Star Pets......Jodi

05 February 2010

This month's star pet is Jodi a 7 year old Border Collie.

Jodi was seen at the practice in July of last year as she had suddenly collapsed during her morning walk. On examination by the vet it was discovered that she had a bounding heart rate and possibly a heart murmur. Her owners had not reported anything unusual prior to the collapse. She was booked in for a routine blood test to establish if any underlying problems were present before further tests were performed to investigate her collapse.

On the day of her blood test Jodi's owner reported that she was now becoming generally exercise intolerant which was unusual as Jodi is normally a very active dog. She had collapsed again at home but recovered very quickly. Her heart rate was still abnormally fast so the plan was to perform the blood test as arranged and if normal then the vet felt that she may have to see a cardiac specialist for an ultrasound scan and ECG (an electrocardiogram which plots the electrical impulses of the heart) to investigate possible cardiac problems.

The results of the blood test revealed that Jodi was anaemic (low red blood cell count). This could account for both the collapsing episodes and also the bounding heart rate and heart murmur. The vet needed to establish the cause of the anaemia so a further blood test was sent to an outside laboratory for a cytologist to examine the cells present and hopefully provide more information about the type of anaemia. A Combes test was also performed (a crude test for autoimmune disease where the body produces auto-antibodies directed against red blood cells resulting in their destruction or removal). The vet also had to think about the possibility of apparently clinically silent internal blood loss or exposure to an oxidative toxin such as onions or paracetamol which could account for red blood cell destruction. A further test was performed to establish Jodi's blood type in case she needed a future blood transfusion if the situation worsened.

A few days later and the results came back positive for autoimmune hemolytic anaemia and a further in house hematology test showed us her red blood cell count was falling further. However her symptoms and blood cytology results were not entirely consistent with a red cell destructive auto-immune disease and it was felt the problem may lie with the abnormal production of red cells in the bone marrow.

Jodi was admitted for the day so she could be sedated and an x-ray taken of her chest and abdomen to check for signs of internal bleeding. Her x-ray results showed an apparently enlarged liver and spleen so the vet decided to refer her for an ultrasound scan at a local practice in Wolverhampton to be sure she was not undergoing an internal bleed.

By the following day the results of the ultrasound came back as normal with no abnormal masses being found in either her abdomen or chest and no evidence of internal bleeding as a cause for Jodi's anaemia.

Jodi's bone marrow biopsy

The next investigative step involved sampling Jodi's bone marrow in an attempt to establish the cause of her low red cell count. She was admitted for a blood transfusion prior to the procedure as her red blood cell count was still falling and a transfusion would help support throughout the anaesthetic. A regular blood donor client (whose dog has the same blood group as Jodi) kindly stepped in to provide a blood donor. Jodi received enough new red blood cells to allow her to safely undergo an anaesthetic for her bone marrow biopsy.

Once Jodi was under a full anaesthetic the vet was able to aspirate bone marrow from her iliac crests (an accessible part of the pelvis) and this site usually allows a good marrow harvest. Bone marrow smears were prepared from the biopsies. A short while later Jodi was back in her kennel recovering from her operation. She was sent home later that day with immunosuppressive doses of steroids pending the results.

Bone marrow biopsy results and Jodi's treatment

The bone marrow test results came back a few days later and revealed that Jodi had destruction of the normal red blood cell producing elements in the bone marrow - this was due to replacement of bone marrow by fibrous tissue and could be the precursor to the development of a bone marrow tumour. The cause was essentially unknown but the result is a condition known as 'red cell aplasia' where red blood cell production effectively ceases. The vet decided to try Jodi on a course of immunosuppressive drugs and monitor her red cell count to check if her condition was improving or deteriorating further.

Jodi responded very well to treatment and her hematology results started to gradually improve. She was gradually weaned off all treatment and by October was no longer on medication. Regular hematology blood tests and blood smear examination revealed a good recovery.

Jodi's spinal problems

In January this year Jodi's owners noticed that she was having difficulty walking and seemed to be becoming lethargic. On examination by the vet it was discovered that Jodi was very uncomfortable on palpation of her lumbar spine and she was in pain when moving around. She was given pain relief and booked in the following day for x-rays or her spine.

The following morning Jodi was back into the surgery being admitted for the day. Pre-anaesthetic blood results and a recent blood smear examination did not reveal a recurrence of her anaemia problems or signs of infection or organ disease. Once she was under a full anaesthetic, x-rays were taken of her pelvis and lumbar spine. Sadly the x-rays revealed a large bony mass affecting her lumbar spine. It was not apparent on x-rays taken seven months earlier. It is probably the cause of Jodi's pain and lethargy and differential diagnoses include severe spinal arthritis, disc / vertebral body infection or a tumourous process. Ideally the site needs further investigation and perhaps even a biopsy to confirm the nature of the mass and establish if it is related to Jodi's previous bone marrow disease. At this stage however Jodi's owners have elected to adopt a conservative approach - they wish to manage Jodi's symptoms medically. Jodi is doing well on strong pain relief and exercise control and we hope she continues to lead a happy life for some considerable time to come.