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scott@vtx-cpd.com

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  • scott@vtx-cpd.com
    Keymaster
    10:23 08/08/22

    Hello.

    Hope you are well. This is a great question. There is real debate regarding the significance of folate. Honestly, it is much less often significantly decreased compared with cobalamin. What was the cobabalamin level in this case? Many of the problems associated with low folate and cobalamin come from human literature. An equivalent relationship between hypocobalaminemia or hypofolatemia and hematologic changes in small animal veterinary species has not been established, although reports of anisocytosis, macrocytosis, anemia, or pancytopenia in association with hypocobalaminemia do exist.

    Honestly, I would supplement folate if low in most GI cases. It is a very safe thing to do. I would normally use the oral Cobalaplex product from Protein as it will supplement folate and cobalamin.

    How are you supplementing the cobalamin in this case?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    17:52 01/08/22

    Hello.

    I hope you are well! I have attached a table that I hope helps:

    MDB-Values

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    10:41 29/07/22

    Replying to Gergana G. 27/07/2022 - 20:50

    Hello.

    I would not consider a blood transfusion in this case. I would only consider the transfusion if the dog decompensates or is cardiovascular unstable. I would probably not increase the steroid dose if the dog is already on 2mg/kg/day and is having GI signs.

    There are some cases that require a 3rd immunosuppressive drug. If the dog is doing better then I would maybe hold off for a bit and repeat haematology in 7 days.

    The spleen is most likely to be extramedullary haematopoesis but you could consider FNA’s to make sure not something like lymphoma.

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    10:05 29/07/22

    Replying to Victoria T. 29/07/2022 - 09:33

    Hello Victoria.

    I am so pleased you have enjoyed the course!

    Thank you so much for your support.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    17:05 27/07/22

    Hello Gergana.

    I hope you are well. Tricky case!!!!

    Has the dog had any other investigations? Any imaging? Have you tested for any other infectious disease?

    It is odd that you are not getting a better response with the medication. I would worry that the dog is ill despite the PCV not being that bad and there could be more going on.

    I look forward to hearing from you!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    16:55 27/07/22

    Replying to Grigory Brodetsky 27/07/2022 - 13:29

    Thank you so much Grigory!

    Thank you for supporting this course, I am so pleased you enjoyed it.

    Please let me know if I can do anything more to help.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    20:17 25/07/22

    Replying to Sybil Dryburgh 21/07/2022 - 22:21

    Hello.

    Some really good points. I have contacted VPIS to ask them what their evidence is for recommending PPI’s routinely with NSAID toxicity.

    It seems like the standard of care with acute toxicity in human medicine is not to give PPI’s unless evidence of GI signs. It would seem like the incidence of GI signs is actually quite low.

    I will let you know what VPIS say.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    16:30 21/07/22

    Replying to Nathalie Cunha 17/07/2022 - 18:25

    Hello.

    Great question. There is not really any time restriction on this. Most of the situations when you are faced with the decision to perform auto transfusion will be more acute situations. Blood is unlikely to be in a body cavity for a long time. If there is a bleed that then stops, the peritoneum will reabsorb that blood.

    In short, I would not worry how long it has been there.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    14:40 21/07/22

    Replying to Gergana G. 20/07/2022 - 21:35

    Hello.

    Regarding reticulocytes, this is a brilliant recourse:

    Module 6.4: Reticulocyte Procedure

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    14:37 21/07/22

    Replying to Gergana G. 20/07/2022 - 21:37

    Hello.

    Lovely to hear from you. Thank you for the reply.

    We did do FIP serology in this case. The serology was a moderately high positive. I suppose the big issue with this is how to interpret this. Many cats will be serology positive but not have FIP.

    The other investigations/imaging were more consistent with FeLV/possible lymphoma so we did not take the FIP diagnostics any further.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    14:32 21/07/22

    Regarding the bilirubin!

    So, I think there is evidence of haemolysis in this case. There is a positive Coomb’s, agglutination and some ghost cells. I think this will be the reason the bilirubin is high.

    The other reason that bilirubin would be high, apart from liver disease, would be hyperbilirubinemia of sepsis.

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    14:25 21/07/22

    Replying to Nathalie Cunha 19/07/2022 - 18:28

    Hello.

    Regarding the FeLV, I would definitely follow up with an alternative test. This would normally be IFA as you mention or PCR. We carried out PCR in this case and it was confirmed as positive for FeLV. I would agree, many of the abnormalities here from a haematology POV would be explained by the FeLV.

    We would normally consider blood loss and haemolysis as the main DDX for regenerative anemia. However there are cases of IMHA that are non regenerative. Up to 30% of dogs with IMHA will be non regenerative. Many more anaemia cases in cate are generally non regenerative due to some degree of BM involvement. So I would still keep haemolysis/immune mediated destruction on the list.

    With the concern about possible neoplasia with FeLV we carried out abdominal US and thoracic radiography. There was evidence of abdominal lymphadenopathy.

    What would your next steps be?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    10:46 21/07/22

    This is from another human review:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347500/

    ”However, complications of excessive gastric acid suppression, like dyspepsia, luminal dysbiosis, gastric microfloral imbalance, vitamin B12 deficiency, pernicious anemia, osteoarthritis, malabsorption of certain drugs active in the acidic microenvironment and even gastric parietal cell hyperplasia and gastric cancer staunchly warrant against rampant use of PPIs and histamine receptor blockers [104]. In fact, a recent study also indicated that PPIs can actually exacerbate indomethacin-induced small intestinal damage by detrimentally altering intestinal microbiome composition [135]. Hence, gastric acid is in no way a physiological evil and opting for anti-oxidant-based therapeutic strategy to prevent the gastric mucosa from NSAID-induced cytopathies is a rather safer approach than indiscriminate usage of acid suppressors.”

    I just love the use of the words ”staunchly” and ”physiological evil”!!!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    17:48 19/07/22

    Replying to Nathalie Cunha 17/07/2022 - 18:58

    Spot on!

    I honestly think a good starting point for many feline anemia cases is assessing for FeLV/FIV and the haemotrophic mycoplasmas.

    By definition this is either a non-regenerative anaemia or a pre-regenerative anaemia. Many feline anemia cases are mon-regenerative but it would never be a bad idea to look for free fluid in the pericardial, pleural and peritoneal spaces.

    The PCV for mycoplasma was negative.
    A SNAP test for FeLV was positive!

    Does this explain the haematology? What would you do next?

    Would you trust the SNAP test as definitely positive?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster
    17:43 19/07/22

    Replying to Nathalie Cunha 17/07/2022 - 18:41

    So, based on this reticulocyte count, this is a non regenerative anaemia.

    Scott 🙂

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