Clinical signs of IMTP can also include:
• anaemia
• ecchymosis
• petechiae
• collapse
• lethargy and weakness
• anorexia
• epistaxis
• scleral haemorrhage
• haematuria
• mucosal bleeding.
Investigations
On admission, an up-to-date haematological examination was performed, and a range of diagnostic tests were completed to rule out infectious disease. The investigations comprised:
• 4DX( IDEXX) – a test for Dirofilaria immitis, borreliosis, ehrlichiosis and anaplasmosis
• Angio Detect( IDEXX) – a test for Angiostrongylus vasorum( lungworm)
• measurement of packed cell volume( PCV) and total protein
• blood gas analysis
• haematology
• blood smear evaluation
• urine dipstick analysis and measurement of specific gravity
• determination of blood type.
Peach ' s results showed a severe regenerative anaemia with a PCV of 15 %( normal range 35 – 50 %) and raised lactate level of 6.5 mmol / l( normal range 0.6 – 2.9 mmol / l). The external laboratory test results showed hypoproteinaemia, reflective of blood loss, and mildly raised urea. An external platelet count revealed a marked thrombocytopenia with a platelet count of 3 × 10 9 / l( normal range 140 – 700 × 10 9 / l). The infectious disease tests were negative.
On further examination, Peach was tachycardic with a heart rate of 160 bpm, with increased respiratory rate and effort.
Diagnostic imaging can be used to rule out secondary causes such as neoplasia. Peach underwent a conscious abdominal ultrasound examination to look for the source of bleeding from the upper gastrointestinal tract. Possible ulceration of the colon was noted; however, no clear bleeding was seen. Gastrointestinal bleeds serve as a prognostic indicator and are associated with a more guarded prognosis due to the likelihood of internal haemorrhage.
Petechial haemorrhage observed on the abdomen indicated severe thrombocytopenia and impaired primary haemostasis. Due to ongoing haemorrhage, Peach ' s PCV decreased to 11 %, and she became haemodynamically unstable, indicating the need for a blood transfusion.
A common presenting sign in patients with IMTP is anaemia, due to compromised haemostasis. Anaemia can occur as a result of significant blood loss. Clinical signs that can be observed include:
• pale mucous membranes
• exercise intolerance
• tachycardia
• tachypnoea
• a flow heart murmur.
Treatment
Treatment of primary IMTP predominantly focuses on suppressing the immune system to stop platelet destruction. Immunosuppression is typically achieved by using glucocorticoids; however, depending on the severity of the disease, additional medications may be used in conjunction [ 4 ]. Patients may be managed at home or may require hospitalisation.
Peach was already on corticosteroids; therefore, dexamethasone was continued intravenously at 1 ml / 10 kg( Colvasone, Norbrook, 0.2 % solution). Peach was also started on an immunosuppressive drug, ciclosporin( Virbac, 100 mg / ml), at 50 mg orally twice daily, as well as omeprazole 10 mg( Boehringer Ingelheim Animal Health, 370 mg / g) orally twice daily and sucralfate 500 mg( Bova UK) orally three times daily, 1 hour before being fed, to provide gastroprotection. Side effects of glucocorticoids include, but are not limited to, polyuria and polydipsia, increased appetite and skin infections due to immunosuppression.
Peach was reverse barrier nursed, with separate equipment being used, and personal protective equipment( PPE) such as an apron and gloves were worn when handling her. She was taken for frequent walks, ensuring she did not come into contact with any other patients. Peach was offered water hourly to avoid regurgitation.
The platelet count typically begins to rise 1 – 15 days after beginning treatment for IMTP [ 4 ]. Vincristine( Pfizer,
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