Objective—To characterize the clinical course of disease and identify prognostic indicators for immune-mediated thrombocytopenia in dogs.
Design—Retrospective cohort study.
Animals—73 dogs treated for immune-mediated thrombocytopenia at the Foster Hospital for Small Animals at the Tufts Cummings School of Veterinary Medicine and the Tufts Veterinary Emergency Treatment and Specialties Hospital.
Procedures—Medical records from the period of January 2002 through June 2008 were reviewed to identify dogs with a diagnosis of immune-mediated thrombocytopenia. Data collected included signalment, clinical signs, results of initial diagnostic tests, treatment, complications, and survival duration.
Results—Dog ages ranged from 5 months to 15 years (median, 8.1 years). Cocker Spaniels were overrepresented, compared with their distribution in the entire hospital population during the same period. Sixty-one of the 73 (84%) dogs survived to discharge. Seven (11 %) of those dogs were lost to follow-up. Five of the remaining 54 (9%) dogs had a relapse of the disease. The presence of melena or high BUN concentration at admission to the hospital was significantly correlated with a decreased probability of survival.
Conclusions and Clinical Relevance—Immune-mediated thrombocytopenia is a serious yet treatable disease, which may have a lower rate of recurrence than previously reported. The presence of melena or high BUN concentration in the study suggested a poor prognosis for affected dogs.
Objective—To determine whether changes in presurgical plasma lactate concentration (before and after initial fluid resuscitation and gastric decompression) were associated with short-term outcome for dogs with gastric dilatation-volvulus (GDV).
Design—Retrospective case series.
Procedures—Medical records were reviewed, and signalment, history, resuscitative treatments, serial presurgical lactate concentrations, surgical findings, and short-term outcome were obtained for dogs with confirmed GDV.
Results—36 of 40 (90%) dogs with an initial lactate concentration ≤ 9.0 mmol/L survived, compared with only 13 of 24 (54%) dogs with a high initial lactate (HIL) concentration (> 9.0 mmol/L). Within HIL dogs, there was no difference in mean ± SD initial lactate concentration between survivors and nonsurvivors (10.6 ± 2.3 mmol/L vs 11.2 ± 2.3 mmol/L, respectively); however, there were significant differences in post-treatment lactate concentration, absolute change in lactate concentration, and percentage change in lactate concentration following resuscitative treatment. By use of optimal cutoff values within HIL dogs, survival rates for dogs with final lactate concentration > 6.4 mmol/L (23%), absolute change in lactate concentration ≤ 4 mmol/L (10%), or percentage change in lactate concentration ≤ 42.5% (15%) were significantly lower than survival rates for dogs with a final lactate concentration ≤ 6.4 mmol/L (91%), absolute change in lactate concentration > 4 mmol/L (86%), or percentage change in lactate concentration > 42.5% (100%).
Conclusions and Clinical Relevance—Calculating changes in plasma lactate concentration following initial treatment in dogs with GDV may assist in determining prognosis and identifying patients that require more aggressive treatment.
OBJECTIVE To determine whether critically ill dogs had increased platelet activation and whether the proportion of activated platelets correlated with severity of illness.
ANIMALS 82 dogs in the intensive care unit of a veterinary teaching hospital and 24 healthy control dogs.
PROCEDURES Flow cytometry with monoclonal mouse anti-human CD61 and CD62 antibodies in resting and ADP-treated samples and kaolin-activated thromboelastography were used to compare platelet activation in blood samples of critically ill and control dogs. Serum antithrombin, von Willebrand factor, fibrinogen, and activated protein C concentrations; prothrombin time (PT); and activated partial thromboplastin time (aPTT) were measured. Revised survival prediction index, acute patient physiology and laboratory evaluation, systemic inflammatory response syndrome, and multiple organ dysfunction syndrome scores were used to estimate severity of illness. Severity of illness scores and platelet activation measurements were compared with survival time and duration and cost of hospitalization.
RESULTS Critically ill and control dogs had no differences in platelet activation for non–ADP-treated samples measured. Critically ill dogs had significantly increased platelet activation in response to 2, 6, and 10μM ADP. Critically ill dogs had significantly increased maximum amplitude, α angle, and global clot strength and significantly decreased clot formation time. Critically ill dogs had significantly increased fibrinogen concentration, PT, and aPTT and significantly decreased antithrombin concentration. Survivors and nonsurvivors had similar flow cytometry and thromboelastography values. Three dogs developed macrothrombosis.
CONCLUSIONS AND CLINICAL RELEVANCE In this study, critically ill dogs had hyperreactive platelets, which may have contributed to a high incidence of hypercoagulability in this patient population.
Objective—To determine reference values for kaolin-activated thromboelastography in echocardiographically normal cats.
Animals—30 healthy cats without evidence of cardiomyopathy on echocardiographic examination.
Procedures—All cats underwent echocardiographic examination, the findings of which were reviewed by a board-certified cardiologist. Cats that struggled (n = 10) received mild sedation with butorphanol and midazolam IM to permit phlebotomy without interruption in jugular venous blood flow. Blood samples were collected for analysis of thromboelastography variables, PCV, total solids concentration, platelet count, activated partial thromboplastin time, prothrombin time, fibrinogen concentration, and antithrombin concentration.
Results—All 4 thromboelastography variables had < 5% mean intra-assay variability. Mean values were as follows: reaction time, 4.3 minutes; clotting time, 1.6 minutes; α angle, 66.5°; and maximum amplitude, 56.4 mm. Compared with nonsedated cats, cats that required sedation had a significantly shorter clotting time and greater α angle, whereas reaction time and maximum amplitude were not significantly different.
Conclusions and Clinical Relevance—Kaolin-activated thromboelastography was a reliable test with unremarkable intra-assay variability in echocardiographically normal cats. Sedation may affect certain thromboelastography variables, but the effect is unlikely to be clinically important. It remains unknown whether subclinical cardiomyopathy has a significant effect on thromboelastography variables in cats.
Objective—To evaluate whether games of popular professional football teams have an effect on small animal emergency room caseload and percentage of dogs and cats that subsequently are hospitalized, are euthanatized, or die following admission to veterinary emergency rooms located within a dedicated fan base.
Animals—818 dogs and cats admitted to the emergency room.
Procedures—During the 2007 New England Patriots (NEP) football season, small animal emergency room caseload was recorded for Sunday (4-hour blocks, 8:00 AM until 12:00 midnight) and Monday night (7:00 PM to 11:00 PM). Number of dogs and cats that subsequently were hospitalized, died, or were euthanatized was recorded. Mean game importance rating (GIR) was determined for NEP games (scale, 1 [mild] to 3 [great]).
Results—Percentage of dogs and cats admitted from 12:00 noon to 4:00 PM on Sundays during NEP games (mean GIR, 1.7) versus non-NEP games was not different. Mean ± SD percentage of dogs and cats admitted from 4:00 PM to 8:00 PM on Sundays during NEP games (mean GIR, 2.4) versus non-NEP games was significantly different (18 ± 5% and 25 ± 7% of daily caseload, respectively). Percentage of dogs and cats admitted from 8:00 PM to 12:00 midnight on Sundays during NEP games (mean GIR, 2.1) versus non-NEP games was not different. Game type (NEP vs non-NEP) during emergency room admission did not influence whether dogs and cats subsequently were hospitalized, died, or were euthanatized.
Conclusions and Clinical Relevance—Professional sporting events may influence veterinary emergency room caseloads.
Case Description—An 8-month-old male Saint Bernard developed tetanic seizures and hyperthermia during evaluation of bilateral osteochondritis dissecans of the shoulder joints. Further investigation revealed that the dog was receiving an unbalanced homemade diet.
Clinical Findings—Preliminary evaluation of the dog revealed bilateral signs of pain and mild muscle wasting in the shoulder joint areas. Serum biochemical analysis revealed severe hypocalcemia, hyponatremia, hypochloremia, hyperphosphatemia, vitamin D deficiency, and taurine deficiency. Diffuse osteopenia was identified on radiographs of the mandible and long bones, confirming bone demineralization. Analysis of the homemade diet revealed that the dog's diet was severely deficient in a variety of nutrients.
Treatment and Outcome—The dog responded positively to treatment for hypocalcemia, hyperthermia, and seizures. The dog's diet was changed to a complete and balanced canine diet formulated for growth. Body weight and body condition were monitored, and dietary intake was adjusted to achieve optimal body condition during growth. After initial evaluation, serial monitoring of serum calcium and taurine concentrations revealed that values were within reference limits and the dog had no further clinical signs associated with dietary deficiency.
Clinical Relevance—Findings in this puppy highlight the risks associated with feeding an unbalanced homemade diet during growth and the importance of obtaining a thorough dietary history from all patients. For owners who elect to feed a homemade diet, it is critical to have the homemade diet carefully formulated by a veterinary nutritionist to avoid severe nutrient imbalances, especially in young, growing dogs.
Objective—To establish a focused assessment with
sonography for trauma (FAST) protocol in dogs, determine
whether FAST can be performed by veterinary
clinicians without extensive ultrasonographic experience,
and assess the frequency of free fluid (as
determined via FAST) in the abdominal cavity of dogs
following motor vehicle accidents (MVAs).
Animals—100 client-owned dogs evaluated within 24
hours of an MVA.
Procedure—Dogs were placed in lateral recumbency
for the FAST examination. To detect fluid in the
abdomen, 2 ultrasonographic views (transverse and
longitudinal) were obtained at each of 4 sites (just
caudal to the xiphoid process, on the midline over the
urinary bladder, and at the left and right flank regions).
Results—In the 100 dogs evaluated via FAST, free
abdominal fluid was detected in 45 dogs. In 40 of
those 45 dogs, abdominocentesis was performed;
hemoperitoneum and uroperitoneum were diagnosed
in 38 and 2 dogs, respectively. Compared with dogs
that had no free abdominal fluid detected via FAST,
dogs that had free abdominal fluid detected via FAST
had significantly higher heart rates and serum lactate
concentrations and significantly lower PCVs and total
Conclusions and Clinical Relevance—Results indicate
that FAST is a simple and rapid technique that
can be performed on dogs in an emergency setting to
detect intra-abdominal free fluid and can be performed
by veterinary clinicians with minimal previous
ultrasonographic experience. (J Am Vet Med Assoc 2004;225:1198–1204)
Objective—To determine whether multiple organ dysfunction syndrome (MODS) could be identified in dogs with sepsis secondary to gastrointestinal tract leakage, and whether the number of affected organ systems was significantly associated with mortality rate.
Design—Multicenter retrospective case series.
Procedures—Medical records for dogs treated surgically because of sepsis secondary to gastrointestinal tract leakage between 2003 and 2007 were reviewed. Sepsis was diagnosed on the basis of results of bacterial culture of peritoneal fluid, gross evidence of gastrointestinal tract leakage at surgery, or both. Renal dysfunction was defined as a ≥ 0.5 mg/dL increase in serum creatinine concentration after surgery. Cardiovascular dysfunction was defined as hypotension requiring vasopressor treatment. Respiratory dysfunction was defined as a need for supplemental oxygen administration or mechanical ventilation. Hepatic dysfunction was defined as a serum bilirubin concentration > 0.5 mg/dL. Dysfunction of coagulation was defined as prolonged prothrombin time, prolonged partial thromboplastin time, or platelet count ≤ 100,000/μL.
Results—89 (78%) dogs had dysfunction of 1 or more organ systems, and 57 (50%) dogs had MODS. Mortality rate increased as the number of dysfunctional organ systems increased. Mortality rate was 70% (40/57) for dogs with MODS and 25% (14/57) for dogs without.
Conclusions and Clinical Relevance—Results indicated that MODS, defined as dysfunction of at least 2 organ systems, can be identified in dogs with sepsis and that organ system dysfunction increased the odds of death.