From:
Bruce Williams, DVM
Date: 2001-07-28 23:59:00 UTC
Subject: Platelets
Learn from mistakes, wherever they come from. I apologize for being
scarce on a weekend, but we lost one of our own this evening,
following adrenal surgery yesterday (and a relatively famous one, who
was pictured on the cover of the JAVMA last April 15th in a
watercolor I painted as a lark)
Not a happy story, but one that might be of interest to everyone else
out there.
For the last two months or so, Cosmo was becoming progressiely more
lethargic. His hair loss had dramatically increase, he had assumed
the pot-bellied, pear shape appearance that is occasionally seen in
adrenal cases, and over the last week or so had beome very lethargic.
Yesterday I took him over to Charlie Weiss' for surgery.
Preoperative bloodwork showed everything looked pretty good, except
for a marked decrease in platelets (45,000/cm instead of the normal
150,000+) Knowing that ferret don't spontaneously bleed until
10,000, and that his condition was deteriorating relatively quickly,
we opted to proceed with surgery, following a transfusion. Post-
transfusion, the platelet count was 338,000. Surgery was uneventful,
with removal of a right adrenal malignancy and a nodule off the
pancrease (he had never shown signs of insulinoma.) REcovery was
uneventful and he went home with me about 90 mins after surgery. He
did fine lst night, and was sternal and realtively alert.
This AM, he was non-responsive, hypothermic (97 degrees) in
significant pain, and had bruising surrounding the incision site. He
spent the balace of the day in ICU with fluid, steroids, and
torbutrol for pain. This afternoon he was not progressing, and died
peacefully following a third shot of torbugesic.
The necropsy resulted in an interesting, but not altogether
unexpected finding (given his post-operative signs). The elevated
platelet count was not in error, but these platelets were likely not
functional. Slow bleeding was seen at every area of surgical
dissection, and subcutaneously at venipuncture sites. In effect, he
died of hemorrhage brought on by deficient platelet function. His
own were too few to stem the damage of surgery, and the transfused
ones were non-functional, it would appear.
I need to review with Charlie how the transfused blood was collected,
and work backward to see if there was a step in the collection that
might have resulted in the platelet's lack of activation in Cosmo's
circulation.
The moral of this particular tale is that while conventional wisdom
is that ferrets may be successfully operated on with platelet counts
less than 50,000 - there will be some mortality. Had his condition
been better, perhaps we might have been able to delay surgery, but as
he was already slipping away, we took a caluclated risk, and lost.
Watch those platelets.
With kindest regards,
Bruce Williams