– 5 year FNA Springer Spaniel diagnosed with IMHA 3 months ago
– Responded to steroids and azathioprine and blood transfusion
– No underlying causes identified
– Developed acute pancreatitis a few weeks ago with severe haemorrhagic diarrhea
– Ultrasound showed vacuolar hepatopathy, thickened/irregular gallbladder and pancreatitis
– Treated antibiotics, losec, sucralfate, switched from azathioprine to ciclosporin
– HCT now 29.5%, minimal signs of regeneration, mild spherocytosis, still has leucocytosis with regenerative left shift, no haemolysis, bilirubin normal
– 5 year FNA Springer Spaniel diagnosed with IMHA 3 months ago
– Responded to steroids and azathioprine and blood transfusion
– No underlying causes identified
– Developed acute pancreatitis a few weeks ago with severe haemorrhagic diarrhea
– Ultrasound showed vacuolar hepatopathy, thickened/irregular gallbladder and pancreatitis
– Treated antibiotics, losec, sucralfate, switched from azathioprine to ciclosporin
– HCT now 29.5%, minimal signs of regeneration, mild spherocytosis, still has leucocytosis with regenerative left shift, no haemolysis, bilirubin normal
– Do you think it is safe to wean off steroids even though there is still an inflammatory leukogram?
Comments
HCT still low and would
HCT still low and would expect more of a regenerative pattern with IMHA. With the inflammatory leukogram anemia of chronic disease is possible – possible underlying issues such as pancreatic abscessation, thoracic pathology, neopalsia, low grade gastric ulceration should be investigated. Would also run a Coombs’ and/or in-saline agglutination test and if negative then IMHA unlikley.
HCT dropped to 11 at
HCT dropped to 11 at diagnosis, was in saline agglutination positive and jaundiced with spherocytes, had blood transfusion and was previously more regenerative than on last sample.
My concern is that steroids are potentially causing low grade ulceration, so was going to wean off and monitor closely. My worry is the active leucocytosis, should I be worried about this? I feel the haemolysis is under control and spherocytes just lingering now that RBCs lasting longer. She is no longer having GI signs so I think pancreatitis under control but may still have chronic cholecysitis given gallbladder wall thickening. I was worried about azathioprine causing/contributing to pancreatitis so switched to ciclosporin, do you think this is a real problem, do you see it?
Thank you very much for your help.