Gizmo is a 3 year old Capuchin (Cebus apella) male monkey. Approximately 2 to 3 months ago, he began to have syncopal episodes. He was admitted to the University of Florida, Veterinary Medical Teaching Hospital (VMTH), wildlife care service on 6/18/01. Physical examination (PE) revealed pale mucous membranes, and grade ¼ systolic murmur. The rest of the PE was within normal limits. Tests performed were complete blood count (CBC), chemistry panel, thoracic and abdominal radiographs, and fecal examination for parasite ova and occult blood. CBC revealed a severe non-regenerative anemia (HCT 10.4%), and leukopenia with a relative basophilia (Temporal CBC test results are summarized in the table below). Trace amounts of occult blood were found in feces. Other diagnostic test results were normal. Metronidazole therapy was started and Gizmo was discharged from the VMTH with an open diagnosis. Kari was instructed to return to the VMTH for a recheck on results and trace fecal occult blood on 6/21/01. Second CBC results showed a slight improvement, and a regenerative response (30% reticulocyte count). At this time differential diagnosis (DDX) included: autoimmune hemolytic anemia, red blood cell destruction due to metabolic RBC defect, preleukemia, occult neoplasia. The VMTH was not able to perform a Coombs test that would recognize non-human primate antigens. Therefore, empirical treatment with prednisolone (1 mg/kg body weight once per day) was started. Approximately 5 days later, a Coombs test designed to recognize human RBC antigens was performed and found to be negative. Prednisolone therapy was tapered off during the following two weeks, and Gizmo’s condition appeared to be improving (HCT increased to 18.2%, and heart murmur disappeared. We concluded that the heart murmur was a result of the hemodynamic compensation for the severe anemia. During the week of 7/16/01, Gizmo began to have recurring syncopal episodes. PE on 7/31/01 revealed peripheral lymphadenopathy, pale mucous membranes and a soft grade ¼ systolic murmur. His hematocrit had dropped to 12%, and reticulocyte count was 1.1%. Upon careful questioning, it was discovered that Gizmo’s face would swell up, similar to an anaphylactic reaction prior to the attack. At this point, a presumptive diagnosis of systemic mastocytoma was made. Although a bone marrow biosy is indicated, we felt that Gizmo’s current emotional and physical condition prevented it. Prednisolone therapy was re-instituted at 1mg/kg body weight Q24 hours, cimetidine at 5mg/kg BID, and benadryl at 5mg/kg BID. Since this time, Gizmo’s anaphylactic attacks have continued. Recheck PE on 8/15/01 revealed pale mucous membranes, and peripheral lymhadenopathy. Blood was collected for a CBC, and inguinal and submandibular lymph nodes were aspirated for cytology. CBC results show no improvement, cytology of lymph node aspirates revealed the presence of mast cells in the lymph nodes. However, evaluation of the lymph node aspirates by a qualified clinical pathologist are still pending.

 Test
	 	Normal
	 	values 	  6/18/01 6/21/01 6/27/01 7/31/01 8/15/01
 
RBC M/ml 	5.4-7.0   1.16 	  1.46 	  1.99 	  1.48 	  1.32
 
Hgb g/dl 	13.7-16.9 3.19    4.07    5.56    3.7     3.84
 
HCT % 		41.5-50.1 9.82   12.9    18.3    13.1     11.4
 
MCV fl 		75.1-83.5 84.7   88.4    91.9    88.8     86.7
 
MCH pg 		22.4-27.2 27.5   27.9    28      25       29.1
 
MCHC g/dl 	28.6-33.4 32.5   31.5    30.5    28.2     33.6
 
Plateletes
K/ml 		153-475  119     392      749             696
 
WBC K/ml 	4.7-8.6   2.16   2.44    7.86    1.2      2.78
 
Segs %           39-67    48     41      64      20       32 

Lymph %          29-55    40     37      16      73       51 

Mono % 		   0-4     8      5       9       6        6
 
Eos % 		   0-6            3       8                1 

Baso % 		   0-2     4     14 	  3       1       10 

Reticulocyte %     < 1           30             1.1       3.5
 
Tot. protein g/dl  7.2-8.4 6.5   7.1    7.3     6.3       7.0