Waffle was brought to Anderson Moores by his referring vet in February with a few days history of lethargy and reduced appetite. On the morning of the referral, Waffle had developed petechial haemmorhages and he was bleeding profusely from a loose, deciduous tooth. On arrival, Waffle was collapsed and minimally responsive. He had very pale mucous membranes and was tachycardic with hyperdynamic pulses. There were diffuse petechial and ecchymotic haemorrhages over the mucous membranes and skin, he was bleeding from a premolar and there were a number of blood clots within the mouth.
Blood work revealed marked anaemia, hypoproteinaemia and severe thrombocytopaenia presumed to be secondary to marked haemmorhage that was being driven by a severe coagulopathy. Waffle had a severe hepatopathy with markedly elevated ALT activity and hyperbilirubinaemia as the cause of his coagulopathy.
Waffle was managed with crystalloid fluid therapy, fresh frozen plasma and packed red blood cells. Over the course of the first 48 hours of hospitalisation, his coagulopathy and resultant blood loss necessitated the use of 16 units of various blood products.
After investigations, the cause was presumed to be toxin ingestion causing a severe, acute hepatopathy and resultant coagulopathy. Toxicology testing failed to identify the cause (this is actually still pending and I’ll let you know if the cause is identified!).
Waffle was in a critical condition for the first 48 hours of hospitalisation at Anderson Moores but he started to slowly stabilise thereafter with resolution of the coagulopathy. He was discharged after one week; his hepatopathy was improving and one week post discharge he was clinically felt to be normal. His hepatopathy had almost completely biochemically resolved.
Waffle’s survival is thanks to the rapid action of his referring vets in recognising the severity of the problem and getting him to Anderson Moores in a timely fashion as well as the skills, knowledge and dedication of the medicine and nursing team here at Anderson Moores.