1. OPD No. 540-700 17/10/2015 DVM. Naridsara Panyakrue (Bearing pet hospital) DVM. Naridsara Panyakrue (Bearing pet hospital) DOZO

2. Signalment Name: Dozo Species: Canine Breed: Poodle Sex: Intact Male Age: 10 yr. Weight: 6 kg. Name: Dozo Species: Canine Breed: Poodle Sex: Intact Male Age: 10 yr. Weight: 6 kg.

3. Owner Complain (17/10/2015) Depress Cough Decrease appetite Duration : about 3 weeks Depress Cough Decrease appetite Duration : about 3 weeks

4. History taking Mental status: Depress Appetite: Decrease appetite Type of Diet: Commercial Urination: Normal Defecation: Normal Environment: Outdoor Other animal contact: Yes (other dogs) Program ectoparasite control : NO Mental status: Depress Appetite: Decrease appetite Type of Diet: Commercial Urination: Normal Defecation: Normal Environment: Outdoor Other animal contact: Yes (other dogs) Program ectoparasite control : NO

5. History treatment 23 September 2015(Bearing vet pet hospital)  subcutaneous fluid and ABO injected 14 October 2015(Bearing vet pet hospital)  Give ABO drug, Mucolytic drug and vitamin 23 September 2015(Bearing vet pet hospital)  subcutaneous fluid and ABO injected 14 October 2015(Bearing vet pet hospital)  Give ABO drug, Mucolytic drug and vitamin

6. General Physical Examination Rectal Temperature: 104.2°F Body Condition Score: 3/5 Hydration Status: <5 % Mucus Membrane: Pale pink Cardiovascular Regular Heart Sound Normal Heart Sound Pulse quality: Strong CRT 2 second Respiration: Type of Respiration: Normal Normal lung sound Ectoparasite: Tick Orther: Havn’t Nasal discharge and Ocular discharge Cough reflex: possitive Rectal Temperature: 104.2°F Body Condition Score: 3/5 Hydration Status: <5 % Mucus Membrane: Pale pink Cardiovascular Regular Heart Sound Normal Heart Sound Pulse quality: Strong CRT 2 second Respiration: Type of Respiration: Normal Normal lung sound Ectoparasite: Tick Orther: Havn’t Nasal discharge and Ocular discharge Cough reflex: possitive

7. Problem List 1.Fever 2.Depress 3.Decrease appetence 4.Tick infestation 1.Fever 2.Depress 3.Decrease appetence 4.Tick infestation

8. Differential diagnosis 1.Blood parasite 2.Hepatic disease 3.Kidney disease 1.Blood parasite 2.Hepatic disease 3.Kidney disease

9. Initial plan CBC + Blood parasite Blood Chemical analysis Snap4Dx CBC + Blood parasite Blood Chemical analysis Snap4Dx

10. Blood HematologyResult Reference Hct (%) 30.339-56 Hb (g/dl) 9.811-19 RBC (10 6 /µl) 4.85.5-8.5 MCV (fl) 72.662-72 MCH (pg) 22.220-25 MCHC (g/dl) 30.630-38 WBC count (*10 3 (µL)) 186-17 Granulocyte (%) 82.960-83 Lymphocyte (%) 14.812-30 Monocyte (%) 2.32-9 Eosinophil (%) 1.3 Basophil (%) -≤ 0.25 Platelet count (*10 3 (cells/µl))41 117-460 MPV (fl)11.9 - PDW17 - PCT (%)0.048 - Blood parasiteEhrlichia spp. +ve- 17/10/58 Normocytic Hyperchromic anemia, Thrombocytopenia, Ehrlichiosis

11. Blood chemistryResultReference BUN (mg/dl) 8 7-27 Creatinine (mg/dl) 0.40.5-1.8 BUN/Crea 18 AST((SGOT) (U/L)) 1830-50 ALT ((SGPT) (U/L)) 201 10-125 ALP (U/L) 34423-212

12. Result Ehrlichiosis Thrombocytopenia Anemia Hepatocellular injury Ehrlichiosis Thrombocytopenia Anemia Hepatocellular injury

13. Systemic involve Cardiovascular system Hepatobiliary system Cardiovascular system Hepatobiliary system

14. Differential Diagnosis Anemia Hemolytic anemia Non-regenerative anemia Regenerative anemia Bone marrow disease Drug/Chemical induced Infectious Chronic disease Decrease Erythropoietin Immune External blood loss Internal blood loss Blood loss anemia Blood paraite Immune-mediated anemia Chemical or toxin Herediary hemolytic anemia Heartworm

15. Revise Problem List Problem List 1.Fever 2.Depress 3.Decrease appetence 4.Tick infestation 5.Cough Lab CBC : Normocytic Hyperchromic anemia, Thrombocytopenia Ehrlichia spp +ve Blood Chemical analysis : High AsT, ALT and ALP Cough induce: possive

16. Final diagnosis Ehrlichiosis Hepatocellular injury Ehrlichiosis Hepatocellular injury

17. Tentative diagnosis Anaplasmosis Babiesiosis

18. Doxycycline(100) 1 t. po pc sid/14t Metadoxil(500) ½ t. po pc sid/7t Ursolin 1 cap po pc sid/7t Tolfedine(60) ½ t po pc sid/1t Folic 1 t. po pc sid/7t FBC 1t po pc sid/7t Bromhexine 1t po pc bid/14t Doxycycline(100) 1 t. po pc sid/14t Metadoxil(500) ½ t. po pc sid/7t Ursolin 1 cap po pc sid/7t Tolfedine(60) ½ t po pc sid/1t Folic 1 t. po pc sid/7t FBC 1t po pc sid/7t Bromhexine 1t po pc bid/14t Treatment plan

19. Future plan Blood Recheck: CBC, Serum chemistry every 14 day Following every two week Recheck blood parasite in the next month Snap4DX?: orther blood parasite Ultrasound:? differantiate bile duct obstruction and hepatic parenchyma Liver biopsy?: final diagnosis Live disease

20. Prognosis Poor to guard

21. Client education Food management Recommend: l/d Prevention : control tick, flea, Environment : Bayticol 10 cc/15 liter for wash cage animal : Bayticol 10 cc/15 liter bath every 2 week. Vaccination Food management Recommend: l/d Prevention : control tick, flea, Environment : Bayticol 10 cc/15 liter for wash cage animal : Bayticol 10 cc/15 liter bath every 2 week. Vaccination