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Pardo M, Spencer E, Odunayo A, Ramirez ML, Rudloff E, Shafford H, Weil A, Wolff E. 2024 AAHA Fluid Therapy Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2024; 60:131-163. [PMID: 38885492 DOI: 10.5326/jaaha-ms-7444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
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.
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Affiliation(s)
- Mariana Pardo
- Critical Care Veterinarian Consulting, Pleasantville, New York (M.P.)
| | - Erin Spencer
- Veterinary Emergency Group, Derry, New Hampshire (E.S.)
| | | | - Mary L Ramirez
- North Dallas Veterinary Emergency and Specialty Hospital, Frisco, Texas (M.L.R.)
| | - Elke Rudloff
- Blue Pearl Pet Hospice, Milwaukee, Wisconsin (E.R.)
| | - Heidi Shafford
- Veterinary Anesthesia Specialists, Gladstone, Oregon (H.S.)
| | - Ann Weil
- Purdue University, West Lafayette, Indiana (A.W.)
| | - Ewan Wolff
- Blue Pearl NE Portland, Portland, Oregon (E.W.)
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Magalhães TR, Gregório H, Araújo J, Ribeiro L, Dourado MJ, Batista S, Queiroga FL. Prognostic factors associated with survival and hospitalization time in pediatric canine patients diagnosed with presumptive acute viral gastroenteritis. Vet World 2022; 15:2095-2101. [PMID: 36313832 PMCID: PMC9615509 DOI: 10.14202/vetworld.2022.2095-2101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Aim: Acute viral gastroenteritis is one of the main causes of hospitalization in dogs during the 1st 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.
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Affiliation(s)
- Tomás Rodrigues Magalhães
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Hugo Gregório
- Anicura - Centro Hospitalar Veterinário, R. Manuel Pinto de Azevedo 118 4100-320 Porto, Portugal
| | - João Araújo
- Hospital Veterinário Bom Jesus, Av. General Carilho da Silva Pinto 52 4715-380 Braga, Portugal
| | - Lénio Ribeiro
- Anicura - Centro Hospitalar Veterinário, R. Manuel Pinto de Azevedo 118 4100-320 Porto, Portugal
| | - Maria João Dourado
- Hospital Veterinário Bom Jesus, Av. General Carilho da Silva Pinto 52 4715-380 Braga, Portugal
| | - Sofia Batista
- Anicura - Centro Hospitalar Veterinário, R. Manuel Pinto de Azevedo 118 4100-320 Porto, Portugal
| | - Felisbina Luisa Queiroga
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; Center for the Study of Animal Sciences, CECA-ICETA, University of Porto, Porto, Portugal
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Polovitzer J, Guija-De-Arespacochaga A, Auer A, Künzel F. Successful treatment of coagulation disorders and hypoalbuminaemia in a puppy with Infectious Canine Hepatitis. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2022; 50:302-307. [PMID: 36067772 DOI: 10.1055/a-1907-0877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Due to high vaccination coverage of the dog population in Western and Middle Europe, veterinarians are usually not familiar with clinical signs and treatment of Infectious Canine Hepatitis (ICH). This case report describes a 4-month-old female mixed breed dog that was imported from Bulgaria. According to the history, the puppy was presented with lethargy, pyrexia, icterus and melaena. On clinical examination, the dog additionally exhibited a painful abdomen and bleeding tendency at the venous puncture sites. Blood analysis revealed anaemia, left shift without leucocytosis, increased liver enzymes and prolonged coagulation times. Polymerase Chain Reaction (PCR) and subsequently sequence analysis performed out of urine confirmed Canine Adenovirus 1 (CAV-1) as the causative agent of the disease. Peripheral oedema developed on the dog´s head and limbs during the progression of the disease due to severe hypoalbuminaemia. Initial treatment of the puppy included transfusion of whole blood and fresh frozen plasma. Hypoalbuminaemia was treated by transfusion using human albumin. On day eight after starting the treatment, the dog was released from the hospital due to an unremarkable clinically condition. This case report indicates that ICH might become a re-emerging disease by means of rising dog imports. Especially, the severe form of ICH can be associated with several life-threatening complications that require hospitalisation and intensive care treatment.
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Affiliation(s)
- Julia Polovitzer
- Department for Companion Animals and Horses, Small Animal Clinic, Internal Medicine, University of Veterinary Medicine
| | | | - Angelika Auer
- Department of Pathobiology, Institute of Virology, University of Veterinary Medicine
| | - Frank Künzel
- Department for Companion Animals and Horses, Small Animal Clinic, Internal Medicine, University of Veterinary Medicine
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Shnaiderman‐Torban A, Steinman A, Abu Ahmad W, Kushnir Y, Abells Sutton G, Epstein A, Kelmer G. Preoperative and intraoperative risk factors for post‐anaesthetic pulmonary oedema in horses. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Anat Shnaiderman‐Torban
- Veterinary Teaching Hospital Koret School of Veterinary Medicine The Robert H. Smith Faculty of Agriculture, Food and Environment The Hebrew University of Jerusalem Rehovot Israel
| | - Amir Steinman
- Veterinary Teaching Hospital Koret School of Veterinary Medicine The Robert H. Smith Faculty of Agriculture, Food and Environment The Hebrew University of Jerusalem Rehovot Israel
| | - Wiessam Abu Ahmad
- Hadassah Braun School of Public Health and Community Medicine The Hebrew University of Jerusalem Israel
| | - Yishai Kushnir
- Veterinary Teaching Hospital Koret School of Veterinary Medicine The Robert H. Smith Faculty of Agriculture, Food and Environment The Hebrew University of Jerusalem Rehovot Israel
| | - Gila Abells Sutton
- Veterinary Teaching Hospital Koret School of Veterinary Medicine The Robert H. Smith Faculty of Agriculture, Food and Environment The Hebrew University of Jerusalem Rehovot Israel
| | - Ana Epstein
- Veterinary Teaching Hospital Koret School of Veterinary Medicine The Robert H. Smith Faculty of Agriculture, Food and Environment The Hebrew University of Jerusalem Rehovot Israel
| | - Gal Kelmer
- Veterinary Teaching Hospital Koret School of Veterinary Medicine The Robert H. Smith Faculty of Agriculture, Food and Environment The Hebrew University of Jerusalem Rehovot Israel
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Klainbart S, Segev G, Kelmer E, Chen H. Therapeutic plasma exchange for the management of a type III hypersensitivity reaction and suspected immune-mediated vasculitis assumed to be caused by human albumin administration in a dog. J Vet Emerg Crit Care (San Antonio) 2022; 32:532-538. [PMID: 35234339 DOI: 10.1111/vec.13188] [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: 05/16/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the successful treatment of a life-threatening type III hypersensitivity reaction suspected to have been related to human serum albumin (HSA) administration in a dog with therapeutic plasma exchange (TPE). CASE SUMMARY A 3-year-old neutered male mixed breed dog was suspected to have developed immune-mediated vasculitis 2 weeks after the administration of HSA (740 mg/kg) for the management of hypoalbuminemia resulting from septic peritonitis. The dog was presented with fever, edema, hypoalbuminemia (26 g/L [2.6 g/dL]; reference interval, 30-44 g/L [3.0-4.4 g/dL]), and coagulopathy. The dog was treated with fresh frozen plasma (FFP) and glucocorticoids but remained hypoalbuminemic (18 g/L [1.8 g/dL]) and developed acute kidney injury (AKI). Over 4 days, 3 TPE treatments were performed, with a total of 2.7 plasma volumes exchanged. Replacement fluids consisted of a combination of FFP, hydroxyethyl starch 6%, and 0.9% saline solution. Following TPE treatments, serum albumin concentration increased (from 18 g/L [1.8 g/dL] to 25 g/L [2.5 g/dL]), serum creatinine concentration decreased (from 340 μmol/L [3.9 mg/dL] to 87 μmol/L [0.98 mg/dL]), and clotting times normalized (activated partial thromboplastin time decreased from 33 seconds to 14.5 seconds). There was a gradual but consistent clinical improvement of the edema and overall demeanor of the dog. No significant adverse effects were noted during the TPE treatments, and the dog was discharged after 8 days of hospitalization. Following discharge, the dog had complete clinical resolution of edema and AKI. NEW/UNIQUE INFORMATION: This is the first report describing successful use of TPE for the management of an immune-mediated reaction (type III hypersensitivity) following HSA administration.
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Affiliation(s)
- Sigal Klainbart
- Department of Small Animal Emergency and Critical Care, The Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Department of Small Animal Internal Medicine, The Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Efrat Kelmer
- Department of Small Animal Emergency and Critical Care, The Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Hilla Chen
- Department of Small Animal Internal Medicine, The Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Chee W, Sharp CR, Boyd CJ, Claus MA, Smart L. Stability of ex vivo coagulation factor activity in never-frozen and thawed refrigerated canine plasma stored for 42 days. J Vet Emerg Crit Care (San Antonio) 2021; 32:189-195. [PMID: 34766698 DOI: 10.1111/vec.13152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/05/2020] [Accepted: 08/23/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The primary objective of this study was to document coagulation factor activity in canine "NEVER-FROZEN" and "THAWED" refrigerated plasma for the purposes of defining recommended expiration dates. We hypothesized that NEVER-FROZEN and THAWED refrigerated plasma would maintain >50% activity of coagulation factors V (FV), VII (FVII), VIII (FVIII), IX (FIX), X (FX), and von Willebrand factor antigen (vWF) and a concentration of fibrinogen above the lower bound of the reference interval (>0.982 g/L) for greater than 14 days but less than 42 days. DESIGN Prospective laboratory-based study. SETTING University teaching hospital blood bank. ANIMALS Ten canine plasma units derived from healthy client-owned blood donors. INTERVENTIONS Serial sampling (days 0, 1, 3, 5, 7, 10, 14, 17, 21, 24, 28, 32, 35, 39, 42) from NEVER-FROZEN and THAWED refrigerated canine plasma units was conducted for measurement of activities of FV, FVII, FVIII, FIX, FX, vWF, and fibrinogen concentrations using the ACL TOP 300. Plasma was defined as "suitable for transfusion" at a given time point if the entire 95% confidence interval for each factor was above 50% activity and above a fibrinogen concentration of 0.982 g/L. MEASUREMENTS AND MAIN RESULTS The lower bounds of the FVIII and vWF confidence intervals were above 50% up to and including day 32 for NEVER-FROZEN refrigerated plasma and day 28 for THAWED refrigerated plasma. Confidence intervals for FV, FVII, FIX, and FX remained above 50% activity at all time points. The lower bound of the fibrinogen concentration was <0.982 g/L on day 39 for NEVER-FROZEN refrigerated plasma and on day 35 for THAWED refrigerated plasma. CONCLUSIONS Refrigerated canine plasma from these 10 dogs retained coagulation factor activity above the limit that we defined as suitable for transfusion for up to 32 days when NEVER-FROZEN and 28 days when THAWED. Further studies should evaluate the clinical outcomes and effects on coagulation factor activity of dogs receiving refrigerated plasma transfusions.
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Affiliation(s)
- Weiqin Chee
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
| | - Claire R Sharp
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
| | - Corrin J Boyd
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
| | - Melissa A Claus
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
| | - Lisa Smart
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
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Adamik KN, Yozova ID. Colloids Yes or No? - a "Gretchen Question" Answered. Front Vet Sci 2021; 8:624049. [PMID: 34277747 PMCID: PMC8282815 DOI: 10.3389/fvets.2021.624049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
Colloid solutions, both natural and synthetic, had been widely accepted as having superior volume expanding effects than crystalloids. Synthetic colloid solutions were previously considered at least as effective as natural colloids, as well as being cheaper and easily available. As a result, synthetic colloids (and HES in particular) were the preferred resuscitation fluid in many countries. In the past decade, several cascading events have called into question their efficacy and revealed their harmful effects. In 2013, the medicines authorities placed substantial restrictions on HES administration in people which has resulted in an overall decrease in their use. Whether natural colloids (such as albumin-containing solutions) should replace synthetic colloids remains inconclusive based on the current evidence. Albumin seems to be safer than synthetic colloids in people, but clear evidence of a positive effect on survival is still lacking. Furthermore, species-specific albumin is not widely available, while xenotransfusions with human serum albumin have known side effects. Veterinary data on the safety and efficacy of synthetic and natural colloids is limited to mostly retrospective evaluations or experimental studies with small numbers of patients (mainly dogs). Large, prospective, randomized, long-term outcome-oriented studies are lacking. This review focuses on advantages and disadvantages of synthetic and natural colloids in veterinary medicine. Adopting human guidelines is weighed against the particularities of our specific patient populations, including the risk-benefit ratio and lack of alternatives available in human medicine.
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Affiliation(s)
- Katja-Nicole Adamik
- Division of Small Animal Emergency and Critical Care, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Ivayla D. Yozova
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Edwards TH, Meledeo MA, Peltier GC, Ruiz DD, Henderson AF, Travieso S, Pusateri AE. Effects of refrigerated storage on hemostatic stability of four canine plasma products. Am J Vet Res 2020; 81:964-972. [PMID: 33251844 DOI: 10.2460/ajvr.81.12.964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess clotting times, coagulation factor activities, sterility, and thromboelastographic parameters of liquid plasma (LP), thawed fresh frozen plasma (FFP-T), and 2 novel formulations of freeze-dried plasma (FDP) stored refrigerated over 35 days. SAMPLE 6 units of canine LP and FFP-T from a commercial animal blood bank and 5 units each of 2 formulations of canine FDP. PROCEDURES Prothrombin time; activated partial thromboplastin time; activities of coagulation factors II, V, VII, VIII, IX, X, XI, and XII; and thromboelastographic parameters were determined for each product on days 0 (baseline), 3, 7, 14, 21, 28, and 35. For each day, a sample of each product was also submitted for aerobic bacterial culture. RESULTS Small changes in coagulation factor activities and mild increased time to initial clot formation in LP and FFP-T were noted over the 35-day storage period. Activities of factor VIII in FDP1 and factor XII in FDP2 were < 50% at baseline but varied throughout. Compared with FFP-T, time to initial clot formation was increased and clot strength was preserved or increased for the FDPs throughout the study. One FDP had decreased pH, compared with other products. No plasma product yielded bacterial growth. CONCLUSIONS AND CLINICAL RELEVANCE Liquid plasma and FFP-T would be reasonable to use when stored refrigerated for up to 35 days. Both FDP products showed variability in coagulation factor activities. Studies investigating the usefulness of these plasma products (FDPs) in dogs and the variable days of refrigerated storage (all products) are warranted. (Am J Vet Res 2020;81:964-972).
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Abstract
Transfusion medicine can be a lifesaving intervention. Component therapy has expanded the availability and blood products available. Patient safety and minimizing risk is important and can be accomplished through proper donor screening, collection, storage, compatibility testing, administration, and monitoring. The pros and cons of available products must be considered and tailored to each individual patient. Recent discoveries include new antigens and blood types, microbial effects on blood type, and the association between blood type and disease prevalence.
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Affiliation(s)
- Kendon W Kuo
- Emergency and Critical Care, Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Road, Auburn, AL 36849-5540, USA
| | - Maureen McMichael
- Emergency and Critical Care, Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Road, Auburn, AL 36849-5540, USA.
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Mansi ET, Waldrop JE, Davidow EB. Retrospective evaluation of the indications, safety and effects of fresh frozen plasma transfusions in 36 cats (2014-2018). J Feline Med Surg 2020; 22:696-704. [PMID: 31576775 PMCID: PMC10814499 DOI: 10.1177/1098612x19876728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The goals of this study were to classify the indications, risks, effects on coagulation times and outcomes of cats receiving fresh frozen plasma (FFP) transfusions in clinical practice. METHODS This was a retrospective study of FFP transfusions administered in two referral hospitals from 2014 to 2018. Transfusion administration forms and medical records were reviewed. Information was collected on indication, underlying condition, coagulation times and signs of transfusion reactions. Seven-day outcomes after FFP administration were also evaluated when available. RESULTS Thirty-six cats received 54 FFP transfusions. Ninety-four percent of cats were administered FFP for treatment of a coagulopathy. Twenty cats had paired coagulation testing before and after FFP administration. Eighteen of these cats had improved coagulation times after receiving 1-3 units of FFP. Eight of the 36 cats had probable transfusion reactions (14.8% of 54 FFP transfusions). These reactions included respiratory signs (n = 4), fever (n = 2) and gastrointestinal signs (n = 2). Five of the eight cats with probable reactions had received packed red blood cells contemporaneously. Overall mortality rate during hospitalization was 29.7%, with 52.8% (n = 19/36) of cats confirmed to be alive 7 days after discharge. CONCLUSIONS AND RELEVANCE This retrospective study shows that FFP transfusions improve coagulation times in cats. Transfusion reactions are a risk, and risk-benefit ratios must be measured prior to administration and possible reactions monitored. In the study cats, the FFP transfusions appeared to be a tolerable risk given the benefit to prolonged coagulation times.
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Affiliation(s)
- Elizabeth T Mansi
- Emergency and Critical Care Service, BluePearl Veterinary Partners, Seattle, WA, USA
| | - Jennifer E Waldrop
- Emergency and Critical Care Service, BluePearl Veterinary Partners, Seattle, WA, USA
| | - Elizabeth B Davidow
- Emergency and Critical Care Service, BluePearl Veterinary Partners, Seattle, WA, USA
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Lane WG, Sinnott-Stutzman VB. Retrospective evaluation of fresh frozen plasma use in 121 cats: 2009-2016. J Vet Emerg Crit Care (San Antonio) 2020; 30:558-566. [PMID: 32643232 DOI: 10.1111/vec.12972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/19/2018] [Accepted: 10/31/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To document indications for fresh frozen plasma (FFP) use in cats, doses administered, and frequency of adverse transfusion reactions (ATR). DESIGN Retrospective observational study from January 2009 to November 2016. SETTING Large urban referral and emergency facility. ANIMALS One hundred twenty-one client-owned cats that received FFP. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Signalment, indication(s), dose, pre- and posttransfusion total plasma protein, prothrombin time, activated partial thromboplastin time, as well as possible ATR, primary disease process, and outcome were recorded. Doppler blood pressure was increased posttransfusion (mean pre 99.5 ± 30.8 mm Hg; post 108.5 ± 32.5 mm Hg, P = .027). Cats were significantly less likely to be coagulopathic posttransfusion (P < 0.001). Most common indications were suspected coagulopathy (n = 105, 83%), hemorrhage (n = 45, 35%), and hypotension (n = 32, 25%). Median dose was 6 mL/kg (interquartile range = 3 mL/kg) and was negatively correlated with body weight (r = -.598, P < 0.001). Possible ATR occurred in 17 of 108 (16%, 95% confidence interval [CI], 10-24%) of transfusions. Increased body temperature was most common in 11 of 108 (10%, 95% CI, 5-18%), followed by tachypnea/dyspnea in 8 of 108 (7%, 95% CI, 3-13%). Common primary disease processes included liver disease (n = 41, 34%), neoplasia (n = 19, 16%), and sepsis (n = 15, 12%). Overall mortality was 54%. Improvement of clotting times was associated with increased odds of survival (odds ratio = 2.4; 95% CI, 1.1-5.3; P = 0.023). CONCLUSIONS Clinician justifications for FFP transfusions are comparable to that reported in dogs; however, the mL/kg dose is lower. Coagulopathy and blood pressure significantly improve posttransfusion. Possible ATR were as frequent as that reported with feline packed RBCs transfusions and classified as mild.
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Affiliation(s)
- William G Lane
- Department of Emergency and Critical Care, Angell Animal Medical Center, Boston, Massachusetts
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Latimer CR, Lux CN, Grimes JA, Benitez ME, Culp WTN, Ben-Aderet D, Brown DC. Evaluation of short-term outcomes and potential risk factors for death and intestinal dehiscence following full-thickness large intestinal incisions in dogs. J Am Vet Med Assoc 2020; 255:915-925. [PMID: 31573871 DOI: 10.2460/javma.255.8.915] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine complication rates for dogs in which full-thickness large intestinal incisions were performed, assess potential risk factors for death during hospitalization and for intestinal dehiscence following these surgeries, and report short-term mortality rates for these patients. ANIMALS 90 dogs. PROCEDURES Medical records of 4 veterinary referral hospitals were reviewed to identify dogs that underwent large intestinal surgery requiring full-thickness incisions. Signalment, history, clinicopathologic data, medical treatments, surgical procedures, complications, and outcomes were recorded. Descriptive statistics were calculated; data were analyzed for association with survival to discharge (with logistic regression analysis) and postoperative intestinal dehiscence (with Fisher exact or Wilcoxon rank sum tests). RESULTS Overall 7-day postoperative intestinal dehiscence and mortality rates were 9 of 90 (10%) and 15 of 90 (17%). Dogs with preoperative anorexia, hypoglycemia, or neutrophils with toxic changes and those that received preoperative antimicrobial treatment had greater odds of death than did dogs without these findings. Preexisting colon trauma or dehiscence, preexisting peritonitis, administration of blood products, administration of > 2 classes of antimicrobials, positive microbial culture results for a surgical sample, and open abdominal management of peritonitis after surgery were associated with development of intestinal dehiscence. Five of 9 dogs with intestinal dehiscence died or were euthanized. CONCLUSIONS AND CLINICAL RELEVANCE Factors associated with failure to survive to discharge were considered suggestive of sepsis. Results suggested the dehiscence rate for full-thickness large intestinal incisions may not be as high as previously reported, but several factors may influence this outcome and larger, longer-term studies are needed to confirm these findings.
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Donahue ME, Fernandez AL. Effects of storage over a 36-month period on coagulation factors in a canine plasma product obtained by use of plasmapheresis. Am J Vet Res 2019; 80:578-585. [PMID: 31140844 DOI: 10.2460/ajvr.80.6.578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate stability of coagulation factors in canine plasma obtained by use of plasmapheresis and stored over a 36-month period. SAMPLE Canine plasma obtained by use of plasmapheresis acquired from a commercial blood bank. PROCEDURES Coagulation testing for fibrinogen concentration and activity of factors II, V, VII, VIII, and IX and von Willebrand factor was performed on canine plasma obtained by use of plasmapheresis. Samples were obtained for testing at 6-month intervals from plasma stored for up to 36 months. RESULTS A simple mixed linear regression model was created for each analysis. Median value for the fibrinogen concentration was > 150 mg/dL for all time points, except at 467, 650, and 1,015 days of storage. Median value for factor VIII was > 70% only at 650 days. Median value for factor V was > 50% through 650 days. Median value for factors VII and X was > 50% through 833 days, and median value for factors II and VII was > 50% through 1,015 days. Median value for von Willebrand factor was > 50% for the entire study (1,198 days). Median value for factor X was always < 50%. CONCLUSIONS AND CLINICAL RELEVANCE Coagulation factors degraded over time at variable rates, and all labile factors remained at > 50% activity for longer than 1 year. Plasma collected by plasmapheresis potentially offers prolonged life span of some clotting factors. Plasmapheresis is an acceptable form of canine plasma collection for transfusion purposes, and further studies should be performed to determine all of its benefits.
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Murgia E, Troia R, Bulgarelli C, Pelizzola M, Foglia A, Dondi F, Giunti M. Prognostic Significance of Organ Dysfunction in Cats With Polytrauma. Front Vet Sci 2019; 6:189. [PMID: 31294034 PMCID: PMC6598119 DOI: 10.3389/fvets.2019.00189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/28/2019] [Indexed: 11/13/2022] Open
Abstract
Polytrauma is a common emergency condition in small animals and is frequently associated with higher morbidity and mortality rates compared to minor trauma. Multiple Organ Dysfunction Syndrome (MODS) is a major complication of extensive traumatic injury, carrying a high risk of death despite intensive care treatment. Little is known about the prevalence and the prognostic impact of MODS in feline polytrauma. The current study aimed to prospectively evaluate the occurrence and the prognostic significance of organ dysfunction at admission in a population of polytraumatized cats. Cats with polytrauma requiring intensive care unit hospitalization were included and categorized according to outcome (survivors/non-survivors). Clinical and clinicopathological data, including scores of disease severity [Animal Trauma Triage Score (ATTS), APPLEfast, and APPLEfull], selected organ dysfunction and presence of MODS were evaluated upon admission, and analyzed with respect to mortality. Non-parametric statistics was performed and P < 0.05 was considered significant. Thirty-eight cats met the inclusion criteria: 8/38 (21%) had penetrating trauma, while 30/38 (79%) had blunt trauma. The overall in-hospital mortality was 37% (14/38). Cats with evidence of MODS upon admission had significantly higher frequency of death compared to cats without MODS (9/14 vs. 2/24 P = 0.0004). Hemostatic dysfunction, respiratory dysfunction, and MODS upon admission were significantly associated with mortality in the univariate logistic regression analysis (P = 0.005, P = 0.001, P = 0.001, respectively). The values of APPLEfast, APPLEfull, and ATTS were independently associated with a higher risk of death and positively correlated with the number of dysfunctional organs (P = 0.025, P = 0.004, P = 0.003, r = 0.57, P = 0.0002; r = 0.59, P = 0.0001; r = 0.55, P = 0.0003, respectively). Multiple Organ Dysfunction Syndrome is a common complication of feline polytrauma and its development is associated with increased disease severity and worse outcomes. The presence of hemostatic dysfunction and respiratory dysfunction upon admission is associated with a higher risk of death. The ATTS and the APPLE scores are useful prognostic tools for the assessment of cats with polytrauma.
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Affiliation(s)
- Elsa Murgia
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Roberta Troia
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Cecilia Bulgarelli
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Pelizzola
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Armando Foglia
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Dondi
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Massimo Giunti
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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15
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Turner MA, Rahilly LJ, Katheryn O'Marra S. Ex vivo evaluation of the efficacy of canine fresh-frozen plasma thawed using a microwave plasma defroster. J Vet Emerg Crit Care (San Antonio) 2018; 28:603-607. [PMID: 30299566 DOI: 10.1111/vec.12768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/13/2016] [Accepted: 01/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Commercial microwave plasma defrosters (MPDs) are used globally in human medicine to safely thaw fresh-frozen plasma (FFP), but this technology has never been tested in a veterinary setting. This study was undertaken to assess the efficacy of a commercial MPD for the rapid thawing of canine FFP. STUDY DESIGN Twenty-three units (twelve 120 mL and eleven 240 mL) of canine FFP were thawed using an MPD. Time-to-thaw and pre- and postthawing temperatures of the units were measured. Clotting factor activities (factors II, V, VII, VIII, IX, X, and von Willebrand factor), fibrinogen concentrations, prothrombin times, and activated partial thromboplastin times were measured. KEY FINDINGS The evaluated MPD effectively thaws plasma quickly for both 120 mL units (2.7 ± 0.08 min) and 240 mL units (3.9 ± 0.15 min) while maintaining clinically relevant activities of clotting factors and fibrinogen concentration. While some measurements of factor VIII activity fell below the reference interval, none fell below 40%. One 240 mL unit had von Willebrand factor activity <70%. There was no evidence of excessively heated plasma to indicate a safety concern. SIGNIFICANCE The MPD evaluated in this study provides a useful means to rapidly thaw canine FFP for correction of factor-deficient coagulopathy.
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Affiliation(s)
| | - Louisa Jane Rahilly
- Emergency & Critical Care, Cape Cod Veterinary Specialists, Buzzards Bay, MA, 02532
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16
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Yagneswar H, Todd JM, Sharkey LC, Rendahl A, Tart K. Retrospective comparison of standard clotting tests and novel clot waveform parameters in dogs using the turbidimetric ACL-TOP CTS 300 coagulation analyzer. J Vet Diagn Invest 2018; 30:868-877. [PMID: 30204058 DOI: 10.1177/1040638718797386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Clot waveforms are generated by coagulation analyzers, such as the ACL-TOP, that utilize photo-optical turbidimetric methods to measure prothrombin time (PT) and activated partial thromboplastin time (aPTT), which are standard clotting tests (SCTs). Additional quantitative clot waveform analysis (CWA) parameters include maximum velocity of the PT curve (PT1d), maximum acceleration of the aPTT curve (aPTT2d), and their change in optical density (ODdelta). We explored the potential for CWA to contribute unique information compared to SCTs and quantitative fibrinogen assay (QFA) in dogs with clinical indications for laboratory evaluation of coagulation. We retrospectively evaluated the frequency and agreement between normal, high, and low values of CWA and SCTs for 203 dogs relative to reference intervals (RIs). Most dogs had SCTs within RIs, but most CWA values were high regardless of whether SCT values were within, below, or above the RI. Agreement between SCTs and CWA was slight (kappa <30%). Clinically significant bleeding was noted in 28 of 203 (14%) dogs. SCTs were not different between bleeders and non-bleeders. Median QFA, PT1d, aPTTdelta, and aPTT2d values were statistically significantly higher than RIs in non-bleeders compared to bleeders, whose median values were not below RI. Compared with SCTs, CWA identified differences between the 2 groups. However, wide overlap between the 2 groups limits the use of CWA to clinically discriminate between bleeders and non-bleeders in a heterogeneous population of dogs. Further studies on the diagnostic utility of CWA in coagulopathic dogs are needed.
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Affiliation(s)
- Hamsini Yagneswar
- Departments of Veterinary Clinical Sciences (Yagneswar, Tart, Todd, Sharkey), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Veterinary and Biomedical Science (Rendahl), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Current address: Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, N Grafton, MA 01536 (Sharkey)
| | - Jeffrey M Todd
- Departments of Veterinary Clinical Sciences (Yagneswar, Tart, Todd, Sharkey), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Veterinary and Biomedical Science (Rendahl), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Current address: Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, N Grafton, MA 01536 (Sharkey)
| | - Leslie C Sharkey
- Departments of Veterinary Clinical Sciences (Yagneswar, Tart, Todd, Sharkey), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Veterinary and Biomedical Science (Rendahl), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Current address: Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, N Grafton, MA 01536 (Sharkey)
| | - Aaron Rendahl
- Departments of Veterinary Clinical Sciences (Yagneswar, Tart, Todd, Sharkey), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Veterinary and Biomedical Science (Rendahl), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Current address: Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, N Grafton, MA 01536 (Sharkey)
| | - Kelly Tart
- Departments of Veterinary Clinical Sciences (Yagneswar, Tart, Todd, Sharkey), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Veterinary and Biomedical Science (Rendahl), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Current address: Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, N Grafton, MA 01536 (Sharkey)
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17
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Torkildsen L, Bishop MA, Barr JW, Pashmakova MB. Comparison of multiple thawing techniques on thaw time and stability of hemostatic proteins in canine plasma products. J Small Anim Pract 2018; 59:641-645. [PMID: 30047139 DOI: 10.1111/jsap.12903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/19/2018] [Accepted: 04/28/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare thawing times of fresh frozen canine plasma between a 37 °C warm water bath, running water bath and dry plasma thawer and compare haemostatic protein stability after thawing in a warm water bath or dry plasma thawer. MATERIALS AND METHODS To measure thawing times, a 240-mL bag of frozen plasma was thawed in warm water bath, running water bath or dry plasma thawer-10 times for each method. To evaluate stability of haemostatic proteins, fresh canine donor plasma samples were split into 120-mL bags and 3-mL control aliquots before freezing. Bags were thawed by warm water bath or dry plasma thawer and aliquots equilibrated to room temperature. Concentrations of haemostatic proteins, albumin, D-dimers, prothrombin time and partial thromboplastin time were obtained. RESULTS The running water bath had the shortest thaw time: median thaw time of 15 minutes versus 18 minutes for both the dry plasma thawer and warm water bath. Statistically significant differences in partial thromboplastin time, factor VII, factor X, von Willebrand factor, and von Willebrand factor collagen binding assay were detected among groups but were unlikely to be clinically relevant. CLINICAL SIGNIFICANCE A traditional running water bath provided the fastest thawing time but the dry plasma thawer resulted in the most stable haemostatic proteins.
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Affiliation(s)
- L Torkildsen
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas 77843, USA
| | - M A Bishop
- WAVE Veterinary Internal Medicine, Naples, Florida 34113, USA
| | - J W Barr
- BluePearl Veterinary Partners, LLC, Spring, Texas 77388, USA
| | - M B Pashmakova
- BluePearl Veterinary Partners, LLC, Spring, Texas 77388, USA
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18
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Sharkey LC, Little KJ, Williams KD, Todd JM, Richardson R, Gwynn AD, Rendahl A. Performance characteristics of the turbidimetric ACL-TOP CTS 300 coagulation analyzer in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2018; 28:317-325. [PMID: 29901847 DOI: 10.1111/vec.12727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/05/2016] [Accepted: 07/29/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the technical performance of the turbidimetric ACL-TOP CTS 300 coagulation analyzer (IL) in dogs and cats and to create reference intervals for standard and novel parameters. DESIGN Coagulation testing results from dogs and cats generated by the IL were prospectively compared with another mechanical clot detection system. Precision was documented and reference intervals were created for prothrombin time, activated partial thromboplastin time, and Clauss fibrinogen and D-dimer values, as well as for the quantitative clot curve parameters (high and low amplitude, delta, and first and second derivative curves). Clot curve signatures containing common artifacts due to lipemia, hemolysis, or preactivation were demonstrated. ANIMALS Residual frozen plasma from 20 dogs and 10 cats was used for method comparison; prospectively recruited healthy dogs (n = 48) and cats (n = 45) were used for reference interval and precision studies. MEASUREMENTS AND MAIN RESULTS Bland-Altman analysis showed a proportional positive bias in the IL compared with mechanical clot detection in dogs and a suggestion of a similar pattern in cats. Precision was good and met manufacturer's recommendations for all assays. Reference intervals are reported. Clot curve artifacts were similar in animals to those reported in people. CONCLUSIONS The turbidimetric system had a slight high proportional positive bias compared with mechanical clot detection. Thus, new reference intervals were generated including for novel parameters generated by clot curve analysis. Some preanalytical errors can be identified by inspection of clot curves. This robust novel technology compares favorably with mechanical endpoint detection methods and can be used in dogs and cats.
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Affiliation(s)
- Leslie C Sharkey
- Veterinary Clinical Sciences Department, University of Minnesota, St. Paul, MN, 55108
| | - Kim J Little
- Veterinary Clinical Sciences Department, University of Minnesota, St. Paul, MN, 55108
| | - Kevin D Williams
- Veterinary Clinical Sciences Department, University of Minnesota, St. Paul, MN, 55108
| | - Jeffrey M Todd
- Veterinary Clinical Sciences Department, University of Minnesota, St. Paul, MN, 55108
| | - Rae Richardson
- Veterinary Clinical Sciences Department, University of Minnesota, St. Paul, MN, 55108
| | - Angela D Gwynn
- Veterinary Clinical Sciences Department, University of Minnesota, St. Paul, MN, 55108
| | - Aaron Rendahl
- Veterinary Clinical Sciences Department, University of Minnesota, St. Paul, MN, 55108
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19
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McDevitt HL, Mayhew PD, Giuffrida MA, Brown DC, Culp WTN, Runge JJ. Short-term clinical outcome of laparoscopic liver biopsy in dogs: 106 cases (2003–2013). J Am Vet Med Assoc 2016; 248:83-90. [DOI: 10.2460/javma.248.1.83] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Chan DL. The swinging pendulum between consensus and controversy in veterinary emergency and critical care. J Vet Emerg Crit Care (San Antonio) 2015; 25:1-3. [PMID: 25597283 DOI: 10.1111/vec.12285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel L Chan
- The Royal Veterinary College, University of London, UK
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