Studi Kasus

Oleh : drh Putri Sajuthi

 Sinyalemen
Nama : Candy
Jenis Hewan : Kucing
Ras : Domestic Short Hair
Jenis Kelamin : Betina
Umur : 2 tahun
BB : 2.3 kg
 Anamnesa dan Temuan Klinis
• Muntah
• Diare
• Kurus
• Lesu
• Suhu 37.8
• pucat
• Abdomen tension
 Muntah dan Diare
- Primary Gastro Intestinal :
 FBO
 Infection
Virus : Panleukopenia, (Corona)
Bakteri : E.coli, Salmonella,
Parasit : Giardia, Coccidia, Tritrichomonas, Cacing
Toxin : Botulinum
- Secondary Gastro Intestinal
Liver
Ginjal
Pankreas, dll
 Pemeriksaan

1. Feces? Kultur? Natif?

2. Ultrasonografi ?

3. Xray?

4. Lab darah?

5. Test virus?
Natif Feces
USG
USG
Xray
 Hematologi
Parameter CBC Hasil Kisaran Normal
WBC (x 109 /l) 23,0 5,5 – 19.5
Limfosit (x 109 /l) 3,36 1,5 – 7
Monosit (x 109 /l) 0,72 0 – 1,5
Neutrofil (x 109 /l) 18,4 2,5 – 14
Eosinofil (x 109 /l) 0,5 0–1
Basofil (x 109 /l) 0,01 0 – 0,2
RBC (x 1012/l) 4.43 5 – 10
Haemoglobin (g/dl) 6 8 – 15
HCT (%) 18.5 24 – 35
MCV (fl) 41.8 39 – 55
MCH (pg) 13.5 12,5 – 17,5
MCHC (g/dl) 32.4 30 – 36
Platelet (x 109 /l) 211 300 – 800
 Kimia Darah (8/5/17)
Kimia Darah Hasil Kisaran Normal
ALB (g/dL) 1.9 2,2 – 4,4
ALP (U/L) 300 10 – 90
ALT (U/L) 28 20 – 100
Crea 1.6 1-2
T Bil (mg/dL) 0.37 0,1 – 0,6
BUN (mg/dL) 99 10 – 30
TP (g/dL) 7,2 5,4 – 8,2
Glob (g/dL) 5,3 1,3 – 5,7
FPV test
Diagnosa dan diagnosa banding
Tindakan Lanjutan??
Laparotomi
Terapi
 Kasus 2
• Nama Hewan : Joy (Betina)
• Ras : mix
• Umur : 5 Tahun
• BB : 6.6 Kg
• Temuan Klinis :
anoreksia
lesu
pucat
Ptechie
Echimosa
Perdarahan sklera
Tanda-tanda
perdarahan
 Lanjutan Pemeriksaan
• Hematologi
• Kimia Darah
• Urinalisis
 Hematologi
Pemeriksaan Hasil Satuan Nilai Normal

WBC 1.2 10^3/µL 6.0-17.0

Limfosit 0.2 10^3/µL 1.0-4.8

Monosit - 10^3/µL 0.15-1.35

Eosinofil - 10^3/µL 0.01-1.25

Granulosit 1 10^3/µL 3.5-14.0

RBC 2.24 10^6/µL 5.5-8.5

Hb 4.5 g/dL 12.0-18.0

HCT 13 % 37.0-55.0

MCV 58 fL 60.0-77.0

MCH 20.1 pg 19.5-24.5

MCHC 34.6 g/dL 32.0-36.0

PLT 15 10^3/µL 200-500

 Kimia Darah
Pemeriksaan Hasil Satuan Nilai Normal

AST 72 U/L 8.9-48.5

ALT 75 U/L 8.2-57.3

BUN 45.9 mg/dL 10.0-20.0

Creatinin 1.6 mg/dL 1.0-2.0

Total Protein 9 g/dL 5.4-7.5

Albumin 1.7 g/dL 2.6-4.0

Globulin 7.3 g/dL 2.7-4.4

Ratio A/G 0.23 0.6-1.1

Total Bilirubin 0.167 mg/dL 0.07-0.61

ALP 199 U/L 10.6-100.7

Glukosa 64.3 mg/dL 60-100

• Urinalisis
Pemeriksaan Hasil
Warna Kuning
Konsistensi Encer
Berat Jenis 1.013
pH 5
Lekosit -
Nitrit -
Protein 2+
Glukosa -
Keton -
Urobilinogen -
Bilirubin -
Darah -
Hemoglobin -
 Interpretasi
• Pansitopenia (anemia + leukopenia+
trombositopenia)
• ↑ AST & ALT
• Hyperproteinemia, hyperglobulinemia
• Hypoalbuminemia
• ↑ ALP (Liver damage, young animal,
steroid)
• Urine : proteinuria
Anemia (regeneratif vs non
regeneratif)
Anemia (hemolisis vs hemoragi)
Extravaskular vs Intravaskular
Leukopenia (Limfopenia dan Neutropenia)
– Low productin  bone marrow
suppression  apakah hanya neutrophil
atau semua sel ???
– ↑ Penggunaan  banyak band (pd
infeksi bacterial, sepsis, pyometra)
Trombositopenia
• Primer : ptechie, echimosa
– Increased consumption of platelets (DIC)
– Shorter life-span
– Platelet migration inhibitor factor
– Splenic problem
– Impaired bone marrow production
• Sekunder  permasalahan pada factor
pembeku darah
– Fibrin tidak terbentuk
– Gejala klinis : Hematoma, Hemothorax,
Hemascos
• Hyperproteinemia dengan hyperglobulinemia  ↑
gamma globulin
• ↑↑ Gamma globulin  immune complex disease
– Uveitis
– Glomerulonephritis
– Poliarthritis
– Vaskulitis
• Hypoalbuminemia
– ↓ oncotic pressure  Edema, ascites
– Loss antithrombin 3  terjadi thrombus formasi 
DIC
– Tubular cell failure  renal failure (azotemia dan
BJ turun)
Vit K
Proteinuria 
Glomerulonephritis 
• Idiopatic
• Immune complexis disease + chronic
presistent infection
• Antibodies against basal membrane  SLE
Diagnosa
– Ehrlichia canis  Monosit (Canine Monositic
Ehrlichiosis/CME)
– Vektor : “brown dog tick” (Rhipicephalus
sanguineus)
Phatogenesis
• Acute Phase
– 1- 4 minggu
– Mononuclear cell affected
– Easy to treat, good prognosis
– Inflammatory, possibly autoimmune reaction
• Chronic phases
– 1 bulan-tahun
– Difficult to treat, guarded prognosis
– Invasion bone marrow
– Suppression bone marrow  pancytopenia
• Subclinical
– No clinical sign (present organism without
disease)
Gejala klinis
• Fase akut
demam, (ptechie/ecchymosa, epistaxis),
vasculitis, limpadenopathy, edema kaki dan
scrotum
• Fase kronis
(ptechie/ecchymosa, epistaxis), anemia,
vasculitis, lymphadenopathy, neurological
disorder, lameness (polyarthritis), uveitis,
edema, glomerulonephritis
Acute Phase
 Chronic Phase
• Morula sudah tidak terlihat
• Deteksi menggunakan test kit  Idexx 4DX
• Doxycycline 5-10 mg/kg BB q12h PO
minimum 3 weeks
• Chronic infection : for several months up to 1
year
• Additional symptomatic treatment
– Blood transfusion
– Prednisolone (????)
• Prevention
– Tick control  repellent (Permethrine)
Transfusi
 1 minggu pasca terapi
Pemeriksaan Hasil Satuan Nilai Normal
Sel Darah Putih (WBC) 25 10^3/μL 6 – 17
Limfosit 6.1 10^3/μL 1 – 4.8
Monosit 1.2 10^3/μL 0.15 – 1.35
Eosinofil 0.1 10^3/μL 0.01 – 1.25
Granulosit 17.6 10^3/μL 3.5 – 14
Sel Darah Merah 3.79 10^6/μL 5.5 – 8.5
(RBC)
Hemoglobin (Hb) 7.8 g/dL 12 – 18
Hematokrit (HCT) 24.1 % 37 – 55
MCV 63.6 fL 60 – 77
MCH 20.6 Pg 19.5 - 24.5
MCHC 32.4 g/dL 32 – 36
Trombosit (PLT) 228 10^3/μL 200 – 500
Total Protein 7.4 g/dL 5.4 – 7.5
Albumin 3.4 g/dL 2.6 – 4.0
Globulin 4 g/dL 2.7 – 4.4