1. 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

2. 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

3. 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

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

5. 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

6. Sissy
GlobalFAST®:
VetBLUE®
TFAST®
AFAST®

7. Sissy
GlobalFAST®:
VetBLUE®
TFAST®
AFAST®

8. 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®

9. 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)

10. 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