Retrospective evaluation of indications, transfusion protocols, and acute transfusion reactions associated with the administration of lyophilized canine albumin: 53 cases (2009-2020).

OBJECTIVES: To describe the administration of lyophilized canine albumin (LCA) and determine the increase in serum albumin concentrations post-LCA transfusion. To describe the incidence and types of acute transfusion reactions (TRs) and associated outcome in dogs presenting to a veterinary teaching hospital. DESIGN: Retrospective and descriptive study from 2009 to 2020. SETTING: University teaching hospital. ANIMALS: Fifty-three client-owned dogs included in the study if they received an LCA transfusion and had vital sign monitoring recorded for at least for 4 hours after starting the LCA transfusion. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The 53 dogs available for study inclusion received 64 LCA transfusions. Signalment; underlying disease; indications for LCA transfusion; pre- and posttransfusion serum albumin concentration; volume, concentration, and dose of LCA; duration of transfusion; administration of other blood products or synthetic colloids; occurrence, timing, and type of TR; length of hospitalization; and outcome were recorded. Serum albumin concentrations increased post-LCA transfusion, with a median dose of 0.56 g/kg and a median posttransfusion serum albumin increase of 3 g/L (0.3 g/dL) (P = 0.008). TRs occurred in 13 of 64 (20.3%) transfusion events. Volume per kilogram, dose (g/kg), concentration, duration of transfusion, and additional administration of synthetic colloids were not associated with TRs. Three (23%) TRs were classified as febrile nonhemolytic transfusion reaction, 5 (38.5%) as transfusion-associated dyspnea (development of respiratory distress and limited diagnostics), and 5 (38.5%) had clinical signs that could not be defined by any 1 TR category. Six (46.1%) of 13 events were nonsevere, 5 (38.5%) were severe, and 2 (15.4%) were life-threatening. CONCLUSIONS: Administration of LCA can be used to increase serum albumin concentrations, although the clinical implications of this increase are unknown. Acute TRs associated with LCA are relatively frequent and can be life-threatening. Careful monitoring is vital.

Knowledge and attitudes towards surgical safety checklists: a survey of veterinary professionals.

OBJECTIVE: To determine the knowledge and use of safe surgical checklists (SSCs) and surgical safety practices (SSPs) in different sectors of veterinary medicine. SAMPLE: 1,235 small animal veterinarians who perform surgery in the United States and Canada. PROCEDURES: An online survey was distributed to veterinarians through social media platforms, specialty listservs, and the Veterinary Information Network. Respondents provided information regarding their role, practice type, as well as knowledge, attitudes, and use of SSCs. Respondents also provided information about performance of SSPs including team introductions; confirmation of antibiotic prophylaxis, patient identity, procedure to be performed; and confirmation of completion of all procedures. RESULTS: A greater proportion of Diplomates of the American College of Veterinary Surgeons (49/77 [64%]) reported using an SSC than other veterinarians (257/1157 [22%]; P < .0001). A greater proportion of veterinarians working in university and multispecialty hospitals reported using a SSC (71/142 [50%]) than in other practice settings (235/1092 [22%]; P < .0001). Use of a SSC correlated with consistent performance of surgical safety practices listed above (P < .0001). Primary care veterinarians commonly reported not using a SSC because they did not know about them (359/590 [61%]). Of the 507 respondents who had ever used a SSC, 333 (66%) believed the checklist had prevented an error or complication. CLINICAL RELEVANCE: Despite widespread knowledge and adoption of SSC use in human medicine, knowledge and use of SSCs is lacking in primary care veterinary practice. Checklist use has previously been shown to decrease post operative complications and in this study was correlated with increased use of SSPs that decreased complications.

Prevalence and factors associated with initial and subsequent shockable cardiac arrest rhythms and their association with patient outcomes in dogs and cats undergoing cardiopulmonary resuscitation: A RECOVER registry study.

OBJECTIVE: To report the prevalence of initial shockable cardiac arrest rhythms (I-SHKR), incidence of subsequent shockable cardiac arrest rhythms (S-SHKR), and factors associated with I-SHKRs and S-SHKRs and explore their association with return of spontaneous circulation (ROSC) rates in dogs and cats undergoing CPR. DESIGN: Multi-institutional prospective case series from 2016 to 2021, retrospectively analyzed. SETTING: Eight university and eight private practice veterinary hospitals. ANIMALS: A total of 457 dogs and 170 cats with recorded cardiac arrest rhythm and event outcome reported in the Reassessment Campaign on Veterinary Resuscitation CPR registry. MEASUREMENTS AND MAIN RESULTS: Logistic regression was used to evaluate association of animal, hospital, and arrest variables with I-SHKRs and S-SHKRs and with patient outcomes. Odds ratios (ORs) were generated, and significance was set at P < 0.05. Of 627 animals included, 28 (4%) had I-SHKRs. Odds for I-SHKRs were significantly higher in animals with a metabolic cause of arrest (OR 7.61) and that received lidocaine (OR 17.50) or amiodarone (OR 21.22) and significantly lower in animals experiencing arrest during daytime hours (OR 0.22), in the ICU (OR 0.27), in the emergency room (OR 0.13), and out of hospital (OR 0.18) and that received epinephrine (OR 0.19). Of 599 initial nonshockable rhythms, 74 (12%) developed S-SHKRs. Odds for S-SHKRs were significantly higher in animals with higher body weight (OR 1.03), hemorrhage (OR 2.85), or intracranial cause of arrest (OR 3.73) and that received epinephrine (OR 11.36) or lidocaine (OR 18.72) and significantly decreased in those arresting in ICU (OR 0.27), emergency room (OR 0.29), and out of hospital (OR 0.38). Overall, 171 (27%) animals achieved ROSC, 81 (13%) achieved sustained ROSC, and 15 (2%) survived. Neither I-SHKRs nor S-SHKRs were significantly associated with ROSC. CONCLUSIONS: I-SHKRs and S-SHKRs occur infrequently in dogs and cats undergoing CPR and are not associated with increased ROSC rates.

The influence of leukoreduction on the acute transfusion-related complication rate in 455 dogs receiving 730 packed RBCs: 2014-2017.

OBJECTIVE: To investigate the influence of prestorage leukoreduction of packed RBCs (pRBCs) on acute transfusion-related complication rate in dogs. SETTING: Two private referral hospitals. DESIGN: Retrospective case study. ANIMALS: Four hundred and fifty-five dogs receiving nonleukoreduced (nLR) or leukoreduced (LR) pRBC between January 1, 2014 and July 31, 2017. MEASUREMENTS AND MAIN RESULTS: Transfusions were retrospectively reviewed to record data about the patient, donor, unit, transfusion event, acute complications, hospital discharge, and cause of death. Of 730 transfusion events in 455 dogs, 288 used LR pRBC and 442 used nLR pRBC. There was a 18.9% (138/730) overall complication rate. Seven (0.96%) complications were life-threatening. The most common complications were pyrexia (5.6%), gastrointestinal signs (4.9%), and hemolysis with no other signs (4.1%). Pyrexia with no other clinical signs, consistent with a febrile nonhemolytic transfusion reaction (FNHTR), occurred in 3.2% of transfusion events. There was a significant (P = 0.03) decrease in the rate of FNHTR with LR pRBC (1%) versus nLR pRBC (4.5%). Use of LR pRBC did not decrease in-hospital mortality. The odds of any complication, hemolysis only, FNHTR, and more severe complications increased with pRBC age. Leukoreduction did not decrease the impact of pRBC age on these complications. Use of older pRBC did not increase the incidence of life-threatening complications or mortality. Dogs receiving pRBC for blood loss were more likely to have gastrointestinal and more severe complications than those dogs that had hemolysis. The effect of pRBC unit age on complications was not influenced by the underlying reason for transfusion. Dogs that received a previous transfusion were more likely to have respiratory complications. CONCLUSION: In this study, the use of LR pRBC was associated with a decreased rate of FNHTR but no other complications. Unit age was associated with the incidence of hemolysis, FNHTR, and complication severity but not the rate of life-threatening complications or mortality.

Medical errors: Experiences, attitudes and perspectives of incoming and outgoing final-year veterinary students in the USA.

BACKGROUND: Medical errors have an impact on veterinary patient safety. Studies in human medicine suggest that students can help prevent medical errors. However, there are no studies that address the role of veterinary students in patient safety. METHODS: An electronic survey was distributed to incoming final-year (IFY) and outgoing final-year (OFY) students at the Washington State University College of Veterinary Medicine. Response data were compared between class year groups with a Fisher's exact test and Mann-Whitney U test. RESULTS: The response rate was 26.8% (70/261). Most respondents (85.7%) reported being present during a medical error, and 60% reported causing a medical error. The OFY group indicated lower agreement with documenting an error in the patient record and whether all errors should be disclosed. The IFY group felt more distress surrounding potential errors and sequential career implications. Compared with the IFY group, the OFY group agreed more that errors occur frequently in veterinary medicine and disagreed more that hospital staffing is adequate to ensure patient safety. Open responses recognised a need for communication training and identified that the OFY group regarded errors more actionably, whereas the IFY group viewed errors more emotionally. CONCLUSION: Most veterinary students will experience medical errors prior to graduation, but some lack clarity around appropriate disclosure and documentation. Additional training on medical errors and error disclosure should be provided to veterinary students.

Lack of association between feline AB blood groups and retroviral status: a multicenter, multicountry study.

OBJECTIVES: The relationship between blood group antigens and disease has been studied in humans. Blood types have been associated with both decreased and increased rates of various infections. In addition, blood group expression has been shown to vary with some cancers and gastrointestinal diseases. The objective of this study was to explore whether there is a relationship between blood type and retroviral infections in cats. METHODS: Case records from a veterinary research laboratory, veterinary teaching hospitals and veterinary blood banks were retrospectively searched for cats where both blood type and retroviral status (feline leukemia [FeLV], feline immunodeficiency virus [FIV] or both) were listed (part 1). In addition, a sample of 33 cats with confirmed FIV infection was genotyped to determine blood groups (part 2). RESULTS: In part 1, 709 cats were identified, 119 of which were positive for retroviral infection. Among all cases, 621 were type A (87.6%), 68 were type B (9.6%) and 20 were type AB (2.8%). There was no relationship between overall retroviral status (positive/negative) and blood type (P = 0.43), between FeLV status and blood type (P = 0.86) or between FIV status and blood type (P = 0.94). There was no difference in the distribution of blood types between cats that were healthy and typed as possible blood donors vs sick cats that were typed prior to a possible transfusion (P = 0.13). In part 2, of the 33 FIV-infected cats, all blood group genotypes were identified, although this test did not discriminate type A from type AB. CONCLUSIONS AND RELEVANCE: No relationship was identified between feline retroviral status and blood type in this study. The relationship between blood type and other disease states requires further study in veterinary patients.

Association of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS). Part 1: Definitions and clinical signs.

OBJECTIVE: To use a systematic, evidence-based consensus process to develop definitions for transfusion reactions in dogs and cats. DESIGN: Evidence evaluation of the literature was carried out for identified transfusion reaction types in dogs and cats. Reaction definitions were generated based on synthesis of human and veterinary literature. Consensus on the definitions was achieved through Delphi-style surveys. Draft recommendations were made available through industry specialty listservs and comments were incorporated. RESULTS: Definitions with imputability criteria were developed for 14 types of transfusion reactions. CONCLUSIONS: The evidence review and consensus process resulted in definitions that can be used to facilitate future veterinary transfusion reaction research.

Association of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS) Part 2: Prevention and monitoring.

OBJECTIVE: To systematically review available evidence to develop guidelines for the prevention of transfusion reactions and monitoring of transfusion administration in dogs and cats. DESIGN: Evidence evaluation of the literature (identified through Medline searches through Pubmed and Google Scholar searches) was carried out for identified transfusion reaction types in dogs and cats. Evidence was evaluated using PICO (Population, Intervention, Comparison, Outcome) questions generated for each reaction type. Evidence was categorized by level of evidence (LOE) and quality (Good, Fair, or Poor). Guidelines for prevention and monitoring were generated based on the synthesis of the evidence. Consensus on the final recommendations and a proposed transfusion administration monitoring form was achieved through Delphi-style surveys. Draft recommendations and the monitoring form were made available through veterinary specialty listservs and comments were incorporated. RESULTS: Twenty-nine guidelines and a transfusion administration monitoring form were formulated from the evidence review with a high degree of consensus CONCLUSIONS: This systematic evidence evaluation process yielded recommended prevention and monitoring guidelines and a proposed transfusion administration form. However, significant knowledge gaps were identified, demonstrating the need for additional research in veterinary transfusion medicine.

Association of Veterinary Hematology and Transfusion Medicine (AVHTM) transfusion reaction small animal consensus statement (TRACS). Part 3: Diagnosis and treatment.

OBJECTIVE: To systematically review available evidence to develop guidelines for diagnosis and treatment of transfusion-associated reactions in dogs and cats. DESIGN: Standardized and systemic evaluation of the literature (identified through Medline via PubMed and Google Scholar searches) was carried out for identified transfusion reaction types in dogs and cats. The available evidence was evaluated using PICO (Population, Intervention, Comparison, Outcome) questions generated for each reaction type. The evidence was categorized by level of evidence (LOE) and quality (Good, Fair, or Poor). Guidelines, diagnostic, and treatment algorithms were generated based on the evaluation of the evidence. Consensus on the final guidelines was achieved through Delphi-style surveys. Draft recommendations were disseminated through veterinary specialty listservs for review and comments, which were evaluated and integrated prior to final publication. RESULTS: Medline via PubMed and Google Scholar databases were searched. There were 14 Population Intervention Comparison Outcome questions identified and corresponding worksheets were developed focusing on the diagnosis and treatment of transfusion-associated reactions in dogs and cats. Fourteen guidelines and four algorithms were developed with a high degree of consensus. CONCLUSIONS: This systematic evidence evaluation process yielded recommended diagnostic and treatment algorithms for use in practice. However, significant knowledge gaps were identified, demonstrating the need for additional research in veterinary transfusion medicine.

Retrospective evaluation of urinary indwelling catheter type in cats with urethral obstruction (January 2014 to December 2014): 91 cases.

OBJECTIVE: To investigate the influence of urinary catheter type on recurrence rate (rUO) in cats with urethral obstruction. DESIGN: Retrospective study. SETTING: Two private referral hospitals. ANIMALS: Ninety-one cats diagnosed with urethral obstruction treated with a 3.5-Fr Argyle (AR) or 3.5-Fr red rubber (RR) indwelling catheter presenting in 2014. MEASUREMENTS AND MAIN RESULTS: One hundred sixty-six cats were identified using diagnostic code search with 91 cats meeting inclusion criteria. All were treated with IV fluids, buprenorphine, prazosin, and an indwelling urethral catheter with a closed collection system. Catheter groups did not differ statistically in baseline characteristics, medication treatment, or catheterization time. Follow-up was available for 91 cats at 24 hours, 86 cats at 7 days, and 84 cats at 30 days. There was no statistical difference in rUO between cats with different catheter types at any time in this retrospective study. CONCLUSIONS: No difference in rUO was found in cats treated for urethral obstruction with a 3.5-Fr AR or RR catheter, however, due to the retrospective nature of this study the inability to detect a difference may be due to the small sample size of this study. Recurrent urethral obstruction in this study at 30 days was 11%.

Retrospective evaluation of the indications, safety and effects of fresh frozen plasma transfusions in 36 cats (2014-2018).

OBJECTIVES: The goals of this study were to classify the indications, risks, effects on coagulation times and outcomes of cats receiving fresh frozen plasma (FFP) transfusions in clinical practice. METHODS: This was a retrospective study of FFP transfusions administered in two referral hospitals from 2014 to 2018. Transfusion administration forms and medical records were reviewed. Information was collected on indication, underlying condition, coagulation times and signs of transfusion reactions. Seven-day outcomes after FFP administration were also evaluated when available. RESULTS: Thirty-six cats received 54 FFP transfusions. Ninety-four percent of cats were administered FFP for treatment of a coagulopathy. Twenty cats had paired coagulation testing before and after FFP administration. Eighteen of these cats had improved coagulation times after receiving 1-3 units of FFP. Eight of the 36 cats had probable transfusion reactions (14.8% of 54 FFP transfusions). These reactions included respiratory signs (n = 4), fever (n = 2) and gastrointestinal signs (n = 2). Five of the eight cats with probable reactions had received packed red blood cells contemporaneously. Overall mortality rate during hospitalization was 29.7%, with 52.8% (n = 19/36) of cats confirmed to be alive 7 days after discharge. CONCLUSIONS AND RELEVANCE: This retrospective study shows that FFP transfusions improve coagulation times in cats. Transfusion reactions are a risk, and risk-benefit ratios must be measured prior to administration and possible reactions monitored. In the study cats, the FFP transfusions appeared to be a tolerable risk given the benefit to prolonged coagulation times.

Initial treatment factors associated with feline urethral obstruction recurrence rate: 192 cases (2004-2010).

OBJECTIVE: To evaluate the association of treatment factors during initial urinary catheterization (IUC) of cats with recurrence of urethral obstruction at 24 hours and 30 days after catheter removal. DESIGN: Retrospective case series. ANIMALS: 192 male cats with urethral obstruction that were treated at an emergency and specialty center from 2004 through 2010. PROCEDURES: Data were obtained from the cats' medical records. Duration of indwelling catheterization, catheterization with a 5F versus 3.5F urinary catheter, treatment with phenoxybenzamine versus prazosin, consistent administration of pain medication, and treatment with meloxicam or antimicrobials during IUC were reviewed for association with rate of recurrent urethral obstruction (rUO). RESULTS: Overall rUO rates were 10.94% (21/192 cats) at 24 hours and 23.57% (37/157 cats) at 30 days after IUC. At 24 hours and 30 days after IUC, rUO developed in 10 of 140 (7.14%) and 20 of 110 (18.18%) prazosin-treated cats, respectively, compared with 10 of 46 (21.74%) and 16 of 41 (39.02%) phenoxybenzamine-treated cats, respectively. Reobstruction developed following use of a 5F or 3.5F urinary catheter in 11 of 58 (18.97%) and 7 of 105 (6.67%) cats, respectively, through 24 hours. There was no association between rUO and duration of urinary catheterization, administration of antimicrobials or meloxicam, or consistent administration of pain medication during IUC. CONCLUSIONS AND CLINICAL RELEVANCE: At 24 hours and 30 days after IUC, rUO rates in prazosin-treated cats were significantly lower than rates in phenoxybenzamine-treated cats. Reobstruction rate at 24 hours was significantly lower when a 3.5F versus 5F urinary catheter was used.

Use of fresh platelet concentrate or lyophilized platelets in thrombocytopenic dogs with clinical signs of hemorrhage: a preliminary trial in 37 dogs.

OBJECTIVE: To examine the safety and feasibility of using lyophilized platelets (LYO) and fresh platelet concentrate (FRESH) in bleeding thrombocytopenic dogs. DESIGN: Preliminary prospective randomized clinical trial. SETTING: Two private referral centers and 3 university teaching hospitals. ANIMALS: Thirty-seven dogs with a complaint of hemorrhage associated with thrombocytopenia (platelet count <70 × 10(9) /L [70,000/µL], a hematocrit >15%, and that had received neither vincristine nor platelet-containing transfusions within 72 h of enrollment were studied. INTERVENTIONS: Animals were randomized to receive LYO or FRESH, dosed according to weight. Physical examination, complete blood counts, and coagulation testing (prothrombin time and activated partial thromboplastin time) were performed at enrollment. Physical examinations were also performed immediately post transfusion, and at 1 and 24 h after transfusion. Complete blood counts were repeated immediately post transfusion and at 24 h. Collected data included bleeding score (BLS), response to transfusion, adverse reactions, hospitalization time, need for additional transfusions, survival to discharge, and 28-d survival. MEASUREMENTS AND MAIN RESULTS: Twenty-two dogs received LYO and 15 received FRESH. There was no difference between groups in age, weight, BLS, platelet count, white blood cell count, hematocrit, or presence of melena. There was no difference between groups in transfusion reaction rates, the need for additional transfusions, 24-h BLS, hospitalization time, survival to discharge, or 28-d survival. CONCLUSIONS: Transfusion of LYO was feasible and associated with a low transfusion reaction rate in this limited study of thrombocytopenic canine patients presenting with mild-to-severe hemorrhage. LYO were easy to use and provided storage advantages over FRESH. Further study of this product, including examination of efficacy and platelet life span, is warranted.