C10024307 / invoice 10000

Reason:Spontaneous bleeding from gums and generalised bleeding starting Tuesday morningHistory:Peach presented with spontaneous bleeding from gums noticed Tuesday morning. Initially seen by regular veterinarian Wednesday who suggested trauma from chewing something and applied anaesthetic, performed health check with no abnormalities detected. Bleeding persisted, prompting second opinion. Groomer identified blood clot on harness, generalised rash, bleeding teeth and gums, excessive fur loss, and tongue colour changes. Lives with beagle who remains well. No known toxin exposure identified. Recent park visit to unfamiliar location on weekend but no observed ingestion of foreign materialSubjective:Growling and snapping when attempting oral examinationObjective:MM: pink with petechiae, CRT: < 2sec, <5% dehydrated.EENT: Bleeding gums and teeth, blotchy gum appearance, tongue colour changesPLN: Soft, symmetrical, normal size/character.Cardiovascular: No heart murmur, regular rhythm.Pulmonary: Normal lung sound and effort.Abdomen: Soft and non-painful. No masses palpated. No fluid wave.Musculoskeletal: Ambulatory x4 with no obvious lameness.Integument:Small spots of bruising throughout bodyNeurologic: Alert and appropriate, cranial nerves intact, normal gait. no neuro deficits on PE.Assessment:Suspected immune-mediated thrombocytopenia. Low platelet count with mild anaemia secondary to bleeding.Plan:- PT/PTT: 12/114 (mildly elevated)- Bloodgas: WNL, PCV 33, TP 70- Close respiratory monitoring for signs of bleeding progression- Monitor for worsening anaemia requiring blood transfusion therapy- Cross type and blood product preparation if transfusion becomes necessary- Transfer to internal medicine team for further work up in the morningClient Communication:Discussed suspected immune-mediated thrombocytopenia. Explained coagulation panel will help rule out toxin exposure, particularly rat bait poisoning. Discussed monitoring plan including overnight hospitalisation to watch for bleeding progression, especially into lungs or abdomen. Explained mild anaemia present but not severe enough currently to require transfusion. Discussed transfer to internal medicine specialists tomorrow for comprehensive workup including abdominal ultrasound to identify potential triggers. Provided cost estimates for overnight care and specialist referral. Discussed potential need for blood transfusion and associated costs if condition deteriorates.    Vital Signs    Weight: 31.7;