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Our sincere thanks to
Dr. Rhonda Feinmehl for providing this interesting case.
Canine Case Study
10-year-old male Bouvier des Flanders
History and Clinical Presentation
Owner is concerned about decreased appetite and weight loss. Last year
he weighed 92.7 pounds, and currently weighs 83.4 pounds. Vaccinations
are current. The physical examination was unremarkable. Diagnostic
approach: CBC, chemistry panel, heartworm test, T4 and
urinalysis.
LaserCyte® Hematology
Results
10-year-old
Bouvier des Flanders
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Complete Blood Count Description
Erythron—Mild
anemia. Although the red cell distribution width (RDW) is slightly
increased, suggesting some anisocytosis, there is no increase in the
numbers of reticulocytes (no response to the anemia at this time).
Leukon—Leukopenia
characterized as a lymphopenia.
Thrombon/Platelets—Mild
thrombocytopenia.
Peripheral Blood-Smear Evaluation
Scanning the blood smear confirms the LaserCyte results. The red blood
cells are normochromic and there is a mild to moderate anisocytosis.
There also is a leukopenia with very few lymphocytes on the slide. The
neutrophils show expected normal morphology (no left shift or evidence
of cytotoxicity). Platelet numbers appear reduced and there are a few
large forms (macrothrombocytes). No blood parasites or atypical cells
identified on the scan.
Chemistry Panel and Urinalysis
 The predominant finding on the chemistry panel
is a marked hyperproteinemia of 12.3 g/dL (reference range
5.0–7.4 g/dL) with a marked hypoalbuminemia of 1.4 g/dL
(reference range 2.7–4.4 g/dL) and a hyperglobulinemia of 10.9
g/dL (reference range 1.6–3.6 g/dL). Total T4 is
low-normal at 1.1 ug/dL, and the heartworm antigen test is negative.
The urine is concentrated with a 1.030 specific gravity. Urine
chemistries revealed 1+ blood and 3+ proteins with a pH of 5.0. The
urine sediment is active and contains bacteria, leukocytes and
epithelial cells.
Additional Testing
Hyperglobulinemia can be either polyclonal or monoclonal in nature. A
serum protein electrophoreses confirmed the hypoalbuminemia and
revealed a marked monoclonal gammopathy with the monoclonal peak
traveling in the beta globulin region. The primary differential
diagnoses for monoclonal gammopathy in a dog are multiple myeloma,
ehrlichiosis and lymphosarcoma. The Ehrlichia canis IFA titer
was weak positive at 1:40. Urine test for Bence-Jones proteinuria was
negative. Survey radiographs revealed multiple lytic areas in the
spine. Because of the radiographic changes, as well as the unexplained
bicytopenia (anemia and thrombocytopenia), a bone marrow cytology was
performed. Cytologic examination of the smears revealed a plasma cell
myeloma and myelophthisis.
 
Clinical Diagnosis
Combining the characteristic finding of a monoclonal gammopathy,
radiographic evidence of multiple bony lesions and cytologic evidence
of a plasma cell myeloma, the clinical diagnosis is multiple myeloma.
Current Case Status and Follow-Up VetTest
Results
The dog was begun on a combination of oral melphalan and prednisone.
The patient is currently continuing medication at home, has maintained
his weight (83.1 pounds) and is doing well in partial remission. Over
the past month the hematology parameters have improved (WBC:
6,400/µL, Hct: 44.1%, platelets: 266,000/µL) and the
globulin concentration has decreased.
VetTest Chemistry Results
10-year-old
Bouvier des Flanders
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This summary was written by Drs. Jim Matthews and
Denis DeNicola of IDEXX Laboratories.
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