Case 6

Roxy comes back in two weeks for her follow-up. Her owners report that she had a couple days of decreased appetite once they started the azathioprine, but that resolved and Roxy seems to be doing much better. Roxy's owners have been more vigilant about taking her out to eliminate, so the accidents in the house have decreased. She is eating the diet well, and her physical examination findings are good. You perform a CBC and limited serum chemistry profile to evaluate her liver. These are her results:

CBC

Patient values

Reference range

WBC (/µl)

18,820

4,000-15,500

-Neutrophils (/µl)

15,040

2,060-10,600

-Monocytes (/µl)

2,000

0-840

-Lymphocytes (/µl)

1,230

690-4,500

-Eosinophils (/µl)

550

0-1,200

Hct (%)

32

36-60

Liver panel

Patient values

Reference range

ALP (IU/L)

350

5-131

ALT (IU/L)

87

12-118

Albumin (g/dl)

3.1

2.7-4.4

Globulin (g/dl)

3.0

1.6-3.6

Glucose (mg/dl)

137

70-138

Sodium (mEq/L)

145

139-154

Potassium (mEq/L)

5.1

3.6-5.5

Excellent! Her albumin concentration is much improved there is not evidence of hepatotoxicosis, and her CBC results do not show bone marrow suppression from the azathioprine. The elevated ALP activity is likely due to the corticosteroids. You recommend decreasing her prednisone to once a day and continuing the azathioprine and cobalamine injections on the original schedule.

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