Peripheral blood from a dog left in a car
Case information
A 2 year-old female spayed mixed breed dog presented after being left in a car for 3 hours. The recorded minimum and maximum temperatures for the day of presentation were 53.1 F and 78.1 F, respectively. When found, she was laterally recumbent and was not able to stand or lift her head. She was immediately hosed with cold water and presented to the emergency service for treatment. On presentation she was dull, unresponsive and recumbent. She had a body temperature of 101.9 F and was tachypnic and tachycardic. She had petechiation on her ventral abdomen, hemorrhage in both eyes and erythema of her ears. She vomited on abdominal palpation and had diarrhea containing a small amount of fresh blood. Blood was drawn for a complete blood count, chemistry and coagulation panels.
Evaluate the abbreviated results of these tests (Tables 1 and 2) and images of the blood smear (Figure 1a and 1b, taken at 500x magnification) below, and then consider the following questions:
- There is a large number of nucleated red blood cells (nRBCs) noted on the CBC report (see arrows in Figure 1a). What are some possible causes of increased numbers of nRBCs (rubricytosis)? Why did we need to correct the WBC count?
- Identify the cells indicated by the arrowheads in Figure 1b.
- Based on the chemistry panel results which organ systems have been affected by the hyperthermia?
- How do you explain the decreasing platelet count from day 1 (on presentation) to day 2 of hospitalization? Use other lab data to support your answer.
| Table 1: Abbreviated CBC results | ||||
| Test | Day 1 | Day 2 | Units | Reference interval |
| Hct | 66 H | 49 | % | 41-58 |
| Nucleated RBCs | 55 H | 3 H | /100 WBC | 0-1 |
| WBC | 9.9 | 9.8 | thou/μL | 5.7-14.2 |
| Corrected WBC | 6.4 | 9.5 | thou/μL | 5.7-14.2 |
| SEG NEU | 4.5 | 7.5 | thou/μL | 2.7-9.4 |
| BAND NEU | 0 | 0.7 | thou/μL | 0-0.1 |
| LYMPH | 1.2 | 1.3 | thou/μL | 0.9-4.7 |
| Platelets | 246 | 23 L | thou/μL | 186-545 |
| Table 2: Abbreviated CHEM and COAG results | ||||
| Test | Day 1 | Day 2 | Units | Reference interval |
| Urea | 17 | 42 H | mg/dL | 10-32 |
| Creatinine | 1.9 H | 3.4 H | mg/dL | 0.6-1.4 |
| Total Protein | 8.5 H | 4.2 L | g/dL | 5.3-7 |
| Albumin | 5.0 H | 2.5 L | g/dL | 3.1-4.2 |
| Globulin | 3.5 | 1.7 L | g/dL | 1.9-3.6 |
| ALT | 62 | 529 H | U/L | 20-98 |
| AST | 104 H | 1599 H | U/L | 14-51 |
| CK | 710 H | 19338 H | U/L | 48-261 |
| APTT | 24.3 H | sec | 8.5-15.5 | |
| PT | 16.0 H | sec | 11-15.5 | |
| Fibrinogen | 136 L | mg/dL | 150-490 | |
| Antithrombin | 50 L | % | 65-145 | |
| D-Dimer | 5229 H | ng/mL | 0-575 | |
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