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== 全血细胞计数和血液化学解释 == CBC and blood chemistry interpretation A second CBC obtained 10 hours after the first one showed evidence of anemia (RBC 4.31 × 1012/l, reference range: 5.65–8.87 × 1012/l; Hct 26.8%, reference range: 37.3%–61.7%; and Hgb 9.5 g/dl, reference range: 13.1–20.5 g/dl), an increased WBC (17.6 × 109/l, reference range: 6–16.9 × 109/l), and segmented neutrophils (15.19× 109/l, reference range: 2.8–10.5 × 109/l). PLT was lower than the previous one and lower compared to the reference ranges: 116 × 109/l (reference range: 175–500× 109/l). A third CBC performed about 12 hours after the second one showed further decrease in the RBC (up to 3.36 × 1012/l reference range: 5.65–8.87 × 1012/l Hct 20.2%, reference range: 37.3%–61.7%; and Hgb 7.4 g/dl, reference range: 13.1–20.5 g/dl). PLT and WBC were unchanged compared to the previous blood work. Total bilirubin (28 mg/dl) and serum urea (25 mg/dl) increased (reference ranges: 7–25 mg/dl and 8.6–11.8 mg/dl, respectively). All data are reported in Table 1. A sample of pleural effusion was collected for culture and susceptibility testing, as well as cytologic evaluation. Cytology of the pleural fluid and a concentrated sample prepared from submitted fluid were of low cellularity with marked hemodilution. Most nucleated cells were macrophages, and these were often vacuolated and contained phagocytized cellular material. Low numbers of reactive mesothelial cells were seen. No infectious organisms or overtly atypical cell populations were found. Neutrophils were compatible with the degree of hemodilution. There was evidence of prior hemorrhage (phagocytized erythrocytes), but significant inflammation (pericarditis) was not apparent in the cytology of the pleural fluid. 在第一次全血细胞计数 '''10 小时后'''获得第二次全血细胞计数'''显示贫血'''证据(红细胞 4.31 × 10^12/l,参考范围:5.65-8.87 × 1012/l;Hct 26.8%,参考范围:37.3%–61.7%;Hgb 9.5 g/dl,参考范围:13.1-20.5 g/dl),'''白细胞增加'''(17.6 × 10^9/l,参考范围:6-16.9 × 10^9/l)和分段中性粒细胞(15.19×10^9/l,参考范围:2.8-10.5 × 10^9/l)。'''PLT低于前一个''',低于参考范围:116×10^9/l(参考范围:175-500×10^9/l)。大约 12 小时后进行第三次全血细胞计数第二个显示红细胞进一步下降(高达3.36×10^12/l参考范围:5.65-8.87×10^12/l Hct 20.2%,参考范围:37.3%-61.7%;Hgb 7.4 g/dl,参考范围:13.1-20.5 g/dl)。PLT和WBC与之前的血液检查相比没有变化。总胆红素 (28 mg/dl) 和血清尿素 (25 mg/dl) 增加(参考范围:分别为 7-25 mg/dl 和 8.6-11.8 mg/dl)。所有数据均在表1中报告。收集胸腔积液样本进行培养和药敏试验,以及细胞学评估。'''胸腔积液'''的细胞学检查和从提交的液体制备的浓缩样本的细胞学检查显示细胞浓度低,'''有明显的血液稀释'''。大多数有核细胞是巨噬细胞,这些细胞通常是空泡化的,并含有吞噬细胞化的细胞物质。观察到反应性间皮细胞数量较少。未发现传染性生物体或明显的非典型细胞群。中性粒细胞与血液稀释程度相容。有既往出血(吞噬红细胞)的证据,但在胸腔积液细胞学检查中不明显有明显的炎症(心包炎)。 A coagulation profile was completed and showed severe prolongation of prothrombin and partial thromboplastin time (PTT) PT (prothrombin time 100 seconds, reference range: 11–17 seconds; and PPT 128 seconds, reference range: 12–16 seconds) (Valchev et al., 2008). Cardiac troponin I was within normal ranges (0.01 ng/ml, reference range: <0.06 ng/ml). 完成凝血曲线并显示凝血酶原和部分凝血活酶时间 (PTT) PT 的严重延长(凝血酶原时间 100 秒,参考范围:11-17 秒;PPT 128 秒,参考范围:12-16 秒)(Valchev 等人,2008 年)。心肌肌钙蛋白I在正常范围内(0.01 ng/ml,参考范围:<0.06 ng/ml)。 The patient was hospitalized overnight with IV fluid therapy and was started on amoxicillin-clavulanic acid (25 mg/kg every 12 hours PO – Synulox, Zoetis) and vitamin K (5 mg/kg every 12 hours IV; Vitamin K1 Laboratoire TVM, Domes Pharma). 患者住院过夜接受静脉输液治疗,并开始使用阿莫西林-克拉维酸(25 mg/kg,每 12 小时 PO – Synulox、Zoetis)和维生素 K(5 mg/kg,每 12 小时静脉注射;维生素 K1 实验室 TVM,Domes Pharma)。 A CT examination, follow-up echocardiography, and possible pericardiocentesis in case of cardiac tamponade were planned for the next day. The next morning the patient was bright, alert, and responsive. She ate normally during the night. The mucous membrane refill time was within normal ranges and the jugular pulses were normal. Temperature was 39.7°C. The heart rate was 180 beats per minute and heart sounds were not muffled. Femoral pulses were strong. Pulmonary auscultation was unremarkable and the previous respiratory signs had resolved. Already after the first IV vitamin K supplementation, PT/PTT returned within normal limits. Oscillometric blood pressure evaluation was within normal limits (systolic pressure average of 143 mmHg). 计划在第二天进行 CT 检查、随访超声心动图和心包穿刺术(如果发生心包填塞)。第二天早上,病人神采奕奕,神志清醒,反应灵敏。她晚上吃得很正常。黏膜再充盈时间在正常范围内,颈静脉搏动正常。温度为39.7°C。 心率为每分钟180次,心音没有减弱。股动脉搏动很强。肺部听诊无明显异常,既往呼吸系统体征已消退。在第一次静脉注射维生素 K 后,PT/PTT 恢复到正常范围内。示波血压评估在正常范围内(收缩压平均值为 143 mmHg)。 24 hours later, the transthoracic echocardiogram revealed complete resolution of pericardial fluid and a significative thinning of the pericardial serosa. Two days after the beginning of the IV vitamin K supplementation, the pericardial serosa was completely normal (Supplementary Video II) and thoracic radiographs were within normal limits. The dog was discharged with oral dose of vitamin K (2.5 mg/kg every 12 hours for 3 weeks). The CBC and blood chemistry performed after 2 weeks were within the reference ranges. 24 小时后,经胸超声心动图显示心包积液完全消退,心包浆膜明显变薄。静脉注射维生素K开始两天后,心包浆膜完全正常(补充视频II),胸片在正常范围内。狗出院时口服维生素K(每12小时2.5mg / kg,持续3周)。2周后进行的CBC和血液化学检查在参考范围内。 <br>
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