Case 6

Hooray! Roxy's albumin concentration has improved. It is not within the normal range yet but is better and there is less risk of effusion. The mature neutrophilia monocytosis and elevated ALP activity are is likely a response to the corticosteroids, and the mild non-regenerative anemia is likely anemia of chronic disease. She seems to be exhibiting side effects from the prednisone, however, so you add azathioprine at 1 mg/kg once a day, another immunosuppressant drug often used to treat patients with immune-mediated or inflammatory disease. Side effects can occur with this medication (bone marrow suppression, hepatotoxicosis), so patient monitoring is important, but the benefits typically outweigh the risks. This medication can take two to three weeks to reach its full effect, so you recommend a follow-up visit in two weeks to check her CBC results, and, if all looks good, you plan to decrease the prednisone to once a day. In the meantime, you recommend that her owners get some housebreaking pads to use inside since the prednisone dose can't be decreased immediately.

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