Case 2 - interpreting case data

Tico, a 7-year-old male neutered pug, presents to the clinic with a two-week history of lethargy, inappetence, and intermittent fever. The physical exam revels mild lymphadenopathy and a fever of 39.7C.

History

Tico, a 7-year-old male neutered pug, presents to the clinic with a two-week history of lethargy, inappetence, and intermittent fever. The physical exam revels mild lymphadenopathy and a fever of 39.7C.

CBC test results

	Dog results	Interpretation	Reference Range	Units
HCT	32%	Low	37 - 55 %
Total WBC's	32	High	4 - 12	x 109/L
Differential		Leukocytosis
Neutrophils - segmented	38.0	High	0.6 - 4.5	x 109/L
Neutrophils - bands	1.2	High
Monocytes	1.8	High	0.15 - 1.35	x 109/L

Categorise/classify/characterise the changes present and note which parameters support each part of your description

• Low HCT = anemia

• WBCs = leukocytosis

• Segmented and band neutrophils = left shift

• Monocytes = monocytosis

Anemia with severe neutrophilia with a marked left shift

What is the most likely cause of Tico’s neutrophilia?

Inflammation due to infection → marked neutrophilia with a left shift and monocytosis are classic features of an inflammatory leukogram

What is the most appropriate first-line treatment based on your initial findings?

Broad spectrum antibiotics → b/c bacterial infections are a common cause of inflammatory leukogram

Follow up after 14 days

Initiate broad-spectrum antibiotics → since bacterial infections are a common cause of inflammatory leukogram, starting empirical antibiotic treatment is the most appropriate therapy for this case

What are some key CBC findings that you think suggest hematopoietic neoplasia rather than inflammatory response?

• Persistent neutrophilia despite treatment

• Presence of dysplastic neutrophils → hypersegmentation, abnormal nuclear shapes

• Blast like cells → strong indicator of bone marrow disease

• The lack of toxic change

After 2 weeks of antibiotic therapy, Tico’s neutrophilia has not resolved, what is the best next step?

Take a bone marrow aspirate → necessary step to determine the underlying cuase of persistent neutrophilia and dysplastic changes in this case