My 12 pound pomeranian (not overwight, just large for breed) was sick with vomiting about a week ago. We have taken him back to the vet and he has a platelet count of 17. They are wanting to give him FFP and Doxycycline. Shoudl I be requesting anythgin further at this point?
Type of Animal: Pomeranian
Pet's Gender: Male
Pet's Age: 5
Name of Dog: Shadow
Hello, I am very sorry to hear about Shadow.Is he experiencing any symptoms? (bruising of the skin on his ventral chest and abdomen or gums)?
Has he had any testing for tick borne dieseases?
Was the platelet count rechecked manually?
We have noted some bruising. We initially noted blood in his left eye then searched further. CBC done yesterday cnofirmed via send out to be 30 and 17 on send out lab No loss of appetiteor decreased activity level but he does have a cough.
Has he been exposed to estrogens (does anyone in your home use estrogen replacement skin creams)?
No to all of those. No ticks noted and no expusure to high tick areas.
Has he been given either the antibiotic chloramphenicol or a sulfonamide?
He was given and Sulflmeth/Trimeth last week plus a probiotic
She is wanting to start Doxycycline for possible tick born pathogens
Also given Flagyl
Most of the time with symptomatic thrombocytopenia we do diagnose immune medicated disease (body Attacks itself).But we do need to rule out other causes too. Infectious causes like tick borne diseases (ehrlichia or rocky mountain spotted fever) should be checked for.I suspect that's why they are putting him on Doxycycline.There are some medications that can stimulate an immune response and lead to thrombocytopenia, sulfonamide antibiotics can cause that.
His original PLT count was 45 prior to initiation of the sulfa. She is wanitng to administer 120 cc FFP today then recheck. is that a correct amount for a PLT of 17?
She had felt the first sample was low due to clotting and sample size
It is possible that platelets can clump and artificially lead to a low count.Was he symptomatic then?
By the way here is a link to information about sulfa drugs and low platelet counts: http://www.marvistavet.com/html/body_trimethoprim_sulfa.html
Should I also request a steroid at this point or would the potential for bleeding be too great? That was the point that he had been vomiting and diarrhea
The GI symptoms were the original insults that promted the first visit
Basically they stimulate an immune response and lead to a secondary autoimmune type response, attacking their own platelets. Steroids can be given in an injectable form to start. I understand why they don't want to give them but he likely needs them. As I assume that his body is attacking his own platelets.
The fresh frozen plasma will buy some time, but we need to stop the body from attacking the platelets.
Would they have run a manual on that to se the morphology of the platelets in the lab, and would that point to a direction?
What else should be considered in addition to the FFP administration at this point? What other tests or interventions would be appropriate now rather than later?
I had collected stool this AM for possible parasites
If he is bruising his platelet count is truly low. They will get a better count by checking it manually but it is likely too low.The good news is if this is drug related then taking the drug away will help and steroids will suppress the immune system so the body has time to pump out more platelets.I would check a tick borne disease panel just to be complete. Gastrointestinal parasites won't cause low platelets.
Can steroids also be given IV to decrease the number of sticks and bleeding?
He will have the IV for FFP anyway
He has developed a cough ove the past two days. Is the cough related to the thrombocytopenia?
Because his platelet count was low before the sulfas were started there may be an underlying issue that was exacerbated and led to further destruction of platelets after the sulfas.Yes he can be given steroids iv.The cough may be due to bleeding in the lungs, but a chest radiograph may be helpful.
If you are in the Southwest part of the US then Valley Fever (a fungal infection) should be checked for as well.
No blood noted and BS are clear with auscultation
I am Mid South outside of Memphis
We live in city
So not likely to be a Valley fever, but I am surprised you don't see more ticks and their blood parasites.
His outdoor exposure is limited to walks and outside to pee
We camp in the summer but no trips so far this year
He is on Advantage Multi
So replace platelets, Doxycyline and steroids for now then recheck platelets either today or Monday?
The trouble with tick borne diseases is that they can be silent for awhile and show up months later, in some cases a year or more.That's an excellent product. But it doesn't protect against ticks. Advantix does though.I'd recheck platelets Monday.
And yes, the rest is exactly what I'd recommend. Except I'd run a tick panel.
We are handling delicately. No extra stimulation at all. Any additional lab work that you would recommend?
Other than a tick panel if he doesn't respond the next step would be a bone marrow. But lets give him time to respond too.
If you are camping I would recommend a product that covers ticks too. Frontline or Advantix are options.
Okay, thanks. The vet just called and is asking for him to come for his FFP transfusion. Thanks for the input. We want all the info we can get. Have a good day.
Very welcome, best of luck with your boy. Please let me know how things turn out for him.
19 years of experience treating dogs, cats, mice, rats, rabbits, guinea pigs, hamsters, & iguanas