Establishing a protocol for thromboelastography in sea turtles

DEVELOPING A THROMBOELASTOGRAPHY ASSAY IN ELASMOBRANCHS

Thromboelastography (TEG) is a hemostatic assay evaluating clot initiation time, kinetics, strength, and extent of fibrinolysis. Hemostatic assays in nonmammalian species have been less extensively studied because of lack of taxon-specific reagents and unique physiology. Hemostatic or hemorrhagic disease has been described postmortem in elasmobranchs, but antemortem detection of coagulopathies is limited in this taxon. The study aimed to establish an elasmobranch TEG protocol to improve hemostatic evaluation and facilitate advanced treatment options for animals under human care. Multiple clotting initiators were assessed for efficacy with frozen-thawed citrated plasma, fresh citrated plasma, and fresh whole citrated blood: RapidTEGTM, citrated kaolin, Reptilase®, and species brain-derived thromboplastin prepared by two different methods. Initial evaluation found plasma samples clot inconsistently, but TEG analyses using fresh whole blood consistently led to measurable TEG reactions using multiple clotting initiators. The most reliable elasmobranch TEG results were observed using citrated fresh whole blood and the RapidTEG clot initiation reagent.

Coagulation Disorders, Testing, and Treatment in Exotic Animal Critical Care

Despite poor recognition in the literature, exotic companion animals are affected by many diseases that can result in disordered coagulation and fibrinolysis. This article outlines current knowledge of hemostasis, common diagnostic tests and reviews reported diseases associated with coagulopathy in small mammals, bird and reptiles. A range of conditions affect platelets and thrombocytes, endothelium and blood vessels, and plasma clotting factors. Improved recognition and monitoring of hemostatic disorders will enable targeted therapy and improved case outcomes.

Clinical Pathology of Freshwater Turtles

Freshwater turtles are physiologically unique in their adaptations to life on both land and freshwater habitats. Appropriate interpretation of laboratory values specific to these species is important for both conservation efforts in free-ranging populations and in captive populations, especially because these animals become increasingly popular as pets. Although normal physiology has been well characterized, understanding of clinicopathologic changes in response to disease processes in freshwater chelonian species is relatively limited. This article reviews the current knowledge of hematology, plasma biochemistry, and urinalysis specific to freshwater turtles, with correlates to other chelonian species when specific data are unavailable.

Viscoelastic Coagulation Testing in Exotic Animals

Whole blood viscoelastic coagulation testing (VCT) allows global assessment of hemostasis and fibrinolysis. Although not widely used in exotic animal practice, VCT has been used in exotic animal research settings. Differences in patient demographics and analytical variables can result in dramatically different results with the same analyzer. To improve the utility of VCT in exotic animal medicine, standardization of protocols is necessary to facilitate the establishment of reference intervals. Despite these challenges, the quantitative/qualitative nature of VCT has already proved its real-world value to some clinicians.

Coagulation testing in green iguanas (Iguana iguana) with development of prothrombin time assays using reptile and avian thromboplastin

BACKGROUND

Captive reptiles often present with clinical signs suggestive of a clotting disorder or severe illness that can induce or exacerbate a coagulopathy. However, coagulopathies in reptiles are difficult to characterize due to lack of species-appropriate reagents to perform coagulation tests. The objective of this study was to develop screening tests to evaluate the extrinsic and common pathways of coagulation in green iguanas (Iguana iguana).

KEY FINDINGS

Reptile and avian thromboplastin, extracted from reptile and avian brains, respectively, were used to initiate coagulation in prothrombin time (PT) assays and commercially available reagents were used to determine Russell's viper venom time, thrombin time, and fibrinogen using the Clauss method. Coagulation assays were performed on citrate-anticoagulated plasma from 18 healthy green iguanas. Results were summarized as median (minimum-maximum): PT (reptile thromboplastin), 34.8 seconds (27.1-42.1 s), PT (avian thromboplastin), 78.5 seconds (51.6-114.23 s), Russell's viper venom time, 56.15 seconds (18.4-79.7 s), thrombin time, 10 seconds (7.0-36.5 s), and fibrinogen, 258 mg/dl (89-563.0) (2.58 [0.89-5.63 g/L]).

SIGNIFICANCE

Commercial reagents can be used to evaluate the common pathway and fibrinogen; however, avian- or reptile-sourced thromboplastin is preferred for a reliable coagulation trigger to perform the PT assay and evaluate the extrinsic pathway.

SAFETY OF MULTIPLE-DOSE INTRAMUSCULAR KETOPROFEN TREATMENT IN LOGGERHEAD TURTLES (CARETTA CARETTA)

Sea turtles are frequently presented for rehabilitation with injuries for which analgesic treatment is warranted. Ketoprofen is a nonsteroidal anti-inflammatory drug (NSAID) widely used in clinical veterinary medicine for musculoskeletal pain relief. Pharmacokinetics of 2 mg/kg IM have been studied in loggerhead sea turtles (Caretta caretta) as a single and a repeated dose q24hr for 3 days. Safety of longer term administration has not been performed, however, and NSAID use carries a risk of potential complications, including gastrointestinal ulceration, kidney damage, and bleeding. The objective of the current study was to determine the effects of a 5-day course of ketoprofen on thromboelastography (TEG) and hematological (including thrombocytes) and plasma biochemical analytes in loggerheads. A secondary objective was to determine 24-hr trough concentrations of ketoprofen after 5 days of treatment. Eight loggerheads were treated with ketoprofen 2 mg/kg IM q24hr for 5 days, and TEG, hematology, and plasma biochemistry panels were performed before and at the conclusion of treatment. Eight controls were treated with an equivalent volume of saline intramuscularly. Virtually no changes were detected before and after treatment or between treatment and control groups in any of the 24 endpoints evaluated, and marginal differences were not considered clinically relevant. Plasma ketoprofen concentrations after 5 days of treatment indicated no accumulation over that duration. Ketoprofen at 2 mg/kg IM q24hr for up to 5 days in loggerheads appears safe with respect to blood clotting and blood data, although other potential effects were not evaluated.

Advances in Exotic Animal Clinical Pathology

Over the last 10 years, exotic animal clinical pathology has been evolving, improving health assessment in avian, mammal, fish, reptile, and amphibian patients. These advances are reviewed in this article. Species-specific reference intervals for blood parameters are becoming more available (eg, for ionized calcium, endocrine panels, and vitamin D plasmatic concentrations). In addition, new technologies are being developed to facilitate targeted metabolite detection and result acquisition by veterinarians. Novel techniques, biomarkers, and clinical changes related to disease have been described in avian, mammal, fish, reptile and amphibian species. The use of mobile applications may also be helpful.