Sissy 12 year old SF choc lab Tx for hypothyroidism Owner called a couple of weeks ago, and said she was having some trouble posturing to defecate – never came in Called on emergency Sat night. Sissy was lethargic and not taking food Recommended that she come in He wants to wait until Monday Sun morning – taking food Sunday aft – breathing hard, passing black stools, vomiting coffee grounds, very weak

Sissy Exam – T 102.8oF, P 185 bpm Tachypnea, dyspnea Very pale mucous membranes Unable to walk – carried in on stretcher Weak femoral pulses, undetectable dorsal pedal pulses Systolic BP 80 mmHg Hx – no exposure to rodenticide CBC PCV 17%, WBC 17K (segs, monos) Platelets 44K

Sissy Profile Glucose 352 g/dl Albumin 2.0 g/dl globulin 2.5 g/dl BUN 85, creat normal, phos normal Working Dx – acute GI Blood Loss DDx: Coagulopathy – primary, secondary or both *Bleeding GI lesion – neoplasia, ulcer* Hookworm anemia unlikely (Sentinel®) GI foreign body

Sissy Tx Plan: Transfuse Vit K 5 mg/kg SC Dx Plan: Get BTT prior to transfusion PT – 34 sec (n. 7-12 sec) PTT – 117 sec (n. 12-22 sec) ACT – 270 sec (n. <120 sec) GlobalFAST®

Sissy Coagulopathy: Problems with both primary and secondary hemostasis DDx: Liver failure – (acute), chronic Paraneoplastic coagulopathy DIC (Rodenticide toxicity) Old dog, GI bleed, DIC – cancer Not a simple GI bleed

Sissy GlobalFAST®: VetBLUE® TFAST® AFAST®

Sissy GlobalFAST®: VetBLUE® TFAST® AFAST®

Sissy GlobalFAST®: VetBLUE® TFAST® AFAST® Glide sign rules out pneumothorax & pleural effusion Many nodules in the lungs 3-5mm No lung rockets – no bleeding into the lungs Rodenticide toxicity unlikely TFAST® no pericardial effusion Volume contraction AFAST®

Sissy GlobalFAST®: AFAST® DDx: lung nodules, DIC No GB halo, AFS = 0, no pleural or pericardial effusion, flat cava Rules out anaphylaxis (too insidious) No abdominal masses seen Liver appears normal Chronic liver failure unlikely DDx: lung nodules, DIC Metastatic neoplasia + bleeding GI mass SIRS due to lung granulomas (fungal)

Sissy Sissy arrests and dies during transfusion Necropsy: Mineralized 3-5mm nodules throughout all lung lobes Generalized hemorrhage in the GI tract – very small GI mural mass with no evidence of local bleeding Tissues submitted from lungs, liver, spleen, kidneys, gut, GI mass Dx – Metastatic carcinoma with DIC, splenic thrombosis