Our quest for creating a space that is welcoming to all: A commentary from the American College of Veterinary Emergency and Critical Care Diversity, Equity, and Inclusion Committee.

Diversity, equity, and inclusion (DEI) are crucial elements of successful veterinary emergency and critical care practices across the world. Embracing the elements of DEI creates a work environment that is safe and welcoming for all the members of the team. The American College of Veterinary Emergency and Critical Care DEI committee was formed to enhance and support efforts to increase racial diversity in veterinary emergency and critical care, as well as provide resources that will generate DEI practices across the country. This article provides an overview of the vision of the committee and some of the steps that have been taken to create a welcoming space for all represented in veterinary emergency and critical care.

Development and implementation of a hemovigilance program at a university veterinary teaching hospital.

OBJECTIVE: To describe the development and implementation of a small animal hemovigilance program at a university veterinary teaching hospital. DESIGN: Retrospective observational descriptive study performed between October 2014 and March 2019. SETTING: University teaching hospital. ANIMALS: Dogs and cats receiving blood product transfusions . INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:  A hemovigilance working group composed of veterinary specialists in clinical pathology, internal medicine, and emergency and critical care was established. This group developed evidence-based definitions of transfusion reactions, reaction classification systems, and a transfusion reaction reporting form. The reporting form contained sections for patient information, transfusion information, administration details, and reaction details. Reaction events were classified by reaction type, severity grade, and imputability to the transfusion. Following implementation of the hemovigilance program, transfusion reaction data were collected and examined for the period spanning October 2014 and March 2019. During the study period, 718 canine transfusions (4 whole blood, 400 packed RBC [pRBC], 300 fresh frozen plasma [FFP], 7 platelet rich plasma, and 7 cryoprecipitate) and 124 feline transfusions (5 whole blood, 95 pRBC, and 24 FFP) were administered. There were 32 total reactions (27 canine and 5 feline), with the most common reaction being febrile nonhemolytic transfusion reactions (19/32; 59%). The incidence rate of transfusion reactions was found to be 3.8% in dogs and 4.0% in cats. For the confirmed reactions, classification criteria for case definition, reaction severity grade, and imputability were able to be determined and recorded. This allowed targeted interventions to be implemented in order to potentially reduce future reactions. CONCLUSIONS: A hemovigilance program can be instituted successfully in a veterinary hospital setting and once developed, standardized reporting tools could be utilized by multiple hospitals and provide the basis for more widespread reaction reporting in veterinary medicine.

Dal-induced red blood cell incompatibilities in a Doberman Pinscher with von Willebrand factor deficiency and ehrlichiosis.

OBJECTIVE: To describe a complex case involving the management of a dog with von Willebrand disease (vWD), active ehrlichiosis infection, nonregenerative anemia, and blood type incompatibility related to the Dal antigen. CASE SUMMARY: A 13-week-oldintact male Doberman Pinscher weighing 7.2 kg was presented to the emergency service for a previous hemorrhaging event and progressive nonregenerative anemia. The dog had received a fresh whole blood transfusion 8 days prior to presentation due to severe anemia. Upon presentation, the puppy was tachycardic, and his mucous membranes were pale. A CBC revealed a nonregenerative anemia with a PCV of 0.11 L/L (11%). von Willebrand factor deficiency was suspected and later confirmed. The dog's blood type was dog erythrocyte antigen (DEA) 1 positive, but cross-matching to 4 RBC units, both DEA 1 positive and negative, failed to yield any compatible units. Antibody against a possible Dal RBC antigen was suspected, and 11 blood donors (Dalmatians and Dobermans) were cross-matched to find 2 compatible donors. After an uneventful fresh whole blood transfusion, a bone marrow biopsy revealed a hypocellular bone marrow and erythroid hypoplasia. A SNAP4DxPlus test and subsequent polymerase chain reaction (PCR) testing were positive for Ehrlichia ewingii and E. canis. Treatment with doxycycline was started, and the PCV was 0.17 L/L (17%) at discharge. At the 1-week follow-up, the PCV was 0.24 L/L (24%), and the puppy was doing well. NEW OR UNIQUE INFORMATION PROVIDED: This is a unique case of a dog presenting with several challenging disorders, including vWD resulting in hemorrhage, ehrlichiosis potentially contributing to a nonregenerative anemia, and a blood type incompatibility due to the Dal antigen. Doberman Pinschers have a high prevalence of vWD- and Dal-negative phenotype, which emphasizes the value of cross-matching and the recognition of antigen prevalence in specific breeds.

Development and assessment of a formal learning module to educate veterinary students in an intensive care unit about transfusion reactions.

OBJECTIVE: To develop and assess the instructional efficacy of an online learning module on transfusion reactions in small animals and to evaluate participants' satisfaction of the module. DESIGN: Randomized controlled trial. SETTING: University teaching hospital. SUBJECTS: A total of 55, fourth-year veterinary students, 27 in a treatment group that received the learning module plus standard rotation training and 28 in a control group (no module) who received only standard training INTERVENTIONS: Students received a pretest on transfusion reactions followed by administration of a transfusion reaction learning module covering recognition, treatment, prevention, case examples, and self-assessment questions for 6 common transfusion reactions. Students also received a module satisfaction survey, a post-test at 2 weeks post-module, and a retention test at 6 weeks post-module. MEASUREMENTS AND MAIN RESULTS: Previous transfusion medicine exposure did not affect pretest scores and there was no difference in pretest scores between groups. The module group scored higher on the post-test (P < 0.001) and retention test (P = 0.002) than the control group. Mean post-test scores were 74.4% and 57.7% and mean retention test scores were 80.6% and 56.5% for the module and control groups, respectively. The module group scored higher on posttest and retention questions involving reaction recognition (P < 0.001). Students were overall very satisfied with the module with an average score of 4.8 (1-5). CONCLUSIONS: A transfusion reaction instructional module can be delivered successfully to veterinary students on an ICU-based clinical rotation. Students taking the module scored significantly better on post-assessments up to 6 weeks after module administration as compared to students receiving only conventional clinical rotation training.

Procoagulant phospholipid concentration in canine erythrocyte concentrates stored with or without prestorage leukoreduction.

OBJECTIVE: To evaluate canine erythrocyte concentrates (ECs) for the presence of procoagulant phospholipid (PPL), determine whether PPL concentration changes during the course of storage of ECs, and ascertain whether prestorage leukoreduction (removal of leukocytes via gravity filtration) reduces the development of PPL. SAMPLE: 10 whole blood units (420 g each) collected from 10 random-source, clinically normal dogs (1 U/dog). PROCEDURES: The dogs were randomized to 1 of 2 groups. Of the 10 whole blood units collected, 5 were processed through a standard method, and 5 underwent leukoreduction. Whole blood units were processed to generate ECs, from which aliquots were aseptically collected from each unit weekly for 5 weeks. Supernatants from the concentrates were evaluated for procoagulant activity, which was converted to PPL concentration, by use of an automated assay and by measurement of real-time thrombin generation. RESULTS: Supernatants from stored canine ECs contained procoagulant activity as measured by both assays. In general, the PPL concentration gradually increased during the storage period, but leukoreduction reduced the development of increased procoagulant activity over time. CONCLUSIONS AND CLINICAL RELEVANCE: The presence of PPL in canine ECs may be associated with procoagulant and proinflammatory effects in vivo, which could have adverse consequences for dogs treated with ECs.

The effect of a pre-anesthetic infusion of amino acids on body temperature, venous blood pH, glucose, creatinine, and lactate of healthy dogs during anesthesia.

OBJECTIVE: To evaluate the effect of preanesthetic, intravenous (IV) amino acids on body temperature of anesthetized healthy dogs. STUDY DESIGN: Randomized, experimental, crossover study. ANIMALS: Eight mixed-breed dogs approximately 2 years of age weighing 20.7 ± 2.1 kg. METHODS: Dogs received 10% amino acid solution (AA) or 0.9% saline (SA) IV at 5 mL kg(-1) over 60 minutes. Body temperature (BT) was recorded at 5 minute intervals during infusions. Dogs were then anesthetized with sevoflurane for 90 minutes. BT was recorded at 5 minute intervals during anesthesia. Jugular blood samples were analyzed for pH, glucose, creatinine, and lactate concentrations at baseline, after infusion, after anesthesia and after 24 hours. RESULTS: BT at conclusion of infusion decreased -0.34 ± 0.42 °C in group AA and -0.40 ± 0.38 °C in group SA and was not different between groups (p = 0.072). BT decreased 2.72 ± 0.37 °C in group AA and 2.88 ± 0.26 °C in group SA after anesthesia and was different between groups (p < 0.05). Creatinine in group AA was increased immediately after infusion (p < 0.0001) and at 24 hours (p < 0.0001). There were no differences between groups for other parameters. Values for both groups were never outside the clinical reference ranges. CONCLUSIONS AND CLINICAL RELEVANCE: In healthy dogs, preanesthetic IV infusion of amino acids attenuated heat loss compared to controls, however, the amount attenuated may not be clinically useful. Further studies are warranted to determine if nutrient-induced thermogenesis is beneficial to dogs undergoing anesthesia.

Contrast-enhanced multidetector computed tomography to diagnose pulmonary thromboembolism in an awake dog with pyothorax.

OBJECTIVES: To (1) describe the use of contrast-enhanced multidetector computed tomography (CE-MDCT) for identifying pulmonary thromboembolism (PTE) in an awake dog with pyothorax, (2) report the first documented case of PTE associated with pyothorax in veterinary medicine, and (3) review diagnostic imaging modalities and therapeutic options for PTE. CASE SUMMARY: A 5-year, 4-month-old female neutered Labrador Retriever was presented for respiratory distress secondary to a pyothorax. The dog underwent thoracic exploratory surgery in which no underlying etiology was identified. Aerobic bacterial culture grew Streptococcus canis. The patient remained hypoxemic despite thoracocentesis and surgery. CE-MDCT was performed without general anesthesia and showed luminal-filling defects in the right cranial and right and left caudal lobar primary pulmonary arteries consistent with PTE. Anticoagulant therapy using unfractionated heparin was initiated. The dog responded well and was discharged 3 days postoperatively. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first reported case of PTE diagnosed in a dog with pyothorax using CE-MDCT.

Cytokine concentration in stored canine erythrocyte concentrates.

OBJECTIVE: To evaluate the effect of leukoreduction (LR) as compared to standard nonleukoreduced (NLR) units on cytokine concentrations in canine erythrocyte concentrates during regular storage time. DESIGN: Randomized, experimental study. SETTING: University teaching hospital. ANIMALS: Ten random-source research dogs. INTERVENTIONS: One unit of whole blood was collected from each dog and randomized to standard processing (NLR, n = 5) or prestorage LR (n = 5). All units were stored at 4°C. Samples were aseptically collected from each unit weekly for 5 weeks. On day 35, 1 mL of blood was collected from each unit and submitted for aerobic culture. MEASUREMENT AND MAIN RESULTS: An ELISA assay was used to analyze the concentrations of IL-1ß, IL-8, TNF-α, and IL-10. There were no significant effects of either group or storage time for IL-1ß, IL-10, or TNF-α. IL-8 concentration was significantly increased over the storage period in NLR units, and was significantly higher compared to LR units on days 28 and 35. Aerobic culture was negative on all units. CONCLUSIONS: This study demonstrated a marked, storage time-dependent accumulation of IL-8 in canine erythrocyte concentrates. Prestorage LR attenuated the accumulation of IL-8. This chemokine may contribute to the proinflammatory effects of transfusion of stored erythrocyte concentrates.

Treatment of ibuprofen toxicosis in a dog with IV lipid emulsion.

A 3 yr old spayed female mixed-breed dog weighing 19.4 kg was evaluated for ingestion of 1,856 mg/kg (180 tablets) of ibuprofen, a human formulated nonsteroidal anti-inflammatory drug (NSAID). At the time of presentation, the patient was alert and hypersalivating, but her mental status rapidly declined to obtunded, stuporous, and then comatose within 30 min of presentation. Initial treatment included supportive therapy with prostaglandin analogs and antiemetics. An IV lipid emulsion (ILE) was administered as a bolus, followed by a constant rate infusion. Clinical signs began to improve approximately 3 hr after completion of the lipid infusion. The patient required supportive care for 3 days before discharge. This case report demonstrates the use of ILE for treatment of ibuprofen toxicosis in a dog. ILE infusion may be a therapeutic option for patients with toxicosis due to lipid-soluble drugs.

Microparticles in stored canine RBC concentrates.

BACKGROUND: Transfusion of RBC concentrates may cause adverse effects in the recipient, particularly when stored > 2 weeks. Prestorage removal of WBCs and platelets (leukoreduction, LR) improves clinical outcome in the human recipient. As blood ages during storage, progressive alterations in the structure and function of the cells occur. Changes in cell membranes may lead to formation of microparticles (MPs) in stored blood. OBJECTIVES: The aim of the study was to quantify MP concentration in supernatants from canine RBC concentrates from 11 clinically healthy dogs. METHODS: Whole blood units (n = 11) were collected and randomized either to be stored without LR (n = 5), or to be subject to prestorage LR (n = 6). Whole blood was processed for the generation of RBC concentrates, from which aliquots were aseptically collected weekly for 5 weeks. Supernatants from the concentrates were evaluated for phosphatidylserine-expressing MPs by flow cytometry using staining with Annexin-V-phycoerythrin. RESULTS: Microparticle counts were similar between non-LR and LR units on storage days 0 and 7, but were significantly higher in non-LR units on days 14, 21, 28, and 35. MPs increased during the 35-day storage by a mean (SD) of 1.8 (1.4)-fold in LR units and 5.5 (3.1)-fold in non-LR units. CONCLUSIONS: There was marked formation of phosphatidylserine-expressing MPs during storage beyond 7 days in canine RBC concentrates. Prestorage LR attenuated the generation of MPs.