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Tey N, Koenig A, Hodges K, Brainard BM. Evaluation of activation characteristics of a canine platelet concentrate produced by a commercial double centrifugation system. Front Vet Sci 2024; 11:1384938. [PMID: 38855414 PMCID: PMC11157093 DOI: 10.3389/fvets.2024.1384938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/30/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction In veterinary medicine there are few readily available products for platelet transfusion to patients with thrombocytopenia. Commercial tabletop platelet concentrating systems have recently become available to veterinarians, primarily directed towards uses associated with regenerative medicine. These systems could potentially be used to produce fresh concentrated platelets for use in transfusion medicine. This study evaluated the concentration, activation, and sterility of a double centrifugation platelet concentrate (PC) produced by a commercial benchtop system. Methods Ten healthy dogs were studied. Whole blood was collected and mixed with ACD-A in a 1:7.6 ratio of ACD-A to whole blood. 12 mL of this mixture was processed into PC via single centrifugation, while 60 mL of the anticoagulated whole blood was processed via a commercial double centrifugation system. Both types of PC were evaluated for platelet concentration, CD62P expression with and without thrombin stimulation, and for sterility. Results Mean platelet count in the double centrifuged PC was 863 ± 352 × 103/μL, with very low white blood cell contamination (median of 0.47 × 103 leukocyte/μL (range 0.15-2.18 × 103/μL)). The double-centrifuged PC had similar baseline activation characteristics (as determined by P-selectin expression) as the single centrifuge PC (0.76% vs. 0.72% unstimulated, 30.5% vs. 34.9% stimulated, p = 0.432). Discussion The benchtop PC system studied here did not cause activation of platelets during production and produced a sterile product that can be further investigated as a source of fresh platelet concentrates for transfusion purposes.
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Affiliation(s)
| | | | | | - Benjamin M. Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
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LeVine DN, Goggs R, Kohn B, Mackin AJ, Kidd L, Garden OA, Brooks MB, Eldermire ERB, Abrams-Ogg A, Appleman EH, Archer TM, Bianco D, Blois SL, Brainard BM, Callan MB, Fellman CL, Haines JM, Hale AS, Huang AA, Lucy JM, O'Marra SK, Rozanski EA, Thomason JM, Walton JE, Wilson HE. ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats. J Vet Intern Med 2024. [PMID: 38779941 DOI: 10.1111/jvim.17079] [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: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence-based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell-containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence-based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non-PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.
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Affiliation(s)
- Dana N LeVine
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Barbara Kohn
- Small Animal Clinic, School of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Andrew J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Linda Kidd
- Linda Kidd Veterinary Internal Medicine Consulting, Carlsbad, California, USA
| | - Oliver A Garden
- School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Marjory B Brooks
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Erin R B Eldermire
- Flower-Sprecher Veterinary Library, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Anthony Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Elizabeth H Appleman
- Department of Internal Medicine, The Animal Medical Center, New York, New York, USA
| | - Todd M Archer
- Bluff City Veterinary Specialists, Memphis, Tennessee, USA
| | - Domenico Bianco
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, USA
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Mary Beth Callan
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Claire L Fellman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Jillian M Haines
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Anne S Hale
- Zia Pet Hospital, Rio Rancho, New Mexico, USA
| | | | - John M Lucy
- Oradell Animal Hospital, Paramus, New Jersey, USA
| | - Shana K O'Marra
- Northwest Veterinary Critical Care Services, Vancouver, Washington, USA
| | - Elizabeth A Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - John M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Jenny E Walton
- Veterinary Apheresis Service UK, Washington, Tyne and Wear, United Kingdom
| | - Helen E Wilson
- Langford Vets, University of Bristol, Langford, Somerset, United Kingdom
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3
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Stikeman E, Bianco D. Use of human intravenous immunoglobulin for the treatment of 12 dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia. J Small Anim Pract 2024; 65:338-345. [PMID: 38239177 DOI: 10.1111/jsap.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To evaluate the safety and efficacy of human intravenous immunoglobulin in dogs with newly diagnosed malignancy and presumed secondary immune-mediated thrombocytopenia. MATERIALS AND METHODS Twelve client-owned dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia were prospectively enrolled to receive a single infusion of human intravenous immunoglobulin at a dose of 0.5 to 1 mg/kg intravenous over 8 hours. A complete treatment response was defined as a platelet estimation of ≥40,000 platelets/μL within 24 hours and a partial response within 48 hours from the completion of human intravenous immunoglobulin infusion. No treatment response was defined as a platelet estimation remaining <40,000 platelets/μL over 48 hours from the completion of the human intravenous immunoglobulin infusion. This pilot study had a prospective, open-label, uncontrolled design. RESULTS Out of the 12 enrolled dogs, seven completed the study. A complete treatment response to human intravenous immunoglobulin was identified in one lymphoma dog and a partial response was noted in another lymphoma dog. The remaining 10 dogs had no response to human intravenous immunoglobulin. No clinically relevant adverse reactions to human intravenous immunoglobulin occurred in any of the 12 initially enrolled dogs during the infusion and over a 3-month follow-up period for the seven surviving dogs. CLINICAL SIGNIFICANCE The results of this study suggest that the use of human intravenous immunoglobulin in dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia appears safe, but not effective for the treatment of thrombocytopenia. Larger multi-centre, prospective, double-blinded, placebo-controlled, outcome-based, malignancy-specific studies are needed to further evaluate these preliminary findings.
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Affiliation(s)
- E Stikeman
- Internal Medicine Department, Metropolitan Animal Specialty Hospital, 6565 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
| | - D Bianco
- Internal Medicine Department, Metropolitan Animal Specialty Hospital, 6565 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
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Arjoonsingh A, Haines JM, Hwang JK, Guess SC, Wardrop KJ. Evaluation of platelet additive solution for prolonging storage of functional canine platelet concentrate. J Vet Emerg Crit Care (San Antonio) 2023; 33:656-664. [PMID: 37639315 DOI: 10.1111/vec.13335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 04/07/2022] [Accepted: 06/23/2022] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To assess storage lesion development, platelet function, and bacterial growth in canine platelet concentrates (PCs) stored in a platelet additive solution (PAS) or a plasma control at 4°C for 21 days. DESIGN Prospective, ex vivo, experimental controlled study. SETTING University veterinary teaching hospital. ANIMALS Ten units of canine PCs collected from blood bank donations. INTERVENTIONS The PCs were separated into 2 bags, 1 containing 100% plasma and the other containing 35% plasma and 65% of a PAS (Plasma-Lyte A), and stored at 4°C for 21 days. At days 0, 7, 14, and 21, PCs were analyzed for the presence of swirling, aggregate formation, platelet counts, platelet indices, glucose, lactate, lactate dehydrogenase, Pvco2 , Pvo2 , aggregation via light aggregometry, activation percentages using flow cytometry, and bacterial growth. MEASUREMENTS AND MAIN RESULTS Cold-stored PCs in both PAS and plasma control maintained mean pH >6.8 and mean lactate <9.0 mmol/L over 21 days, with no difference in glucose utilization. Swirl was maintained in both solutions for most days (76/80 combined total samples), with no difference in aggregate formation between solutions. The Pvco2 was higher in plasma on all days (P < 0.001), with no difference in Pvo2 . Platelet indices did not reflect significant storage lesion development in either solution. Lactate dehydrogenase did not differ between solutions but did increase from day 7 to day 21. Mean maximal aggregation percentage was reduced overall but with no significant difference between solutions. The only observed difference in mean activation percentage between solutions was in PAS on day 7, which was significantly higher than plasma (P < 0.05). No bacterial growth occurred during storage. CONCLUSIONS Cold storage in PAS and plasma allowed PCs to be stored for up to 21 days with minimal storage lesion development, maintenance of platelet function, limited platelet activation, and no bacterial growth within stored bags.
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Affiliation(s)
- Avin Arjoonsingh
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Jillian M Haines
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Julianne K Hwang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Sarah C Guess
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - K Jane Wardrop
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
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Walton J. Companion animal blood banking: the importance of raising awareness and improving donor retention. Vet Rec 2023; 193:74-76. [PMID: 37477311 DOI: 10.1002/vetr.3289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
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Kim MY, Han HJ. Dose-dependent effect of canine lyophilized platelet on an in vitro hemodilution model. BMC Vet Res 2023; 19:61. [PMID: 36932415 PMCID: PMC10022049 DOI: 10.1186/s12917-023-03614-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
The transfusion of stored platelets has emerged as an efficient method for treating dogs with thrombocytopenia. However, the availability of fresh platelets is limited in veterinary medicine due to demanding storage conditions. Lyophilized platelets have long shelf lives and can be easily stored, increasing their accessibility for thrombocytopenic dogs. Due to the lack of research and information on the dose effect, canine lyophilized platelets are used at a clinical dosage without research-based evidence. This study was to evaluate the dose effect of lyophilized canine platelets on blood coagulability. Three different concentrations of lyophilized canine platelets were added to in vitro hemodilution blood model, increasing the platelet count by 25, 50, and 100 × 106/ml and coagulation profiles were analyzed. The coagulability was evaluated via the plasma fibrinogen concentration, coagulation time, thromboelastography (TEG), and platelet function analyzer (PFA). Higher concentrations of lyophilized platelets showed dose-dependent association with decreased aPTT and R-time of TEG and increased alpha angle and MA of TEG. These results showed the potential that the higher dose of canine lyophilized platelets better improve blood coagulability than the standard dose and provided the basis for further safety and clinical studies.
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Affiliation(s)
- Mu-Young Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, 05029, Seoul, Republic of Korea
| | - Hyun-Jung Han
- Department of Veterinary Emergency and Critical Care, College of Veterinary Medicine, Konkuk University, 05029, Seoul, Republic of Korea.
- KU Center for Animal Blood Medical Science, Konkuk University, 05029, Seoul, Republic of Korea.
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Van Vertloo LR, Portanova AZ, Donnini EK, Hale AS, LeVine DN. Prophylactic use of a lyophilized platelet product for rhinoscopic diagnosis and treatment of sinonasal aspergillosis in a dog with a P2Y12 platelet receptor mutation. J Vet Emerg Crit Care (San Antonio) 2023; 33:242-246. [PMID: 36815741 DOI: 10.1111/vec.13284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To describe the periprocedural use of a lyophilized platelet product during rhinoscopic diagnosis and treatment of sinonasal aspergillosis in a Greater Swiss Mountain Dog with a P2Y12 platelet receptor disorder. CASE SUMMARY After the development of severe epistaxis, a Greater Swiss Mountain Dog was diagnosed with thrombopathia secondary to a P2Y12 receptor gene mutation. Concurrent primary nasal disease was also suspected due to persistent mucopurulent nasal discharge. One month after the initial presentation for epistaxis, the dog was readmitted for workup of nasal disease. Computed tomography of the head showed turbinate lysis and regional lymphadenopathy. Because of concern for a high risk of bleeding in a thrombopathic patient subjected to rhinoscopy and nasal biopsies, a lyophilized platelet product was administered prior to the procedure. Rhinoscopic exam revealed fungal plaques consistent with Aspergillus spp. that were later confirmed on fungal culture to be Aspergillus fumigatus. Rhinoscopic biopsies were performed as well as debridement of the fungal plaques, followed by topical administration of clotrimazole solution. Bleeding was minimal during and after the procedure, and the dog recovered uneventfully. NEW OR UNIQUE INFORMATION PROVIDED This is the first report of the prophylactic use of lyophilized platelets in a thrombopathic patient undergoing an invasive procedure with potential for significant hemorrhage. Minimal bleeding occurred during the procedure, suggesting that lyophilized platelets could be used for the prevention of bleeding in thrombopathic patients undergoing invasive procedures.
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Affiliation(s)
- Laura R Van Vertloo
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, USA
| | | | - Elle K Donnini
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, USA
- Iowa Veterinary Specialties, Des Moines, Iowa, USA
| | - Anne S Hale
- BodeVet, Rockville, Maryland, USA
- Thrive Pet Healthcare, Albuquerque, New Mexico, USA
| | - Dana N LeVine
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, USA
- Department of Clinical Sciences, Auburn University, Auburn, Alabama, USA
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8
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Saint-Pierre LM, Farrell KS, Hopper K, Reagan KL. Retrospective evaluation of fresh platelet concentrate administration in dogs: Patient characteristics, outcomes, and transfusion practices in 189 transfusion episodes (2008-2019). J Vet Emerg Crit Care (San Antonio) 2023; 33:360-370. [PMID: 36799875 DOI: 10.1111/vec.13281] [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: 02/14/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To describe patient characteristics, underlying disease processes, clinical outcomes, transfusion dose and type (therapeutic or prophylactic), platelet count changes, and adverse events associated with platelet concentrate (PC) administration in dogs. DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS A total of 149 dogs, representing 189 PC transfusion episodes. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In this population, 39 of 149 dogs (26.2%) were diagnosed with primary immune-mediated thrombocytopenia, 22 of 149 (14.8%) had decreased bone marrow production, 12 of 149 (8.0%) received PC during a massive transfusion, 3 of 149 (2.0%) had congenital thrombocytopathia, 59 of 149 (39.6%) had severe thrombocytopenia of other causes, and 14 of 149 (9.4%) underwent transfusion for miscellaneous causes without a documented severe thrombocytopenia. In 117 of 149 dogs (78.5%), >1 site of hemorrhage was noted. The most common sites of hemorrhage were the gastrointestinal (GI) tract in 89 of 149 (59.7%) and the skin in 78 of 149 (52.3%). Overall survival to discharge was 59.1% (88/149). The median PC dose was 0.8 units per 10 kg of body weight per transfusion episode (range: 0.2-6.7). Of 189 episodes, 29 of 189 (15.7%) were prophylactic, and 158 of 189 (83.6%) were therapeutic. For 99 of 189 transfusion episodes, paired pre- and postplatelet counts were available within 24 hours. The median platelet count change was 5.0 × 109 /L (5000/μL; range: -115 × 109 /L to 158 × 109 /L [-115,000 to 158,000/μL]); the posttransfusion platelet count was significantly higher than pretransfusion (P < 0.0001). The increase in platelet count after transfusion was greater in the prophylactic group than the therapeutic group (P = 0.0167). Transfusion reactions were suspected during 2 of 168 episodes (1.2%). CONCLUSIONS Immune-mediated thrombocytopenia was the most common disease process that resulted in PC transfusion. PC was more frequently administered to animals with active hemorrhage rather than prophylactically, and most dogs had evidence of hemorrhage in multiple organ systems, particularly the GI tract and skin. PC transfusions typically appeared safe, and the median platelet count increased after transfusion.
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Affiliation(s)
- Laurence M Saint-Pierre
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, California, USA
| | - Kate S Farrell
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Krystle L Reagan
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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Mannucci E, Blong A, Zorn C, Walton R. Case report: Xenotransfusion of canine lyophilized platelets for hemostasis in a feline patient with post-operative abdominal hemorrhage. Front Vet Sci 2023; 10:1113846. [PMID: 36825233 PMCID: PMC9942615 DOI: 10.3389/fvets.2023.1113846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
Objective To describe the management of post-operative abdominal hemorrhage with a xenotransfusion of canine lyophilized platelets in a feline patient. Case summary A 9-year-old male castrated domestic shorthair presented for a spontaneous hemoabdomen secondary to hepatic amyloidosis. Clinically significant hemorrhage occurred in the perioperative and post-operative period and the patient received a massive transfusion and anti-fibrinolytic therapy in combination with a xenotransfusion of canine lyophilized platelets at 0.9 × 109 particles/kg and recombinant human factor VIIa (rhFVIIa). The combination of these interventions decreased transfusion requirements in this patient and the xenotransfusion was well tolerated with no acute or immediate transfusion reactions noted. New or unique information provided This case report describes the xenotransfusion of canine lyophilized platelets in a feline patient with severe, non-compressible abdominal hemorrhage.
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Affiliation(s)
- Elizabeth Mannucci
- Emergency and Critical Care Department, VCA West Los Angeles Animal Hospital, Los Angeles, CA, United States
| | - April Blong
- Department of Clinical Sciences, Iowa State University, Ames, IA, United States
| | - Chelsea Zorn
- Department of Clinical Sciences, Iowa State University, Ames, IA, United States
| | - Rebecca Walton
- Emergency and Critical Care Department, VCA West Los Angeles Animal Hospital, Los Angeles, CA, United States,Department of Clinical Sciences, Iowa State University, Ames, IA, United States,*Correspondence: Rebecca Walton ✉
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10
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Ravicini S, Haines JM, Hwang JK, Wardrop KJ. The effects of additive solutions on the development of storage lesions in canine platelet concentrates stored at 4°C. J Vet Emerg Crit Care (San Antonio) 2022; 32:592-601. [DOI: 10.1111/vec.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Sara Ravicini
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Washington State University Pullman Washington USA
| | - Jillian M. Haines
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Washington State University Pullman Washington USA
| | - Julianne K. Hwang
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Washington State University Pullman Washington USA
| | - K. Jane Wardrop
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Washington State University Pullman Washington USA
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11
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A review of treatments for non-compressible torso hemorrhage (NCTH) and internal bleeding. Biomaterials 2022; 283:121432. [DOI: 10.1016/j.biomaterials.2022.121432] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/26/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
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12
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Edwards TH, Pusateri AE, Mays EL, Bynum JA, Cap AP. Lessons Learned From the Battlefield and Applicability to Veterinary Medicine - Part 2: Transfusion Advances. Front Vet Sci 2021; 8:571370. [PMID: 34026881 PMCID: PMC8138582 DOI: 10.3389/fvets.2021.571370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Thomas H Edwards
- U.S. Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, TX, United States
| | - Anthony E Pusateri
- U.S. Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, TX, United States
| | - Erin Long Mays
- Veterinary Specialty Services, Manchester, MO, United States
| | - James A Bynum
- U.S. Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, TX, United States
| | - Andrew P Cap
- U.S. Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, TX, United States
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13
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Odunayo A, Nash KJ, Davidow EB, Blois SL, Goy-Thollot I, Harris L, Humm K, Musulin S, Sharp CR, Spada E, Thomason J, Walton J, Jane Wardrop K. Association of Veterinary Hematology and Transfusion Medicine (AVHTM) transfusion reaction small animal consensus statement (TRACS). Part 3: Diagnosis and treatment. J Vet Emerg Crit Care (San Antonio) 2021; 31:189-203. [PMID: 33751797 DOI: 10.1111/vec.13043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/06/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To systematically review available evidence to develop guidelines for diagnosis and treatment of transfusion-associated reactions in dogs and cats. DESIGN Standardized and systemic evaluation of the literature (identified through Medline via PubMed and Google Scholar searches) was carried out for identified transfusion reaction types in dogs and cats. The available evidence was evaluated using PICO (Population, Intervention, Comparison, Outcome) questions generated for each reaction type. The evidence was categorized by level of evidence (LOE) and quality (Good, Fair, or Poor). Guidelines, diagnostic, and treatment algorithms were generated based on the evaluation of the evidence. Consensus on the final guidelines was achieved through Delphi-style surveys. Draft recommendations were disseminated through veterinary specialty listservs for review and comments, which were evaluated and integrated prior to final publication. RESULTS Medline via PubMed and Google Scholar databases were searched. There were 14 Population Intervention Comparison Outcome questions identified and corresponding worksheets were developed focusing on the diagnosis and treatment of transfusion-associated reactions in dogs and cats. Fourteen guidelines and four algorithms were developed with a high degree of consensus. CONCLUSIONS This systematic evidence evaluation process yielded recommended diagnostic and treatment algorithms for use in practice. However, significant knowledge gaps were identified, demonstrating the need for additional research in veterinary transfusion medicine.
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Affiliation(s)
- Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, USA
| | - Katherine J Nash
- VetMED Emergency and Specialty Veterinary Hospital, Phoenix, Arizona, USA
| | - Elizabeth B Davidow
- Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | | | | | - Karen Humm
- Department of Clinical Science and Services, The Royal Veterinary College, London, UK
| | - Sarah Musulin
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Claire R Sharp
- School of Veterinary Medicine, Murdoch University, Perth, Australia
| | - Eva Spada
- Department of Veterinary Medicine, University of Milan, Lodi, Italy
| | - John Thomason
- Department of Clinical Sciences, Mississippi State University, Mississippi State, Mississippi, USA
| | | | - K Jane Wardrop
- Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
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Goggs R, Brainard BM, LeVine DN, Calabro J, Harrell K, Mills T, Stone R, Davidson B, Iacovetta C, Harris L, Gicking J, Aslanian M, Ziegler A, Fulcher B, Lightfoot T, Miller M, Loftus J, Walton R, Blong A, Kishbaugh J, Hale AS. Lyophilized platelets versus cryopreserved platelets for management of bleeding in thrombocytopenic dogs: A multicenter randomized clinical trial. J Vet Intern Med 2020; 34:2384-2397. [PMID: 33016527 PMCID: PMC7694820 DOI: 10.1111/jvim.15922] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background Thrombocytopenia in dogs is common in critical care medicine, but availability of fresh platelet concentrates in veterinary medicine can be limiting. Lyophilized platelets have long shelf‐lives and can be easily transported, stored, and administered in various settings. Objective To evaluate the efficacy and safety of a novel trehalose‐stabilized canine lyophilized platelet product in thrombocytopenic dogs with clinically‐evident bleeding. Animals Eighty‐eight dogs with platelet counts <50 × 103/μL and a standardized bleeding assessment tool (DOGiBAT) score ≥2. Methods Multicenter, randomized, non‐blinded, non‐inferiority clinical trial comparing dimethyl sulfoxide (DMSO)‐stabilized cryopreserved platelet concentrates (CPP) with trehalose‐stabilized lyophilized platelets (LP) for control of bleeding in thrombocytopenic dogs. Dogs were randomized to receive 3 × 109 platelets/kg of LP or CPP. Primary outcome measures were change in DOGiBAT score, platelet count, need for additional red cell transfusion and all‐cause mortality. Results Fifty dogs received LP and 38 received CPP. Baseline demographics and clinical characteristics of both groups were comparable. At 1‐hour post‐transfusion, LP were superior for change in DOGiBAT score, and non‐inferior at 24‐hours post‐transfusion. The LP were non‐inferior to CPP for change in platelet count, need for additional red blood cell units, and survival to discharge. The LP were superior for change in hematocrit at 1‐hour post‐transfusion, and non‐inferior at 24‐hours. No adverse effects were noted in either group. Conclusions and Clinical Importance A novel trehalose‐stabilized canine LP product appears to be logistically superior and is clinically non‐inferior to DMSO‐stabilized canine CPP for management of bleeding in thrombocytopenic dogs.
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Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Dana N LeVine
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | | | - Karyn Harrell
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Tracy Mills
- VCA Clinical Research, VCA Animal Hospitals, Los Angeles, California, USA
| | | | | | | | | | | | | | | | | | | | - Meredith Miller
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - John Loftus
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Rebecca Walton
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - April Blong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
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Lasta CS, Hlavac N, Marcondes NA, Dalmolin ML, Terra SR, de Almeida Lacerda L, Faulhaber GAM, González FHD. Quality control in veterinary blood banks: evaluation of canine platelet concentrates stored for five days. BMC Vet Res 2020; 16:25. [PMID: 32000762 PMCID: PMC6990466 DOI: 10.1186/s12917-020-2254-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 01/22/2020] [Indexed: 12/03/2022] Open
Abstract
Background Platelets undergo structural, biochemical and functional alterations when stored, and platelet storage lesions reduce platelet function and half-life after transfusion. The objective of this study was to evaluate stored canine platelet concentrates with platelet aggregation, flow cytometry and biochemistry assays. Twenty-two bags of canine platelet concentrates were obtained by the platelet-rich plasma method and were assessed on days 1, 3 and 5 after collection. Parameters such as platelet counts, residual leukocytes, platelet swirling, glucose, lactate, pH, CD62P expression (platelet activation), JC-1 (mitochondrial function) and annexin V (apoptosis and cell death) were assessed. Results Over the five days of storage there was a significant decrease in glucose, HCO3, pCO2, ATP, pH, swirling and mitochondrial function, associated with a significant increase in lactate levels and pO2. At the end of storage pH was 5.9 ± 0.6 and lactate levels were 2.8 ± 1.2 mmol/L. Results of the quality parameters evaluated were similar to those reported in human platelets studies. The deleterious effects of storage were more pronounced in bags with higher platelet counts (> 7.49 × 1010/unit), suggesting that canine platelet concentrates should not contain an excessive number of platelets. Conclusions Quality parameters of canine platelets under standard storage conditions were similar to those observed in human platelets. Our results have potential to be used for the routine evaluation and quality control in veterinary blood banks.
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Affiliation(s)
- Camila Serina Lasta
- Departamento de Saúde, Faculdade de Medicina Veterinária, Centro Universitário Ritter dos Reis - UniRitter - Campus FAPA, Av. Manoel Elias, 2001, 91240-261, Porto Alegre, Brazil. .,Departamento de Patologia Clínica Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Nicole Hlavac
- Departamento de Anatomia, Patologia e Clínicas Veterinárias, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Silvia Resende Terra
- Departamento de Patologia Clínica Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Gustavo Adolpho Moreira Faulhaber
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Medicina, Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Félix Hilário Díaz González
- Departamento de Patologia Clínica Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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16
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Whitley N. Dealing with immune‐mediated haematological diseases in dogs and cats 2. Thrombocytopenia and Evan's syndrome. IN PRACTICE 2020. [DOI: 10.1136/inp.l6458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Bozorgmanesh R, Magdesian KG, Sutton-Burges JW, Owens SD, Tablin F. Equine platelet concentrate preparation and validation. J Vet Intern Med 2019; 33:1500-1506. [PMID: 30868640 PMCID: PMC6524399 DOI: 10.1111/jvim.15472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/21/2019] [Indexed: 12/02/2022] Open
Abstract
Background Development of equine platelet concentrate (PC) would aid management of cases requiring transfused platelets (PLTs), where adminstration of whole‐blood or platelet‐rich plasma (PRP) might be contraindicated. Objectives To test and validate a method for production of an equine PRP‐PC product. Animals Six healthy Thoroughbred geldings from a research herd. Methods In this prospective experimental study, whole blood was collected and processed through multiple centrifugation steps to yield 120 mL of PC. The PC was stored at 22°C and gently and continuously agitated. Measurements of PLT count, pH, and concentrations of glucose, lactate, electrolytes, lactate dehydrogenase (LDH), and aspartate aminotransferase (AST), as well as partial pressures of oxygen and carbon dioxide were performed on days 0, 1, 2, 3, 5, and 7. Platelet aggregometry and bacterial culture were also performed. Results The PC always had a PLT count of ≥550 × 103 cells/μL. Aggregometry graph amplitude (P < .0001) and area under the curve (P < .05) significantly decreased over time. Sodium, chloride, lactate (P < .0001), and oxygen (P < .01) concentrations significantly increased over time. pH (P < .001), glucose and bicarbonate concentrations (P < .0001) significantly decreased over time. There was no significant difference in potassium concentration, PLT count, LDH and AST activities and no bacterial growth from culture. Conclusions and Clinical Importance The described technique yielded a PC that meets the standards of the American Association of Blood Banks for human PC.
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Affiliation(s)
- Rana Bozorgmanesh
- McGee Medicine Center, Hagyard Equine Medical Institute, Lexington, Kentucky
| | - K Gary Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Julie W Sutton-Burges
- Transfusion Medicine, School of Veterinary Medicine, University of California, Davis, California
| | - Sean D Owens
- Department of Clinical Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, California
| | - Fern Tablin
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California, Davis, California
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18
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Makielski KM, Brooks MB, Wang C, Cullen JN, O'Connor AM, LeVine DN. Development and implementation of a novel immune thrombocytopenia bleeding score for dogs. J Vet Intern Med 2018; 32:1041-1050. [PMID: 29681130 PMCID: PMC5980571 DOI: 10.1111/jvim.15089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/05/2018] [Accepted: 01/31/2018] [Indexed: 01/19/2023] Open
Abstract
Background A method of quantifying clinical bleeding in dogs with immune thrombocytopenia (ITP) is needed because ITP patients have variable bleeding tendencies that inconsistently correlate with platelet count. A scoring system will facilitate patient comparisons and allow stratification based on bleeding severity in clinical trials. Hypothesis/Objectives To develop and evaluate a bleeding assessment tool for dogs, and a training course for improving its consistent implementation. Animals Client‐owned dogs (n = 61) with platelet counts <50,000/μL; 34 classified as primary ITP, 17 as secondary ITP, and 10 as non‐ITP. Methods A novel bleeding assessment tool, DOGiBAT, comprising bleeding grades from 0 (none) to 2 (severe) at 9 anatomic sites, was developed. Clinicians and technicians completed a training course and quiz before scoring thrombocytopenic patients. The training course was assessed by randomizing student volunteers to take the quiz with or without prior training. A logistic regression model assessed the association between training and quiz performance. The correlation of DOGiBAT score with platelet count and outcome measures was assessed in the thrombocytopenic dogs. Results Clinicians and technicians consistently applied the DOGiBAT, correctly scoring all quiz cases. The odds of trained students answering correctly were higher than those of untrained students (P < .0001). In clinical cases, DOGiBAT score and platelet count were inversely correlated (rs = −0.527, P < .0001), and DOGiBAT directly correlated with transfusion requirements (rs = 0.512, P < .0001) and hospitalization duration (rs = 0.35, P = .006). Conclusions and Clinical Importance The DOGiBAT and assessment quiz are simple tools to standardize evaluation of bleeding severity. With further validation, the DOGiBAT may provide a clinically relevant metric to characterize ITP severity and monitor response in treatment trials.
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Affiliation(s)
- Kelly M Makielski
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Marjory B Brooks
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York
| | - Chong Wang
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa.,Department of Statistics, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Jonah N Cullen
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Annette M O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Dana N LeVine
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
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19
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Kishbaugh JC, Valitutto MT, Ober JE, Zimmerman DM, Howard LL, Schmitt DL, Sanchez CR, Murray S. Do lyophilized platelets hold promise for treatment of hemorrhagic diseases in wild animals? J Am Vet Med Assoc 2018; 252:168-170. [PMID: 29319441 DOI: 10.2460/javma.252.2.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Milford EM, Reade MC. Comprehensive review of platelet storage methods for use in the treatment of active hemorrhage. Transfusion 2017; 56 Suppl 2:S140-8. [PMID: 27100750 DOI: 10.1111/trf.13504] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 12/14/2022]
Abstract
This review considers the various methods currently in use, or under investigation, for the storage of platelets intended for use in the treatment of active hemorrhage. The current standard practice of storing platelets at room temperature (RT) (20°C-24°C) optimizes circulating time, but at the expense of hemostatic function and logistical considerations. A number of alternatives are under investigation. Novel storage media additives appear to attenuate the deleterious changes that affect RT stored platelets. Cold storage was originally abandoned due to the poor circulating time of platelets stored at 4°C, but such platelets may actually be more hemostatically effective, with a number of other advantages, compared to RT stored platelets. Periodically re-warming cold stored platelets (temperature cycling, TC) may combine the hemostatic efficacy of cold stored platelets with the longer circulating times of RT storage. Alternatives to liquid storage include cryopreservation (freezing) or lyophilization (freeze-drying). The former has had some limited clinical use and larger clinical trials are underway, while the latter is still in the preclinical stage with promising in vitro and in vivo results. The importance of platelet transfusion in the management of active hemorrhage is now well accepted, so it is timely that platelet storage methods are reviewed with consideration of not only their circulating time, but also their hemostatic efficacy.
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Affiliation(s)
- Elissa M Milford
- Australian Defence Force, Australia.,University of Queensland, Australia
| | - Michael C Reade
- Australian Defence Force, Australia.,University of Queensland, Australia
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21
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22
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Control of severe intra-abdominal hemorrhage with an infusible platelet-derived hemostatic agent in a nonhuman primate (rhesus macaque) model. J Trauma Acute Care Surg 2016; 80:617-24. [PMID: 26808038 DOI: 10.1097/ta.0000000000000964] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hemorrhage remains the leading cause of potentially survivable trauma mortality. Recent reports indicate that injuries sustained in noncompressible anatomic locations (i.e., truncal and junctional) account for 86.5% of hemorrhage-related deaths. Infusible human platelet-derived hemostatic agents (hPDHAs) represent a promising strategy to reduce blood loss from noncompressible injuries. Here, we evaluate the hemostatic efficacy of a lyophilized hPDHA in a rhesus macaque model of severe, uncontrolled hemorrhage. METHODS Hemorrhage was induced via laparoscopic 60% left-lobe hepatectomy in anesthetized rhesus macaques (T = 0 minute). Treatment infusion began with an 11-mL bolus (T = 5-6 minutes) of either 5% albumin solution (control; n = 8) or hPDHA (1.2 × 10(10) platelet equivalents, n = 8), followed by 2.8-mL/min 0.9% normal saline at T = 6-20 minutes. Resuscitation continued with normal saline (0.22 mL/kg/min) to a total volume of 20 mL/kg at T = 120 minutes, at which time surgical hemostasis was achieved and percent blood loss quantified. Animals were monitored until T = 480 minutes and then euthanized, and necropsy was performed with emphasis on intravascular and end-organ thrombi. Data are expressed as mean ± SEM; significance, p < 0.05. RESULTS Both groups exhibited a ∼70% decrease in mean arterial pressure (MAP) from T = 0-5 minutes. Percent blood loss was 44.2 ± 3.9% in hPDHA animals, and 44.3 ± 3.3% in controls. Survival rates were 4 of 8 for hPDHA animals and 7 of 8 for controls. Regardless of treatment, percent blood loss was greater (p < 0.02) in nonsurviving animals (55 ± 2%, n = 5) compared with surviving animals (42% ± 3%, n = 11). No pathologic intravascular thrombi were observed in either group. CONCLUSION The isolated administration of hPDHA did not significantly reduce blood loss; however, thrombocytopenia was not present in the model, and clinically, platelets would be administered in combination with plasma. Mortality was not statistically different between groups (p = 0.14) but was related to blood loss. Future studies should consider the use of hPDHA in combination with additional therapeutics (e.g., factors) and a model that incorporates thrombocytopenia or platelet dysfunction.
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23
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Ng ZY, Stokes JE, Alvarez L, Bartges JW. Cryopreserved platelet concentrate transfusions in 43 dogs: a retrospective study (2007-2013). J Vet Emerg Crit Care (San Antonio) 2016; 26:720-8. [PMID: 27376965 DOI: 10.1111/vec.12503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/05/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To clinically characterize a group of thrombocytopenic dogs that received cryopreserved platelet concentrate (cPC) transfusion, assess efficacy of cPC treatment in improving patient outcome, and compare treated dogs to a control population of thrombocytopenic dogs that did not receive cPC transfusions. DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS Eighty-six client-owned dogs (43 in treatment group, 43 in control group). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Medical records of thrombocytopenic dogs that received cPC transfusions and those of thrombocytopenic dogs that did not receive cPC (control population) from January 2007 through March 2013 were reviewed. Dogs receiving cPC were statistically more likely than controls to have a platelet trigger for cPC transfusion (P = 0.01), lower platelet count (P = 0.009) and hematocrit at presentation (P = 0.001), and lower hematocrit after cPC (P = 0.02). Although there was a statistically significant increase in platelet count from pre- to post-cPC transfusion (P = 0.002), cPC was not found to be effective in improving clinical bleeding or increasing survival compared to the control group. No other characteristics were statistically different between groups. No dogs receiving cPC had an acute transfusion reaction during hospitalization. CONCLUSIONS In the population described in this study, cPC was not found to increase survival, but was well tolerated. Controlled, prospective studies are necessary to determine indications for and efficacy of cPC transfusions.
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Affiliation(s)
- Zenithson Y Ng
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4544.
| | - Jennifer E Stokes
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4544
| | - Lucia Alvarez
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4544
| | - Joe W Bartges
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4544
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Nandi S, Brown AC. Platelet-mimetic strategies for modulating the wound environment and inflammatory responses. Exp Biol Med (Maywood) 2016; 241:1138-48. [PMID: 27190260 PMCID: PMC4950360 DOI: 10.1177/1535370216647126] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Platelets closely interface with the immune system to fight pathogens, target wound sites, and regulate tissue repair. Natural platelet levels within the body can be depleted for a variety of reasons, including excessive bleeding following traumatic injury, or diseases such as cancer and bacterial or viral infections. Platelet transfusions are commonly used to improve platelet count and hemostatic function in these cases, but transfusions can be complicated by the contamination risks and short storage life of donated platelets. Lyophilized platelets that can be freeze-dried and stored for longer periods of time and synthetic platelet-mimetic technologies that can enhance or replace the functions of natural platelets, while minimizing adverse immune responses have been explored as alternatives to transfusion. Synthetic platelets typically comprise nanoparticles surface-decorated with peptides or ligands to recreate specific biological characteristics of platelets, including targeting of wound and disease sites and facilitating platelet aggregation. Recent efforts in synthetic platelet design have additionally focused on matching platelet shape and mechanics to recreate the marginalization and clot contraction capabilities of natural platelets. The ability to specifically tune the properties of synthetic platelet-mimetic materials has shown utility in a variety of applications including hemostasis, drug delivery, and targeted delivery of cancer therapeutics.
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Affiliation(s)
- Seema Nandi
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel-Hill, Raleigh, NC 27606, USA
| | - Ashley C Brown
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel-Hill, Raleigh, NC 27606, USA
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25
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Jagodich TA, Holowaychuk MK. Transfusion practice in dogs and cats: an Internet-based survey. J Vet Emerg Crit Care (San Antonio) 2016; 26:360-72. [DOI: 10.1111/vec.12451] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/29/2014] [Accepted: 08/09/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Tiffany A. Jagodich
- Department of Clinical Studies, Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Marie K. Holowaychuk
- Department of Clinical Studies, Ontario Veterinary College; University of Guelph; Guelph ON Canada
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26
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Schwartz D, Sharkey L, Armstrong PJ, Knudson C, Kelley J. Platelet volume and plateletcrit in dogs with presumed primary immune-mediated thrombocytopenia. J Vet Intern Med 2014; 28:1575-9. [PMID: 25056453 PMCID: PMC4895566 DOI: 10.1111/jvim.12405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/13/2014] [Accepted: 05/29/2014] [Indexed: 11/29/2022] Open
Abstract
Background Mean platelet volume (MPV) and plateletcrit (PCT) are indices used in evaluating immune‐mediated thrombocytopenia (IMT) in humans and in dogs with congenital macrothrombocytopenia. These indices may provide clinically valuable information in acquired thrombocytopenia. Hypothesis/Objectives Dogs with presumed primary IMT will have increased MPV, and therefore platelet mass (PCT) will increase faster than platelet count (PLT) during recovery. Animals Forty‐nine dogs with automated PLT < 30,000/μL because of presumed primary IMT and hematocrit (HCT), PCT, MPV, and platelet distribution width determined from the same complete blood count (CBC), and 46 healthy controls. Methods Case‐control retrospective study; PLT, PCT, MPV, and platelet distribution width (PDW) were recorded from CBCs from 49 dogs, with 45 having data collected on the day of presentation. Fifteen were confirmed to have attained a PLT ≥ 75,000/μL on at least 1 CBC within 15 days after admission. The PCT equivalent to a PLT of 75,000/μL (assuming an average MPV) was calculated for comparison with PLT in terms of time to achieve a threshold of platelet mass by the 2 measures. Results Mean platelet volume was higher in IMT dogs (17.3 fl) than the reference population (10.5 fl) (P < .0001). The PDW was not significantly different among the groups. The median time for PCT to reach threshold in confirmed responders was faster (3 days) compared with PLT (4 days). Conclusions and Clinical Importance Immune‐mediated thrombocytopenia is characterized by increased MPV. Time to achieve a threshold PCT tended to be shorter than PLT, suggesting that PCT may be a useful platelet parameter for monitoring dogs with IMT.
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Affiliation(s)
- D Schwartz
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN
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27
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Abstract
This article reviews the use of transfusion medicine in veterinary medicine and discusses current research regarding donor screening and component therapy. Typing and crossmatching methodologies are discussed. Available components, potential uses, and controversies in treatment are also discussed.
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Affiliation(s)
- Beth Davidow
- Animal Critical Care and Emergency Services, 11536 Lake City Way Northeast, Seattle, WA 98125, USA.
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