Vet Point Vest
Breed: mix German Shepherd
Age: 9 years
Anamnesis: the dog and it’s owner are very close to our vet practice, they ask for anual hematology and biochemistry exams, abdominal ultrasounds x-rays just for prevention. In the 19th of September 2018 the owner called beacause her dog was not being herself, she was not eating for 24 h and she thinks the dog is in pain.
Clinical findings: when the dog got to our practice she was lethargic, with pale mucose membranes, tahicardic, dispneic and with an enlarged abodomen.
Blood samples were taken and the results were:
-mild anemia 4130000 mm3
-hemoglobine 9,9 g/dL
-hematocrit 27,2 %
-severe trombocitopenia 52.000 /mm3
-extended clotting time
-TCR >2 sec
-CPK increased 955 U/L
-ASAT 289 U/L
-ALAT 70 U/L
-Ureea 124 mg/dL
We performed and ultrasound and there was free fluid in the abdomen and after the paracentesis we removed aprox. 300 ml of blood from the abdomen. We suspected an abdominal hemorrage.
- Intoxication with anticoagulant raticides
- Internal bleeding: organ hemorrage
After a few hours of i.v fluids (aprox 2000 ml NaCl 0,9%) to reestablish blood volemia we decided to do a laparatomy.
Thoracid X-rays were free for pulmonary metastasis. At the ecocardiography the heart was free of any mass in the right atrium.
Splenomegaly with ruptured spleen was our main concern, we did a splenectomy and removed aprox 4L of free blood from the abdomen. The splenectomy was made with sutures and the attached omentum was removed in bloc. A thorough abdominal lavage was made and the instruments were changed to minimize the risk of metastatic seeding.
A sample of the spleen was sent to the histopathology lab. That night we performed a blood transfusion from a 60 kg Tossa Inu.
The next morning the dog was feeling great, she ate normal, she waig her tail and everything was great.
After too weeks our suspected diagnosis was confirmed: Spleen’s red pulp hiperplasia and splenic haemangiosarcoma. The staging could be: T1 (primary site tumor), N1(regional lymph node involvement: mesenteric lymphadenitis 2 weeks after surgery), N0( no evidence of distant metastatis: clear lungs, heart, liver at ultrasound).
Final diagnosis: Visceral Hemangiosarcoma stage II
I also tested cardiac canine troponin I (a marker with high specificity for cardiac injury) at PraxisLab in Budapest to check for miocardial metastatic modifications but the result was normal ( <0,25) .
Treatment: it has been 2 months since the surgery and splenectomy was the treatment of choice at that time.
She received ONCOSUPORT (RX) and a shot of 3 ml of Theranekron (Tarantula cubensis extract) every 5 days.
We finally found Doxorubicine and we started the treatment with the following protocol:
-Doxorubicine 30 mg/m2 = 16 mg/38 kg every 2 weeks for 5 treatments. It does have a cardiotoxic effect but if the dog lives long enough I will continue as much as I can.
-Maropitant (Cerenia) 1mg/kg 2-3 days after chemotherapy.
Other drugs that can be used with a antiangiogenic effects are : Masivet, Thalidomide, Palladia.
The prognosis with dogs with haemangiosarcoma treated with splenectomy only is really poor, 2-3 months surviving time after surgery. Even with chemiotherapy the surviving time of 12 months is only 10%. Median survival time with spelectomy and doxorubicine is 132 days.