Pearl presented with vague non specific clinical signs, she had vomited once and urinated in her bed which was not at all like her, but she had no fever, was bright and alert on exam with nice pink mucus membranes and a crisp capillary refill time, had a relaxed abdomen on palpation and seemed generally quite happy. She was treated symptomatically, with the proviso that if she was not quickly back to normal we should see her again.
When Pearl came in a few days later, her owners noted that she seemd to be urinating only small amounts, and had leaked urine in her bed although her vomiting had not recurred. An xray revealed poor Pearl had a bladder absolutely jam packed with stones that was obviously the cause of her urination problems and, after consultation with her owners Pearl was scheduled for surgery.
As part of her pre-anesthetic preparation a blood panel was performed to check for any abnormalities which might complicate Pearl’s surgery. To our surprise, Pearls bloods showed very low levels of platelets, a vital component of the system which controls and stops bleeding. She also had a fever and some other changes in her blood which led to a diagnosis of Immune Mediated Thrombocytopenia.
As a result of her blood tests we had to postpone poor Pearls surgery because her low platelet numbers would have placed her at severe risk of bleeding. We treated her thrombocytopenia with drugs designed to calm down an over active immune system. After a few weeks of medication and repeat testing to confirm that her platelet numbers were both adequate and stable, we were able to take her to surgery and remove the bladder stones.
Bladder stones removed from Pearl’s bladder.
Pearl is now doing well at home on a diet designed to reduce the risk of recurrence of bladder stones.
Pearl’s story illustrates a few things. First of all, sometimes more than one thing is going on at the same time. In Pearls case it was her bladder stones that were making her miserable which brought her to the hospital. However, the potentially life threatening Thrombocytopenia was the really dangerous condition. Without her bladder stones, we might not have found her Thrombocytopenia until she was much more sick. Lastly, the importance of preansthetic screening. Without a blood panel we would not have detected Pearl’s low platelet numbers. If we had taken her to surgery she would have been at a severe risk of life threatening hemorrhage from her surgery site.