AVP Vol 52 Issue 1 March 2022 - Flipbook - Page 16
Although fibrin/fibrinogen degradation
products and D-dimer concentrations were
not measured, the clinical findings
and laboratory results (Table 1), and
the combination of overt haemorrhage
(hypocoagulability) and thrombus formation
(hypercoagulability), were considered strongly
supportive of a diagnosis of DIC. To reduce
platelet aggregation, clopidogrel (Plavix,
Sanofi-Aventis, Macquarie Park, NSW; 2.2 mg/
kg orally every 24 hr) was commenced.
The dog appeared brighter and was eating
well, although the increased respiratory effort
continued. In-hospital clinicopathological
results demonstrated ongoing coagulopathy
and a slight reduction in PCV (Table 1).
The dog was hyporexic and the PCV decreased
throughout the day from 0.22 L/L to 0.18
L/L. A transfusion of packed red blood
cells (300ml, compatible crossmatch) was
administered. Monitoring of PCV and TPP
was performed, and the PCV increased to
0.30 L/L a few hours after the transfusion.
The dog’s respiratory effort and appetite had
improved. The PCV had decreased slightly,
and there were marked increases of inhospital PT and aPTT. Blood was submitted
for a CBC and coagulation panel. This
showed a moderate neutrophilia, clumped
platelets, although they appeared reduced
on blood smear, an prolonged PT, normal
aPTT and prolonged TT (Table 1). Clopidogrel
was consequently discontinued, due to the
subjective reduction in platelet numbers.
Thoracic radiographs were repeated to
investigate an ongoing, mildly increased
respiratory effort. A dorsocaudal alveolar
pulmonary pattern was noted, which was not
considered to be significant.
Day 54 (seven days after presentation)
The dog’s PCV remained at 0.27 L/L and an
in-hospital platelet count was approximately
60 x 109/L. The dog’s demeanour and
respiration were considered sufficiently
stable to warrant discharge from hospital,
and treatment with amoxycillin/clavulanic
acid and prednisolone was continued.
The dog was rechecked daily and was
reported to be bright and eating well at home.
The owner expressed no concerns. On Day
56, PCV was slightly reduced to 0.25 L/L, but
remained stable on Day 57 at 0.26 L/L. There
was ongoing thrombocytopenia and increasing
neutrophilia (Table 1). Schistocytosis,
acanthocytosis and target cells were noted
on smears. A coagulation panel, submitted
on Day 57, showed that PT, aPTT and TT
were significantly increased, and fibrinogen
Day 59 (five days after discharge)
The dog was presented to our emergency
service for hyporexia and epistaxis. The
dog had developed mild pyrexia (39.3°C).
There was ventral abdominal petechiation
and bruising of the penis. The anaemia had
stabilised, while schistocytosis, neutrophilia
and thrombocytopenia remained present.
Changes consistent with infarcts in both
renal cortices were identified on abdominal
ultrasonography. The portal thrombus also
remained visible. Thoracic radiographs
showed improvement in the bronchointerstitial
and alveolar pulmonary patterns compared to
previous radiographs (on Day 53).
Coagulation times remained significantly
prolonged, and fibrinogen remained below
the limit of detection (Table 1).