Signalment: Canine, m/c, miniature poodle, 8 years old
	History: Since 3 years of age, dog has had a seasonal pruritic skin disease affecting the tailhead region. The condition responds well to flea control and corticosteroid injections. This year, the alopecia has gotten progressively worse and has persisted into winter months. Glucocorticoid therapy has not helped and was discontinued 90 days ago. While on cortisone, PU/PD is present PU/PD is not currently present. Dog has a good appetite and weight gain has been gradual over the past several years. The dog seems to sleep more but is still eager to go outside and take walks with the owner. There are no other problems identified by the owner.
	Physical Examination: T. 101.2; HR 50; RR: 20; Wt: 22 pounds; MM: pink; CRT <2.0 secs. Lymph nodes are normal. Examine the slide for dermatological lesions. The skin is not thin and feels thick in some areas. Auscultation is normal except a marked sinus arrhythmia is present. Abdominal palpation is normal.
	Diagnostic Plan:Using the POVMR format, identify the problems and formulate a diagnostic plan for this case.

No.	Problem
1.	Symmetrical, non-pruritic alopecia
2.	History of seasonal pruritic alopecia
3.	Bradycardia
4.
5.
6.
7.
8.
9.
10.

B. Of the problems you have identified, which is (are) the most important to manage?

A. DX: List ruleouts for the problems you identified in Step 2.

Problem No.	Ruleout(s)
1.	Hypothyroidism; hyperadrenocorticism (spontaneous and iatrogenic); adult onset growth hormone deficiency; hypotestosteronism; follicular dysplasia
2.	Flea allergy dermatitis
3.	Heart block; hypothyroidism; hyperkalemia
4.
5.
6.
7.
8.
9.
10.

B. List those diagnostic procedures that will be most cost-effective.

1.  2.

3.  4.

5.  6.

7.  8.

9.  10.

Analyze the initial database results.

Hematology:

RBC Morphology:

Test	Value	Unit	Point your mouse here to view Hematology Norms	Test	Value
WBC	12600	x 103 /mm3		Normal	marked lipemia
RBC	5	x 106 /mm3		Rouleaux	0
HGB	12.1	gr/dl		Polychrome	0
PCV	29	%		Aniso	0
MCV	60	fl		Poik	0
MCV	22	pg		Crenation	0
MCHC	34	g/dL		Target	0
PLT	225000	x 103 /mm3		Hypochrome	0
TP	12.6	g/dL		BasoStrip	0
FIB		mg/dL		Sphero	0
Retic	0	%		NRBC/100 WBC	0
PUNT
AGGR
SED RATE		x 103 /mm3

Differentials:

Assessment: What is your assessment of the hematology data?

Test	%	Absolute	Point your mouse here to view Hematology Norms	A mild non-regenerative anemia is present. Of the ruleouts listed, only hypothyroidism causes non-regenerative anemia. Hyperlipemia is present and causes should be pursued. Mild lymphopenia is present consistent with stress or hyperadrenocorticism. The total protein is falsely elevated by the lipemia present.
SEG		10200
Band		0
Lymph		900
Eosin		500
Mono		1000
Baso		0
Other
PLTest
Toxic change

Biochemical profile:

Test	Value	Unit	Point your mouse here to view Chemistry Norms	Test	Value	Unit
Sodium	145	m mol/L		T. Bili	0.2	mg/dl
Potassium	4	m mol/L		ALKP	90	u/l
Chloride	118	m mol/L		ALT	35	u/l
TCO2	20	m mol/L		AST		u/l
Urea	20	mg/dl		LDH		u/l
Creatinine	1	mg/dl		CK		u/l
Calcium	10.6	mg/dl		GGT		u/l
Phosphorus	4.2	mg/dl		Magnesium		mg/dl
Glucose	125	mg/dl		Osmolality		mosm/L
T. Protein	6.5	g/dl		Anion Gap		mosm/L
Albumin	4	g/dl
Globulin	2.5	g/dl
A/G ratio

What is your assessment of the biochemical profile ?

The profile is normal. There is no biochemical evidence of hyperadrenocorticism.

Urinalysis:

Microscopic Sediment Exam:

Test	Value	Unit		Test	Value	Unit
Volume	10	ml		WBC	0-1	ml
Color	yellow			RBC	0
Transparency	clear			Bacteria	0
Specific Gravity	1.042			Epitheliel	0
Phosphorus				Fat	0
Protein	0	mg/dl		Sperm	0
Ketones	0	mg/dl		CaOxalate	0
Bilirubin	trace			CaCarbonate	0
Blood	0			TriplePhos	0
Urobili	trace			Bilirubin	0	mg/dl
				Amorph	0	mg/dl
				Casts	0

What is your assessment of the urinalysis data?

The UA is normal.

Identify the major ruleout(s) supported by this data.

Hypothyroidism

Have you identified any new problems?	No Yes	If so, what are they?
YES: Non-regenerative anemia; hyperlipemia

List the diagnostic tests or procedures that should be performed next.

Thyroid function tests; ECG

RX:

What immediate therapy would you prescribe for problems identified in Section 2?

None is required at this time

Learning Issues:

	Review/describe the endocrinological causes of anemia in dogs.
	Describe the causes of hyperlipemia in dogs and how they are differentiated.
	Describe the various thyroid function tests used in dogs and their advantages and disadvantages.
	Describe the mechanisms for alopecia in endocrinopathies.

Continue with Expanded Case Evaluation

Problems? Content: Dr. Michael D. Lorenz; Web page operation: Betty Handlin
Copyright^© 1999 Oklahoma State University College of Veterinary Medicine
This page was last updated 10/19/07 09:51:09 AM