scott@vtx-cpd.com

Replying to Victoria Rubasinska 28/07/2023 - 19:37

Hello Vicki!

Great question! I hope you are having a great week and enjoying the course.

I will pop the question to Ariane. I will also be interested to see her answer!

Scott 🙂

Replying to Nadia C. 26/07/2023 - 23:12

Hey Nadia!

This is a REALLY interesting question. I have definitely used TXA in GI bleeding cases, but often the more chronic cases that are bleeding due to NSAIDs or masses. I would also use in GI bleeding cases with thrombocytopenia. Most of the AHD cases self resolve and many of them present with high PCV’s. I must admit I do not routinely use TXA in these cases.

There is nothing as far as I am aware in the veterinary literature about this and I am not able to find anything in the human literature.

It is an interesting thought, but I am not sure I would be using in these acute HGE cases.

Love to hear your thought though!

Scott 🙂

Replying to Talia C. 25/07/2023 - 11:20

Talia.

These are really good points. I agree, you want to give yourself the best chance of getting the best sample. I would say that for this reason it is probably best to go for a long bone (humerus) when you can. The sternum is good for a quick sample, which might be helpful for things like leishmaniasis and some neoplastic problems. I did a bone marrow yesterday and only managed to get an aspirate, I totally failed getting a core sample. I still sent the sample off and you can often still get good information from the core.

Hopefully you will get a case soon that you can take a sample from!

Scott 🙂

Just as a bit of a fun fact!

The enrofloxacin issue is not thought to be as much of a problem in lions and tigers!

Scott 🙂

INVESTIGATION OF ENROFLOXACIN-ASSOCIATED RETINAL TOXICITY IN NONDOMESTIC FELIDS

Kim M Newkirk, L Kathryn Beard, Xiaocun Sun, Edward C Ramsay

Abstract
Enrofloxacin is known to cause retinal toxicity in domestic cats. The hallmark lesion of enrofloxacin-associated retinal toxicity in domestic cats is thinning of the outer nuclear layer of the retina. Enrofloxacin is commonly used to treat bacterial infections in nondomestic felids because of its action against a wide spectrum of bacteria and the ability for it to be given orally. No previous studies have investigated the potential retinal toxicity of enrofloxacin in nondomestic felids. This retrospective study evaluated 81 eyes from 14 lions ( Panthera leo ) and 33 tigers ( Panthera tigris ) that had been enucleated or collected postmortem. The thickness of the outer nuclear retina was assessed in two separate sites in each eye by counting the rows of nuclei and by using digital image analysis software to determine the area of the nuclei at each site. Medical records were reviewed to determine the enrofloxacin dose for each cat. Cats that had not received enrofloxacin (n = 11) were compared with treated animals (n = 36). The outer nuclear layer thickness or area in treated versus untreated cats was not significantly different. Additionally, no clinical blindness was reported in any of the cats. This study showed no evidence of enrofloxacin-associated thinning of the outer nuclear layer in the lions and tigers evaluated, suggesting that enrofloxacin can be used safely in these animals.

Replying to Nadia C. 16/07/2023 - 21:17

It does sound great.

I really like that veterinary medicine is moving in this way. I think we need to be flexible in the way we create roles for vet. If they want to do consult only, we should be OK with that!

Sound like the perfect role for you.

Scott 🙂

Replying to Nadia C. 20/07/2023 - 21:06

Hello Nadia.

Thank you so much for these brilliant comments. I love the case summary. This is exactly what we should be doing with these challenging cases, always go back to the initial problem list!

I think the red blood cell fragmentation changes are the really interesting part of this case. There are smaller number of spherocytes and ghost cells which would be consistent with IMHA. However, the other fragmentation changes are more prevalent and would not be consistent with IMHA. There are some boxes being ticked here for IMHA, but it would not be a confident diagnosis of IMHA in my opinion.

I think faecal occult blood testing would be a very reasonable test to run. Low albumin and globulin would be consistent with bleeding, but we do not see this in every case. The lack of low albumin and globulin does not rule out GI bleeding. Faecal occult blood testing was negative.

The 4DX would also be a good idea. None of the infectious disease organism that would be detected on this test would cause direct haemolysis, but could be part of a secondary IMHA type situation.

We did carry out chest radiography, which was unremarkable.

I agree, the PK deficiency is really unlikely.

SO… I think we have 2 main questions:

1. The splenic FNA’s are ‘normal’. Does this give you enough confidence to move on from the spleen?
2. Would you be confident enough based on the information you have to treat for IMHA?

Thank you again for all of your brilliant thoughts.

Scott 🙂