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Case Studies in Clinical Hemostasis

Bernard Feldman United States

CASE 1

An eight-month-old male Golden Retriever puppy was presented because of a swollen and painful left stifle joint of 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. (Details on request.)

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 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 %

40

(37-55)

Plasma Protein g/dl

5.9

(6.0-8.0)

Hb g/dl

13

(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 %

1.4

(0-1.5)

Lymphocytes

1700

(1000-4800)

Nrbcs/100wbc

0

(0)

Monocytes

300

(150-1350)

RBC morph

Polychromasia

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

-

(<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

0

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

Negative

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). Previously in excellent health, he had an unremarkable history and no 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

12

(12)

PT sec

11

(12 )

APTT sec

18

(18)

FDP ug/ml

 -

(<10)

Antithrombin III %

-

(>85)

Chemistry

ALT mU/ml

47

(4-66)

SUN mg/dl

22

(5-28)

ALP mU/ml

83

(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/d

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

A two-year-old intact male Norwegian Elkhound was presented because of dyspnea and hemoptysis. The patient had a checkered history of vague minor illnesses, however this presentation was acute. The owner is a good observer and a good client.

Hemogram

PCV %

34

(37-55)

Plasma Protein g/dl

4.9

(6.0-8.0)

Hb g/dl

11

(12-18)

Fibrinogen mg/dl

625

(200-400)

RBC x 106/ul

5.8

(6-8)

Icterus Index units

4.0

(2-7)

MCV fl

65

(60-77)

WBC (corrected) /ul

5100

(6000-17500)

MCHC g/dl

36

(31-35)

Band

0

(0-400)

MCH pg

21

(19-24)

Neutrophils

4500

(3000-11500)

Retics %

0

(0-1.5)

Lymphocytes

600

(1000-4800)

Nrbcs/100wbc

11

(0)

Monocytes

0

(150-1350)

RBC morph

Schistocytes

Eosinophils

0

(100-1250)

WBC morph

Toxic granulation

Basophils

0

(0)

Plat x 103/ul

200

(200-400)

Disintegrated cells

0

(0)

Plat morph

Normal

Unidentifiable cells

0

(0)

BT min

1.9

(<4.2 )

Thrombin time (TT) sec

12

(12)

PT sec

10

(12 )

APTT sec

17

(18)

FDP ug/ml

 >40

(<10)

Antithrombin III %

55

(>85)

Chemistry

ALT mU/ml

64

(4-66)

SUN mg/dl

77

(5-28)

ALP mU/ml

54

(0-88)

Creatinine mg/dl

2.1

(<1.5)

T. Bili mg/dl

0.2

(0.1-0.6)

Na mEq/L

153

(145-153)

Gluc mg/dl

93

(70-120)

K mEq/L

5.1

(2.7-5.3)

S. Protein g/dl

4.5

(5.3-7.8)

Cl mEq/L

111

(110-119)

Albumin g/dl

1.2

(3.0 -4.0)

TCO2 mEq/L

18

(19-24)

Chol mg/dl

672

(28-255)

Ca mg/dl

7.9

(9.8-11)

AG mEq/L

17

(12-20)

P mg/dl

6.9

(2.5-6.2)

Urinalysis (Cystocentesis)

SG

1.021

Sediment

Color

Yellow

Rbc/HPF

0

Transparency

Clear

Wbc/HPF

0

pH

6.5

Casts/LPF

1-2 waxy

Protein

4+

Crystals

MAP

Glucose

Negative

Epithelial cells

0

Ketones

Negative

Bacteria

Negative

Occult Blood

Negative

Urobilinogen

Positive

Bilirubin

Negative

CASE 5

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 two of the three 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 Indexunits

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)

D-dimers

 10

(0)

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

Bilirubin

Negative

Ketones

Negative

Bacteria

Negative

Occult Blood

Positive

Urobilinogen

Positive


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