Clinical history:
An approximately 11-week-old intact male mixed breed dog was presented to the emergency service as a referral for severe anemia and suspected babesiosis. The dog had a history of being transported from Texas three weeks prior. One week after transport, the dog was evaluated by his primary veterinarian for acute onset of lethargy, where he was febrile (40.4°C) with an otherwise normal physical exam. An in-house complete blood cell count (CBC) showed a severe microcytic (MCV 61 fL, reference interval [RI] 61.6-73.5 fL), normochromic (MCHC 347 g/L, RI 320-379 g/L), non-regenerative (reticulocyte count 6.3x109/L, RI 10.0-110.0 x109/L) anemia (HCT 0.147 L/L, RI 0.373-0.617 L/L), as well as a normal leukocyte (6.29 x109/L, RI 5.05-16.76 x109/L) and neutrophil count (4.57 x109/L, RI 2.95-11.84 x109/L), and severe thrombocytopenia (platelet count 23 x109/L, RI 148-484 x109/L). The dog was treated with 15 mL/kg of packed red blood cells (pRBC) over 4 hours. He was discharged home having also received 150 mL of subcutaneous fluids (unknown type), and prescribed omeprazole (10 mg PO q 24 h), sucralfate (1 gram PO q 8 h), and amoxicillin/clavulanate (10 mg/kg PO q 12 h; Clavamox, Zoetis). The fever had improved (39.4°C) before discharge. The following day he was returned to the referring hospital for recheck, where a packed cell volume (PCV) was 23%. Eight days later, the dog re-presented to his primary veterinarian due to lethargy, and a PCV was 15%. An in-house blood smear evaluation was suspicious for Babesia , so polymerase chain reaction (PCR) testing was submitted to a reference laboratory. The dog was discharged home with clindamycin (75 mg PO q 12 h). The next day, the owner reported that the dog was too weak to stand, prompting referral.