinal tract secondary to 23, 177–189.
the thrombocytopenia, leading to the anemia. She Blois, S., Lang, S., Wood, R., Monteith, G. (2015)
received intravenous immunoglobulin (IVIG) as a Biologic variability and correlation of platelet function
last-ditch effort to stop the immune-mediated testing in healthy dogs. Veterinary Clinical Pathology
44, 503–510.
destruction of her platelets. She was continued on Brass, L. (2010) Understanding and evaluating platelet
the 2 mg/kg/day of prednisone and started on function. ASH Education Book 1, 387–396.
mycophenolate mofetil (10 mg/kg by mouth every Brooks, M.B., Catalfamo, J.L. (2013). Current diagnostic
12 hours) in lieu of cyclosporine as a secondary trends in coagulation disorders among dogs and cats.
immunosuppressive agent. She was also given Veterinary Clinics of North America Small Animal 43,
sucralfate and omeprazole to treat any gastrointes- 1349–1372.
tinal ulceration leading to the bleeding. Buttarello, M., Plebani, M. (2008) Automated blood cell
Three days later, her platelet count was above counts. American Journal of Clinical Pathology 130,
500,000/μL. Nine months later it continued to be 104–116.
greater than 400,000/μL on every recheck platelet Favaloro, E., Mohammed, S., Patzke, J. (2017)
Preanalytical issues in hemostasis and thrombo-
count performed, despite slowly weaning her com- sis testing. In: Favaloro, E., Lippi, G. (eds)
pletely off the prednisone. During the prednisone Hemostasis and Thrombosis. Methods in Molecular
weaning, Maui continued to receive mycopheno- Biology. Humana Press, New York, New York, USA,
late at 10 mg/kg twice daily. At the time of writing, pp. 29–42.

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