C10007190 / invoice 10000

06/03/2026 Presented for skin check/ hotspot?

HISTORY
O noticed large red spot on tummy - concerned it might be a rash or a hotspot
Has been licking and scratching the area
Otherwise healthy 
EDUD normal 
No V+/D+/C+
Going on daily walks - always on lead 
Free access to concrete backyard 
No known access to toxins inc rat bait 
A couple of weeks ago was body slammed in park by another big dog 
No current meds
Vacc and worming - UTD

EXAM
BAR
HR = PR = 120, no hm/a detected on ausc 
Normal resp effort and clear BVS
MM pink & moist, CRT <2s - very mouth shy 
EEN - NAD
LNs - NAD
Abdomen - soft and comfortable on palpation 
Temp - NE
Integ - ventral abdomen - severe echymoses and multifocal petechiae 
New echymosis developed after holding for blood sample

CBC - severe thrombocytopaenia - confirmed with manual smear 
Coags - WNL

ASSESSMENT & PLAN
Thrombocytopaenia
DDx increased destruction (primary vs secondary - no anaemia) vs increased loss/ consumption vs other
No signs of anaemia or haemorrhage - most likely immune mediated vs idiopathic 
Dex 0.24mg/kg sc
Pred 1.6mg/kg PO bid (total 3.3mg/kg/day) for 7-14 days
Revisit in 48h for repeat bloods and re-assess response to meds 

07/03/2026 Represent as concerned pale on gums

O: Gums pale pink. BAR. HR 120. RR 24 and no concerns. Abdomen comfortable. Swelling on right abdomen fluidy and non-painful. Small purpura on abdomen/groin.

A: Suspect IMTP but stable for now

P: Considering veins, bruising and likely concerns on anxiety, advise continue to monitor at home. Can consider vincristine in AM. Client advised also vomited so SC maropitant at this time.

Discussed blood transfusion and prognosis IMTP.

07/03/2026 Recheck for IMTP
Lethargic overnight
Vomited once - seen by Elliot overnight, given maropitant, elected for monitoring as stable
This morning, owner concerned about a "wobbly ribcage"
Has not had any initial oral prednisolone yet, just dexamethasone inj SQ
No epistaxis, haemoptysis, haematuria or melaena yet,
E:
QAR (anxious)
Temp 37.6
HR 150, no murmurs, good pulses and rhythm
RR 24 clear, RHS of thorax - wobbly fluid accumulation SQ - suspect haemorrhage into third space
Abdominal palpation comfortable
Very head and mouth shy - brief glimpse of MM pale pink not white, no crt
Sclera white but could not check conjunctiva

Purpura left inguinal - slightly bigger since yesterday 
right ventral flank - same

Diet: prime 100 air dried (lamb), Proudi - frozen meat blocks, cooked chicken

A: IMTP early

P: Has only been 12 hours since blood test and diagnosis and not wanting to cause further bruising or stress have decided to prioritize steroid therapy for now. Focus to give 10mg prednisolone bid over next 2-3 days (added difficulty of head shyness) and recheck on Monday/Tuesday. Keep quiet and confined to avoid injury. If deteriorates then of course return sooner.

Leave SQ fluid accumulation for now - want to avoid further trauma and bleeding, can consider compression bandage.

Have discussed if medical management unsuccessful  then likely course of action would require blood transfusion +/- vincrsitine/azathioprine, with bone marrow biopsy and abdominal ultrasound

07/03/2026 Hx emailed to East Ivanhoe vets: management@ivanhoeeastvet.com.au (ACM)

09/03/2026 History:
RRR was 34-40 but not at rest
Seems comfortable in waiting room - O considered to take him home
NO v/d
Doing well on meds dispensed
Swelling around RHS thorax reducing in size

Examination:
Teddy is BAR
Pink MM
RE normal
RR around 40 in vet clinic
walking comfortable
Bruising on abdominal region

Assessment:
Monitor at home
Recheck RV PLT and blood smear in 7 days post dx or sooner INB

Possible missed information of RRR needs to be <30 compared to general RRR <30. Possible this info was not mentioned last consult
Plan to go home and monitor, recheck if worried
O will continue at RV
Discussed IMTP with O as still not 100% on the disease