"Chloe" - Blood in the Urine
I was reading through my list of patients for the day on the computer when I noticed the name of "Chloe". She had been listed by reception staff with "blood in urine". Nice and straightforward I thought to myself, probably a simple case of cystitis. And so when she walked into my consulting room with her owner I had great expectations of resolving her issues easily and promptly.
"Chloe" seemed remarkably perky despite her situation, almost pleased with herself. No matter I thought, she may be through the worst of the discomfort. It was at that point I asked her owner, Mrs Barrett, whether she might possibly have brought in a urine sample from "Chloe". Being both conscientious and smart in realising that I clearly needed some help Mrs Barrett promptly pulled a filled urine sample container from her bag.
It was at this point my eyes opened wide and I suddenly realised that we were dealing with something potentially life threatening. My immediate response was to make "Chloe's" owner aware of the situation and enquire as to whether "Chloe" had possibly eaten anything toxic. Garlic and leek she suggested. I have to admit that whilst I was aware that poisoning due to members of the onion family (Allium) is recognised the volumes involved didn't appear to make it most likely. However, after we had admitted "Chloe", performed the blood tests and the Fairfield team had made the appropriate calculations it was clear that this was the actual definitive diagnosis.
Weighing in at less than 15 pounds "Chloe" only had to consume a relatively small amount to trigger the toxic process. Thiosulphate, the toxic ingredient in onions, garlic and leeks, damages circulating red blood cells. These are then eliminated from the body causing large quantities of blood pigment (haemoglobin) to appear in the urine as in "Chloe's" case. Clearly, if sufficient red blood cells are involved then the patient can die from haemolytic anaemia or internal bleeding. Fortunately, through careful blood monitoring, we were able to establish that "Chloe's" tasty morsel had a very visible dramatic effect on the colour of her urine but no other further long term consequences. In future, I will wait to see what owners pull out from their bags before jumping to any hasty conclusions!