scott@vtx-cpd.com

Replying to Nadia C. 16/07/2023 - 21:22

Hey Nadia.

Thanks for your reply.

I agree. Lots going on. The stand out thing for me are the red blood cell shape changes, there are a lot of them! More than I would be comfortable with.

We did indeed do coagulation parameters in this patient. I would not routinely carry out PT and aPTT before doing abdominal FNA’s. My main concern would be platelet number. If there are enough platelets, then normally I am good to go!

I agree though, it this case the PT and aPTT was a good shout. Both these parameters were normal. We did preform FNA’s of the spleen. These came back as extramedullary haematopoiesis. Frustrating!

Next steps?

Scott 🙂

Hello everyone.

I thought I would share the blood smear images form this dog. They are probably the most thought provoking part of this case and always the right thing to do in an anaemic patient!

Let me know your thoughts!

Scott 🙂

Thank you for all of the replies so far!

A 5-year-old neutered male DSH was presented to a referral hospital in Scotland for lethargy, coughing and wheezing of 1 month’s duration, as well as hypercalcaemia (3.3 mmol/l; reference interval [RI] 2–3 mmol/l) detected by the referring veterinarian. Defaecation, thirst and urination were normal. The cat was fed a good-quality commercial diet, and routine vaccinations and prevention against external and internal parasites were up to date. It was an indoor/outdoor cat and an avid hunter, with no travel history outside of Scotland. On physical examination, the cat had harsh lung sounds with a normal respiratory rate (25 breaths/min) and effort. The peripheral lymph nodes were increased in size; the remainder of the physical examination, including a retinal examination, was unremarkable.

Haematology, serum biochemistry (including thyroxine) and urine analysis were unremarkable, except for hypercalcaemia (ionised calcium [iCa] 1.75 mmol/l [RI 1.1–1.35 mmol/l]). Ionised hypercalcaemia was confirmed with a repeated blood sample, and there was no haemolysis or lipolysis. Feline immunodeficiency virus antibody and feline leukaemia virus antigen were negative, and blood pressure was normal.

What are your DDX for the hypercalcaemia?
Could this tie in with the respiratory changes and does this help narrow down your DDX?

Scott 🙂

Replying to Francesca Lamb 11/06/2023 - 17:35

Hello Francesca.

Thank you so much for your brilliant reply. I am sorry about my delay. I just wanted to make sure others got the opportunity to answer too. I purposely shared little information about the case so we focused on the images. I totally agree, I think there is a relatively generalised alveolar/interstitial pattern.

Differential diagnoses included infectious pneumonia (bacterial, parasitic, protozoal, viral or fungal), primary or metastatic neoplasia or, less likely, idiopathic pulmonary fibrosis. The spine and vertebrae were carefully examined in all radiographs for the presence of osteolytic lesions, and none were found.

I will share some further information about the case!

Thank you again for the reply. I hope you are enjoying the course.

Scott 🙂

Replying to Dan T. 14/07/2023 - 10:53

Thanks Dan.

This is really helpful. To be honest, I think my first task will be to actually find out what the company values are when I am locumimg. If I am being honest, I would not be able to recall what the values were for the last clinical job I had. I am going to be looking in to that. I think being more aware, and making others aware of the company values is a start.

This has also made me think really carefully about the fact that we do not have company values with vtx. We have a directors meeting next week and this is now top of the agenda!

Scott x