C09989866 / invoice 10000

Reason: CBC, PCV/TPAppointment Notes: Call TaraIntern: TBDRAFTHistory: Bear presents for a recheck of his IMHA. Bear was initially managed by ARH IM from 04/11/2025 for a persistent, strongly regenerative anaemia. On presentation, physical examination revealed pale pink mucous membranes and a grade II/VI left-sided systolic heart murmur. Initial laboratory work showed a PCV of 24% with icteric serum, a CRP of 40.5 mg/L, and urinalysis findings of USG >1.060, 2+ protein, and 3+ bilirubin. Thoracic radiographs and abdominal ultrasound were unremarkable. An external CBC confirmed severe, strongly regenerative anaemia with spherocytes and schistocytes, borderline neutropaenia, and mild thrombocytopaenia. Coombs and anaemia PCR tests were negative. A presumed diagnosis of primary (non-associative) immune-mediated haemolytic anaemia (IMHA) was made, supported by haemolysis, ghost cells, and spherocytes. Treatment was initiated with prednisolone and clopidogrel. On 18/11/2025, the prednisolone dose was reduced to 15 mg PO SID Om 17/12/2025, prednisolone was decreased to 10mg PO SID due to improved PCV 40% and resolving spherocytes with no evidence of ongoing haemolysis. Soft-formed faeces, polyphagia and exercise intolerance persisted. At the review on 09/02/2026, his owner reported significant improvement in energy levels and exercise tolerance, though he remained polyphagic. Examination revealed a weight gain of 1.1kg and resolution of the previously noted heart murmur. In-house PCV/TP was stable at 40/76. A CBC showed a mild neutrophilia (13.3 x10^9/L; ref 3.1-10.3) and monocytosis (1.2 x10^9/L; ref 0.2-1.0), with resolution of the previous eosinophilia and no spherocytes seen. A faecal PCR panel returned unremarkable, and the soft faeces were suspected to be due to dietary indiscretion. The non-associative IMHA was considered in remission. Genetic testing for known mutations causing Pyruvate Kinase deficiency was negative. Prednisolone was tapered to 7.5 mg PO SID and continue clopidogrel unchanged A mild subclinical relapse in Bear’s IMHA was identified on the 12/02/2026  following inadvertent prednisolone dose reduction to 3.5mg PO SID (intended dose of 7.5mg SID). CBC identified mild but strongly regenerative normocytic normochromic anaemia. No evidence of spherocytes or ghost cells. Prednisolone increased back to 7.5mg PO SID. Prednisolone increased to 10mg PO SID on 19/02/26. At his last recheck on 26/02/26, Bear was well at home, however had developed soft formed faeces with ongoing polyphagia. PCV/TP 31/72. External CBC identified stable HCT, ongoing regenerative response, and glucocorticoid-induced stress leukogram, no band neutrophils suggestive of resolution of inflammation. No spherocytes. Bear's IMHA appears to have stabilise following prednisolone dose increase back to original dose following relapse. Prednisolone and clopidogrel continued unchanged. Today (05/03/26), Owner reports Bear has been XXXCurrent Diet: Dry food (science diet) + homecooked chicken mince with vegetables and rice Past pertinent history: Nil Current Medications: Prednisolone 10 mg BID Clopridogrel 18.75mg SID Examination Findings: T: 38.5C       MM: pink P:60 bpm      CRT: <2s R:24 bpm Demeanour: BAR Hydration: euhydrated Weight: 11.0kg (+100g) Body Condition Score: 8/9 Muscle Condition Score:3/3 Cardiovascular: Mild bradycardia. No noted arrhythmia or murmur, femoral pulses strong and synchronous.  Respiratory: WNL Abdomen: WNL Superficial LNs: WNL Ocular: WNL Ears: WNL Integument: WNL Oral exam: WNL Musculoskeletal: moving well in consultation, full MSK exam not performed Neurological: mentation appropriate, full exam not performed Rectal: NP Laboratory: PCV/TP 36/77 (clear) (cf 31/72 (clear) on 19/02)  QML CBC -> pending * 3 person hold for venipuncture (legs, body, head tapper). Wriggly but will tolerate jugular venipuncture with firm hold. Tolerated very well today. Assessment: Problem List: - Polyphagia (ongoing) - IMHA - relapse following marked reduction in dose from 10mg to 3.75mg instead of prescribed 7.5mgXXXXXXXBear remains reasonably well at home, with the recent development of soft faeces and mild lethargy suspected to be secondary to increased prednisolone dosage. Bear's manual haematocrit today is static, suggestive of ongoing mild and stable anaemia, hoped to be indicative of stable disease. External CBC identified stable HCT, ongoing regenerative response, and glucocorticoid-induced stress leucogram, no band neutrophils suggestive of resolution of inflammation. No spherocytes. Bear's IMHA appears to have stabilise following prednisolone dose increase back to original dose following relapse. Ongoing close monitoring is warranted. Treatment: Prednisolone 10mg PO BIDClopidogrel 18.75mg SID Plan: Continue medications as previous. Review with CBC and PCV/TP in one week.    Vital Signs