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Splenic Vein Thrombus In A Dog

by jk176 - February 19, 2022 View Case Report

Hello,

Dilly is a 10 year old f/s Scottish Deerhound who presented on 1/20/22 for lethargy and decreased appetite. She has always been a picker eater, but now is even more so. No V/D. T 103.8

PE revealed - severe periodontal disease, 1/6 systolic murmur, severe splenomegaly, non painful, abdomen
her pulses were strong, toned, mid-depth and fast, her tongue was lavender and moist with some phlegm

Blood work- chem wnl, t4, wnl, cbc - rbc 9.4 (4.8-9.3), HCT 61 (36-60)
T4 0.7 (0.8-3.5)

tick pcr negative and 4dx negative
She was treated with enrofloxacin and carprofen and showed mild improvement

Abd u/s - splenomegaly, large splenic vein thrombus, smaller left portal vein thrombus
splenic cytology - mild extramedullary hematopoiesis
PT wnl
PTT 130 (75-105

Echo - aortic root dilation with LV concentric hypertrophy -
possibly secondary to a connective tissue disorder given lack of hypertension

Internal med consult - no identified cause for thrombus
The owner spoke with the breeder who mentioned this could be a breed related disorder.

Current treatment - Cerenia 60 mg PO SID , mirtazapine 15 mg PO SID, clopidogrel 75 mg PO SID
Xarelto 25 mg PO SID

follow up with internist 2 weeks after starting above meds - no change in splenic and portal vein thrombi

2/19/22 recheck exam - Dilly's appetite is even worse and she is more lethargic. Her appetite and energy are better in the evenings.
She has lost 4 lbs in one month and was very thin to begin with.
pulse - toned, fast, deep, strong
tongue - small pink, moist
ears warm, feet cool

Assessment - blood stagnation possibly due to damp/phlegm, tb obstruction, blood deficiency, spleen qi deficiency

There was an equivocal response to needling or GB41, 34, BL22, and BL20.

I started her on Kan Six Gentle pets (Liu Jun Zi Tang) and a low dose of Jing Tang Compound Dan Shen. I was concerned about overdoing anti-coagulant/anti-platelet effects of the Western meds, but as she hasn't responded to them I decided to add this on. What's your advice on using this with the western meds?

The other formula I considered: Xiao Chai Hu Tang and possibly Xue Fu Zhu Yu Tang

What other formulas are indicated for splenic and portal vein thrombi?
What do you recommend?

Thank you,
Jennifer

by naturevet

February 25, 2022

Hi Jennifer

A tendency to coagulation makes me think of endothelial dysfunction (ED), with its sticky vessel lining that tends to aggregate platelets and promote WBC tethering and egress. ED, in turn, makes me think of Blood movers and tonics most of all. In other words, I start to look for Blood stasis and/or Blood deficiency.

Shao Yang disharmony is often an underlying cause of Blood stasis, since the Shao Yang regulates the flow of Yang, which in turn regulates Blood flow. Signs of uneven Yang distribution here include the hot head yet cold paws.

The pulse is very typical of a Shao Yang disharmony pulse, where Yang is trapped in the body interior, especially the Stomach and Large Intestine. This can be associated with inappetance and even gastric ulceration and vomiting, and is more likely to induce symptoms in the morning. Shao Yang disharmony is also the leading cause of splenomegaly, even if due presumably to extra-medullary hematopoiesis.

Putting it all together, we need (probably) a Shao Yang harmonizing, Blood moving and Yang Ming cooling formula, I think, despite the equivocal response to GB points. Particularly if there was a fever, we should be thinking about 'deeply penetrated pathogens', which is the bailiwick of Shao Yang harmonizing formulas.

All of that being said, I'd be tempted to use Qing Ying Tang in tandem with Xiao Chai Hu Tang. The two formulas together cover most of your bases and should result in tangible improvements. Yi Guan Jian targets the Stomach and Large Intestine in particular, if the dog is somewhat better, but still inappetant. It's possible, though, that the cooling herbs in QYT will be enough to reduce any gastric inflammation, which can be present even if the patient is not vomiting

Hopefully this helps! Let us know how it goes!

Steve

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