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scott@vtx-cpd.com

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Viewing 15 posts - 856 through 870 (of 2,024 total)
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  • scott@vtx-cpd.com
    Keymaster
    17:43 09/07/23

    Replying to Nadia C. 09/07/2023 - 12:42

    Brilliant!

    Maybe our paths will cross! Thank you again for the great questions.

    I really hope you are enjoying the course!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    10:16 09/07/23

    Replying to Nadia C. 08/07/2023 - 22:15

    HAHAH!

    This makes sense now. If you are working in a centre that has a TEG machine, then they will consider this gold standard. Overall, TEG is the only way to assess global coagulation. Many centres do not have access to TEG and therefore it is still very reasonable to look at PT and aPTT. So neither Pride or Paragon are wrong, they simply have different kit. I have worked in many clinical situations where PT and aPTT are totally acceptable.

    How interesting that you work at Paragon… I am actually doing a locum there in a few weeks! We must say hello!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    10:09 09/07/23

    Replying to Nadia C. 08/07/2023 - 22:29

    Hello Nadia.

    Thank you for your response. I agree, practically we also take blood from the catheter at the time of catheter placement. We will then be using those catheters for multiple IV infusions/IV lines. We would then normally take repeated blood samples from the jugular vein. It think it is less practical to take a blood sample from a peripheral catheter when it has been in for a few days. The exception would be if we have a central line in place. The great benefit of central lines is the ability to take repeated blood samples.

    Really interesting that you work as an in patient vet. That must be quite a rewarding role?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    19:10 08/07/23

    Felipe.

    These are very inspiring words. It reminds me of the quote:

    “Change. But start slowly, because direction is more important than speed.”

    Thank you again for everything.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    08:25 08/07/23

    Replying to Carolyn C. 28/06/2023 - 06:46

    Hello Carolyn.

    Your key problem list and DDX are perfect!

    I think ruling Addison’s out in this case is a great shout. We did run a basal cortisol which was 100 nmol/l. Any result over 55 nmol/l is not consistent with Addison’s, so we were confident this was not the problem in this case. I was less suspicious of Addison’s as there was a lymphopenia, but good rule out! I love the possible link between the Addison’s and GI bleeding and anaemia and low albumin too. We can sometimes see increases in potassium due to haemolysis. This is not uncommon in samples that have been transported to the lab. If in doubt, I would run the sample again on a fresh one in house.

    Again, great thinking regarding the possibility of liver disease in this case. In order for glucose and albumin to go down there would have to be over 75% liver function loss. I think this is less likely in this case. We can sometimes see albumin go down a little with a negative acute phase response. This could be due to almost any infections or inflammatory disease. Often the globulin will increase in these situations (as it is an acute phase protein), which it has not in this case.

    In the emergency stetting we did do a POCUS scan of the chest and abdomen and there was no free fluid. The in saline agglutination was negative and we had a look at a blood smear. I have shared the blood smear images. I would love to hear your thoughts.

    Thank you again for your brilliant suggestions.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    09:54 07/07/23

    Replying to Nadia C. 24/06/2023 - 16:24

    Nadia!

    Thank you so much for these really brilliant points!

    Your suggests regarding possible hypoadrenocorticism (HA) are great. Despite the lack of the classic stress leukogram, there is a lymphopenia, which would be less common in a true HA patient.

    A study of 53 dogs with HA who were compared with 110 sick control dogs highlighted some useful differences between CBC findings in dogs with and without HA. While median blood cell counts in dogs with HA were within reference limits, dogs with HA had lower neutrophil counts and higher lymphocyte and eosinophil counts than did ill dogs without HA. An absolute lymphocyte count >2000 cells/mcL was about 58% sensitive and 85% specific as a screening tool for HA.

    This was a lab sample that was sent to the external lab, so it would not be unusual to get a mild hypoglycaemia and hyperkalaemia due to transit. Glucose consumption in transit and potassium increase due to haemolysis. Having said that, the basal cortisol is a good shout!

    Some other great suggestions, and as always the blood smear is key! I have shared images below:

    Smear-1
    Smear-2
    Smear-3

    Would love to hear your thoughts. What can you see?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    09:34 07/07/23

    Replying to Nadia C. 24/06/2023 - 16:14

    Another great question Nadia!

    Bleeding due to amyloidosis is mostly a problem in cats. It can be a reason that cats would present with abdominal bleeding. The amyloid will deposit abnormally in the liver. This is an insoluble protein and will cause a change in the liver architecture. This makes the tissue more friable and prone to splitting/fracture. This is what makes the tissue more prone to bleeding.

    I hope that makes sense!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    09:29 07/07/23

    Replying to Nadia C. 24/06/2023 - 16:12

    Hello Nadia.

    Another great question! The faecal occult blood test is generally detecting haemoglobin in the sample. That is the reason for the vegetarian diet. There are a few ways of running this test, so the methodology will have some effect on false positive/false negative results. I would try to stick to the vegetarian rule if possible. A great commercial option if Purina HA:

    https://pubmed.ncbi.nlm.nih.gov/32196727/

    I hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    09:22 07/07/23

    Replying to Carolyn C. 28/06/2023 - 06:00

    Hey Carolyn!

    Really great question. So the answer does depend a little on the type of test being carried out, but generally better to do vegetarian if possible. This will probably not be too problematic for a few days in cats, but I understand your concern.

    This study is helpful:

    https://pubmed.ncbi.nlm.nih.gov/31509050/

    In real life I would probably stick to Purina HA if possible (wet or dry based on this study) before doing FOB testing. I hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    08:39 07/07/23

    Hello Nadia.

    Really lovely to hear from you. I really hope you are enjoying the course.

    Practically speaking I would use PT and aPTT to assess secondary coagulation in practice. These would be the methods that are most widely available.

    There are different analysers that perform viscoelastic testing, including the ROTEM®, TEG® and Sonoclot®, results of which are not directly comparable (McMichael et al 2014). Even the same type of analyser does not yield comparable results in different institutions when subjected to standardized testing (Goggs et al 2018). To add confusion, each company uses specific terminology for the technique and results, which is only applicable to their analyser, although the provided results provide similar information. With the ROTEM® , the technique is called thrombelastrometry and with the TEG® analysers, the technique is called thrombelastography (abbreviated to TEG; the latter should only be used for results obtained from TEG® analysers and not those from the ROTEM® or Sonoclot®).

    Generally speaking we have most information in veterinary medicine regarding TEG®. If there was the option to use thromboelastography then I would use that! The problem is that machines that perform this sort of testing are not widely used in practice (although commercially available). In time I am sure TEG will become more widely available.

    What are you currently using?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    16:57 06/07/23

    Replying to Francesca Lamb 06/07/2023 - 09:24

    Hey Fran!

    I hope you are well and enjoying the course! I totally get it, it does seem like a bit of a scary procedure. It really is something that you should not have to resort to on many occasions. The blind BAL will suffice in most cases. This is really reserved for the super sick cases that you are worried about the GA in. I will try and look for more resources and chat through the procedure more at the live Q&A to get you feeling a bit more confident about it!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    10:03 05/07/23

    Replying to Nadia C. 27/06/2023 - 23:56

    Hello Nadia.

    I hope you are safe and well. No problem regarding journal club!

    We can make the recording available if you would be keen to watch it back?

    I really hope you are enjoying the course.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    08:49 04/07/23

    Replying to Kathryn B. 03/07/2023 - 16:04

    Hey.

    I have probably confused things a little by sharing the later blood results from day 23! The one thing we can be confident of is that the blood glucose was persistently high. The dog was diabetic… feel like that is not too much of a give away! 🙂

    The main intervention between the 2 time points was insulin therapy was started.

    There were some more investigations along the way too…

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    22:30 29/06/23

    Replying to Kerry Doolin 25/06/2023 - 05:08

    Well hello Kerry!

    Amazing to have you join us. You obviously have to share a picture of the Pug now. These wee dogs have a funny way of making it into our lives! I don’t know if you remember we rescued one a wee while back too!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    22:49 27/06/23

    Replying to Talia C. 27/06/2023 - 19:07

    Talia!

    Brilliant to see you. You have had quite the career! How cool to have worked in so many incredible places.

    I hope you enjoy the course and we can help a bit with the tricky anaemia cases.

    Thank you again for supporting vtx.

    Scott 🙂

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Viewing 15 posts - 856 through 870 (of 2,024 total)
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