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ISU Student Experience

Hematuria/Hemolysis

Written by: Krystal M.


Patient History

Wrigley is a 9-year-old, male neutered, boxer mix. He presented to IVS for hematuria (bloody urine) and lethargy lasting two weeks. He has had no prior history of urination problems, no polyuria (increased urination), polydipsia (increased drinking), or stranguria (difficulty urinating). No weight loss was evident, and he had been eating and drinking well at home with a varied diet including human food, including garlic- marinated chicken the night before. He had no history of recent travel and was up-to-date on preventative medicine.

Physical Exam

Wrigley’s physical exam was unremarkable. Blood was drawn for diagnostic testing and urine was collected via a urinary catheter. The extracted urine was port-wine in color.

Diagnostic Results

A chemistry panel helped to determine the overall health of Wrigley by looking at his organ function and electrolyte balances. The significant findings include:

  • Hyperbilirubinemia: high total bilirubin concentration
    • This high value can be seen secondary to destruction of red blood cells (hemolysis)
  • Neutrophilia: high number of neutrophils, a type of white blood cell
    • This can be indicative of a bacterial infection

A CBC (complete blood count) measures different components of blood such as red blood cells, white blood cells, and platelets. The significant findings include:

  • Bloody serum
    • This is due to hemolysis (breakdown of red blood cells), either within the body or during collection
  • PCV (packed cell volume)= 54%
    • This tells us that Wrigley has a normal percentage of red blood cells to the total blood volume, so anemia (depletion of red blood cells) is not a concern at this point
  • Neutrophilia

Urinalysis via catheter

  • High number of red blood cells present in sample

4x

  • Negative for anaplasma (tick-bornedisease), ehrlichia (tick-borne disease), lyme (tick-borne disease), and heartworm (parasite)

Saline agglutination to test for auto-immune disease

  • Negative on micro and macro evaluation

Abdominal ultrasound

  • Hyperechoic liver (appears brighter than normal)
  • Hyperechoic (brighter) small nodule in spleen, likely age related though neoplasia cannot be ruled out

Liver and spleen samples

  • Ultrasound guided fine needle aspirates
  • Did not reveal underlying cause for hematuria

Diagnosis and Plan

  • Suspect hematuria (blood in urine) along with hyperbilirubemia, making the concern for hemolysis
  • Place on IV fluids to prevent Acute Kidney Injury
  • Start on antibiotic to combat infectious agents that might be contributing to clinical signs and treat potential of cystitis (inflammation of the bladder)

Treatment

  • IV fluids at 100 ml/hr then increased to 150 ml/hr to promote diuresis (production of urine)
  • Unasyn was added to his fluids, which is an IV antibiotic
  • Urine changed from port wine to dark tea color then to clear during his hospitalization
  • He was sent home once urine was clear and diagnostic values were stable
  • Home meds: Clavamox and Tramadol
    • Clavamox: antibiotic to treat potential of bacterial infectioncausing clinical signs
    • Tramadol: synthetic narcotic for pain relief
  • Discharge instructions for the owner:
    • A definitive cause for his clinical signs was never found,though in hospital treatments alleviated his symptoms
    • Recommend further testing: recheck bloodwork in 48 hours
      •  Further tests may include: coagulation panel (PT/PTT), Coombs test, cytoscopy
    • Watch for pale mucous membranes, increased respiratory rate, lethargy, vomiting, and inappetence
  • Update on Wrigley:
    • He has been doing very well at home
    • There have been no subsequent signs of blood in his urine
    • He is no longer lethargic and is enjoying his daily walks once again!

 


References


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