Bernard F. Feldman, DVM, PhD
Virginia-Maryland Regional College of Veterinary Medicine Virginia Polytechnic Institute and State University
Blacksburg, VA, USA
Case 1
An eight month old male Golden Retriever puppy was presented because of a swollen and painful left stifle joint--one day's duration. Owner related previous occasional minor joint problems and occasional hematuria. There was no history of epistaxis, gastrointestinal bleeding, purpura, polydipsia or polyuria.
Hemogram
|
PCV % |
32 |
(37-55) |
Plasma Protein g/dl |
5.7 |
(6.0-8.0) |
|
Hb g/dl |
10.5 |
(12-18) |
Fibrinogen mg/dl |
475 |
(200-400) |
|
RBC x 106/ul |
3.9 |
(6-8) |
Icterus Index units |
5.0 |
(2-7) |
|
MCV fl |
75 |
(60-77) |
WBC (corrected) /ul |
17000 |
(6000-17500) |
|
MCHC g/dl |
32.6 |
(31-35) |
Band |
300 |
(0-400) |
|
MCH pg |
21.5 |
(19-24) |
Neutrophils |
11000 |
(3000-11500) |
|
Retics % |
1.9 |
(0-1.5) |
Lymphocytes |
5300 |
(1000-4800) |
|
Nrbcs/100wbc |
0 |
(0) |
Monocytes |
1350 |
(150-1350) |
|
RBC morph |
Polychromasia |
|
Eosinophils |
1250 |
(100-1250) |
|
WBC morph |
Slight toxicity |
|
Basophils |
0 |
(0) |
|
Plat x 103/ul |
175 |
(200-400) |
Disintegrated cells |
0 |
(0) |
|
Plat morph |
Some mega forms |
|
Unidentifiable cells |
0 |
(0) |
|
BT min |
4.0 |
(<4.2 ) |
Thrombin time (TT) sec |
10 |
(12) |
|
PT sec |
12 |
(12 ) |
APTT sec |
37 |
(18) |
|
FDP ug/ml |
12 |
(<10) |
Antithrombin III % |
- |
(>85) |
Chemistry
|
ALT mU/ml |
67 |
(4-66) |
SUN mg/dl |
35 |
(5-28) |
|
ALP mU/ml |
102 |
(0-88) |
Creatinine mg/dl |
1.0 |
(<1.5) |
|
T. Bili mg/dl |
0.3 |
(0.1-0.6) |
Na mEq/L |
148 |
(145-153) |
|
Gluc mg/dl |
109 |
(70-120) |
K mEq/L |
3.2 |
(2.7-5.3) |
|
S. Protein g/dl |
5.0 |
(5.3-7.8) |
Cl mEq/L |
116 |
(110-119) |
|
Albumin g/dl |
2.6 |
(3.0-4.0) |
TCO2 mEq/L |
20 |
(19-24) |
|
Chol mg/dl |
175 |
(28-255) |
Ca mg/dl |
10.2 |
(9.8-11) |
|
AG mEq/L |
15 |
(12-20) |
P mg/dl |
3.4 |
(2.5-6.2) |
Urinalysis (Cystocentesis)
|
SG |
1.027 |
Sediment |
|
|
Color |
Red |
Rbc/HPF |
TNTC |
|
Transparency |
Clear |
Wbc/HPF |
1 |
|
pH |
7.2 |
Casts/LPF |
1 hemoglobin |
|
Protein |
Trace |
Crystals |
Negative |
|
Glucose |
Negative |
Epithelial cells |
0 |
|
Ketones |
Negative |
Bacteria |
Negative |
|
Occult Blood |
Positive |
Urobilinogen |
Negative |
|
Bilirubin |
Negative |
|
|
Case 2
A three year old intact female Irish Setter was referred for evaluation of recurrent epistaxis. These episodes, usually lasting 5-10 minutes, had been recurring for several years, especially in the summer. Blood loss was from both nostrils and was not apparently associated with trauma. Her past history revealed increased blood when she lost her puppy teeth and during estrus. There was no family history of excessive bleeding tendency. Physical examination was entirely within normal limits.
Hemogram
|
PCV % |
36 |
(37-55) |
Plasma Protein g/dl |
5.9 |
(6.0-8.0) |
|
Hb g/dl |
12 |
(12-18) |
Fibrinogen mg/dl |
350 |
(200-400) |
|
RBC x 106/ul |
5.1 |
(6-8) |
Icterus Index units |
3.0 |
(2-7) |
|
MCV fl |
73 |
(60-77) |
WBC (corrected) /ul |
12500 |
(6000-17500) |
|
MCHC g/dl |
33.1 |
(31-35) |
Band |
0 |
(0-400) |
|
MCH pg |
19.8 |
(19-24) |
Neutrophils |
10000 |
(3000-11500) |
|
Retics % |
1.7 |
(0-1.5) |
Lymphocytes |
1700 |
(1000-4800) |
|
Nrbcs/100wbc |
0 |
(0) |
Monocytes |
300 |
(150-1350) |
|
RBC morph |
Slt. polychr |
Eosinophils |
500 |
(100-1250) |
|
WBC morph |
Normal |
|
Basophils |
0 |
(0) |
|
Plat x 103/ul |
135 |
(200-400) |
Disintegrated cells |
0 |
(0) |
|
Plat morph |
Normal |
|
Unidentifiable cells |
0 |
(0) |
|
BT min |
1.8 |
(<4.2 ) |
Thrombin time (TT) sec |
10 |
(12) |
|
PT sec |
27 |
(12 ) |
APTT sec |
19 |
(18) |
|
FDP ug/ml |
0 |
(<10) |
Antithrombin III % |
- |
(>85) |
Chemistry
|
ALT mU/ml |
54 |
(4-66) |
SUN mg/dl |
17 |
(5-28) |
|
ALP mU/ml |
17 |
(0-88) |
Creatinine mg/dl |
1.0 |
(<1.5) |
|
T. Bili mg/dl |
0 |
(0.1-0.6) |
Na mEq/L |
144 |
(145-153) |
|
Gluc mg/dl |
97 |
(70-120) |
K mEq/L |
3.6 |
(2.7-5.3) |
|
S. Protein g/dl |
5.2 |
(5.3-7.8) |
Cl mEq/L |
110 |
(110-119) |
|
Albumin g/dl |
2.9 |
(3.0-4.0) |
TCO2 mEq/L |
19 |
(19-24) |
|
Chol mg/dl |
112 |
(28-255) |
Ca mg/dl |
9.9 |
(9.8-11) |
|
AG mEq/L |
21 |
(12-20) |
P mg/dl |
3.0 |
(2.5-6.2) |
Urinalysis (Cystocentesis)
|
SG |
1.033 |
Sediment |
|
|
Color |
Yellow |
Rbc/HPF |
8 |
|
Transparency |
Clear |
Wbc/HPF |
1 |
|
pH |
6.4 |
Casts/LPF |
Negative |
|
Protein |
Trace |
Crystals |
Negative |
|
Glucose |
Negative |
Epithelial cells |
1-2 |
|
Ketones |
Negative |
Bacteria |
Negative |
|
Occult Blood |
Positive |
Urobilinogen |
Positive |
|
Bilirubin |
Negative |
|
|
Case 3
A 12 year old mixed breed male dog was admitted to the hospital for elective castration due to benign prostatic hypertrophy (no tumor palpable, symmetrical glandular size increase, difficulty urinating and defecating). He had previously been in excellent health and had an unremarkable history and no past history of bleeding. Surgery was uneventful but petechiae and ecchymoses on the ventral abdomen were noted four days postoperatively.
Hemogram
|
PCV % |
44 |
(37-55) |
Plasma Protein g/dl |
7.3 |
(6.0-8.0) |
|
Hb g/dl |
14 |
(12-18) |
Fibrinogen mg/dl |
500 |
(200-400) |
|
RBC x 106/ul |
6.2 |
(6-8) |
Icterus Index units |
4.0 |
(2-7) |
|
MCV fl |
71 |
(60-77) |
WBC (corrected) /ul |
2200 |
(6000-17500) |
|
MCHC g/dl |
34 |
(31-35) |
Band |
0 |
(0-400) |
|
MCH pg |
22.5 |
(19-24) |
Neutrophils |
1800 |
(3000-11500) |
|
Retics % |
0 |
(0-1.5) |
Lymphocytes |
200 |
(1000-4800) |
|
Nrbcs/100wbc |
0 |
(0) |
Monocytes |
200 |
(150-1350) |
|
RBC morph |
Normal |
|
Eosinophils |
0 |
(100-1250) |
|
WBC morph |
Normal |
|
Basophils |
0 |
(0) |
|
Plat x 103/ul |
65 |
(200-400) |
Disintegrated cells |
0 |
(0) |
|
Plat morph |
Some oval, large |
Unidentifiable cells |
0 |
(0) |
|
BT min |
ND |
(<4.2 ) |
Thrombin time (TT) sec |
13 |
(12) |
|
PT sec |
11 |
(12 ) |
APTT sec |
20 |
(18) |
|
FDP ug/ml |
- |
(<10) |
Antithrombin III % |
- |
(>85) |
Chemistry
|
ALT mU/ml |
107 |
(4-66) |
SUN mg/dl |
35 |
(5-28) |
|
ALP mU/ml |
143 |
(0-88) |
Creatinine mg/dl |
0.4 |
(<1.5) |
|
T. Bili mg/dl |
0.3 |
(0.1-0.6) |
Na mEq/L |
151 |
(145-153) |
|
Gluc mg/dl |
119 |
(70-120) |
K mEq/L |
4.7 |
(2.7-5.3) |
|
S. Protein g/dl |
6.8 |
(5.3-7.8) |
Cl mEq/L |
113 |
(110-119) |
|
Albumin g/dl |
3.0 |
(3.0-4.0) |
TCO2 mEq/L |
24 |
(19-24) |
|
Chol mg/dl |
230 |
(28-255) |
Ca mg/dl |
10.2 |
(9.8-11) |
|
AG mEq/L |
18 |
(12-20) |
P mg/dl |
5.5 |
(2.5-6.2) |
Urinalysis (Cystocentesis)
|
SG |
1.050 |
Sediment |
|
|
Color |
Yellow |
Rbc/HPF |
4 |
|
Transparency |
Turbid |
Wbc/HPF |
5 |
|
pH |
7.7 |
Casts/LPF |
1-2 coarse granular |
|
Protein |
2+ |
Crystals |
Negative |
|
Glucose |
Negative |
Epithelial cells |
8-10 |
|
Ketones |
Negative |
Bacteria |
Negative |
|
Occult Blood |
Negative |
Urobilinogen |
Positive |
|
Bilirubin |
Negative |
|
|
Case 4
An urgent consultation was requested for a patient in the intensive care unit. A seven year old, mixed breed, spayed female dog had returned from surgery following extensive bowel resection for sarcoma. During surgery she was autotransfused from vacuumed abdominal blood. Over the 24 hour postoperative period she had received three units of whole blood for extensive intraoperative blood loss. Following surgery, oozing was observed from the abdominal drain tube and following venipuncture. During the immediate postoperative period (30 minutes) she had received 2 of the 3 units of blood. There was no previous history of bleeding and a hemostatic profile performed 24 hours presurgically was within reference intervals. Petechiae and purpura were noted on the lower limbs. Chest radiographs were normal and blood culture was negative.
Hemogram
|
PCV % |
22 |
(37-55) |
Plasma Protein g/dl |
6.0 |
(6.0-8.0) |
|
Hb g/dl |
7.6 |
(12-18) |
Fibrinogen mg/dl |
200 |
(200-400) |
|
RBC x 106/ul |
3.2 |
(6-8) |
Icterus Index units |
4.0 |
(2-7) |
|
MCV fl |
65 |
(60-77) |
WBC (corrected) /ul |
10800 |
(6000-17500) |
|
MCHC g/dl |
31.5 |
(31-35) |
Band |
750 |
(0-400) |
|
MCH pg |
20 |
(19-24) |
Neutrophils |
7750 |
(3000-11500) |
|
Retics % |
0 |
(0-1.5) |
Lymphocytes |
1300 |
(1000-4800) |
|
Nrbcs/100wbc |
4 |
(0) |
Monocytes |
900 |
(150-1350) |
|
RBC morph |
Poik/leptocytes |
|
Eosinophils |
100 |
(100-1250) |
|
WBC morph |
Toxic vacuolation |
Basophils |
0 |
(0) |
|
Plat x 103/ul |
25 |
(200-400) |
Disintegrated cells |
0 |
(0) |
|
Plat morph |
Mega forms |
|
Unidentifiable cells |
0 |
(0) |
|
BT min |
ND |
(<4.2 ) |
Thrombin time (TT) sec |
20 |
(12) |
|
PT sec |
19 |
(12 ) |
APTT sec |
31 |
(18) |
|
FDP ug/ml |
0 |
(<10) |
Antithrombin III % |
71 |
(<85) |
Chemistry
|
ALT mU/ml |
214 |
(4-66) |
SUN mg/dl |
14 |
(5-28) |
|
ALP mU/ml |
650 |
(0-88) |
Creatinine mg/dl |
0.2 |
(<1.5) |
|
T. Bili mg/dl |
0.8 |
(0.1-0.6) |
Na mEq/L |
142 |
(145-153) |
|
Gluc mg/dl |
112 |
(70-120) |
K mEq/L |
3.0 |
(2.7-5.3) |
|
S. Protein g/dl |
5.5 |
(5.3-7.8) |
Cl mEq/L |
110 |
(110-119) |
|
Albumin g/dl |
2.8 |
(3.0-4.0) |
TCO2 mEq/L |
14 |
(19-24) |
|
Chol mg/dl |
333 |
(28-255) |
Ca mg/dl |
10.8 |
(9.8-11) |
|
AG mEq/L |
24 |
(12-20) |
P mg/dl |
5.8 |
(2.5-6.2) |
Urinalysis (Cystocentesis)
|
SG |
1.011 |
Sediment |
|
|
Color |
Pink |
Rbc/HPF |
8 |
|
Transparency |
Clear |
Wbc/HPF |
0 |
|
pH |
7.8 |
Casts/LPF |
0 |
|
Protein |
0 |
Crystals |
0 |
|
Glucose |
Negative |
Epithelial cells |
0 |
|
Ketones |
Negative |
Bacteria |
Negative |
|
Occult Blood |
Positive |
Urobilinogen |
Positive |
|
Bilirubin |
Negative |
|
|