Article Reviews

Thrombocytopenia and Periodontal Disease in a Samoyed

Bellow J: Thrombocytopenia and Periodontal Disease in a Samoyed. Veterinary Forum September 2006, 34-40.

Reviewed by Erica Cargill, CVT

Ehrlichia, Lyme disease, Rocky Mountain Spotted Fever, ingestion of certain plants, snake bite, von Willebrands disease, drugs and toxins, and congenital defects may all cause platelet abnormalities or bleeding problem in pets. However, as you will read severe dental disease may be a cause as well. This article shows that this Samoyed's problem was an immune related response to a disease, not an exposure to a toxin.

Article review:

An adult, intact Samoyed presented with severe halitosis, gingival petechia, ecchymosis, and blood pooling due to advanced periodontal disease. Diagnostic labs including CBC (complete blood count), serum chemistries, heartworm antigen and urinalysis were drawn. Abnormal findings included a PVC (packed cell volume) of 31.6%, HgB (hemoglobin) of 11.3 g/dl and platelet count of 33,000. The blood smear examination was verified by normal morphology and density in erythrocytes, leukocytes and platelets. The mucosal bleeding time was prolonged by 12 minutes.

The dog was anesthetized for further evaluation. A diagnosis of stage III and IV periodontal disease and immune-mediated Thrombocytopenia was made. Serum was submitted for tick borne diseases, Babesia and von Willebrands with all results ultimately reported as negative. No further procedures were done at this time and the dog recovered uneventfully Post operative care included IV dexamethasone, oral prednisone and oral doxycycline.

One week later, the dog returned for repeat CBC, HCT (hematocrit), and HgB. With the exception of a platelet count of 60,000, all tests were within normal range. Evaluation at two weeks after initial screening showed a platelet count of 105,000 with resolution of gingival petechia and ecchymosis. Four weeks later, the ALP was slightly elevated, likely due to steroid administration, and platelet count was at 127,000.

The dog was once again anesthetized for a thorough dental procedure. After confirming stage 4 periodontal disease, the teeth were radiographed and extracted as needed. Doxirobe gel instilled, and the flaps closed with suture. Morphine was given at 0.4 mg/kg for post operative analgesia and recovery was normal. The dog was discharged to the owners on oral doxycycline and prednisone.

Two weeks after surgery the dog returned for a follow up examination and repeat blood work. All labs were within normal limits and the antibiotic and steroid discontinued. Evaluation at 3 months post operative showed continued improvement, in part due to the pet owner's continual dental homecare.

This is an important reminder that dental care is an essential piece in an animal's overall healthcare. Thrombocytopenia occurs for many reasons and all possible causes must be ruled out prior to diagnosis. Toxins and drugs are not always the culprit and other problems such as congenital or acquired conditions, infectious diseases, and other causes must also be considered.