Page 4 - Clinical Connections - Summer 2024
P. 4
RVC RESEARCH STUDY VETERINARY SERVICES RVC.AC.UK
Emergency case
COMPLEX IMMUNO-MEDIATED HAEMOLYTIC
ANAEMIA CASE
Clara Mattavelli, Emergency and Critical Care Resident
ollowing a stick ingestion, Daphne, We suspect the IMHA may have been
a four-month-old whippet puppy, triggered by the penicillin-based antibiotic
F had a gastrotomy at her local vets. and/or systemic inflammatory response
A few hours later she was referred to RVC syndrome (SIRS) associated with the
Small Animal Referrals due suspected post- recent sepsis. As a consequence, Daphne鈥檚
operative pyothorax. antibiotic was changed to marbofloxacin.
On her first admission to the RVC, Daphne Given that her packed cell volume (PCV)
was presented to our Emergency Referral remained static, and Daphne was clinically
Service with lethargy and dyspnoea. She stable, we decided to monitor her rather
was diagnosed with a diaphragmatic than commence immunosuppression at that
tear, causing a septic abdomen and point.
concurrent pyothorax, with evidence of Daphne rapidly improved, appeared
pneumoperitoneum and pneumothorax bright and demonstrated a good appetite.
and the presence of a gastric foreign body A very mild positive in-saline agglutination
(Figure 1). 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鈥檚 PCV.
In the following weeks, Daphne went for
Figure 2: Daphne鈥檚 severely pale mucous periodical rechecks at her local practice.
membranes, due to her anaemia on
readmission Blood tests showed a progressive resolution
of her anaemia and normalisation of her
Second RVC admission white blood cell count and morphology. She
Haematology showed marked anaemia completely recovered (Figure 3) and never
Figure 1: Transversal CT image (post-contrast with positive in saline agglutination and mild required immunosuppressive treatment.
lung window) showing mild pneumothorax and
pneumoperitoneum, pleural and peritoneal evidence of intravascular and extravascular
effusion and gastric foreign material haemolysis, suggestive of immune-
mediated destruction (IMHA). Point-of-care
Daphne successfully underwent emergency ultrasound excluded severe
exploratory laparotomy, gastrotomy and post-operative haemorrhage.
diaphragmatic tear repair. She recovered Daphne received an emergency
well from the procedure and was initially packed red blood cell transfusion upon
discharged. However, Daphne represented her readmission. Due to her recent
the next day critically ill (Figure 2) as she history of bicavitary sepsis and major
had developed severe anaemia. surgery, the team opted not to commence
immunosuppressive steroid treatment.
DO YOU EMPLOY AN RVC GRADUATE? WE NEED YOUR FEEDBACK
mployers鈥� feedback is essential in It is appreciated that most skills develop Please use the URL below to
making sure that the RVC continues with experience; however this exercise complete a separate survey for each
E to equip graduates with the skills and is to assess the starting point provided by RVC graduate you line manage.
characteristics they need to be successful the RVC training. Employers鈥� feedback https://rvc.uk.com/rvc-employer-survey
in their profession, and to enable them has generated much valuable information
to develop and sustain a rewarding and stimulated many improvements for our As a thank you, you can enter into a prize
professional life. students, including the development of the draw with a chance to win one 拢100 voucher
For over ten years the Royal Veterinary RVC Clinical Skills Centre. and two 拢50 vouchers!
College has sought feedback from If you line manage an RVC graduate of For further information please contact
employers of our recent graduates, to find the last five years, we would welcome your the RVC Academic Quality team at
out how well the curriculum is equipping feedback via our annual RVC Employer AQOfficerSE@rvc.ac.uk
them for their first months and years in Survey.
employment.
For small animal referrals, please call:
01707 666399
Email:
qmhreception@rvc.ac.uk
4 Summer 2024
