Thursday, October 27, 2011

710. Follow up: Acute Tick fever in a young dog that went to a dog park

DRAFT CASE REPORT
DAY 1
Thursday, Oct 20, 2011
English Cocker, Male, 2 years, 11 kg
Dog eating less. Not active. The friend suggested taking the dog to see me.
I saw small ticks all over the body. The dog had been to a dog park in Pasir Ris recently/

Very pale gums. Blood test - low haemogloblin, low RBC and low platelets. Blood smear on Giemsa stain showed Babesia gibsoni. Ehrlichia seen. 0.5 ml Imizole (imidocarb) SC given. Dosage is 0.5 ml/10 kg.

IV dextrose and baytril. Vit K1 2 ml IV. Doxycycline 5mg/kg twice a day for 21 days. 10mg/kg twice a day had been proposed by some vet books but this is 4x the standard dose. Multivitamin paste. Vit K1 tablets (1/4 tab/day).

DAY 2
Friday, Oct 21, 2011
Gums still pale. No appetite. Vit K1 2 ml IV and supportive therapy. However the dog barks loudly when the owner came, exhausting himself. Owner brought his liver treats. He ate one.

Blood test results before Imizole 0.5 ml SC treatment:
Liver profile= Normal
Kidney profile= Normal
Hematology=
*Hemoglobin- 7g/dL  [Normal range: 12-18]
*Red Blood Cells- 2.8 x10^12/L [Normal range: 5.5-8.5]
White Blood Cells- 13.2 x10^9/L [Normal range: 6-17]


*Packed Cell Volume= 0.19 [Normal range: 0.37-0.55]
Platelets= 52 [Normal range: 200-500]


*Nucleated Red Blood Cells seen [Severe demand for RBC to be release from Bone Marrow]
No platelet clump seen
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Blood test results 1 day after Imizole 0.5 ml SC treatment:
Liver profile= Enzymes increased
Kidney profile= Normal
Hematology=
*Hemoglobin- 7g/dL [Normal range: 12-18]
*Red Blood Cells- 2.9 x10^12/L [Normal range: 5.5-8.5]
White Blood Cells- 9.6 x10^9/L [Normal range: 6-17]


Packed Cell Volume= 0.2 [Normal range: 0.37-0.55]
*Platelets= 64 [Normal range: 200-500]

No platelet clump seen but few giant platelets present
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What is the importance of platelets?
a) Numbers:
The platelet count gives a general indication of the clotting ability of the blood. If the number of platelets falls below a certain critical level, spontaneous bleeding may occur. A low platelet count may indicate a problem with platelet production in the bone marrow, or may signal the presence of disease that is causing the platelets to be used up or destroyed.  An increased platelet count often reflects excitement, exertion, or an activated bone marrow. In rare cases, an extremely high platelet count may indicate there is underlying bone marrow cancer.

b) Size:
The size of a platelet is related to its age; young platelets are large and plump, and older platelets are generally smaller. This can be important if the platelet count is low; the presence of large, plump, young platelets in the blood indicates that the bone marrow is functioning well, and is responding to the need for more platelets.

c) Appearance:
 Very rarely, bizarre giant platelets, or abnormal immature platelets may be found, and these may signal the presence of an underlying bone marrow disorder or cancer
[Reference: http://www.fetchdog.com/learn-connect/dog-resource-library/health/diagnostic-tests/Complete-Blood-Count-for-Dogs/D/300600/P/1:5:55:601:6103/I/AR000010025]


DAY 3
Saturday, Oct 22, 2011
4PM
The owner came, her friend and the godfather. 2-hour visit. Loud barks.
At 7 pm, the 3 visitors left. The dog panted, heart beat very fast, as if he had run a sprint. It was bad. Would he die? I should have allowed a 10-minute visit, not 120 minutes!

Connected IV - glucose 100 ml, then dextrose saline with duphalytes 500 ml. Gave lasix IV. Atropine 0.5 ml IM. By the time I went home, it was past 7 pm.

The owner was prohibited from visiting for the next few days. This dog had a keen hearing as he could hear the owner's voice at the reception area some distance away in the back of the Surgery and started barking non-stop for several minutes.

DAY 4
Sunday, Oct 23, 2011
Morning 10 am. Dog felt well. Barking for a while. Smelt food. Not eating. Hand fed A/D canned food and given water and electrolytes.

DAY 5.
Monday, Oct 24, 2011
IV drip. Blood looked reddish unlike bluish blood for past few days. Good news.
Passed normal stools when taken out.
DAY 6.
Tuesday, Oct 25, 2011
Deepavali. Public holiday.
Alert and standing in cage. I am relieved that the gum looks pinker. Blood test at another lab showed normal platelets but still very low Hb and RBC. I phoned owner to take the dog home at 6 pm to be nursed by owner.


DAY 7.
Wednesday, Oct 26, 2011
At home. With iron tablets and good food including egg yolk and liver.

DAY 8.
Thursday, Oct 27, 2011
At home. I phoned the owner at 6.30 pm

"My dog is very active, hungry and thirsty. I found two ticks, a grey one on her body. I put tick powder onto my bed area." One tube Advantix Spot on had been applied on Day 6. Yet he had two ticks stuck in skin. Otherwise appeared normal.
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Scheduled Appointments

DAY 9
Friday, Oct 28, 2011

DAY 11
Sunday, Oct 30, 2011
Scheduled for next Imizole (imidocarb) injection SC. Babesia and Ehrlichia seen on 2nd blood smear on Day 6. Possibly has anaplasmosis?

DAY 12
Monday, Oct 31, 2011
Urine to be collected by the owner for urinalysis.

Acute tick fever needs regular monitoring till negative blood test results 2 weeks after the previous test but most owners don't have the time to do so.

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