Reply To: FREE Webinar: If you prick us, do we not bleed?
Thanks for a really interesting webinar.
I have a question following from an acute IMTP case I had very recently which had a very disappointing outcome. The case was a 1 year old FN Lhasa Apso in good health with no previous significant medical history. She had received full puppy vaccines but was not recently vaccinated. The presenting signs were anorexia,lethargy and coughing of only a few hours duration but worsening when she presented around midnight. There was no epistaxis, no melaena and basically no other presenting signs and she was apparently completely normal earlier that day. Exam revealed slightly pale occular, oral and genital mm with petichiation present, there was slight skin bruising on the abdomen, lung sounds were harsh bilaterally.
Her investigation findings were anaemia with a PCV of 27% slide agglutination negative, severe thrombocytopaenia with automated count around 20×10^9/L and no platelets visible on a blood smear, PT and aPTT were normal, lungworm antigen negative, a conscious chest x-ray was suggestive of pulmonary haemorrhage and haematuria. I had completed her investigations by around 4am and arranged for referral to a specialist centre for first thing in the morning. (I was very worried about the respiratory signs and risk of cerebral bleed etc and thought maybe she was a transfusion candidate… which I now know would have been unlikely to help). She was kept rested and in O2 until transport at which time her PCV was 24%.
Sadly the referral centre recommended euthanasia the same afternoon due to the severity of her condition and deteriorating clinical signs.
My question is would immunosupressive doses of steroids have had any effect on the test results I had carried out (had they not been available at the time) or any further investigations the specialist may have wanted to do. Because she was going for referral within such a short timeframe of hours and her PCV had remained fairly stable I did not initiate any treatment in the few hours between reaching diagnosis and the referral as I was concerned I might have interfered with their further investigations or treatment options. I suspect this case was just extremely acute and a single dose of steroids may not have changed the outcome but it was a very disappointing outcome and I want to learn for the future if I was faced with a similar case again. Thank you