News : 2017 : June

Case of the Month: From the Clinics

In the Case of the Doxycycline Sensitive Macaw, adjunct professor Dr. Lauren Thielen presents the new Case of the Month. An otherwise healthy looking macaw is hiding a high WBC and begins to show clinical abnormalities. Despite the ability to obtain a specific diagnosis in this case, the use of repeated CBC and protein electrophoresis provide key prognostic value in this case.

Clinical presentation

A 1 year-old female, blue throated macaw presented for a post purchase wellness exam. This bird was obtained from a pet store 5 months prior and had no signs of illness at time of initial presentation. On physical examination the patient was deemed to be an apparently healthy bird. Bloodwork was submitted consisting of a full blood chemistry, complete blood count, and protein electrophoresis. Surprisingly, abnormalities on the CBC and EPH were abnormal despite the patient not having any clinical signs.

Initial presentation

CBC abnormalities:

  • Elevated total WBC count- 44.7 X 10³/ul (reference 6-16.4 × 10³/ul)
  • Mild anemia- PCV 38% (reference 40-51%)
    EPH abnormalities:
  • Low A/G ratio- 0.86 (reference 2.6-5)
  • Albumin- 0.76g/dL (reference 1.12-2.43g/dL)
  • Gamma Globulins- 0.80g/dL (reference 0.15-0.58g/dL)
    Chemistry abnormalities:
  • All parameters within normal intervals

The patient was in hospital after this initial examination for routine boarding. On day 3 of boarding she was lethargic with sudden weakness and acutely anorexic. Leading differentials at this time were infectious diseases with Chlamydia high on the list due to history and presentation. Treatment with supportive care and doxycycline was initiated immediately and the patient responded quickly. Followup Chlamydia IFA, EBA, and PCR samples tested negative. However, given favorable changes in the CBC, a 6 week doxycycline course was followed.

Recheck labs – Day 14

CBC abnormalities:

  • Still elevated, but improved total WBC count- 27.9 X 10³/ul (reference 6-16.4 × 10³/ul)
  • Improved anemia- PCV 44% (reference 40-51%)

Recheck labs – Day 35

CBC results:

  • Normalized total WBC count – 14.8 X 10³/ul (reference 6-16.4 × 10³/ul)
  • Normalized PCV- 45% (reference 40-51%)
    EPH results:
  • Normalized A/G ratio- 1.77 (2.6-5)
  • Normalized albumin- 1.36g/dL (1.12-2.43g/dL)
  • Normalized gamma globulins- 0.36g/dL (0.15-0.58g/dL)

It is recommended that all avian patients receive wellness blood work annually. Additionally, post purchase examinations including routine blood work and screening for infectious disease is highly advised as demonstrated in this case. Even with a clinically abnormal bird, specific serology or PCR testing for infectious disease is not always helpful. In this case, CBC and EPH were crucial aids in quantifying response to treatment associated with a noticeable clinical improvement of the patient.