Monday, April 11, 2016

18. VIDEO SCRIPT. A young poodle has severe anaema and thrombocytopenia due to Babesia canis tick fever

TP ..948

April 7, 2016
I got a 1-year-old poodle, lethargic and pale in the gums and tongue.

BLOOD TEST   Apr 7, 2016
                            Toa Payoh Vets  

Haemoglobin     5.2 (12-18)
Red cell count    1.9  (5.5 -8.5)
Platelets             <10   (200-500)

Total White Cell count  21.4 (6-17)
Neutrophils  81%  (60-70%)
Neutrophils absolute 17.3    (3-11.2)

Haematocrit  0.16  (0.37-0.55)
MCV  87  (60-77)
MCH   28 (20-25)
MCHC 32  (32-36)
RDW     24.1%
A regenerative anaemia based on increase in MCV and MCH
The owner did not accept my advice to get a blood transfusion.
No liver and kidney disorder

Blood smear     Babesia +ve

Imizol (imidocarb dipropionate 120mg/ml, SC  0.2 ml given at 3 pm
Dog ate 2 days later and has recovered.       

RESULTS FROM ANOTHER VET (VET 1)  consulted earlier
The grown up children consulted Vet 1 although the father said he wanted them to bring the dog to me. The following are the tests done by Vet 1, an experienced vet.   

BLOOD TEST   Mar 26, 2016                          

Haemoglobin     low
Red cell count    low
Platelets             low

Peripheral blood smear, SNAP 4DX Plus Heartworm done.
Given Iron tablet, prednisolone, IV infusion, Ranitidine 50mg/2ml, Sucralfate 500mg tablets

BLOOD TEST   Mar 30, 2016.

Haemoglobin     low
Red cell count    low
Platelets             low

Given doxycycline 100 mg tablets

The dog was still lethargic and not eating. The father brought him to Toa Payoh Vets on April 7, 2016 and the blood smear showed Babesia canis abundantly inside many red blood cells.

Apr 21, 2016 (2 weeks after the first imizol linjection)
The parents who love this poodle very much brought him  to Toa Payoh Vets for blood test and blood smear 2 weeks after the first injection as advised. The dog had been prescribed Vit K1 10 mg per day but the owner gave 5 mg/day. Nutripet paste with iron and vitamins much loved by this dog but not the Vit K1.

Blood smear by Dr Daniel showed fewer red blood cells infected by Babesia canis compared to 2
weeks ago when almost 90% of the red cells are infected (see above image).

                              Apr 21                       Apr 7               Range

Haemoglobin         5.2                            8.9                    12-18
Red cell count        3.7                            1.9                    5.5 - 8.5
Platelet             less than 10                                             less than 10.              
                         large platelets present                             no platlet clumps seen
PCV                      0.27                           0.16

MCV                    74                                       87*                     (60-77)

MCH                    24                                     28*                       (20-77)

Blood test  show an increase in red cell count and haemoglobin but still below the normal limit. There was a regenerative anaemia (*) in Apr 7.

The platelet is still less than 10 (as 2 weeks ago) but the dog's gums are pink. (see video).  



The father said that his poodle does not have any ticks.

Vet 1's peripheral blood smear did not show Babesia as not many red blood cells have been infected at that time on March 26, 2016. When the dog was seen by me on April 7, 2016, the blood smear showed the Babesia canis in large numbers.

So, I was at the right place and at the right time to produce the positive smear which had around 90% red blood cells infected by Babesia canis.

In conclusion, it may be better to treat a dog with severe anaemia and thrombocytopenia as tick fever although the blood smear is negative. Babesia may not be present in that smear and so the dog's medical condition deteriorates.  It has been reported that most Babesia infected dogs recovers rapidly with treatment and that they become carriers. A second injection should be given 2 weeks later and a blood smear should be done.  

This dog appeared to be recovering slowly but is still eating and active.

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