This Spot Check is based on information from drip.vet’s continuing education: ITP - Immune Thrombocytopenia: Diagnosis & Management.

    BELLA

    Bella, a 5-year-old female spayed Cocker Spaniel, was presented to you for evaluation of acute multifocal ventral abdominal bruising. Per Bella’s family, the skin lesions developed overnight, but she is otherwise clinically normal.

    Relevant History

    • No known V/C/S/D/R
    • Receives monthly year-round heartworm (Heartgard®) and flea/tick (Frontline Plus®) preventatives
    • No vaccinations in the past 8 weeks
    • No antimicrobial exposure in the past 8 weeks
    • No travel outside of Maryland
    • Only animal in residence; housed indoors
    • No previous medical issues
    • Only previous surgery was ovariohysterectomy performed prior to 1st estrus

    Physical examination revealed multifocal dermal petechiae/ecchymoses, OU scleral hemorrhage, melena, and overweight (BCS 6/9). 

    Diagnostic Investigation

    You perform a complete blood count (CBC) and packed cell volume & total solids (PCV/TS), as well as measure to prothrombin time (PT) and activated thromboblastin time (aPTT) to confirm your suspicion. Results showed a HCT 25% (normal MCV & MCHC; absolute reticulocytes 47 K/uL), neutrophils 14.89 K/uL, lymphocytes 0.56 K/uL, PLT 11 K/uL. Peripheral blood smear evaluation identified 0.5 PLT/hpf with no clumping at the feathered edge. PCV/TS were 24% / 4.8 g/dL. PT/aPTT were not prolonged.

     

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    ANSWER:

    B: Immune thrombocytopenia causing spontaneous multifocal hemorrhage

    Bella’s bicytopenia is most likely secondary to immune thrombocytopenia causing spontaneous multifocal hemorrhage. Although bone marrow disease affecting megakaryocytic and erythroid precursors can’t be ruled out without evaluation of bone marrow, such diseases are rare. Similarly, Evan’s syndrome (immune-mediated hemolytic anemia + immune thrombocytopenia) is also relatively uncommon. Bella’s hypoproteinemia based on her low TS also supports a concern for hemorrhage (protein loss). Laboratory error is not likely given the automated HCT was confirmed by a manual PCV, and the automated PLT count was confirmed by peripheral blood smear evaluation.

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