Update on Albumin Therapy in Critical Illness

2024 AAHA Fluid Therapy Guidelines for Dogs and Cats

Fluids are drugs used in veterinary patients capable of producing beneficial therapeutic or inadvertent harmful effects within the body's intravascular, interstitial, and intracellular fluid spaces. The individualized design of a fluid therapy plan requires careful patient assessment and targeted selection of proper fluid types, administration routes, and rates, along with adjustments during therapy tailored specifically as per the individual patient's fluid requirement and therapeutic response. Personalized fluid prescriptions and vigilant patient monitoring help avoid patient morbidity from body fluid deficiencies, fluid excess, and electrolyte derangements and support better patient outcomes. These guidelines provide an overview of fluid dynamics within the fluid spaces of the body, describe various types of fluids and their uses, and outline recommendations for fluid administration for resuscitation, rehydration, and maintenance purposes. The guidelines also outline approaches to fluid therapy for anesthetized patients and reiterate the recommendations of reduced fluid rates in this population of patients. Additionally, the guidelines include practical fluid therapy strategies for patients with various common disorders. The goal of these guidelines is to help veterinary professionals safely and effectively prescribe and administer fluid therapy for canine and feline patients.

Effect of hypoproteinemia on mortality of elderly male patients with chronic heart failure

To explore the effect of hypoproteinemia on cardiac function and prognosis in elderly male patients with chronic heart failure. Among the patients with chronic heart failure hospitalized in the General Hospital of Southern Theater Command from December 2014 to December 2015, 100 elderly male patients with chronic heart failure were selected. The patients were divided into 2 groups based on their serum albumin (ALB) levels: 53 cases in the normal group (ALB ≥ 35 g/L) and 47 cases in the hypoproteinemia group (ALB < 35 g/L). Using the method of prospective study, under the condition of routine treatment of heart failure, follow-up observation for 5 years, we collected relevant data and analyzed the level of serum ALB, cardiac function and prognosis of patients in these 2 groups. The mortality of patients in the hyporoteinemia group were significantly higher than those in the normal group. Left ventricular end-diastolic dimension (LVDD) and brain natriuretic peptide (BNP) in the normal group after 5 years were markedly lower compared with that in the hypoproteinemia group. The mortality of patients with chronic heart failure with hypoproteinemia were higher, and the present study indicated that the ALB level may be associated with the mortality of patients with chronic heart failure.

Retrospective evaluation of indications, transfusion protocols, and acute transfusion reactions associated with the administration of lyophilized canine albumin: 53 cases (2009-2020)

OBJECTIVES

To describe the administration of lyophilized canine albumin (LCA) and determine the increase in serum albumin concentrations post-LCA transfusion. To describe the incidence and types of acute transfusion reactions (TRs) and associated outcome in dogs presenting to a veterinary teaching hospital.

DESIGN

Retrospective and descriptive study from 2009 to 2020.

SETTING

University teaching hospital.

ANIMALS

Fifty-three client-owned dogs included in the study if they received an LCA transfusion and had vital sign monitoring recorded for at least for 4 hours after starting the LCA transfusion.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The 53 dogs available for study inclusion received 64 LCA transfusions. Signalment; underlying disease; indications for LCA transfusion; pre- and posttransfusion serum albumin concentration; volume, concentration, and dose of LCA; duration of transfusion; administration of other blood products or synthetic colloids; occurrence, timing, and type of TR; length of hospitalization; and outcome were recorded. Serum albumin concentrations increased post-LCA transfusion, with a median dose of 0.56 g/kg and a median posttransfusion serum albumin increase of 3 g/L (0.3 g/dL) (P = 0.008). TRs occurred in 13 of 64 (20.3%) transfusion events. Volume per kilogram, dose (g/kg), concentration, duration of transfusion, and additional administration of synthetic colloids were not associated with TRs. Three (23%) TRs were classified as febrile nonhemolytic transfusion reaction, 5 (38.5%) as transfusion-associated dyspnea (development of respiratory distress and limited diagnostics), and 5 (38.5%) had clinical signs that could not be defined by any 1 TR category. Six (46.1%) of 13 events were nonsevere, 5 (38.5%) were severe, and 2 (15.4%) were life-threatening.

CONCLUSIONS

Administration of LCA can be used to increase serum albumin concentrations, although the clinical implications of this increase are unknown. Acute TRs associated with LCA are relatively frequent and can be life-threatening. Careful monitoring is vital.

Albumin use and mortality among intensive care patients with acute heart failure: a retrospective study

OBJECTIVE

Hypoproteinemia is common in patients with acute heart failure, especially in the intensive care unit (ICU). We assessed short-term mortality in patients with acute heart failure for albumin and nonalbumin users.

METHODS

Our study was a retrospective, observational and single-center study. We included patients with acute heart failure from the Medical Information Mart for Intensive Care-IV and compared short-term mortality and length of hospital stay in patients with and without albumin use. We used propensity score matching (PSM) to adjust for confounders, a multivariate Cox proportional hazard regression model, and performed subgroup analysis.

RESULTS

We enrolled 1706 patients with acute heart failure (318 albumin users and 1388 nonalbumin users). The 30-day overall mortality rate was 15.1% (258/1706). After PSM, the 30-day overall mortality was 22.9% (67/292) in the nonalbumin group and 13.7% (40/292) in the albumin group. In the Cox regression model, after propensity matching, the albumin use group was associated with a 47% reduction in 30-day overall mortality [hazard ratio (HR) = 0.53, 95% confidence interval (CI): 0.36-0.78, P = 0.001]. In subgroup analysis, the association was more significant in males, patients with heart failure with reduced ejection fraction (HFrEF), and nonsepsis patients.

CONCLUSION

In conclusion, our investigation suggests that the use of albumin was associated with lower 30-day mortality in patients with acute heart failure, especially in males, those aged >75 years, those with HFrEF, those with higher N-terminal pro-brain natriuretic peptide levels, and those without sepsis.

A Retrospective Study to Compare the Incidence of Hyponatremia after Administration between Linezolid and Tedizolid

Linezolid (LZD) and Tedizolid (TZD) are oxazolidinone antibiotic for meticillin-resistant Staphylococcus aureus (MRSA). Severe hyponatremia after LZD administration have been reported. Severe hyponatremia cause seizures, unconsciousness, and even death. Therefore, we conducted a study to assess the change of serum sodium level after LZD and TZD therapy. We enrolled 67 patients treated with LZD and 28 treated with TZD. We monitored the serum sodium level from the administration to 14 days after administration of oxazolidinone drug. Hyponatremia was defined a sodiuln level ≤134 mmol/L after the initiation of oxazolidinone drug. The frequency of hyponatremia in the LZD group was significantly higher than that in the TZD group (39.7% vs. 11.1%, p < 0.05). The rate of patients administered by injection was significantly higher than in the LZD group than in the TZD group (52.9% vs. 14.8%, p < 0.01). Multiple logistic regression analyses identified the albumin level before the oxazolidinone drug therapy as the independent variables associated with the development of hyponatremia. We revealed that TZD is safer than LZD in terms of hyponatremia. Therefore, cases that LZD is administered by injection should be used more carefully with hyponatremia in patients with low albumin level.

Construction of diagnostic prediction model for Wilson's disease

Background

Wilson's disease, also known as hepatolenticular degeneration, is a rare human autosomal recessive inherited disorder of copper metabolism. The clinical manifestations are diverse, and the diagnosis and treatment are often delayed. The purpose of this study is to establish a new predictive diagnostic model of Wilson's disease and evaluate its predictive efficacy by multivariate regression analysis of small trauma, good accuracy, low cost, and quantifiable serological indicators, in order to identify Wilson's disease early, improve the diagnosis rate, and clarify the treatment plan.

Methods

A retrospective analysis was performed on 127 patients with Wilson's disease admitted to the First People's Hospital of Yunnan Province from January 2003 to May 2022 as the experimental group and 73 patients with normal serological indicators who were not diagnosed with Wilson's disease. SPSS version 26.0 software was used for single factor screening and a multivariate binary logistic regression analysis to screen out independent factors. R version 4.1.0 software was used to establish an intuitive nomogram prediction model for the independent influencing factors included. The accuracy of the nomogram prediction model was evaluated and quantified by calculating the concordance index (C-index) and drawing the calibration curve. At the same time, the area under the curve (AUC) of the nomogram prediction model and the receiver operating characteristic (ROC) curve of the Leipzig score was calculated to compare the predictive ability of the nomogram model and the current Leipzig score for Wilson's disease.

Results

Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), albumin (ALB), uric acid (UA), serum calcium (Ca), serum phosphorus (P), and hemoglobin (HGB) are closely related to the occurrence of Wilson's disease (p < 0.1). The prediction model of Wilson's disease contains seven independent predictors: ALT, AST, AKP, ALB, UA, Ca, and P. The AUC value of the prediction model was 0.971, and the C-index value was 0.972. The calibration curve was well fitted with the ideal curve. The nomogram prediction model had a good predictive effect on the occurrence of Wilson's disease; the ROC curve of Leipzig score was drawn, and the AUC value was calculated. The AUC of the Leipzig score was 0.969, indicating that the prediction model and the scoring system had predictive value, and the nomogram prediction model had a better predictive effect on the research objects of the center.

Conclusion

ALT, AST, AKP, ALB, UA, Ca, and P are independent predictors of Wilson's disease, and can be used as early predictors. Based on the nomogram prediction model, the optimal threshold was determined to be 0.698, which was an important reference index for judging Wilson's disease. Compared with the Leipzig score, the nomogram prediction model has a relatively high sensitivity and specificity and has a good clinical application value.

Three Different Interaction Patterns between MCM-41 and Proteins

As one of the most studied mesoporous silica nanoparticles (MSNs) in drug delivery systems, Mobil Composition of Matter No. 41 (MCM-41) possesses unique properties including perfect channel architecture, excellent load capacity, and good biocompatibility. However, the applications of MCM-41 nanoparticles in drug delivery have not yet been industrialized, due to the interaction between MCM-41 and biomolecules (especially proteins) that affect their in vivo behaviors after dosing. To investigate the interactions between MCM-41 and proteins, this study selected bovine serum albumin (BSA), lysozyme (Lyso), and bovine hemoglobin (BHb) as model proteins and characterized the ultraviolet-visible, fluorescence, circular dichroism spectra and the protein adsorption of MCM-41-protein complex. The UV-Vis spectra exhibited the different absorption increment degrees of three proteins. The fluorescence spectra showed that the fluorescence intensity of proteins changed by different trends. The CD spectra indicated that the secondary structure changes were ranked as BSA > Lyso > BHb, which is consistent with the protein’s adsorption capability on MCM-41. It was shown that there were three different patterns of MCM-41-proteins interactions. The hydrophilic and low-charged BSA followed the strong interaction pattern, the hydrophilic but heavily charged Lyso followed the moderate interaction pattern, and the hydrophobic BHb followed the weak interaction pattern. Different interaction patterns would lead to different effects on the structural properties of proteins, the surface chemistry of MCM-41, and the absorption capability of proteins on MCM-41. We believe our study will provide a better insight into the application of MCM-41 nanoparticles in drug delivery systems.

Clinical risk factors for severity and prognosis of antiresorptive agent-related osteonecrosis of the jaw: a retrospective observational study

INTRODUCTION

The incidence of antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is rare, and its management has not yet been established. This study aimed to investigate the predictors for advanced stage and healing of ARONJ to establish an appropriate treatment strategy.

MATERIALS AND METHODS

We retrospectively analyzed patients diagnosed with ARONJ at Kobe City Medical Center General Hospital between April 2014 and March 2020. Outcomes were defined as stage ≥ 2 ARONJ (primary) and healing of ARONJ (secondary). Multivariate logistic regression analysis was used to detect factors associated with the outcomes, and odds ratios (OR) and 95% confidence intervals (CI) were calculated.

RESULTS

This study included 143 patients (stage ≥ 2 ARONJ, 51%; healing of ARONJ, 60%). Multivariate logistic regression analysis revealed that advanced age (per year) (OR 1.037; 95% CI 1.003-1.072; p = 0.028) and serum albumin (per g/dL) (OR 0.430; 95% CI 0.213-0.869; p = 0.018) were significantly associated with stage ≥ 2 ARONJ. Furthermore, multivariate logistic regression analysis revealed that cancer (yes) (OR 0.099; 95% CI 0.029-0.339; p < 0.001), conservative surgical treatment (yes) (OR 15.42; 95% CI 5.657-42.0; p < 0.001), C-reactive protein (per mg/dL) (OR 0.599; 95% CI 0.415-0.864; p < 0.001), and vitamin D analog (yes) (OR 0.167; 95% CI 0.034-0.827; p = 0.028) were factors associated with healing.

CONCLUSION

Our findings suggest that age and hypoalbuminemia are associated with the severity of ARONJ, and cancer, high inflammation, and vitamin D analog may impair healing. In contrast, conservative surgical treatment can overcome the poor treatment outcomes associated with ARONJ.

Prognostic significance of Naples prognostic score in operable renal cell carcinoma

Background

Naples prognostic score (NPS), a novel scoring system based on nutritional and inflammatory status, is associated with prognosis in several cancers. This study aimed to evaluate the prognostic significance of preoperative NPS in patients undergoing nephrectomy.

Patients and Methods

This study retrospectively analyzed patients with renal cell carcinoma (RCC) who underwent radical or partial nephrectomy between 2010 and 2013. The clinicopathological characteristics of patients stratified by preoperative NPS were compared. Survival analysis was performed using the Kaplan–Meier method and log-rank test. Univariate and multivariate Cox proportional hazards models were used to identify independent prognostic factors. Receiver operating characteristic curves were used to evaluate prediction efficiency.

Results

A total of 638 patients with operable RCC were included. The high-NPS group (NPS group 2) was significantly associated with older age (P < 0.001), larger tumor size (P < 0.001), worse pathological T stage (P < 0.001), positive lymph node pathology (P = 0.002), higher tumor grade (P < 0.001), and greater tumor necrosis (P < 0.001). Multivariable analysis demonstrated that the high-NPS subgroup had significantly worse overall survival (OS) [hazard ratio (HR): 2.25, 95% confidence interval (CI): 1.45–3.50, P < 0.001] and progression-free survival (PFS) (HR: 2.26, 95% CI: 1.48–3.44, P < 0.001). Among several preoperative scoring systems, NPS had the strongest discriminatory power for predicting OS and PFS.

Conclusion

Preoperative NPS can serve as a simple novel risk stratification tool to optimize the prognosis of patients with operable RCC. Further prospective and large-scale studies are needed to validate our findings.

Prognostic factors associated with survival and hospitalization time in pediatric canine patients diagnosed with presumptive acute viral gastroenteritis

Background and Aim:

Acute viral gastroenteritis is one of the main causes of hospitalization in dogs during the 1^st year of life. This retrospective study aimed to describe a pediatric canine population presumptively diagnosed with acute viral gastroenteritis and to identify potential prognostic factors that influence hospitalization time (HT) and mortality.

Materials and Methods:

Canine patients up to 12 months of age diagnosed with presumptive acute viral gastroenteritis were searched retrospectively from two veterinary hospitals during a 5-year period (2015–2020). Information regarding patient signalment, prophylactic care, clinical signs, blood test results, presence of systemic inflammatory response syndrome, and additional treatments were recorded to analyze their association with HT and mortality. Only dogs with a complete medical record until death or discharge were included in the study.

Results:

Ninety-four dogs were identified: 76 dogs (80.9%) survived with a median HT of 5 days (range: 2–16 days) and 18 dogs (19.1%) died with a median HT of 3½ days (range: 1–8 days) after admission. The presence of fever and fresh frozen plasma (FFP) administration was significantly associated with a lower survival rate (p = 0.021 and p = 0.037) in the multivariate analysis. Among survivors, incomplete primo-vaccination, the presence of hematochezia, and FFP administration were considered independent predictors of time to clinical recovery (p = 0.026, p = 0.047, and p = 0.026, respectively), being associated with higher HT.

Conclusion:

The presence of fever and FFP administration was significantly associated with a lower survival rate. An inadequate primo-vaccination status prior to admission, hematochezia, and FFP administration was associated with longer HT in surviving patients. Further studies are needed to confirm the present results.

Effect of hypoalbuminemia on short-term outcomes after colorectal cancer surgery: A propensity score matching analysis

Purpose

The purpose of our study was to investigate the effect of pre-operative hypoalbuminemia on the short-term outcomes after primary colorectal cancer (CRC) surgery.

Materials and methods

The retrospective study enrolled CRC patients who underwent primary surgery from January 2011 to December 2021 in a single teaching hospital. The short-term outcomes were compared between the hypoalbuminemia group and the normal group using propensity score matching (PSM). Univariate and multivariate logistic regression analyses were used for analyzing independent predictors of overall complications and major complications.

Results

A total of 7,072 patients from a single center were enrolled in this study. There were 1,078 (15.2%) patients in the pre-operative hypoalbuminemia group and 5,994 (84.8%) patients in the normal pre-operative albumin group. After 1:1 PSM, there were 1,028 patients in the hypoalbuminemia group and 1,028 patients in the normal group. No significant differences were found in baseline information between the two groups after PSM. In terms of short-term outcomes, the hypoalbuminemia group had a longer operation time (p = 0.003), greater volume of blood loss (p = 0.036), longer hospital stays (p < 0.01), higher proportion of overall complications (p = 0.003), major complications (p = 0.016), higher incidence of pneumonia and abdominal infection (p = 0.001) than the normal group after PSM. Furthermore, hypoalbuminemia was an independent predictor for overall complications (p = 0.008) and major complications (p = 0.016).

Conclusion

Pre-operative hypoalbuminemia increased overall complications and major complications after primary CRC surgery. Furthermore, hypoalbuminemia was an independent predictor for overall complications and major complications.

Mannose-decorated ginsenoside Rb1 albumin nanoparticles for targeted anti-inflammatory therapy

Ginsenoside Rb1 is a potential anti-inflammatory natural molecule, but its therapeutic efficacy was tremendously hampered by the low solubility and non-targeted delivery. In this study, we innovatively developed a mannose (Man)-modified albumin bovine serum albumin carrier (Man-BSA) to overcome the previously mentioned dilemmas of Rb1. The constructed Man-BSA@Rb1 NPs could improve the solubility and increase the cellular uptake of Rb1, finally leading to the enhanced anti-inflammatory effects. The robust therapeutics of Man-BSA@Rb1 NPs were measured in terms of nitrite, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) levels, which might be achieved by potently inhibiting nuclear factor-κB (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathways in lipopolysaccharide (LPS)-induced Raw264.7 cells. Moreover, the therapeutic efficacy of Man-BSA@Rb1 NPs was further confirmed in the d-Gal/LPS-induced liver injury model. The results indicated that Man-BSA may offer a promising system to improve the anti-inflammatory therapy of Rb1.

Physicochemical Study of Albumin Nanoparticles with Chlorambucil

Currently, nanotechnology is considered a promising strategy to enhance drug solubility and other physicochemical properties. Albumin is a biopolymer that can be used in drug delivery systems due to its biodegradability and biocompatibility. The aim of this study was to prepare and characterize albumin nanoparticles with chlorambucil as a controlled drug delivery system. Different concentrations of chlorambucil were incubated with bovine serum albumin (BSA) in order to prepare nanoparticles using the desolvation method. As a result, nanoparticles in sizes ranging from 199.6 to 382.6 nm exhibiting high encapsulation efficiency of chlorambucil were obtained. A spectroscopic study revealed concentration-dependent changes in secondary structure of the albumin chain and in the hydrophobicity of chlorambucil. Based on the results obtained, it was concluded that the investigated structures may be used in the development of a drug delivery system.

Mass Spectrometry, Structural Analysis, and Anti-Inflammatory Properties of Photo-Cross-Linked Human Albumin Hydrogels

Albumin-based hydrogels offer unique benefits such as biodegradability and high binding affinity to various biomolecules, which make them suitable candidates for biomedical applications. Here, we report a non-immunogenic photocurable human serum-based (HSA) hydrogel synthesized by methacryloylation of human serum albumin by methacrylic anhydride (MAA). We used matrix-assisted laser desorption ionization-time-of-flight mass spectrometry, liquid chromatography-tandem mass spectrometry, as well as size exclusion chromatography to evaluate the extent of modification, hydrolytic and enzymatic degradation of methacrylated albumin macromer and its cross-linked hydrogels. The impacts of methacryloylation and cross-linking on alteration of inflammatory response and toxicity were evaluated in vitro using brain-derived HMC3 macrophages and Ex-Ovo chick chorioallantoic membrane assay. Results revealed that the lysines in HSA were the primary targets reacting with MAA, though modification of cysteine, threonine, serine, and tyrosine, with MAA was also confirmed. Both methacrylated HSA and its derived hydrogels were nontoxic and did not induce inflammatory pathways, while significantly reducing macrophage adhesion to the hydrogels; one of the key steps in the process of foreign body reaction to biomaterials. Cytokine and growth factor analysis showed that albumin-based hydrogels demonstrated anti-inflammatory response modulating cellular events in HMC3 macrophages. Ex-Ovo results also confirmed the biocompatibility of HSA macromer and hydrogels along with slight angiogenesis-modulating effects. Photocurable albumin hydrogels may be used as a non-immunogenic platform for various biomedical applications including passivation coatings.

Comparison of Clinical Data Between Patients With Complications and Without Complications After Spinal Tuberculosis Surgery: A Propensity Score Matching Analysis

Purpose

This study used a propensity score matching (PSM) analysis to explore the risk factors of post-operative complications and compared the differences in clinical data between them following spinal tuberculosis surgery.

Methods

The clinical data of patients with spinal tuberculosis were collected in our hospital from June 2012 to June 2021, including general information, laboratory results, surgical information, and hospitalization costs. The data were divided into two groups: complication and without complication groups. The baseline data of the two groups were obtained using the PSM analysis. Univariate and multivariate logistic analyses were used to analyze the differences between the two groups.

Results

A total of 292 patients were included in the PSM analysis: 146 patients with complications and 146 patients without complications. The operation time, incision length, hospital stay, and albumin quantity in the complications group were 162 ± 74.1, 11.2 ± 4.76, 14.7 ± 9.34, and 1.71 ± 2.82, respectively, and those in the without complication group were 138 ± 60.5, 10.2 ± 3.56, 11.7 ± 7.44, and 0.740 ± 2.44, respectively. The laboratory costs, examination costs, guardianship costs, oxygen costs, and total costs in the complications group were higher than those in the without complication group. A significant difference was observed in the albumin quantity by logistic regression analysis (P < 0.05).

Conclusion

Several costs in the complication group were higher than in the without complication group. The albumin quantity may be an independent factor to predict post-operative complications of spinal tuberculosis by logistic regression analysis.

Biomarker Prediction of Postoperative Healing of Diabetic Foot Ulcers: A Retrospective Observational Study of Serum Albumin

PURPOSE

The purpose of this study was to investigate the relationship and to determine potential usefulness of serum albumin as a biomarker for predicting postoperative diabetic foot ulcer (DFU) healing.

DESIGN

A retrospective study.

SUBJECTS AND SETTING

The sample comprised 266 inpatients with type 2 diabetes receiving care in The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Among them, 174 had DFUs and underwent surgery for foot DFUs including amputation, skin grafting, and flap procedures. A comparison group consisted of 92 inpatients without a DFU or surgery.

METHODS

The association between healing and preoperative albumin levels was analyzed via a logistic regression model and receiver operating characteristic (ROC) curve.

RESULTS

The albumin value of patients with DFU grade 3 or more (3.23 ± 0.58 g/dL) was lower than that of patients with DFU grade 1-2 (3.58 ± 0.5 g/dL), and both were lower than that of the comparison group (3.89 ± 0.3 g/dL). Patients with a DFU with hypoalbuminemia (<3.5 g/dL) had a 2.5-fold higher risk of nonhealing at postoperative 28 days than patients with normal levels (odds ratio = 3.51; 95% confidence interval, 1.75-7.06; P < .001). For patients with a DFU overall, the ROC curve showed a preoperative albumin cutoff of 3.44 g/dL for DFU wound healing.

CONCLUSIONS

For patients with a DFU undergoing surgery, preoperative serum albumin may be used as a biomarker for predicting postoperative healing.

Lessons Learned From the Battlefield and Applicability to Veterinary Medicine - Part 2: Transfusion Advances

Since the inception of recent conflicts in Afghanistan and Iraq, transfusion practices in human military medicine have advanced considerably. Today, US military physicians recognize the need to replace the functionality of lost blood in traumatic hemorrhagic shock and whole blood is now the trauma resuscitation product of choice on the battlefield. Building on wartime experiences, military medicine is now one of the country's strongest advocates for the principle of hemostatic resuscitation using whole blood or balanced blood components as the primary means of resuscitation as early as possibly following severe trauma. Based on strong evidence to support this practice in human combat casualties and in civilian trauma care, military veterinarians strive to practice similar hemostatic resuscitation for injured Military Working Dogs. To this end, canine whole blood has become increasingly available in forward environments, and non-traditional storage options for canine blood and blood components are being explored for use in canine trauma. Blood products with improved shelf-life and ease of use are not only useful for military applications, but may also enable civilian general and specialty practices to more easily incorporate hemostatic resuscitation approaches to canine trauma care.