A prospective cohort study to identify clinical diagnostic and prognostic markers of primary immune thrombocytopenia in dogs.

BACKGROUND: Primary immune thrombocytopenia (pITP) in dogs presents a diagnostic challenge, and clinical markers of severity are lacking. OBJECTIVES: Identify clinicopathologic features that differentiate pITP from secondary ITP (sITP) and markers related to bleeding severity, transfusion, and survival of dogs with pITP. ANIMALS: Ninety-eight thrombocytopenic dogs (58 pITP and 40 sITP). METHODS: Client-owned dogs with platelet counts <50 000/µL were enrolled in a prospective, multi-institution cohort study. History and treatment information, through a maximum of 7 days, was recorded on standard data forms. Bleeding severity was scored daily using a bleeding assessment tool (DOGiBAT). At-admission blood samples were collected for CBC, biochemistry, C-reactive protein concentration, and coagulation panels, and to measure platelet surface-associated immunoglobulin G (PSAIg) and expression of platelet membrane proteins and phospholipids. Dogs with evidence of coincident disease were classified as sITP. RESULTS: No definitive pITP diagnostic test was found. However, pITP cases were characterized by lower platelet counts, D dimer concentrations, and platelet membrane protein expression than sITP cases. Differentiation between pITP and sITP was further enhanced using logistic regression modeling combining patient sex, coagulation profile, platelet count, D dimer, and PSAIg. A second model of pITP severity indicated that low hematocrit and high BUN concentration were associated with non-survival. Low hematocrit at admission, but not platelet count or DOGiBAT score, was associated with transfusion. CONCLUSIONS AND CLINICAL IMPORTANCE: Pending validation studies, models constructed from at-admission clinicopathologic findings may improve differentiation of pITP from sITP and identify the most severe pITP cases at the time of presentation.

Spontaneous hemoperitoneum and anaphylactic shock associated with Hymenoptera envenomation in a dog.

OBJECTIVE: To describe the clinical presentation of a dog with spontaneous hemoperitoneum associated with anaphylactic shock from Hymenoptera envenomation. CASE SUMMARY: An 8-year-old female neutered Beagle presented as an emergency for acute onset of collapse, hematemesis, and hematochezia. The dog was tachycardic, tachypneic, and hypotensive. Initial assessment revealed a hemoperitoneum with documentation of a nonclotting sanguineous peritoneal effusion with PCV 81% and total protein concentration 65 g/L (6.5 g/dL). No obvious masses were appreciated ultrasonographically during original presentation and cytology of the peritoneal effusion was unremarkable. Peripheral PCV was 67% and total plasma protein concentration was 72 g/L (7.2 g/dL). A bee stinger was located in the right upper lip after presentation and was postulated to be the inciting trigger for the abdominal hemorrhage and shock. The patient was medically stabilized and ultimately made an uneventful recovery. Abdominal ultrasound performed 3 days after discharge revealed a single 0.85 cm hyperechoic liver nodule. Follow-up evaluation at 6 and 18 months after presentation documented a normal physical examination, unremarkable thoracic radiographs, and no change in the original hyperechoic liver nodule. NEW OR UNIQUE INFORMATION PROVIDED: This report details an unusual clinical presentation of anaphylactic shock due to Hymenoptera envenomation in a dog. To the authors' knowledge, spontaneous hemoperitoneum associated with anaphylaxis and bee envenomation has not been documented in the veterinary literature.