scott@vtx-cpd.com
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Replying to Janette B. 01/08/2023 - 16:04
Hello Janette!
We are so honoured that your are involved with this course! Thank you so much for being a part of it. I know the delegates will learn a lot from you, I certainly have over the years!
Thank you again.
Scott 🙂
Replying to Sara B. 02/08/2023 - 08:13
Hey Sara.
I hope you are well and having a lovely week. Thank you so much for sharing this… super interesting.
This is not a technique I have used specifically. I suppose we use this sort of method when we are using central lines. I have never used this method with peripheral catheters.
I agree with your comments. We would normally only take blood from a peripheral catheter at the time of placement.
I would love to hear other peoples experiences!
Scott 🙂
Replying to Francesca Lamb 24/07/2023 - 16:36
Fran!!! This is gold star stuff… what a brilliant response! Thank you for the time and consideration!
Differential diagnoses for hypercalcemia included granulomatous disease, neoplasia, hypervitaminosis D, renal disease, primary hyperparathyroidism, idiopathic hypercalcaemia, osteolysis or hypoadrenocorticism. Weight loss could be caused by hyporexia, maldigestion, malabsorption, chronic infection or inflammation, renal or hepatic disease, neoplasia, cardiac or – less likely – endocrine disease, including hyperthyroidism (the cat was relatively young for this), diabetes mellitus (polyuria, polydipsia and polyphagia would be expected) or hypoadrenocorticism (rare in cats); underfeeding, poor-quality diet and oral disease had been excluded. Harsh lung sounds could indicate pneumonia, primary or metastatic neoplasia or – less likely – idiopathic pulmonary fibrosis, pulmonary oedema or contusions. Hyporexia is a non-specific clinical sign; in the absence of oral/nasal disease or environmental stress, hyporexia could indicate systemic disease, nausea or pain.
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.
Further investigations of hypercalcaemia included plasma parathyroid hormone concentration (<10 pg/ml [RI <40 pg/ml]; not supporting hyperparathyroidism), plasma parathyroid hormone-related protein (<0.1 pmol/ml [RI <0.5 pmol/ml]; not supporting neoplasia, although there are other mechanisms by which neoplasia could result in hypercalcaemia), 25-hydroxyvitamin D (95 nmol/l [RI 127–335 nmol/l]; not supporting most types of hypervitaminosis D) and serum toxoplasma IgG and IgM titres (<50 and <20 [RI <50 and <20, respectively]). Abdominal ultrasound and radiographs were unremarkable. Thoracic radiographs (Figure 2) revealed a diffuse, interstitial–alveolar pattern, most marked on the caudal lung lobes. 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.
What would your next steps be?
Have a great week!
Scott 🙂
Hey Talia.
These are great questions.
Infectious disease screening is an interesting one! It obviously depends on the case. The 4DX is generally good for screening purposes and I would follow up with PCR if I get positives. Generally imaging would help understand other obvious focuses of inflammation or infection.
In PUO cases generally, I would do joint taps much earlier on. The only reason we moved to the bone marrow biopsies in the case was because of the haematology changes. But yes to the arthrocentesis in most PUO cases.
Blood culture is an interesting on! Again, blood culture would be more helpful in a PUO investigation. You could also consider when there is infection in areas that can be tricky to sample. Cases of bacterial pneumonia and prostatitis for instance.
Hope that makes sense.
Scott 🙂
Thank you for sharing this Helen.
And thank you for all the brilliant content so far!
I hope everyone is having a great week.
Scott 🙂
Replying to Victoria Hughes 31/07/2023 - 06:48
Hello Victoria.
I am so glad that helped! Blood gasses are so tricky. I always have to remind myself. Trying to get some examples to work through is really helpful. I will try and pop some on the forum.
Have a lovely week.
Scott 🙂
Replying to Francesca Lamb 24/07/2023 - 17:14
Hey Fran.
I agree. I avoid it completely and stick to marbofloxacin or pradofloxacin. I just don’t think it is worth the risk. We had an interesting discussion about this on clinics last week. Based on the information we have about enrofloxacin, I think it would be harder to defend of a patient did develop this complication.
Hope you are having a lovely weekend.
Scott 🙂
Replying to Siriol B. 23/07/2023 - 21:15
Thank you again for sharing the details of this interesting case.
Please keep us updated with how the case progresses.
Have an amazing weekend.
Scott 🙂
Replying to Mojca M. 22/07/2023 - 19:29
Hello Mojca!
I am so glad you are enjoying the course.
I will pass on your questions to Felipe. Sorry about the delay.
Hope you are having a lovely weekend.
Scott 🙂
Replying to Talia C. 25/07/2023 - 11:00
I completely agree Talia.
I would often initially sample from the IV when it is placed, but less likely to do it again if the catheter is left in place.
Hope you are having a lovely weekend.
Scott 🙂
Replying to Talia C. 25/07/2023 - 11:33
FNA’s of the spleen can be very frustrating!
Scott 🙂
Replying to Talia C. 25/07/2023 - 11:55
Talia!
Your thoughts are great! I would completely agree with these comments, we were in the same position with this case. Due to the significant red blood cell shape changes, we were still suspicious that the spleen might be more significant. For that reason, we did decide to perform splenectomy in this case. Histopathology confirmed hemangiosarcoma!
This was confirmed as a case of microangiopathic haemolytic anaemia (MAHA). MAHA refers to mechanical haemolytic anaemia characterized by red blood cell fragmentation as they traverse small-calibre blood vessels, typically seen as schistocytes on peripheral blood smear.
We ended up not using steroids in this case, but had blood on hand at the time of surgery to be prepared for any decompensation with the anaemia. I also started some sAME (acetylcysteine). To see is I could help protect the red blood cells a bit.
This was a tricky case from a decision making point of view. Thank you again for all of your brilliant contribution.
Scott 🙂
Replying to Nadia C. 23/07/2023 - 14:44
Hello Nadia.
I would completely agree with these comments, we were in the same position with this case. Due to the significant red blood cell shape changes, we were still suspicious that the spleen might be more significant. For that reason, we did decide to perform splenectomy in this case. Histopathology confirmed hemangiosarcoma!
This was confirmed as a case of microangiopathic haemolytic anaemia (MAHA). MAHA refers to mechanical haemolytic anaemia characterized by red blood cell fragmentation as they traverse small-calibre blood vessels, typically seen as schistocytes on peripheral blood smear.
We ended up not using steroids in this case, but had blood on hand at the time of surgery to be prepared for any decompensation with the anaemia. I also started some sAME (acetylcysteine). To see is I could help protect the red blood cells a bit.
This was a tricky case from a decision making point of view. Thank you again for all of your brilliant contribution.
Scott 🙂
Replying to Sarah M. 26/07/2023 - 12:59
Hello Sarah!
I hope you are well. Nice to see a fellow Ayrshire resident on here!
No surprised to hear about your own dog, it seems we are cursed in that way.
Please let us know if you have any questions. Thank you again for joining the course.
Scott 🙂
Replying to Amy M. 26/07/2023 - 20:41
Hello Amy!
I am so excited that you are starting at Edinburgh Vet School! That is where I did my residency and it is one of my favourite places! Which department are you working in? I also worked in the charity sector in Edinburgh… I feel we are following similar paths! 🙂
I really hope you enjoy the course!
Scott 🙂
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