TRALI or Pulmonary Hemorrhage?

A 7 year-old spayed female miniature poodle was referred to a veterinary teaching hospital emergency service for further evaluation of severe thrombocytopenia due to a suspected immune-mediated thrombocytopenia with a platelet count of 12k/uL confirmed by a blood smear. Initial work-up included standard bloodwork, a tick-borne disease panel, thoracic and abdominal imaging. No apparent underlying causes of presumed ITP were identified. An initial physical examination showed moderate tachycardia with a HR of 150/min, strong femoral pulses, pale mucous membranes and multifocal cutaneous petechiation. The dog was eupneic and had normal bronchovesicular sounds. There was melena on rectal palpation. The patient’s PCV was 20% with TS of 5.5 g/dl.

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