·¬ÇÑapp

Clara Mattavelli, Emergency and Critical Care Resident       

Following a stick ingestion, Daphne, a four-month-old whippet puppy, had a gastrotomy at her local vets. A few hours later she was referred to RVC Small Animal Referrals due suspected post-operative pyothorax.

On her first admission to the RVC, Daphne was presented to our Emergency Referral Service with lethargy and dyspnoea. She was diagnosed with a diaphragmatic tear, causing a septic abdomen and concurrent pyothorax, with evidence of pneumoperitoneum and pneumothorax and the presence of a gastric foreign body.

Daphne successfully underwent exploratory laparotomy, gastrotomy and diaphragmatic tear repair. She recovered well from the procedure and was initially discharged. However, Daphne represented the next day critically ill as she had developed severe anaemia.

Second RVC admission     

Haematology showed marked anaemia with positive in saline agglutination and mild evidence of intravascular and extravascular haemolysis, suggestive of immune-mediated destruction (IMHA). Point-of-care emergency ultrasound excluded severe post-operative haemorrhage.

Daphne received an emergency packed red blood cell transfusion upon her readmission. Due to her recent history of bicavitary sepsis and major surgery, the team opted not to commence immunosuppressive steroid treatment.

We suspect the IMHA may have been triggered by the penicillin-based antibiotic and/or systemic inflammatory response syndrome (SIRS) associated with the recent sepsis. As a consequence, Daphne’s antibiotic was changed to marbofloxacin. Given that her packed cell volume (PCV) remained static, and Daphne was clinically stable, we decided to monitor her rather than commence immunosuppression at that point.

Daphne rapidly improved, appeared bright and demonstrated a good appetite. A very mild positive in-saline agglutination was still present at the point of discharge three days later. However, the anaemia was strongly regenerative and there was a progressive increase in Daphne’s PCV.

In the following weeks, Daphne went for periodical rechecks at her local practice. Blood tests showed a progressive resolution of her anaemia and normalisation of her white blood cell count and morphology. Daphne completely recovered (Figure 3) and never required immunosuppressive treatment.