Sunday, July 29, 2012

Sometimes the minutes DO count

Heartbreaking case today - if only we'd had a few extra hours, the ending might have been drastically different.

"Lucy," a 3 year old westie, presented to her regular veterinarian for not eating the last 3-4 days.  The clients weren't concerned until she collapsed today.  Her regular veterinarian's office took one look at her, noticed her white-as-a-sheet mucous membranes and recommended transfer to our emergency room.  Unfortunately, the clients were a 2 hour drive away from our office.

When they arrived, Lucy was like a rag-doll.  Floppy, listless and mucous membranes white as can be.  The family noted that she did have access to rat bait, but had been abnormal for 3-4 days.  She had no signs of trauma and no evdidence of bleeding, but instantly upon placing an IV catheter and pulling a small sample, it was clear that she was critically anemic.  Her PCV was just 8%; barely enough red blood cells to provide her with the oxygen that her tissues so desperately need.

Given all this information, oxygen and supportive care were initiated.  A unit of packed red cells was warmed and I looked at some in-house testing to determine the cause of her symptoms.  A blood smear was evaluated under the microscope and confirmed the most likely diagnosis; immune mediated hemolytic anemia, or IMHA.  IMHA is a condition where the body's own defenses, the immune system, attack and destroy the red blood cells, which carry oxygen.  The causes of IMHA are unknown, and can include drugs, certain types of infections, rare reactions to vaccines or medications, but most commonly IMHA has no identifiable cause.  More information can be obtained here.

The client gave permission for treatment, despite the risks and guarded prognosis. Just as the blood was nearing room temperature and ready for transfusion, Lucy became agonal; she vomited, stretched out, and started gasping (all typical reactions just before a pet dies).  We worked hard to ger her stabilized; she was intubated, I gave atropine and epinephrine and started bolusing red blood cells in an attempt to pull her back from the brink of death.  Unfortuantely, it was all for naught.  Despite every medication and intervention I could give her, it was simply too late.  The family had waited too long, her body couldn't take it any more and she had nothing left to fight with.  She was gone. If we had only had 30 minutes or more to get her blood transfusion started before she went agonal, she just may have survived.

After several minutes of CPR, the clients and I decided that there was nothing left to do but to say goodbye to Lucy.  With tears in our eyes, we made an impression of Lucy's paw and gave our heartfelt condolences for their loss.  I still am racking my brain to see if I could have done anything differently, but there's just... nothing.  The only way we could have saved her was to have her brought to us sooner.

If your pet isn't feeling well, 3-4 days is much too long to wait.  If you notice your pet isn't acting right, isn't eating, or has any symptoms of illness, call and get advice from your local veterinary office immediately or bring them by for an exam.  It could save your pet's life.



  1. as a vet I was able to pick this up in my own Golden Retriever in time to get the blood in and after a week of intensive care and many weeks of stabiisation, she lived a normal life ( with meds). I was quite shocked how fast she went down hill with minimal lead in - a day of lack of appetite and then a day of quiet - I was lucky to return from work early, get alerted by my son, do a full clinical , and got action immediately on seeing the white membranes - suspecting rat bait.
    I am aware that most owners would have waited overnight - a delay that I am sure would have been fatal.
    Although it did cost thousands to save her! A hard choice for many people.

  2. What a heart breaking story. Such pain in your story. I consider myself lucky to be able to take mine if they are sick. Thank you for the update.

  3. So sad..
    If my dogs skip one meal I take them to my Vet. Labs never miss a meal unless something is wrong... I would rather it be nothing then wait and it be too late..