Sarah Tayler, Lecturer in Small Animal Internal Medicine  

When three-year-old Pomeranian Nyla came into season it lasted longer than usual. She became lethargic, lost her appetite, blotches appeared on her abdomen and she had ongoing bloody vulval discharge.

As a result, Nyla was referred to the RVC, where she was diagnosed with immune-mediated thrombocytopenia (IMTP).

She was in hospital for more than a fortnight and supported by numerous clinicians, as well as products donated by canine donors. As Nyla’s was an extremely complex case, the transdisciplinary approach fostered by RVC Small Animal Referrals was invaluable to her survival and recovery.

Nyla was initially presented to the Emergency and Critical Care (ECC) Service at the Queen Mother Hospital for Animals (QMHA). She was transferred to the Internal Medicine Service the following day, who worked closely with the ECC, Diagnostic Imaging Service, Anaesthesia and Analgesia Service and the Soft Tissue Surgery Service to enable Nyla to make a recovery.

She had multiple trips to the QMHA Intensive Care Unit and received close nursing care from nurses from both the Internal Medicine and ECC services throughout her stay. All staff involved in Nyla’s care got to know her happy-go-lucky personality while she was hospitalised.

Investigations and surgery

Nyla’s investigations were consistent with immune-mediated thrombocytopenia, and immune suppression was commenced with dexamethasone (a steroid medication to suppress the abnormal immune response) the day following admission.

Nyla’s haemometra was considered likely to be a consequence of oestrus occurring while Nyla was thrombocytopenic. However, as it was possible this represented an ongoing immunological trigger – and there was a lack of response to immunosuppression – an ovariohysterectomy was performed six days later.

The surgery was risky as, at that stage, Nyla still had no platelets, and therefore was at much higher risk of significant intra-operative bleeding, which the surgeons had to manage. She was anaesthetised by the Anaesthesia and Analgesia team, who monitored her parameters closely during surgery and ensured that Nyla was comfortable throughout the operation. Thankfully, due to their combined expertise, the surgery went smoothly, with minimal bleeding.

Nyla needed eight blood transfusions during her treatment at the QMHA. She received a combination of packed red blood cells and fresh whole blood transfusions from four different dogs. These quickly helped to restore her red blood cell count. With every transfusion Nyla required close monitoring from the nurses in ICU to ensure that she was tolerating the transfusion well, with no adverse effects.

Without the availability of these blood products Nyla would not have survived. The Blood Donor Programme team works incredibly hard with our amazing blood donors and their owners to make sure we have blood available for patients at their time of need.

Nyla also was commenced on further immunosuppressant therapy (azathioprine) alongside her steroid treatment two days after surgery and received an injection of vincristine to try to boost the number of platelets being released by her bone marrow two days after that. Thankfully after more than two weeks of treatment, Nyla’s blood smear showed that her platelet numbers had recovered.

Discharge and recovery

After spending 16 days in the QMHA, Nyla returned home. The family and their other dog, Ace, had been lost without her.

Nyla's owner, Jo Barrowcliff, commented: “Nyla was severely anaemic and continually needed blood transfusions to keep her alive. We were desperately losing hope. I was glad she had RVC the experts to deal with her. When the vet rang and said: ‘I have good news, Nyla has platelets in her blood’, I can’t describe how wonderful our family felt. We’d gone through weeks of heartbreak thinking we would lose her.”

Jo added: “We owe her blood donors so much! They’ve enabled our beautiful dog to live and come home to us. Nyla would have most certainly died if this service was not available.”

The Blood Donor Programme is supported by the Animal Care Trust, the RVC’s registered charity.