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Krogh AKH, Brunse A, Thymann T, Bochsen L, Kristensen AT. Staphylococcus epidermidis sepsis induces hypercoagulability in preterm pigs. Res Vet Sci 2019; 127:122-129. [PMID: 31704497 DOI: 10.1016/j.rvsc.2019.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/30/2022]
Abstract
Gram positive bacteria are a cause of sepsis in human preterm infants, and associates with high mortality and hemostatic dysfunction. It is unknown whether bovine colostrum may protect against sepsis and prevent hemostatic dysfunction. The current study was part of an overall sepsis study investigating Staphylococcus epidermidis (SE) induced sepsis in premature pigs including investigation of the effect of feeding bovine colostrum. The specific hypothesis of this study was that the hemostatic response would be hypercoagulable in septic pigs compared to non-infected controls, and that feeding bovine colostrum would increase the hypercoagulant response. Thromboelastography, activated partial thromboplastin time, prothrombin time and fibrinogen concentration were characterized in SE infected pigs, SE infected pigs fed bovine colostrum, and uninfected controls. All pigs were followed for 24 h. In addition, the same parameters were evaluated in a group of premature pigs and a group of full born pigs all followed for 11 days. SE septic premature pigs were characterized by increased clot strength and decreased fibrinolysis, significantly low platelet count and high fibrinogen concentration. Feeding bovine colostrum did not affect the hemostatic response. Compared to full born pigs, preterm newborn pigs demonstrated reduced clot strength, prolonged prothrombin time and low fibrinogen concentration. In all pigs, the fibrinogen concentration increased 11 days post-partum. To conclude, SE induced sepsis in premature pigs resulted in hypercoagulability. Bovine colostrum did not mitigate the hemostatic response. A hypocoagulable hemostatic response was present in healthy preterm pigs compared to full born pigs, similar to previous reports in infants.
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Affiliation(s)
- Anne Kirstine Havnsøe Krogh
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Anders Brunse
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Thomas Thymann
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Louise Bochsen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Annemarie T Kristensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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THROMBOELASTOGRAPHY IN THE HEALTHY ASIAN ELEPHANT (ELEPHAS MAXIMUS): REFERENCE INTERVALS AND EFFECTS OF STORAGE. J Zoo Wildl Med 2018. [DOI: 10.1638/2017-0179r.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Devanagondi R, Zhang X, Xu Z, Ives K, Levin A, Gurm H, Owens GE. Hemodynamic and Hematologic Effects of Histotripsy of Free-Flowing Blood: Implications for Ultrasound-Mediated Thrombolysis. J Vasc Interv Radiol 2015; 26:1559-65. [PMID: 25952642 DOI: 10.1016/j.jvir.2015.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/22/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate the extent and consequences of histotripsy-induced hemolysis in vivo. MATERIALS AND METHODS Porcine femoral venous blood was treated with histotripsy in 11 animals with systemic heparinization and 11 without heparin. Serum and hemodynamic measurements were obtained at 0, 2, 5, 10, 15, and 30 minutes and 48-72 hours after the procedure. Fisher exact test was used to determine differences in mortality between heparinized and nonheparinized groups. A linear mixed effects model was used to test for differences in blood analytes and hemodynamic variables over time. RESULTS Of 11 animals in the nonheparinized group, 5 died during or immediately after histotripsy (45% nonheparin mortality vs 0% heparin mortality, P = .035). Serum hematocrit, free hemoglobin, lactate dehydrogenase (LDH), and right ventricular systolic pressure changed significantly (P < .001) over the treatment time. Serum hematocrit decreased slightly (from 32.5% ± 3.6% to 29.4% ± 4.2%), whereas increases were seen in free hemoglobin (from 6.2 mg/dL ± 4.6 to 348 mg/dL ± 100), LDH (from 365 U/L ± 67.8 ± to 722 U/L ± 84.7), and right ventricular systolic pressure (from 23.2 mm Hg ± 7.2 to 39.7 mm Hg ± 12.3). After 48-72 hours, hematocrit remained slightly decreased (P = .005), whereas LDH and free hemoglobin remained slightly increased compared with baseline (both P < .001). CONCLUSIONS Intravascular histotripsy applied to free-flowing venous blood is safe with systemic heparinization, causing only transient hemodynamic and metabolic disturbances, supporting its use as a future noninvasive thrombolytic therapy modality.
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Affiliation(s)
- Rajiv Devanagondi
- Center for Pediatric and Congenital Heart Disease, Cleveland Clinic, 9500 Euclid Avenue, M4-37A, Cleveland, OH 44915..
| | - Xi Zhang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan.; Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kimberly Ives
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Hitinder Gurm
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Gabe E Owens
- Michigan Congenital Heart Center, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
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Soerensen KE, Olsen HG, Skovgaard K, Wiinberg B, Nielsen OL, Leifsson PS, Jensen HE, Kristensen AT, Iburg TM. Disseminated intravascular coagulation in a novel porcine model of severe Staphylococcus aureus sepsis fulfills human clinical criteria. J Comp Pathol 2013; 149:463-74. [PMID: 23746745 DOI: 10.1016/j.jcpa.2013.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 02/26/2013] [Accepted: 04/13/2013] [Indexed: 11/25/2022]
Abstract
Sepsis is a common and often fatal complication in human patients in intensive care units. Relevant and well characterized animal models of sepsis may provide valuable information on pathophysiological mechanisms and be a mean of testing new therapeutic strategies. Large animal models of Staphylococcus aureus sepsis are rare, even though S. aureus increasingly affects human patients. Sepsis changes the haemostatic balance and leads to endothelial cell (EC) activation, coagulopathy and, in severe cases, disseminated intravascular coagulation (DIC). The aim of this study was to characterize the haemostatic and vascular alterations in a novel porcine model of severe S. aureus sepsis, investigating whether the changes fulfill the human clinical criteria for DIC. Five pigs were inoculated intravenously with S. aureus and two control animals were sham-inoculated. Blood samples were collected for thromboelastography (TEG) and assessment of plasma-based haemostatic parameters. Tissue was collected for histopathology and reverse transcriptase quantitative real-time polymerase chain reaction for measurement of mRNA encoding EC markers. All infected animals developed DIC; including procoagulant activation represented by hypercoagulable TEG profiles and prolonged clotting time. Histologically, numerous pulmonary thrombi were present in one pig. Inhibitor consumption was represented by decreasing antithrombin levels in infected pigs. Hyaline globules were found in three infected pigs, confirming fibrinolytic activation. EC activation was identified by expression of von Willebrand factor in small vessels together with elevated mRNA encoding activated EC markers. Severe haemostatic and vascular changes fulfilling the human criteria for DIC were therefore seen in all infected pigs. A tendency towards uncompensated DIC was seen in two animals.
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Affiliation(s)
- K E Soerensen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Pathology and Wildlife Disease, National Veterinary Institute, Sweden.
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Moldal ER, Kirpensteijn J, Kristensen AT, Haga HA, Nødtvedt A, Eriksen T. Evaluation of inflammatory and hemostatic surgical stress responses in male cats after castration under general anesthesia with or without local anesthesia. Am J Vet Res 2013; 73:1824-31. [PMID: 23106471 DOI: 10.2460/ajvr.73.11.1824] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize acute inflammatory and hemostatic surgical stress responses following castration in cats and to evaluate whether the addition of local anesthesia to the anesthetic protocol attenuates these responses. ANIMALS 39 male cats. PROCEDURES Cats undergoing castration were randomly assigned to 2 groups: both groups underwent surgery with general anesthesia, and 1 group additionally received a local anesthetic (lidocaine [2.0 mg/kg in total, divided intratesticularly and SC]) prior to incision. Blood samples were collected after anesthetic induction (baseline) and 1, 5, and 24 hours later. Thromboelastography and coagulation variables (activated partial thromboplastin time [aPTT] and prothrombin time [PT]) were analyzed; fibrinolysis was assessed with plasma D-dimer concentrations. The acute-phase response was evaluated via measurement of plasma fibrinogen and serum amyloid A (last time point, 28 hours) concentrations. Hematologic variables were analyzed at baseline and 1, 5, and 24 hours later. RESULTS Evidence of hemostatic and inflammatory activation after surgery was detected in both groups. Maximum amplitude and G (global clot strength) were significantly increased at 24 hours, and significant, but not clinically relevant, decreases were detected in aPTT at 5 and 24 hours and in PT at 24 hours, compared with baseline values. Serum amyloid A concentrations were significantly higher at 24 and 28 hours than at baseline, and plasma fibrinogen concentration was significantly increased at 24 hours; WBC and RBC counts and Hct were significantly increased at multiple time points. No differences between groups were detected for any variables. CONCLUSIONS AND CLINICAL RELEVANCE Castration appeared to induce hypercoagulability and an acute-phase inflammatory response in cats. Local anesthesia with lidocaine did not attenuate this response.
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Affiliation(s)
- Elena R Moldal
- Department of Companion Animal Clinical Sciences, Norwegian School of Veterinary Science, NO-0033 Oslo, Norway.
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Vymazal T, Filaun M, Horacek M. Impact of retransfusion of blood processed in cell-saver on coagulation versus cardiopulmonary bypass: a prospective observational study using thromboelastography. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 159:131-4. [PMID: 23549515 DOI: 10.5507/bp.2013.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/14/2013] [Indexed: 11/23/2022] Open
Abstract
AIMS To compare an impact of retransfusion of blood processed in cell-saver (CS) with that of cardiopulmonary bypass (CPB) on blood coagulation in patients undergoing cardiac surgery. METHODS Prospective observational study using thromboelastography (TEG). RESULTS TEG samples from 170 patients were analyzed. Cardiopulmonary bypass was used in 100 patients while 70 patients were operated off-pump. In 20 off-pump patients collected blood was processed by cell-saver and returned. In all patients clot formation after heparin neutralization by protamine was unimpaired. However, there was a significant increase in fibrinolysis defined by the TEG parameter Lysis time 30 min after the maximum amplitude of the clot was reached (Ly30) in groups with CPB or CS but this increase still did not exceed the threshold for clinical fibrinolysis (Ly30 > 7.5%). In the group without CPB there was no significant impact on coagulation. CONCLUSION Surgery that avoids CPB and/or CS is the gentlest method for inducing blood coagulation.
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Affiliation(s)
- Tomas Vymazal
- Department of Anaesthesiology and Intensive Care Medicine, 2nd Medical School, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
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Moldal ER, Kristensen AT, Peeters ME, Nødtvedt A, Kirpensteijn J. Hemostatic response to surgical neutering via ovariectomy and ovariohysterectomy in dogs. Am J Vet Res 2012; 73:1469-76. [DOI: 10.2460/ajvr.73.9.1469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Maxwell AD, Owens G, Gurm HS, Ives K, Myers DD, Xu Z. Noninvasive treatment of deep venous thrombosis using pulsed ultrasound cavitation therapy (histotripsy) in a porcine model. J Vasc Interv Radiol 2010; 22:369-77. [PMID: 21194969 DOI: 10.1016/j.jvir.2010.10.007] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 06/14/2010] [Accepted: 10/12/2010] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study evaluated histotripsy as a noninvasive, image-guided method of thrombolysis in a porcine model of deep vein thrombosis. Histotripsy therapy uses short, high-intensity, focused ultrasound pulses to cause mechanical breakdown of targeted soft tissue by acoustic cavitation, which is guided by real-time ultrasound imaging. This is an in vivo feasibility study of histotripsy thrombolysis. METHODS AND MATERIALS Acute thrombi were formed in the femoral vein of juvenile pigs weighing 30-40 kg by balloon occlusion with two catheters and thrombin infusion. A 10-cm-diameter 1-MHz focused transducer was used for therapy. An 8-MHz ultrasound imager was used to align the clot with the therapy focus. Therapy consisted of five cycle pulses delivered at a rate of 1 kHz and peak negative pressure between 14 and 19 MPa. The focus was scanned along the long axis of the vessel to treat the entire visible clot during ultrasound exposure. The targeted region identified by a hyperechoic cavitation bubble cloud was visualized via ultrasound during treatment. RESULTS Thrombus breakdown was apparent as a decrease in echogenicity within the vessel in 10 of 12 cases and in 7 cases improved flow through the vein as measured by color Doppler. Vessel histology found denudation of vascular endothelium and small pockets of hemorrhage in the vessel adventitia and underlying muscle and fatty tissue, but perforation of the vessel wall was never observed. CONCLUSIONS The results indicate histotripsy has potential for development as a noninvasive treatment for deep vein thrombosis.
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Affiliation(s)
- Adam D Maxwell
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.
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Olsson C, Olsson P, Rådegran K, Owall A. Intraoperative blood salvage and retransfusion from citrate treated wounds is safe and feasible. SCAND CARDIOVASC J 2010; 44:177-82. [PMID: 20141340 DOI: 10.3109/14017430903524904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Allogenic blood transfusions are associated with increased morbidity and mortality in surgical patients. The study objective was to investigate the feasibility and safety of intraoperative autotransfusion of unwashed shed whole blood using a novel method. DESIGN Twenty pigs were randomised to autotransfusion or crystalloid volume replacement. In two separate surgical wounds, the surfaces and 400 ml of shed blood were treated in situ with citrate, delivered with an equipment transforming suction to positive pressure. Central haemodynamics were monitored with a pulmonary artery catheter. Effects on oxygen-carrying capacity, formed blood elements, haemolysis, inflammation, metabolism, and coagulation were evaluated with biochemical analyses. RESULTS No clinically relevant adverse effects on haemodynamics were encountered, apart from a decrease in cardiac output and mixed venous saturation similar to that in control animals. Haemoglobin level was better preserved in the autotransfused group (97 vs. 86 g/L, p=0.0007). There were no major differences in biochemical variables and no macroscopic clot formation precluding autotransfusion. CONCLUSIONS The technique was safe and feasible for intraoperative blood salvage and autotransfusion. Haemodynamics and biochemical variables were similar to controls. The technique warrants further studies in humans, as it may contribute towards a reduction of allogenic blood transfusions.
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Affiliation(s)
- Christian Olsson
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
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