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Reply To: The clue is in the blood smear…

Simon Patchett

Looks to me like Acute Lymphoblastic Leukaemia from the blood smear. There is a large peripheral expansion of lymphoid origin cells, they are large (larger than neutrophils if there were any for comparison) lymphoid cells with a higher nuclear:cytoplasmic ratio with visible nucleoli and condensed chromatin and intensely basophilic cytoplasm.

As noted the lack of neutrophils is not surprising as many of these dogs have concurrent neutropenia, thrombocytopenia and anaemias.

Looking at the blood gas we have a mixed respiratory alkalosis and metabolic acidosis – we can see this acidosis is not lactic in origin. There is moderate to severe anaemia, mild hypoglycaemia and mild azotaemia.

On the biochemistry there is moderate to severe Hypoalbuminaemia.

On the haematology there is significant thrombocytopenia, spontaneous bleeding is possible at this count with trauma or surgery but would need confirmation on a smear.

Overall this is one very sick pup. The mild hypoglycaemia is concerning as we know these dogs are at risk of sepsis, DIC and haemorrhage. If wanting to treat this dog (Prognosis considered very poor – variation depending on phenotype) I’d consider whole blood transfusion. But before that making sure we had samples to send for flowcytometry to confirm the diagnosis and 4DX to r/o Erhlichia. Amox/clav 20mg/kg Q6 IV, Glucose CRI as required, and placement of feeding tube for nutritional support. Then aggressive chemotherapy (Vinc + Pred I think is in literature).

Did the owners opt to attempt treatment in this case?