Learn from mistakes, wherever they come from.  I apologize for being scarce
on a weekend, but we lost one of our own this evening, following adrenal
surgery yesterday (and a relatively famous one, who was pictured on the
cover of the JAVMA last April 15th in a watercolor I painted as a lark)
 
Not a happy story, but one that might be of interest to everyone else
out there.
 
For the last two months or so, Cosmo was becoming progressively more
lethargic.  His hair loss had dramatically increased, he had assumed the
pot-bellied, pear shape appearance that is occasionally seen in adrenal
cases, and over the last week or so had become very lethargic.
 
Yesterday I took him over to Charlie Weiss' for surgery.  Preoperative
bloodwork showed everything looked pretty good, except for a marked
decrease in platelets (45,000/cm instead of the normal 150,000+)  Knowing
that ferret don't spontaneously bleed until 10,000, and that his condition
was deteriorating relatively quickly, we opted to proceed with surgery,
following a transfusion.  Post- transfusion, the platelet count was
338,000.  Surgery was uneventful, with removal of a right adrenal
malignancy and a nodule off the pancreas (he had never shown signs of
insulinoma.) Recovery was uneventful and he went home with me about 90
minutes after surgery.  He did fine last night, and was sternal and
relatively alert.
 
This AM, he was non-responsive, hypothermic (97 degrees) in significant
pain, and had bruising surrounding the incision site.  He spent the balance
of the day in ICU with fluid, steroids, and torbutrol for pain.  This
afternoon he was not progressing, and died peacefully following a third
shot of torbugesic.
 
The necropsy resulted in an interesting, but not altogether unexpected
finding (given his post-operative signs).  The elevated platelet count
was not in error, but these platelets were likely not functional.  Slow
bleeding was seen at every area of surgical dissection, and subcutaneously
at venipuncture sites.  In effect, he died of hemorrhage brought on by
deficient platelet function.  His own were too few to stem the damage of
surgery, and the transfused ones were non-functional, it would appear.
 
I need to review with Charlie how the transfused blood was collected, and
work backward to see if there was a step in the collection that might have
resulted in the platelet's lack of activation in Cosmo's circulation.
 
The moral of this particular tale is that while conventional wisdom is that
ferrets may be successfully operated on with platelet counts less than
50,000 - there will be some mortality.  Had his condition been better,
perhaps we might have been able to delay surgery, but as he was already
slipping away, we took a calculated risk, and lost.
 
Watch those platelets.
 
With kindest regards,
Bruce Williams
[Posted in FML issue 3494]