Sophie Adamantos

Feline Blood Transfusions A Pinker Shade of Pale

Practical relevance Blood transfusions are a potentially life-saving procedure that are within the reach of most small animal practitioners. Only minimal equipment is required. Patient group Any cat with clinical signs attributable to a reduced red blood cell mass that is affecting oxygen transport (as a result of reduced packed cell volume or acute blood loss) is a potential candidate for a transfusion. Clinical challenges Although the principles of transfusion medicine are not complicated, there can be fatal consequences if certain steps are omitted. Diagnostics Blood typing kits and blood filters are readily available from veterinary wholesalers, laboratories and blood banking services. Evidence base Over the past three decades, a substantial body of clinical research and reports has built up covering feline blood types and transfusion medicine. This article draws on that research to provide clinical guidance aimed at all veterinarians in feline or small animal practice who either currently practise transfusion medicine or plan to do so.

Autologous blood transfusion following red blood cell salvage for the management of blood loss in 3 dogs with hemoperitoneum.

OBJECTIVE To describe the use of autologous transfusion using a red blood cell salvage device for the management of large volume hemorrhage in 3 dogs with hemoperitoneum. CASE SERIES SUMMARY Three dogs were managed for large volume hemorrhage by autologous transfusion of red blood cells after cell salvage. In all cases, blood was salvaged from the abdominal cavity during surgery. The causes of hemorrhage included testicular arterial hemorrhage after castration, hepatic parenchymal hemorrhage following hepatic dissection for intrahepatic portosystemic shunt ligation, and intra-abdominal serosal hemorrhage associated with Angiostrongylus vasorum infection. In all cases, autologous transfusion was not associated with any identified complications and contributed to improved cardiovascular stability and packed cell volume. NEW OR UNIQUE INFORMATION PROVIDED This case series is the first to describe the use of a semiautomated red blood cell salvage system for the clinical management of acute hemorrhage in dogs. This case series provides evidence that this procedure can be used safely and effectively for the management of clinical hemorrhage. On this basis, further veterinary evaluation can be justified.Objective To describe the use of autologous transfusion using a red blood cell salvage device for the management of large volume hemorrhage in 3 dogs with hemoperitoneum. Case Series Summary Three dogs were managed for large volume hemorrhage by autologous transfusion of red blood cells after cell salvage. In all cases, blood was salvaged from the abdominal cavity during surgery. The causes of hemorrhage included testicular arterial hemorrhage after castration, hepatic parenchymal hemorrhage following hepatic dissection for intrahepatic portosystemic shunt ligation, and intra-abdominal serosal hemorrhage associated with Angiostrongylus vasorum infection. In all cases, autologous transfusion was not associated with any identified complications and contributed to improved cardiovascular stability and packed cell volume. New or Unique Information Provided This case series is the first to describe the use of a semiautomated red blood cell salvage system for the clinical management of acute hemorrhage in dogs. This case series provides evidence that this procedure can be used safely and effectively for the management of clinical hemorrhage. On this basis, further veterinary evaluation can be justified.

Is evaluation of a faecal smear a useful technique in the diagnosis of canine pulmonary angiostrongylosis

OBJECTIVES To describe a method of faecal smear production and to determine the sensitivity and specificity of faecal smear for detection of parasitic larvae using Baermann sedimentation as a gold standard. METHODS Faecal smears were produced from samples submitted to the Royal Veterinary College Diagnostic Laboratory Service for Baermann sedimentation. An inexperienced and an experienced assessor each examined the smear for larvae for a maximum of five minutes. RESULTS One hundred and eighty six samples were analysed of which 28 were positive for Angiostrongylus vasorum on Baermann sedimentation. The experienced assessor had a faecal smear sensitivity of 61% and a specificity of 100%. The inexperienced assessor had a faecal smear sensitivity of 54% and a specificity of 95%. CLINICAL SIGNIFICANCE Faecal smear is an effective and cheap aid to diagnosis of canine angiostrongylosis which can be readily performed in general practice. Its use leads to a rapid detection of infection compared to other available methods. This could lead to swifter treatment of the disease and a decrease in inappropriate diagnostics. A further diagnostic method, such as Baermann sedimentation, is recommended whether the faecal smear result is positive or negative.

Thirteen cases of tetanus in dogs

The records of 13 dogs with tetanus were reviewed, 12 of the dogs survived and were discharged, but the other died as a result of the acute onset of hyperthermia. Long-term follow up was available for 10 of the survivors of which nine were reported to be normal. One case was euthanased after a cervical spine fracture four months after it was discharged. Complications encountered during management included aspiration pneumonia in three cases, urinary tract infection in two cases, and upper respiratory tract obstruction, hiatal hernia, coxofemoral luxation, seizures and respiratory arrest in one case each. None of the dogs required ventilatory support, and the complications were managed successfully. The dogs were nursed intensively and monitored carefully.

Autologous canine red blood cell transfusion using cell salvage devices

Objective To describe the use of automated blood salvage devices for autotransfusion in dogs. Technique Blood salvage devices can be used to collect blood from the intraoperative surgical field or postsurgical drainage sites. The salvage device washes cells in 0.9% saline, removing plasma proteins, other cellular components, and activators of coagulation and inflammation. Washed red blood cells may be safely returned to the patient, minimizing the need for allogeneic blood transfusions. Significance Blood salvage has been safely used in human medicine for decades and is feasible in veterinary medicine. Potential advantages include reduced reliance on banked blood for massive transfusions and minimization of morbidities associated with the use of allogeneic and stored blood products. Concerns about the safety of salvaged blood have been largely dispelled in human medicine but further investigation regarding the safety of such procedures in veterinary patients is warranted.OBJECTIVE To describe the use of automated blood salvage devices for autotransfusion in dogs. TECHNIQUE Blood salvage devices can be used to collect blood from the intraoperative surgical field or postsurgical drainage sites. The salvage device washes cells in 0.9% saline, removing plasma proteins, other cellular components, and activators of coagulation and inflammation. Washed red blood cells may be safely returned to the patient, minimizing the need for allogeneic blood transfusions. SIGNIFICANCE Blood salvage has been safely used in human medicine for decades and is feasible in veterinary medicine. Potential advantages include reduced reliance on banked blood for massive transfusions and minimization of morbidities associated with the use of allogeneic and stored blood products. Concerns about the safety of salvaged blood have been largely dispelled in human medicine but further investigation regarding the safety of such procedures in veterinary patients is warranted.

Total and ionised calcium concentrations in dogs with hypoadrenocorticism

PRIMARY hypoadrenocorticism is a common endocrinopathy in dogs. Hypercalcaemia is recognised in approximately 30 per cent of clinical cases of hypoadrenocorticism ([Peterson and Feinman 1982][1]) and in adrenalectomised dogs ([Rogoff and Stewart 1928][2]. These studies have measured total calcium

Prospective evaluation of complications associated with jugular venous catheter use in a veterinary hospital.

OBJECTIVES To prospectively investigate the incidence of mechanical and infectious complications associated with the use of jugular catheters and risk factors for these complications. METHODS Data was collected over a 6-month period and risk factors associated with the occurrence of mechanical or inflammatory complications were investigated. RESULTS One hundred catheters were placed over a 6-month period, totalling 393 catheter days. Complications were seen in 39% of catheters with a total of 51 complications. Forty-one of these complications were mechanical. A total of 10 inflammatory or infectious complications were identified in eight catheters (a total of 0.03 infectious complications per catheter day). Complications were more likely to occur in patients requiring more than one attempt for placement and patients that were ASA status 3 to 5. Infectious complications were more likely in patients not having general anaesthesia for placement, those having medical rather than surgical disease and those placed out of theatre. No association was found between the skill of the person placing the catheter and risk of complication. CLINICAL SIGNIFICANCE Mechanical complications are frequently associated with jugular catheter placement. Identification of risk factors for complications is important and warrants further study.

Coagulation status in dogs with naturally occurring Angiostrongylus vasorum infection.

OBJECTIVES Angiostrongylus vasorum infection is associated with bleeding tendencies in approximately one-third of clinical cases. The cause of the coagulopathy is poorly understood but may be related to disseminated intravascular coagulation. Thromboelastography is a global evaluation of coagulation and has not been described in a cohort of dogs with this disease. MATERIALS AND METHODS Thromboelastography in association with other measures of coagulation including prothrombin and activated partial thromboplastin times, antithrombin percentage activity and D-dimer and von Willebrand factor concentrations was evaluated in a group of 30 dogs with A. varosum infection. RESULTS A total of 18 dogs had signs of bleeding on physical examination. Thromboelastography was consistent with hypocoagulation in 17 of these dogs. There was no association between any of the other measures and hypocoagulation on thromboelastography. Abnormal coagulation times were not significantly associated with bleeding. Only fibrinogen concentration was significantly lower in dogs that were bleeding compared with those that were not (P = 0 · 026). D-dimer concentrations were increased in 22/25 cases in the study; however, other coagulation parameters were more variable. CLINICAL SIGNIFICANCE Although the changes identified in this study were not consistent, there is activation of coagulation within this population, possibly consistent with an intravascular disseminated coagulopathy.

Uterine rupture and septic peritonitis following dystocia and assisted delivery in a Great Dane bitch.

A Great Dane bitch was treated for presumed primary uterine inertia with repeated doses of oxytocin and manually assisted whelping. She was diagnosed with uterine rupture and septic peritonitis the following day. The uterine rupture is hypothesized to have occurred as a result of the management strategy used to treat dystocia. The dog underwent ovariohysterectomy, and the septic peritonitis was managed with open peritoneal drainage. The dog recovered well and was discharged 5 days later. No previous reports of canine uterine rupture associated with manual intervention appear to have been published. This report highlights the potential dangers involved in such an approach.

Risk of immunologic reactions to human serum albumin solutions

We write to highlight the potential risk of immunologic reactions to human serum albumin (HSA) solutions. Recent advances in veterinary emergency and critical care and the greater availability ofHSA solutions has led to increased use of these products in small animals. We feel that the potential for adverse reactions to HSA solutions is not widely recognised however. Recent research has identified a dichotomous response to the use of HSA solutions in critically ill versus healthy dogs. In critically ill dogs, HSA was reportedly associated with a low number of mild adverse effects although several serious adverse drug reactions were also potentially attributable to HSA administration (Mathews and Barry 2005, Trow and others 2008). In contrast, administration of HSA to healthy animals may be fatal (Francis and others 2007). A study by Martin and others (2008) suggested this may be due to different patterns of anti-HSA antibody production by these two populations. Importantly, of the 68 healthy dogs with no known prior HSA exposure sampled by Martin and others, 7 per cent had pre-existing anti-HSA antibodies. HSA is antigenic in both healthy and in critically ill dogs and repeat administration of HSA to previously exposed dogs can lead to severe anaphylactic reactions and should not be performed (Cohn and others 2007, Martin and others 2008). Based on these studies the potential risks of using HSAmust be carefully considered before the product is administered. Published reports suggest that HSA solutions do increase serum albumin concentrations and colloid osmotic pressure although this may not be associated with a survival benefit. As such, we suggest that other colloids may offer safer alternatives for provision of oncotic support and HSA solutions should only be administered if other forms of treatment have failed. At present, no veterinary licensed preparations containing human serum albumin are available. Use of these products is therefore subject to the cascade as described by the Veterinary Medicines Regulations 2008 thus requiring veterinary surgeons to ensure clients are made aware of the risks of using such a product. At the Queen Mother Hospital for Animals, we record the use of HSA prominently within patients’ medical records. In addition, in our written communications to referring practitioners, we report the use of these solutions in order to prevent inadvertent repeat HSA administration. If the decision to administer HSA is made, we would strongly encourage readers to diligently and prominently record HSA use in the medical records of their patients. In addition, we also feel it is essential that this information be conveyed to any specialist referral centre to which the patient is transferred. Provision of this information may help prevent potentially fatal acute hypersensitivity reactions.