一例犬免疫介导性血小板减少症的诊断与中西医治疗

Diagnosis of a case of canine immune-mediated thrombocytopenia and treatment with traditional Chinese and Western medicine

3岁红色博美犬,食欲减退,精神萎靡,不愿走动;腹部、后肢内侧等部位出现出血点、瘀斑,指压不褪色;大便颜色稍黑;尿液量少、呈红色。体格检查可见背部、腹部、四肢等部位皮肤有轻重不等的紫色瘀斑,牙龈有出血点,眼结膜苍白。血常规检查结果显示,该犬血小板数目为0,白细胞、单核细胞、中性粒细胞均高于参考值;血涂片镜检可见少量多染红细胞,形态未见明显异常,也未见血液寄生虫体;尿常规检查结果显示有潜血,提示有炎症;血液生化指标结果显示,碱性磷酸酶活性、丙氨酸氨基转移酶高于参考值,肌酐质量浓度低于参考值;凝血功能检查未见异常;犬片状边虫抗体/嗜吞噬细胞无形体、心丝虫抗原、莱姆病抗体、埃里希体/伊文氏埃里希体抗体筛查结果均为阴性。综合病史及上述各项检查结果,诊断患犬为原发性免疫介导性血小板减少症(immune-mediated thrombocytopenia,ITP)。经过为期47 d的对症治疗(补液、消炎、止血、护肝、输血)、免疫抑制治疗(口服泼尼松龙)和中兽医辩证治疗,患犬各项指标得到了恢复,停药30 d后回访,未见复发。说明采用中西医结合疗法治疗犬ITP可取得良好的效果。

A 3-year-old red Pomeranian showed loss of appetite,listlessness,and reluctance to move;bleeding spots and ecchymosis appeared on the abdomen inner hind limbs and other parts,and acupressure did not fade;stool was slightly dark;urine was small and red.Physical examination showed that the skin of the back,abdomen,limbs and other parts had different degrees of purple ecchymosis with gingival bleeding spots,and pale conjunctiva.The results of routine blood examination showed that the number of platelets in the dog was 0,and leukocyte,monocyte and neutrophil were all higher than the reference value.A small number of polychromatic red blood cells were found on the microscopic examination of the blood smear,and there was no obvious abnormality in the morphology,and no blood parasites were found.The results of routine wrine showed occult blood and hinted inflammation.The results of blood biochemical indexes showed that the activity of alkaline phosphatase and alanine aminotransferase were higher than the reference values,and the creatinine mass concentration was lower than the reference value.Coagulation function was abnormal,and screening results were negative for canine flaky anaplasma antibodies/Anaplasma phagocytophilum,heartworm antigen,Lyme disease antibodies,Ehrlichia/Ehrlichia ewingii antibodies.Based on the medical history and the results of the above examinations,the dog was diagnosed as primary immune-mediated thrombocytopenia(ITP).After 47 days of symptomatic treatment(rehydration,anti-inflammatory,hemostasis,liver protection,and blood transfusion),immunosuppressive therapy(oral prednisolone)and dialectical treatment by traditional Chinese Veterinary medicine,the dog′s indexes were recovered,and there was no recurrence after 30 days of drug withdrawal in the return visit.The results indicated that the combination therapy of traditional Chinese and Western medicine could achieve good effect in the treatment of dog ITP.