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- Author or Editor: Therese E. O'Toole x
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Abstract
Objective—To describe transfusion practices for treatment of dogs undergoing splenectomy for splenic masses.
Design—Retrospective case series.
Animals—542 client-owned dogs.
Procedures—Medical records of dogs that underwent splenectomy for splenic masses at 2 referral institutions were reviewed. Variables of interest were compared between dogs that did and did not undergo transfusion. Multiple logistic regression analysis was performed to assess associations of transfusion with death during hospitalization and with 30- and 180-day survival rates.
Results—Transfusions were administered to 240 of 542 (44%) dogs; packed RBCs were the most frequently administered blood product. On admission, dogs that subsequently received transfusions had higher mean illness severity score, heart rate, respiratory rate, blood lactate concentration, and prothrombin time, with lower mean PCV, platelet count, serum total solids and albumin concentrations, and base deficit than dogs that did not receive transfusions. Hemoperitoneum and malignancy, especially hemangiosarcoma, were more common in the transfusion group. Overall, 500 of 542 (92%) dogs survived to discharge. Dogs that received transfusions had higher odds of death or euthanasia while hospitalized and lower odds of surviving to 30 or 180 days after hospital discharge than dogs that did not.
Conclusions and Clinical Relevance—Evidence of shock, anemia, and hypocoagulability were apparent triggers for the decision to perform blood transfusion in dogs undergoing splenectomy for splenic masses and were likely attributable to hemoperitoneum and related hypovolemia. Dogs undergoing transfusion more commonly had malignant disease and had greater odds of poor long-term outcome, compared with dogs that did not undergo transfusion.
Abstract
Objective—To describe transfusion practices for treatment of dogs hospitalized because of traumatic injuries.
Design—Retrospective case series.
Animals—125 client-owned dogs.
Procedures—Medical records of dogs that sustained trauma and were hospitalized for ≥ 24 hours after emergency stabilization were reviewed. Admission characteristics and transfusion-specific data were assessed. Receiver operating characteristic curves were plotted to evaluate diagnostic utility of PCV and serum total solids concentration as predictors of transfusion in the study population.
Results—45 of 125 (36%) dogs received transfusions. Packed RBCs were the most commonly administered blood product (42/45 [93%]). Common reasons for transfusion included perioperative hemodynamic support and treatment of shock or worsening anemia. Dogs that underwent transfusion had higher mean heart rate, blood lactate concentration, and animal trauma triage scores, with lower mean PCV, serum total solids concentration, and rectal temperature at admission than dogs that did not undergo transfusion. Total solids concentration and PCV at admission were specific but insensitive predictors of subsequent transfusion. Most (109/125 [87%]) dogs survived to hospital discharge. Significantly fewer dogs that had transfusions survived, compared with dogs that did not have transfusions. Seven of 10 dogs that received massive transfusions survived to discharge.
Conclusions and Clinical Relevance—Apparent clinical triggers for the decision to perform blood transfusion in dogs hospitalized following traumatic injury included evidence of shock or worsening anemia on admission and requirement for perioperative hemodynamic optimization. Although dogs that received transfusions had a lower survival rate than dogs that did not, this was likely attributable to greater severity of injuries in the transfusion group.
Abstract
Objective—To evaluate whole blood hemostasis by means of thromboelastography in dogs with primary immune-mediated hemolytic anemia (IMHA) to determine whether these dogs had evidence of hypercoagulability prior to the administration of immunosuppressant medications, blood transfusion products, or anticoagulant agents.
Design—Evaluation study.
Animals—11 client-owned dogs admitted to a teaching hospital for management of primary IMHA and 20 clinically normal dogs.
Procedures—Citrated whole blood samples were obtained from all dogs for performance of kaolin-activated thromboelastography. Citrated plasma was harvested from blood samples of dogs with IMHA for plasma-based coagulation testing, including activated partial thromboplastin time, prothrombin time, D-dimer concentration, fibrinogen concentration, and antithrombin activity.
Results—Compared with control dogs, dogs with primary IMHA had evidence of hypercoagulability as indicated by a significantly lower median (range) clot formation time (0.8 seconds [0.8 to 2.0 seconds] vs 1.9 seconds [1.3 to 3.8 seconds]), higher median angle (76.1° [59.2° to 84.6°] vs 64.0° [45.4° to 71.0°]), higher median maximum amplitude (75.9 mm [66.3 to 86.3 mm] vs 55.7 mm [49.9 to 63.6 mm]), and higher median clot strength (15,000 dyne/cm2 [9,900 to 31,400 dyne/cm2] vs 6,100 dyne/cm2 [4,900 to 8,700 dyne/cm2]).
Conclusions and Clinical Relevance—Dogs with primary IMHA had hypercoagulability as demonstrated by thromboelastography at the time of initial diagnosis and prior to treatment. Such hypercoagulability may be a precursor to clinically evident thrombosis as a complication of the disease process.
Abstract
Objective—To determine the perioperative mortality rate, causes of death, and risk factors for perioperative death in dogs undergoing splenectomy for splenic mass lesions.
Design—Retrospective case series.
Animals—539 dogs.
Procedures—Medical records of dogs that underwent splenectomy for known splenic masses were reviewed. Perioperative mortality rate and causes of death were determined. Associations between potential prognostic factors and perioperative death were evaluated by multivariable logistic regression analysis.
Results—41 of 539 (7.6%) dogs died during the perioperative period. Thrombotic and coagulopathic syndromes and uncontrolled bleeding from metastatic lesions were the most common causes of death. Of the variables selected for multivariable analysis, platelet count at admission, whether PCV at admission was < 30%, and development of ventricular arrhythmias during surgery were significantly associated with outcome. For each decrease in platelet count of 10,000 platelets/μL, odds of death increased by approximately 6%. For dogs with PCV < 30%, odds of death were approximately twice those for dogs with PCV ≥ 30%, and for dogs that developed intraoperative arrhythmias, odds of death were approximately twice those for dogs that did not.
Conclusions and Clinical Relevance—Marked preoperative thrombocytopenia or anemia and development of intraoperative ventricular arrhythmias were identified as risk factors for perioperative death in dogs with splenic masses. The risk of death may be limited by efforts to prevent thrombotic and coagulopathic syndromes and to control all sources of intra-abdominal hemorrhage.
