Rafael Ruiz de Gopegui

Study of haemostatic disorders in experimentally induced leishmaniasis in Beagle dogs

Haemostatic alterations in dogs experimentally infected with Leishmania infantum were studied before and after therapy with meglumine antimonate. Haemostatic function tests including platelet count, collagen-induced platelet aggregation, prothrombin time, activated partial thromboplastin time, thrombin time, plasma fibrinogen determination, and serum fibrinogen/fibrin degradation products concentration were performed. In the course of infection and before treatment, moderate thrombocytopenia (P<0.00001), decreased collagen induced platelet aggregation (P=0.0003), prolonged thrombin time (P=0.0117) and increased fibrinogen/fibrin degradation products were observed. Statistically significant differences of plasma fibrinogen concentration, prothrombin time, and activated partial thromboplastin time were not encountered. Haemostatic parameters returned to normal values after therapy. The results indicate that Leishmania infection may impair haemostasis suggesting induction of disseminated intravascular coagulation (DIC), and that treating dogs in an early stage of infection may potentially avoid the possibility of developing an uncompensated DIC.

Plasma iron, C-reactive protein, albumin, and plasma fibrinogen concentrations in dogs with systemic inflammatory response syndrome.

OBJECTIVE To investigate the diagnostic and prognostic value over time of plasma iron compared with the inflammatory markers albumin, C-reactive protein (CRP), and fibrinogen in dogs with systemic inflammatory response syndrome (SIRS). DESIGN Prospective observational study of sequentially enrolled dogs. SETTING ICU of a veterinary teaching hospital. ANIMALS One hundred and sixteen client-owned dogs: 54 dogs with SIRS or sepsis, 42 with focal inflammation, and 20 clinically healthy dogs. MEASUREMENTS AND MAIN RESULTS Blood samples were obtained on admission in all study groups, and then on alternate days until discharge or death in both inflammation groups. On admission, dogs with SIRS had significantly lower plasma iron (65 ± 5.8 μg/dL, P = 0.001) concentrations than dogs with focal inflammation (89.5 ± 6.2 μg/dL, P = 0.001). Plasma iron, albumin, and CRP effectively discriminated the SIRS/sepsis group from those presenting with focal inflammation with areas under the curve for the receiver operating curves of 0.679, 0.834, and 0.704, respectively. The admission values for these variables did not discriminate survivors from nonsurvivors within the SIRS/sepsis group. However, the magnitude of increase in iron concentration and the decrease in CRP concentration from admission to hospital discharge was higher in survivors than in nonsurvivors within the SIRS/septic group (22.8 vs. 2.51 μg/dL, respectively, P = 0.021 for iron; -67.1 vs. -4.1 mg/L, respectively, P = 0.002 for CRP), resulting in iron and CRP concentrations at hospital discharge for survivors similar to those in the focal inflammation group. CONCLUSION Hypoferremia is a sensitive marker of systemic inflammation in dogs. In this study, the increase in iron concentrations during the hospitalization period of SIRS/septic dogs was associated with a better prognosis, suggesting that plasma iron in combination with CRP and albumin concentrations might be used to monitor dogs with inflammatory disease processes.Objective To investigate the diagnostic and prognostic value over time of plasma iron compared with the inflammatory markers albumin, C-reactive protein (CRP), and fibrinogen in dogs with systemic inflammatory response syndrome (SIRS). Design Prospective observational study of sequentially enrolled dogs. Setting ICU of a veterinary teaching hospital. Animals One hundred and sixteen client-owned dogs: 54 dogs with SIRS or sepsis, 42 with focal inflammation, and 20 clinically healthy dogs. Measurements and Main Results Blood samples were obtained on admission in all study groups, and then on alternate days until discharge or death in both inflammation groups. On admission, dogs with SIRS had significantly lower plasma iron (65 ± 5.8 μg/dL, P = 0.001) concentrations than dogs with focal inflammation (89.5 ± 6.2 μg/dL, P = 0.001). Plasma iron, albumin, and CRP effectively discriminated the SIRS/sepsis group from those presenting with focal inflammation with areas under the curve for the receiver operating curves of 0.679, 0.834, and 0.704, respectively. The admission values for these variables did not discriminate survivors from nonsurvivors within the SIRS/sepsis group. However, the magnitude of increase in iron concentration and the decrease in CRP concentration from admission to hospital discharge was higher in survivors than in nonsurvivors within the SIRS/septic group (22.8 vs. 2.51 μg/dL, respectively, P = 0.021 for iron; −67.1 vs. −4.1 mg/L, respectively, P = 0.002 for CRP), resulting in iron and CRP concentrations at hospital discharge for survivors similar to those in the focal inflammation group. Conclusion Hypoferremia is a sensitive marker of systemic inflammation in dogs. In this study, the increase in iron concentrations during the hospitalization period of SIRS/septic dogs was associated with a better prognosis, suggesting that plasma iron in combination with CRP and albumin concentrations might be used to monitor dogs with inflammatory disease processes.

Frequency of dog erythrocyte antigen 1.1 expression in dogs from Portugal

BACKGROUND Dog erythrocyte antigen (DEA) 1.1 is the antigen considered most responsible for severe hemolysis owing to incompatible blood transfusions in previously sensitized dogs. Few reports describe the frequency of DEA 1.1 expression in European dogs, and there are no reports in dogs from Portugal. OBJECTIVE The aims of this study were to identify the frequency of DEA 1.1 expression in Portuguese dogs, to examine the relationship between phenotypic traits and expression of this blood group, and to assess the risk of transfusing blood that is not typed or cross-matched. METHODS Expression of DEA 1.1 was determined in 274 dogs using a migration gel test. Weight, sex, breed, and hair length and color were recorded for each dog. Results were analyzed by descriptive statistical analysis, probabilistic analysis, and χ(2)-tests. RESULTS Of 274 dogs, 56.9% were DEA 1.1-positive and 43.1% were DEA 1.1-negative. All Boxers, German Shepherds, and Dobermans were DEA 1.1-negative, whereas all Saint Bernards, 88.9% of Golden Retrievers, 88.2% of Rottweilers, and 61.4% of mixed breed dogs were DEA 1.1-positive. A significant relationship between DEA 1.1 expression and phenotypic traits was not found. The probability of sensitization of recipient dogs following first-time transfusion with blood that was not typed or cross-matched was 24.5%; the probability of an acute hemolytic reaction following a second transfusion with blood from any other donor in the absence of pretransfusion compatibility testing was 6%. CONCLUSION The frequency of DEA 1.1 expression in dogs in Portugal is high, and there is a potential risk of sensitization following transfusion with blood that is not typed or cross-matched. Breed-related frequencies may help predict DEA 1.1-positivity, but the best practice is to type and cross-match blood before transfusion.

Use of blood and blood components in canine and feline patients with hemostatic disorders

Therapy with blood and blood products related to hemostatic disorders in small animal practice is reviewed. Administration of platelet rich plasma and platelet concentrates in thrombocytopenia or thrombopathia is discussed. Vascular purpuras, vasculitis, and vascular inherited defects are also considered. Inherited coagulation disorders are summarized and the therapeutic choices in treating these disorders are also proposed. In addition, acquired coagulation disorders are briefly reviewed.

Severe life-threatening hypokalemia in a cat with suspected distal renal tubular acidosis

OBJECTIVE Description of the clinical presentation and management of a critically ill cat with profound hypokalemia associated with a suspicion of distal renal tubular acidosis (DRTA) and secondary hyperaldosteronism. CASE SUMMARY A cat was presented with severe generalized weakness and acute ventilatory failure associated with severe hypokalemia. The acid-base analysis and complete analytical profile of the urine confirmed the presence of a normal anion-gap metabolic acidosis with a urine pH of 7, a disorder consistent with DRTA. The high plasma renin activity, high aldosterone concentration, and low normal plasma aldosterone concentration/plasma renin activity ratio suggested secondary hyperaldosteronism. The management of the patient in the ICU was successful. No identifiable cause could be determined as a cause for the DRTA, so the disorder was assumed to be the primary problem. NEW OR UNIQUE INFORMATION PROVIDED DRTA is a rare disorder occasionally reported in the veterinary literature; it is especially rare in cats. Complete diagnostic evaluation was necessary to identify the reported disorders as the cause of the clinical presentation. To the authors knowledge, this is the first case reporting DRTA, and a simultaneously documented mineralocorticoid response, as a cause of a life-threatening hypokalemia.

A comparison of traditional and quantitative analysis of acid-base imbalances in hypoalbuminemic dogs.

Objective To compare the traditional (HH) and quantitative approaches used for the evaluation of the acid–base balance in hypoalbuminemic dogs. Design Prospective observational study. Setting ICU of a veterinary teaching hospital. Animals One hundred and five client-owned dogs. Measurements and Main Results Jugular venous blood samples were collected from each patient on admission to determine: total plasma protein (TP), albumin (Alb), blood urea nitrogen (BUN), glucose (Glu), hematocrit (HCT), Na+, Cl−, K+, phosphate (Pi), pH, PvCO2, bicarbonate (HCO3−), anion gap (AG), adjusted anion gap for albumin (AGalb) or phosphate (AGalb-phos), standardized base excess (SBE), strong ion difference (SID), concentration of nonvolatile weak buffers (Atot), and strong ion gap (SIG). Patients were divided in 2 groups according to the severity of the hypoalbuminemia: mild (Alb = 21–25 g/L) and severe (Alb ≤20 g/L). All parameters were compared among groups. Patients with severe hypoalbuminemia showed significant decrease in TP (P = 0.011), Atot (P = 0.050), and a significant increase in adjusted AG (P = 0.048) and the magnitude of SIG (P = 0.011) compared to animals with mild hypoalbuminemia. According to the HH approach, the most frequent imbalances were simple disorders (51.4%), primarily metabolic acidosis (84.7%) associated with a high AG acidosis. However, when using the quantitative method, 58.1% of patients had complex disorders, with SIG acidosis (74.3%) and Atot alkalosis (33.3%) as the most frequent acid–base imbalances. Agreement between methods only matched in 32 cases (kappa < 0.20). Conclusions The agreement between the HH and quantitative methods for interpretation of acid–base balance was poor and many imbalances detected using the quantitative approach were missed using the HH approach. Further studies are necessary to confirm the clinical utility of using the quantitative approach in the decision-making process of the severely ill hypoalbuminemic patients.OBJECTIVE To compare the traditional (HH) and quantitative approaches used for the evaluation of the acid-base balance in hypoalbuminemic dogs. DESIGN Prospective observational study. SETTING ICU of a veterinary teaching hospital. ANIMALS One hundred and five client-owned dogs. MEASUREMENTS AND MAIN RESULTS Jugular venous blood samples were collected from each patient on admission to determine: total plasma protein (TP), albumin (Alb), blood urea nitrogen (BUN), glucose (Glu), hematocrit (HCT), Na(+) , Cl(-) , K(+) , phosphate (Pi ), pH, PvCO2, bicarbonate (HCO3 (-) ), anion gap (AG), adjusted anion gap for albumin (AGalb ) or phosphate (AGalb-phos ), standardized base excess (SBE), strong ion difference (SID), concentration of nonvolatile weak buffers (Atot ), and strong ion gap (SIG). Patients were divided in 2 groups according to the severity of the hypoalbuminemia: mild (Alb = 21-25 g/L) and severe (Alb ≤20 g/L). All parameters were compared among groups. Patients with severe hypoalbuminemia showed significant decrease in TP (P = 0.011), Atot (P = 0.050), and a significant increase in adjusted AG (P = 0.048) and the magnitude of SIG (P = 0.011) compared to animals with mild hypoalbuminemia. According to the HH approach, the most frequent imbalances were simple disorders (51.4%), primarily metabolic acidosis (84.7%) associated with a high AG acidosis. However, when using the quantitative method, 58.1% of patients had complex disorders, with SIG acidosis (74.3%) and Atot alkalosis (33.3%) as the most frequent acid-base imbalances. Agreement between methods only matched in 32 cases (kappa < 0.20). CONCLUSIONS The agreement between the HH and quantitative methods for interpretation of acid-base balance was poor and many imbalances detected using the quantitative approach were missed using the HH approach. Further studies are necessary to confirm the clinical utility of using the quantitative approach in the decision-making process of the severely ill hypoalbuminemic patients.

Volume-dependent hemodynamic effects of blood collection in canine donors - evaluation of 13% and 15% of total blood volume depletion

BACKGROUND There is no consensus regarding the blood volume that could be safely donated by dogs, ranging from 11 to 25% of its total blood volume (TBV). No previous studies evaluated sedated donors. AIM To evaluate the hemodynamic effects of blood collection from sedated and non-sedated dogs and to understand if such effects were volume-dependent. MATERIALS AND METHODS Fifty three donations of 13% of TBV and 20 donations of 15% TBV were performed in dogs sedated with diazepam and ketamine. Additionally, a total of 30 collections of 13% TBV and 20 collections of 15% TBV were performed in non-sedated dogs. Non-invasive arterial blood pressures and pulse rates were registered before and 15 min after donation. RESULTS Post-donation pulse rates increased significantly in both sedated groups, with higher differences in the 15% TBV collections. Systolic arterial pressures decreased significantly in these groups, while diastolic pressures increased significantly in 13% TBV donations. Non-sedated groups revealed a slight, but significant, SBP decrease. No clinical signs related to donations were registered. CONCLUSION These results suggest that the collection of 15% TBV in sedated donors induces hemodynamic variations that may compromise the harmlessness of the procedure, while it seems to be a safe procedure in non-sedated dogs.

Effects of repeated blood donations on iron status and hematologic variables of canine blood donors

OBJECTIVE To evaluate the bone marrow regenerative response and iron status of canine blood donors subjected to repeated blood collections for 1 year. DESIGN Prospective cohort study. ANIMALS 57 blood donor dogs. PROCEDURES Hematologic variables, including reticulocyte percentage, were evaluated before and 10 days after each blood collection in 16 dogs donating 13% of total blood volume (TBV) every 2 months (group 1), 16 dogs donating 13% of TBV every 3 months (group 2), and 25 dogs donating 15% of TBV every 3 months (group 3) for 1 year. Serum concentrations of iron, transferrin, and ferritin were analyzed before inclusion in the study and 10 days after the last donation. RESULTS Significant increases in RBC distribution width, platelet count, WBC count, and reticulocyte percentage were detected after blood donation in all groups. Dogs of group 2 had a significantly higher serum ferritin concentration than did dogs of group 1; dogs of group 1 had a significant decrease in serum ferritin concentration. A positive correlation between the number of blood donations and both RBC distribution width and reticulocyte percentage was found for all groups. CONCLUSIONS AND CLINICAL RELEVANCE All blood donation regimens induced a bone marrow regenerative response, which was able to restore depleted blood cells within 10 days after blood donation while maintaining iron status within the calculated reference range. However, dogs donating 13% of TBV every 2 months had a significant decrease in iron stores, which suggested that iron-related variables must be monitored during prolonged blood donor programs.

Canine packed red blood cell transfusions in Spain

Transfusion medicine is a relatively new and rapidly growing area of research in veterinary medicine. Packed red blood cell transfusion (PRBC) is indicated for treatment of symptomatic anemia resulting from hemorrhage, hemolysis, or ineffective erythropoiesis. The objective of this retrospective study was to identify clinical manifestations and underlying diseases of dogs that received PRBC and determine possible transfusion complications and outcome. Donors were blood typed and previously tested for infectious diseases potentially transmitted by transfusion (Ehrlichia canis, Borrelia burdogferi, Dirofilaria immitis, Anaplasma phagocytophila, Anaplasma platys, Babesia spp., Bartonella spp., and Rickettsia spp, and Leishmania infantum). Recipients were also blood typed and cross-matching was routinely performed before any transfusion. Packed cell volume (PCV) was performed before and after transfusion. Every PRBC transfusion was delivered by a bedside leukoreduction filter. Sixty-five PRBC transfusions were administered to 56 dogs. Twenty-two dogs resulted DEA 1.1 positive and 34 DEA 1.1 negative. Reasons for transfusion included anemia secondary to hemorrhage (n = 48; 74%), hemolysis (n = 8; 12%), and ineffective erythropoiesis (n = 9; 14%). Median PCV before transfusion was 14.7% (range: 7–36%) and the mean post-transfusion was 21% (range: 9–39%). Mean increase in PCV was 6.5%. Thirty-one (70%) dogs were discharged and 17 (30%) dogs died or were euthanized. Transient hyperthermia was the only adverse reaction found. PRBC transfusion for symptomatic treatment of anemia is a safe and useful procedure, if the transfusion is closely supervised throughout its duration.

In vitro hemolysis of stored units of canine packed red blood cells: Hemolysis in stored canine pRBC

BACKGROUND Hemolysis is an important quality parameter of packed red blood cells (pRBCs) that is used to assess the cellular integrity of stored blood units. According to human standards, hemolysis at the end of storage must not exceed 1%, as otherwise it may be responsible for decreased transfusion effectiveness and acute life-threatening reactions. OBJECTIVES This prospective study was designed to evaluate the hemolysis of canine pRBCs stored in an additive solution containing adenine, dextrose, mannitol, and sodium chloride, and to assess its associations with storage time, duration of the collection process, collection disturbances, and with the final volume and PCV of the pRBCs units. METHODS One hundred eighty pRBCs units were collected from canine donors. Hemolysis of the pRBCs units was determined immediately after processing (t = 0). The units were then stored and retested (t = 1) either before administration (during weeks 2, 3, 4, 5, or 6 of storage) or at the end of the storage period (42 d) if not used. RESULTS Mean hemolysis at t = 0 was 0.09% (SD 0.06) and increased during storage, at a more pronounced rate from the 5th (mean values of 0.52%, SD 0.29) to the 6th week (1.2%, SD 0.72). Almost 51% of the units with 36-42 days of shelf-life showed more than 1% hemolysis. Disturbances in the collection process, the volume of the whole blood units, and the volume of stored pRBCs units or their PCV were not related to pRBCs hemolysis. CONCLUSIONS According to human blood bank recommendations regarding acceptable hemolysis, canine pRBCs stored for more than 35 days should be tested to ensure <1% hemolysis prior to administration.