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Heniff AC, Lynch AM, Ruterbories LK, Minter LJ, Georoff TA, Balko JA. INVESTIGATION OF A POINT-OF-CARE VISCOELASTIC COAGULATION MONITOR AND ITS COMPARISON TO THROMBOELASTOGRAPHY IN CLINICALLY HEALTHY AFRICAN ELEPHANTS ( LOXODONTA AFRICANA). J Zoo Wildl Med 2024; 55:164-172. [PMID: 38453499 DOI: 10.1638/2022-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 03/09/2024] Open
Abstract
Elephant endotheliotropic herpesvirus (EEHV) can induce fatal hemorrhagic disease (HD) in African elephants (Loxodonta africana). Once clinical signs develop, progression is rapid, even with aggressive treatment. There is a critical need to develop point-of-care diagnostic tests to aid in identification of EEHV-HD prior to the onset of overt clinical signs. Study objectives were to investigate a novel, point-of-care viscoelastic coagulation monitor (VCM Vet), compare the results to thromboelastography (TEG), and report traditional hemostatic analytes in adult African elephants. Whole blood was collected from seven clinically healthy elephants (four females and three males, 18-47 yr) and analyzed in duplicate via VCM Vet and kaolin-activated TEG 1-3 and 30 min following collection, respectively. Separated plasma was frozen for ancillary coagulation testing. Both analyses generated quantifiable clotting reactions with variables (median [range]) describing clot formation rate (VCM Vet, clot time = 682 s [530-987 s], clot formation time = 244 s [186-744 s], Alpha = 40° [14-47°]; TEG, reaction time = 6.2 min [3.7-11.8 min], kinetic time = 1.3 min [0.9-2.6 min], Alpha = 70° [57-77°]), clot strength (VCM Vet, maximum clot formation = 34 units [20-45 units]; TEG, maximum amplitude = 75 mm [69-80 mm], shear elastic modulus strength = 14.7 Kdynes/s [11.3-19.5 Kdynes/s]), and clot lysis (VCM Vet, lysis index at 30 min = 100% [100-99%], lysis index at 45 min = 98% [95-100%]; TEG, lysis index at 30 min = 0% [0-0.4%], lysis index at 60 min = 1.4% [0-2.6%]) recorded. Additional testing (median [range]) included D-dimer concentration (33 ng/ml [28-94 ng/ml]), prothrombin time (12.4 s [12.2-13.2 s]), activated partial thromboplastin time (17.2 s [14.2-18.8 s]), and fibrinogen concentration (297 [282-383] mg/dL). Tracings generated by VCM Vet and TEG were clinically similar, and there was visual agreement and minimal difference between quantitative variables for duplicate tests. VCM Vet is a promising, user-friendly tool for use in identification and management of coagulopathies in African elephants.
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Affiliation(s)
- Ashlyn C Heniff
- College of Veterinary Medicine, Departments of Clinical Sciences, North Carolina State University, Raleigh, NC 27606, USA
| | - Alex M Lynch
- College of Veterinary Medicine, Departments of Clinical Sciences, North Carolina State University, Raleigh, NC 27606, USA
| | - Laura K Ruterbories
- College of Veterinary Medicine, Departments of Clinical Sciences, North Carolina State University, Raleigh, NC 27606, USA
| | - Larry J Minter
- College of Veterinary Medicine, Departments of Clinical Sciences, North Carolina State University, Raleigh, NC 27606, USA
- North Carolina Zoo, Asheboro, NC 27205, USA
| | - Timothy A Georoff
- College of Veterinary Medicine, Departments of Clinical Sciences, North Carolina State University, Raleigh, NC 27606, USA
- North Carolina Zoo, Asheboro, NC 27205, USA
| | - Julie A Balko
- Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC 27606, USA,
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Cummings CO, Eisenbarth J, deLaforcade A. Viscoelastic Coagulation Testing in Exotic Animals. Vet Clin North Am Exot Anim Pract 2022; 25:597-612. [PMID: 36122942 DOI: 10.1016/j.cvex.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
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.
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Affiliation(s)
- Charles O Cummings
- Tufts Clinical and Translational Science Institute, Tufts Medical Center, 35 Kneeland Street Suite 8, Boston, MA 0211, USA.
| | - Jessica Eisenbarth
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, North Grafton, MA 01536, USA
| | - Armelle deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, North Grafton, MA 01536, USA
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NOVEL DIAGNOSTIC AND THERAPEUTIC APPROACHES TO ELEPHANT ENDOTHELIOTROPIC HERPESVIRUS 1A HEMORRHAGIC DISEASE IN A CAPTIVE JUVENILE ASIAN ELEPHANT (ELEPHAS MAXIMUS). J Zoo Wildl Med 2022; 53:232-240. [DOI: 10.1638/2021-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/21/2022] Open
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Jesus SA, Schmidt A, Fickel J, Doherr MG, Boonprasert K, Thitaram C, Sariya L, Ratanakron P, Hildebrandt TB. Assessing Coagulation Parameters in Healthy Asian Elephants (Elephas maximus) from European and Thai Populations. Animals (Basel) 2022; 12:ani12030361. [PMID: 35158684 PMCID: PMC8833339 DOI: 10.3390/ani12030361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
The Asian elephant population is continuously declining due to several extrinsic reasons in their range countries, but also due to diseases in captive populations worldwide. One of these diseases, the elephant endotheliotropic herpesvirus (EEHV) hemorrhagic disease, is very impactful because it particularly affects Asian elephant calves. It is commonly fatal and presents as an acute and generalized hemorrhagic syndrome. Therefore, having reference values of coagulation parameters, and obtaining such values for diseased animals in a very short time, is of great importance. We analyzed prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen concentrations using a portable and fast point-of-care analyzer (VetScan Pro) in 127 Asian elephants from Thai camps and European captive herds. We found significantly different PT and aPTT coagulation times between elephants from the two regions, as well as clear differences in fibrinogen concentration. Nevertheless, these alterations were not expected to have biological or clinical implications. We have also sequenced the coagulation factor VII gene of 141 animals to assess the presence of a previously reported hereditary coagulation disorder in Asian elephants and to investigate the presence of other mutations. We did not find the previously reported mutation in our study population. Instead, we discovered the presence of several new single nucleotide polymorphisms, two of them being considered as deleterious by effect prediction software.
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Affiliation(s)
- Sónia A. Jesus
- Department of Reproduction Management, Leibniz Institute for Zoo and Wildlife Research, 10315 Berlin, Germany;
- Correspondence:
| | - Anke Schmidt
- Department of Evolutionary Genetics, Leibniz Institute for Zoo and Wildlife Research, 10315 Berlin, Germany; (A.S.); (J.F.)
| | - Jörns Fickel
- Department of Evolutionary Genetics, Leibniz Institute for Zoo and Wildlife Research, 10315 Berlin, Germany; (A.S.); (J.F.)
- Institute of Biochemistry and Biology, University of Potsdam, 14476 Potsdam, Germany
| | - Marcus G. Doherr
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universität, 14163 Berlin, Germany;
| | - Khajohnpat Boonprasert
- Center of Elephant and Wildlife Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand; (K.B.); (C.T.)
| | - Chatchote Thitaram
- Center of Elephant and Wildlife Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand; (K.B.); (C.T.)
| | - Ladawan Sariya
- The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom 73170, Thailand;
| | - Parntep Ratanakron
- Faculty of Veterinary Science and Applied Zoology, Chulabhorn Royal Academy, Bangkok 10210, Thailand;
| | - Thomas B. Hildebrandt
- Department of Reproduction Management, Leibniz Institute for Zoo and Wildlife Research, 10315 Berlin, Germany;
- Faculty of Veterinary Medicine, Freie Universität, 14163 Berlin, Germany
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Perrin KL, Kristensen AT, Bertelsen MF, Denk D. Retrospective review of 27 European cases of fatal elephant endotheliotropic herpesvirus-haemorrhagic disease reveals evidence of disseminated intravascular coagulation. Sci Rep 2021; 11:14173. [PMID: 34238966 PMCID: PMC8266883 DOI: 10.1038/s41598-021-93478-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
Elephant endotheliotropic herpesvirus haemorrhagic disease (EEHV-HD) is widely acknowledged as the most common cause of mortality in young Asian elephants (Elephas maximus) in captivity. The objective of the current study was to perform a blinded, retrospective pathology review of European EEHV-HD fatalities, constituting the largest systematic assessment of EEHV-HD pathology to date. Findings between viral genotypes were compared with the aim to investigate if disseminated intravascular coagulation (DIC) could be substantiated as a significant complicating factor, thereby increasing the understanding of disease pathophysiology. Immunohistochemical staining confirmed endothelial cell (EC) damage and the presence of EC intranuclear inclusion bodies, demonstrating a direct viral cytopathic effect. Microthrombi were observed in 63% of cases in several organs, including lungs, which, together with widespread haemorrhage and thrombocytopenia reported in EEHV-HD case reports, supports the presence of overt DIC as a serious haemostatic complication of active EEHV infection. Death was attributed to widespread vascular damage with multi-organ dysfunction, including severe acute myocardial haemorrhage and subsequent cardiac failure. Systemic inflammation observed in the absence of bacterial infection may be caused by cytokine release syndrome. Findings reinforce the necessity to investigate cytokine responses and haemostatic status during symptomatic and asymptomatic EEHV viraemia, to potentially support the use of anti-inflammatory treatment in conjunction with anti-viral therapy and cardiovascular support.
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Affiliation(s)
- K L Perrin
- Center for Zoo and Wild Animal Health, Copenhagen Zoo, Roskildevej 38, 2000, Frederiksberg, Denmark.
- The Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870, Frederiksberg, Denmark.
| | - A T Kristensen
- The Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870, Frederiksberg, Denmark
| | - M F Bertelsen
- Center for Zoo and Wild Animal Health, Copenhagen Zoo, Roskildevej 38, 2000, Frederiksberg, Denmark
| | - D Denk
- International Zoo Veterinary Group, Station House, Parkwood Street, Keighley, BD21 4NQ, UK
- Institute for Animal Pathology, Ludwig-Maximilians-University, Veterinärstr. 13, 80539, Munich, Germany
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