Black And Blue Or Red All Over - Audrey's skin problems

Audrey is a lovely little 9 year old Pomeranian who visited us because her owner noticed she had red patches on her belly.  They were first seen when Audrey rolled over for those belly rubs that she loves so much. Audrey had been in good health of late. She had recovered well from a bout of pancreatitis and was going about her daily affairs with her usual gusto. Upon examination however, our vet found that it was not just the red patches on her belly, the skin all over her body was bruised!

Trauma is the simplest cause of bruising of the skin. Audrey is too much of a nice girl to get into that sort of trouble and the wide spread of bruising was very concerning.  We began to suspect that Audrey had a coagulopathy (a problem with clotting of the blood) that was allowing capillaries to bleed after the slightest rub, bump or scratch. Coagulopathies can be caused by external factors such as toxicity from rat poisons or internal factors such as severe blood loss, some forms of cancer, liver disease and even attack by the body’s own immune system. Any of these could be potentially fatal and warranted a very close examination of Audrey’s blood cells.

Our next step therefore was to take a blood sample from Audrey to look at all of her blood cells in addition to her electrolytes and enzymes (changes in enzyme levels tell us how well the internal organs are functioning and actually form part of our routine senior blood test). All of Audrey’s internal organs appeared to be functioning well. Audrey’s platelet count, on the other hand, shocked our team.

Platelets (or thrombocytes) are the cells that help with primary coagulation. They initiate the clotting process before the rest of the coagulation ‘cascade’ occurs. Platelets form a tight mesh that stops red blood cells from escaping from blood vessels. The normal platelet count is between 200-500 x 109 cells/litre (200,000,000,000 – 500,000,000,000 cells/litre). Audrey’s platelet count was a measly 9 x 109. That’s 22 times less than the minimum!

Such a low platelet count generally indicates a very focused disease process. The most common cause is immune mediated thrombocytopenia, where the immune system becomes sensitive to and starts attacking the body’s own platelets as if they were foreign cells. The exact trigger for sensitisation is still the subject of investigation.

Unfortunately, there is no way to stop the immune system from attacking platelets only. We started Audrey on a course of corticosteroid tablets and other strong immunosuppressive medication to dull the immune system in general. At the same time, Audrey had to be kept very quiet at home to minimise the risk of trauma, which would cause more bleeding.

Within two weeks we were able to see the results of the medication. No bruising was present on a follow-up examination and on repeat blood test, Audrey’s platelet count was up to 465 x 109! She was back to the normal range.

Treatment is on-going for Audrey at the moment. Her platelets have been within the normal range for the last 2 months. We are in the process of reducing her medications from the high doses that she was started on initially to reduce the potential for unwanted side-effects from the medication. Audrey has been in good spirits at home. She is running around and enjoying life without having to be wrapped in bubble wrap for her own protection.

Audrey’s case highlights the importance of catching a disease early. Vets often rely on owners to pick up the first signs of disease and we treat every worry very seriously as it can often be an indicator of serious underlying. We also recommend regular health checks especially for patients who are starting to get into the geriatric or “senior” range (above 7 years of age). Early treatment of any disease has the highest chance of success.

We will be monitoring Audrey closely with monthly blood tests as we reduce her dose of medications. She may have to be on medications for the rest of her life. We hope to be able to stop most of her tablets or, if necessary, to have her on the lowest dose of medications that controls her disease. In the meantime, Audrey is back to rolling over for her favourite belly rubs at home.

 

Apology: There was an image mixed up in the January 2014 newsletter. The white pomeranian printed in the newsletter is not the above patient, Audrey, and unfortunately we were not able to replace the image as it had gone to print. We sincerely apologise for any inconvenience caused.


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