Effect of early administration of tranexamic acid on ongoing haemorrhage in dogs with non-surgically treated haemoabdomen.

INTRODUCTION: Tranexamic acid (TXA) is an antifibrinolytic drug used for the prophylaxis and treatment of haemorrhage of various origin. This retrospective study investigated the effect of TXA on ongoing bleeding in dogs with nonsurgically treated haemoabdomen. The study population consisted of 48 dogs treated in the period 2009-2020 at the Small Animal Clinic of the Vetsuisse Faculty of Zurich. Twenty-eight of 48 dogs were treated with 20 mg/kg TXA IV within 3h of diagnosis of haemoabdomen. Dogs treated with and without TXA were monitored over 48 hours for signs of ongoing haemorrhage. Ongoing haemorrhage was defined as an increase in abdominal fluid accumulation, a decrease in haematocrit of >5% over time or need for surgical exploration after at least 12 hours of medical treatment. Transfusion requirements, cumulative amount of fluid therapy, heart rate, respiratory rate, temperature, systolic and mean arterial pressure, estimate of abdominal fluid identified by FAST analysis, venous haematocrit, abdominal haematocrit, serum albumin, serum lactate and thrombocyte count were extracted from patient records at 6, 12, 24 and 48 hours after diagnosis of haemoabdomen. Groups were comparable at presentation, however dogs of the TXA group showed a significantly lower abdominal haematocrit at presentation (37 vs 45%, P=0,034) and a higher fluid accumulation (P=0,019), both persisting over time. None of the outcome parameters for ongoing haemorrhage was significantly different between groups. Transfusion requirement was low and similar in both groups. Of interest, none of the 16 dogs undergoing thromboelastometry showed hyperfibrinolysis at presentation. We conclude that other mechanisms than antifibrinolytic therapy was responsible for cessation of bleeding in the majority of patients.

INTRODUCTION: L'acide tranexamique (TXA) est un médicament anti fibrinolytique utilisé pour la prophylaxie et le traitement des hémorragies d'origines diverses. Cette étude rétrospective a examiné l'effet du TXA sur les saignements en cours chez les chiens présentant un hémoabdomen traité sans chirurgie. La population étudiée était composée de 48 chiens traités entre 2009 et 2020 à la clinique pour petits animaux de la faculté Vetsuisse de Zurich. Vingt-huit des 48 chiens ont été traités avec 20 mg/kg de TXA IV dans les 3 heures suivant le diagnostic de l'hémoabdomen. Les chiens traités avec et sans TXA ont été surveillés pendant 48 heures pour détecter les signes d'hémorragie en cours. L'hémorragie en cours a été définie comme une augmentation de l'accumulation de liquide abdominal, une diminution de l'hématocrite de >5% dans le temps ou la nécessité d'une exploration chirurgicale après au moins 12 heures de traitement médical. Les besoins transfusionnels, la quantité cumulative de traitement liquidien, la fréquence cardiaque, la fréquence respiratoire, la température, la pression artérielle systolique et moyenne, l'estimation du liquide abdominal identifié par l'analyse FAST, l'hématocrite veineux, l'hématocrite abdominal, l'albumine sérique, le lactate sérique et la numération des thrombocytes ont été extraits des dossiers des patients à 6, 12, 24 et 48 heures après le diagnostic d'hémoabdomen. Les groupes étaient comparables à la présentation, mais les chiens du groupe TXA présentaient un hématocrite abdominal significativement plus faible à la présentation (37 vs 45 %, P=0,034) et une accumulation de liquide plus importante (P=0,019), ces deux phénomènes persistant dans le temps. Aucun des paramètres de résultat pour l'hémorragie en cours n'était significativement différent entre les groupes. Les besoins en transfusion étaient faibles et similaires dans les deux groupes. Il est intéressant de noter qu'aucun des 16 chiens soumis à la thromboélastométrie ne montrait d'hyperfibrinolyse à la présentation. Nous concluons que d'autres mécanismes que le traitement anti fibrinolytique étaient responsables de l'arrêt des saignements chez la majorité des patients.

Rotational thromboelastometry (ROTEM) parameters in dogs with haemoperitoneum and their associations with clinical and laboratory signs.

INTRODUCTION: Rotational thromboelastometry (ROTEM) is a viscoelastic coagulation test that allows the evaluation of haemostasis from clot formation to clot dissolution. The aim of this retrospective study was to describe the changes in haemostasis using ROTEM parameters in dogs presenting with spontaneous or traumatic haemoperitoneum and to evaluate any associations between clinical and laboratory parameters at presentation with the ROTEM. We hypothesized that the dogs would show signs of hypocoagulability and hyperfibrinolysis and that these changes would correlate with the degree of hypoperfusion. Clinical records were searched for a period of 5 years for dogs presenting with a haemoperitoneum und for whom a -ROTEM analysis at presentation was carried out. Forty dogs were identified, and various clinical and laboratory parameter (heart rate, blood pressure, blood glucose, lactate, serum albumin concentration, PCV (venous and abdominal), ionized calcium, pH and base excess) were retrieved. The following ROTEM parameters were analysed: extrinsic clotting time (ExTEM CT), clot formation time (ExTEM CFT), clot firmness (ExTEM MCF) and maximum lysis (ExTEM ML), as well as fibrinogen (FibTEM) CT and MCF. Compared to institutional reference intervals, dogs with haemoabdomen showed prolongation of ExTEM and FibTEM CT, ExTEM CFT and 50% were hypocoagulable and 62% thrombocytopenic. No hyperfibrinolysis could be detected. Multiple linear regression models showed an association between decreased base excess, trauma and ROTEM signs for hypocoagulability. Furthermore, age was associated with a stronger fibrin clot. In conclusion, 50% of the dogs presented hypocoagulable and changes in ROTEM parameters are similar to those seen with consumption coagulopathy. Base excess and trauma were associated with hypocoagulability, while increasing age was associated with a stronger fibrin clot.

INTRODUCTION: La thromboélastométrie rotationnelle (ROTEM) est un test de coagulation viscoélastique qui permet d'évaluer l'hémostase depuis la formation du caillot jusqu'à sa dissolution. Le but de cette étude rétrospective était de décrire les changements de l'hémostase à l'aide des paramètres ROTEM chez des chiens présentant un hémopéritoine spontané ou traumatique et d'évaluer d'éventuelles association entre les paramètres cliniques et de laboratoire lors de la présentation avec le ROTEM. Nous avons émis l'hypothèse que les chiens montreraient des signes d'hypocoagulabilité et d'hyperfibrinolyse et que ces changements seraient en corrélation avec le degré d'hypoperfusion. Les dossiers cliniques ont été recherchés surune période de 5 ans pour les chiens présentant un hémopéritoine et pour lesquels une analyse ROTEM à la présentation avait été effectuée. Quarante chiens ont été identifiés et divers paramètres cliniques et de laboratoire (fréquence cardiaque, tension artérielle, glycémie, lactate, concentration d'albumine sérique, PCV (veineux et abdominal), calcium ionisé, pH et excès basique) ont été relevés. Les paramètres ­ROTEM suivants ont été analysés: temps de coagulation extrinsèque (ExTEM CT), temps de formation de caillot (ExTEM CFT), fermeté du caillot (ExTEM MCF) et lyse maximale (ExTEM ML), ainsi que fibrinogène ­(FibTEM) CT et MCF. Par rapport aux intervalles de référence admis, les chiens avec hémoabdomen ont montré une prolongation d'ExTEM et FibTEM CT, ExTEM CFT, 50% étaient hypocoagulables et 62% thrombocytopéniques. Aucune hyperfibrinolyse n'a pu être détectée. Plusieurs modèles de régression linéaire ont montré une association entre une diminution de l'excès basique, des traumatismes et des signes ROTEM d'hypocoagulabilité. De plus, l'âge était associé à un caillot de fibrine plus fort. En conclusion, 50% des chiens présentaient une hypocoagulabilité et les changements dans les paramètres ROTEM sont similaires à ceux observés lors de coagulopathie de consommation. Un excès basique et un traumatisme étaient associés à une hypocoagulabilité, tandis qu'une augmentation de l'âge était associée à un caillot de fibrine plus fort.

Effect of 50 mg/kg intravenous tranexamic acid on coagulation assessed by rotational thromboelastometry (ROTEM) in healthy Beagle dogs.

INTRODUCTION: In people, the antifibrinolytic drug tranexamic acid reduces bleeding and the need for blood products with both normal and exaggerated fibrinolysis without increasing the number of thromboembolic events. In dogs, in addition to prevention and treatment of bleeding, higher doses of tranexamic acid can be used to induce vomiting. The objective of this study was to evaluate the effect of a high dose of tranexamic acid on the coagulation of healthy Beagle dogs. A prospective trial was conducted in eight healthy Beagles receiving tranexamic acid for a concurrent trial evaluating different antiemetics. Rotational thromboelastometry (ROTEM) analysis (EXTEM, APTEM, FIBTEM, INTEM) was performed before and 30 minutes after intravenous administration of 50 mg/kg tranexamic acid. ROTEM parameters before and after tranexamic acid administration and between EXTEM and APTEM were compared with Wilcoxon matched-pairs signed rank test and data is presented as median (range). After tranexamic acid administration, FIBTEM clotting time became significantly shorter (p=0.03) from 37 s (28-124 s) to 33 s (27-40 s) and INTEM clot formation time significantly decreased (p=0.02) from 82 s (47-132 s) to 60 s (43-107 s). After tranexamic acid APTEM MCF was significantly weaker (p=0.01) with 45 mm (30-63 mm) than EXTEM MCF with 55 mm (43-69 mm) and than APTEM MCF before tranexamic acid with 55 mm (43-69 mm) (p=0.02). All other analysed parameters including maximum lysis did not change after administration of tranexamic acid. The administration of 50 mg/kg intravenous tranexamic acid resulted in small changes in ROTEM profiles without inducing a hypercoagulable clot. In conclusion, tranexamic acid can safely be administered to healthy dogs with normal coagulation profiles. As an additional finding, APTEM parameters measured in the current study do not support the use of this test in dogs.

INTRODUCTION: Chez l'homme présentant une fibrinolyse normale et exagérée, l'acide tranexamique, un agent antifibrinolytique, réduit les saignements et le besoin de produits sanguins sans augmenter le nombre d'événements thromboemboliques. Chez les chiens, en plus de la prévention et du traitement des saignements, des doses plus élevées d'acide tranexamique peuvent être utilisées pour provoquer des vomissements. L'objectif de cette étude était d'évaluer l'effet d'une dose élevée d'acide tranexamique sur la coagulation de chiens Beagle en bonne santé. Un essai prospectif a été mené chez huit Beagles en bonne santé recevant de l'acide tranexamique dans le cadre d'un essai simultané évaluant différents antiémétiques. Une analyse de la thromboélastométrie rotationnelle (ROTEM) (EXTEM, APTEM, FIBTEM, INTEM) a été réalisée avant et 30 minutes après l'administration intraveineuse de 50 mg/kg d'acide tranexamique. Les paramètres ROTEM avant et après l'administration d'acide tranexamique et entre EXTEM et APTEM ont été comparés au test de rang de Wilcoxon à paires appariées et les données sont présentées sous forme de médiane. Après administration de l'acide tranexamique, le temps de coagulation de FIBTEM est devenu significativement plus court (p = 0,03) de 37 s (28-124 s) à 33 s (27-40 s) et le temps de formation du caillot INTEM a été significativement réduit (p = 0,02) de 82 s (47-132 s) à 60 s (43-107 s). Après l'acide tranexamique, APTEM MCF était significativement plus faible (p = 0,01) avec 45 mm (30-63 mm) que EXTEM MCF avec 55 mm (43-69 mm) et qu'APTEM MCF avant l'acide tranexamique avec 55 mm (43-69 mm) (p = 0,02). Tous les autres paramètres analysés, y compris la lyse maximale, n'ont pas changé après l'administration d'acide tranexamique. L'administration de 50 mg/kg d'acide tranexamique par voie intraveineuse a entraîné de légers changements dans les profils ROTEM sans induire de caillot hypercoagulable. En conclusion, l'acide tranexamique peut être administré en toute sécurité à des chiens en bonne santé présentant des profils de coagulation normaux. Autre constatation supplémentaire, les paramètres APTEM mesurés dans la présente étude n'appuient pas l'utilisation de ce test chez le chien.

Characteristics of hyperfibrinolysis in dogs and cats demonstrated by rotational thromboelastometry (ROTEM).

Hyperfibrinolysis (HFL) is a pathophysiological mechanism that has not been described in dogs or cats extensively. The aim of this study was to describe rotational thromboelastometry (ROTEM) parameters and underlying diagnosis in dogs and cats with HFL and evaluate association with bleeding diathesis. The ROTEM database was retrospectively searched for EXTEM (ROTEM activated with proprietary tissue factor) tracings with maximum lysis at 60min ≥15%. Concurrent ROTEM and plasma coagulation tests, thrombocyte number, diagnosis and survival to hospital discharge were extracted from medical records. Analysis of differences between dogs and cats and of factors associated with bleeding, fulminant HFL (clot breakdown within 30min) and survival to hospital discharge were performed. Hyperfibrinolysis was detected in eight cats presenting with haemoabdomen or haemothorax (n=4/8, 50%) and trauma (n=3/8, 38%) and in 36 dogs with angiostrongylosis (n=12, 33%), neoplasia (n=7, 19%), liver disease (n=4, 11%) and others including apparently healthy dogs (n=3, 8%). Hyperfibrinolysis was associated with prolonged EXTEM and APTEM (EXTEM with added apoprotein for inhibition of HFL) clotting time and decreased FIBTEM (EXTEM with added cytochalasin D for inhibition of thrombocytes) maximum clot firmness (MCF) in dogs and cats and with decreased EXTEM MCF in dogs. Bleeding dogs had significantly hypocoagulable EXTEM tracings. Fulminant HFL was associated with severe hypofibrinogenaemia in dogs (P=0.005) and was not associated with survival to hospital discharge. Evidence of HFL was demonstrated in dogs and cats with bleeding, trauma, parasitic and neoplastic disease. HFL is associated with late and weak clot formation.

Effect of tranexamic acid on intra- and postoperative haemorrhage in dogs with surgically treated hemoperitoneum.

INTRODUCTION: Tranexamic acid (TXA) is an antifibrinolytic drug that is used for uncontrolled bleeding of various origin. This retrospective study investigated the effect of tranexamic acid administration on bleeding tendency in dogs with surgically managed hemoperitoneum. Thirty dogs were treated with (TXA group) and 25 dogs without (CTR group) tranexamic acid prior to surgery. Various parameters (decrease in haematocrit, number of transfusions, shock index and changes in abdominal fluid accumulation) were used for characterization of bleeding tendency and compared between groups. Groups were similar at presentation and prior to surgery. None of the dogs undergoing rotational thromboelastography analysis showed hyperfibrinolysis prior to surgery. Overall transfusion and erythrocyte transfusion requirements as well as bleeding tendency, hospitalisation time and hospital discharge rate were similar between groups. Dogs of the TXA group received significantly more intraoperative plasma transfusions (P=0.013) and showed a higher systolic and mean arterial blood pressure (P=0.002 and 0.050) and lower shock index (P=0.028) with less dogs being in shock (P=0.012) at 24h. In summary, in this study population of dogs with surgically managed spontaneous hemoperitoneum dogs treated with tranexamic acid received more plasma transfusions intraoperatively and showed a lower shock index 24h after presentation. In dogs with surgically treated hemoabdomen tranexamic acid administration prior to surgery does not reduce red blood cell transfusion requirements or postoperative bleeding tendency.

INTRODUCTION: L'acide tranexamique (TXA) est un médicament antifibrinolytique utilisé lors d'hémorragies incontrôlées d'origines diverses. Cette étude rétrospective analyse les effets de l'administration d'acide tranexamique sur la tendance aux hémorragies sur des chiens souffrant d'un hémopéritoine traité chirurgicalement. Trente chiens ont été traités avec de l'acide tranexamique avant chirurgie (groupe TXA) et vingt- cinq ne l'ont pas été (groupe CTR). Divers paramètres (baisse de l'hématocrite, nombre de transfusions, index de choc et modification de l'accumulation de fluide intrapéritonéal) ont été utilisés pour caractériser la tendance à l'hémorragie et effectuer une comparaison entre les deux groups. Les deux groupes étaient semblables lors de l'admission et avant la chirurgie. Aucun des chiens soumis à une analyse par thromboélastométrie rotationnelle ne montrait une hyper fibrinolyse avant la chirurgie. Les besoins en matière de transfusions en général ou de transfusions d'érythrocytes de même que la tendance aux hémorragies, la durée d'hospitalisation et le taux de sortie d'hospitalisation étaient semblables entre les deux groupes. Les chiens du groupe TXA ont reçu significativement plus de transfusions de plasma intra opératives (P=0.013) et présentaient des pressions systoliques et moyennes plus élevées (P=0.002 and 0.050) de même qu'un index de choc plus bas (P=0.028) avec moins de chiens souffrant de choc à 24 heures (P=0.012). En résumé, dans cette étude, la population de chiens présentant un hémopéritoine spontané traité chirurgicalement et ayant reçu de l'acide tranexamique a reçu plus de transfusions de plasma intra opératives et présentait un indexe de choc plus bas 24 heures après l'admission. Chez les chiens traités chirurgicalement pour un hémoabdomen, l'administration d'acide tranexamique avant l'opération n'a pas réduit les besoins en matière de transfusions d'érythrocytes ou la tendance aux hémorragies post-opératoires.

Hyperfibrinolysis diagnosed with rotational thromboelastometry and treated with tranexamic acid in a dog with acute traumatic coagulopathy.

INTRODUCTION: A 4-year old male Australian Cattle Dog involved in a road traffic accident was presented with severe polytrauma to the Small Animal Clinic, University of Zurich. He was presented in hemorrhagic shock, with an initial lactate of 10.3mmol/l and ongoing bleeding from multiple injury sites. Acute traumatic coagulopathy diagnosed with ROTEM within one hour after accident showed marked hypocoagulation and hyperfibrinolysis. Treatment with a total dose of 40mg/kg of tranexamic acid intravenously resulted in successful elimination of hyperfibrinolysis in the following, serially measured ROTEM tracings.

Determination of reference intervals and comparison of venous blood gas parameters using a standard and nonstandard collection method in 51 dogs.

INTRODUCTION: The aim of this study was to determine reference intervals (RI) for venous blood parameters determined with the RAPIDPoint 500 (RP500) blood gas analyzer using blood gas syringes (BGS) and to determine whether immediate analysis of venous blood collected into lithium heparin (LH) tubes can replace anaerobic blood sampling into BGS. The null hypothesis was that canine venous blood samples collected in BGS and in LH tubes are comparable. Jugular blood was collected from 51 healthy dogs into a BGS and a LH tube. The BGS was immediately analyzed followed by the LH tube. The RI were calculated from BGS results. The BGS and LH tubes results were compared using paired t-test or Wilcoxon matched-pairs signed-rank test and Bland-Altman analysis. To assess clinical relevance, the bias between BGS and LH tubes was compared with the allowable total error (TEa). Values derived from LH tubes showed no significant difference for standard bicarbonate (HCO3std), whole blood base excess (BE B), Na, K, Cl, glucose and hemoglobin (tHb). The pH, partial pressure of carbon dioxide and oxygen, actual bicarbonate, extracellular base excess, ionized Ca, anion gap and lactate were significantly (p.

INTRODUCTION: Le but de la présente étude était de déterminer l'intervalle de référence (RI) de l'analyseur de gaz du sang RAPIDPoint 500 (RP500) pour du sang veineux prélevé dans des seringues pour gaz du sang (BGS) ainsi que de voir si une analyse immédiate du sang collecté dans des tubes à l'héparine de lithium (LH) pouvait remplacer la collecte anaérobe dans des seringues BGS. L'hypothèse était que les échantillons sanguins dans les seringues BGS et dans les tubes LH sont comparables. On a prélevé du sang de la veine jugulaire sur BGS et LH chez 51 chiens en bonne santé, on l'a analysé immédiatement avec l'analyseur RP500 et on a calculé les intervalles de référence pour les résultats des prélèvements sur BGS. Les résultats des prélèvements sur BGS et sur LH ont été comparés au moyen de t-test appariés ou d'un test de Wilcoxon signé ainsi que par une analyse de Bland-Altman. Pour juger de la signification clinique, on a comparé le biais entre BGS et LH avec une erreur globale admissible (TEa). Il n'y avait pas de différence significative entre BGS et LH en ce qui concerne le bicarbonate standard, l'excès basique du sang total, le sodium, le potassium, le glucose et l'hémoglobine. Le pH, les pressions partielles de gaz carbonique et d'oxygène, le bicarbonate effectif, l'excès basique extracellulaire, le calcium ionisé, le trou anionique et le lactate étaient significativement (p.

Effects of Hydroxyethyl Starch 130/0.4 on Serum Creatinine Concentration and Development of Acute Kidney Injury in Nonazotemic Cats.

BACKGROUND: Hydroxyethyl-starch (HES) solutions might have renal adverse effects in humans and dogs. OBJECTIVE: To determine if administration of 6% HES-130/0.4 is associated with an increase in serum creatinine concentration and development of acute kidney injury (AKI) in nonazotemic cats. ANIMALS: A total of 62 critically ill cats; 26 HES exposed and 36 unexposed. METHODS: Retrospective cohort study (2012-2015). Serum creatinine concentrations were recorded and changes in serum creatinine concentrations before exposure (baseline) and 2-10 and 11-90 days, respectively, were determined. Development of AKI was defined as a > 150% increase or >26 µmol/L increase in serum creatinine concentration from baseline. Risk factors, such as HES administration, cumulative volume of HES (mL/kg) and number of days of HES administration leading to development of AKI, and change in serum creatinine were analyzed. RESULTS: Cats in the HES cohort received a mean volume of 98.5 ± 76.2 mL/kg (range, 8-278 mL/kg) HES over a median of 4 (range, 1-11) days, resulting in a median dose of 20.1 (range, 8-40.5) mL/kg per day. Short-term %change in serum creatinine concentration (P = 0.40) and development of AKI (P = 0.32) were not significantly different between cohorts. Multivariable logistic regression did not identify HES dose in mL/kg (P = 0.33) and number of days of HES application (P = 0.49) as a risk factor for development of AKI. CONCLUSION AND CLINICAL IMPORTANCE: Hydroxyethyl-starch administration to critically ill nonazotemic cats seems to be safe. A larger prospective study is required to determine the effect of HES administration at higher dosages and for prolonged time periods.

Hyperfibrinolysis and Hypofibrinogenemia Diagnosed With Rotational Thromboelastometry in Dogs Naturally Infected With Angiostrongylus vasorum.

BACKGROUND: The pathomechanism of Angiostrongylus vasorum infection-associated bleeding diathesis in dogs is not fully understood. OBJECTIVE: To describe rotational thromboelastometry (ROTEM) parameters in dogs naturally infected with A. vasorum and to compare ROTEM parameters between infected dogs with and without clinical signs of bleeding. ANIMALS: A total of 21 dogs presented between 2013 and 2016. METHODS: Dogs with A. vasorum infection and ROTEM evaluation were retrospectively identified. Thrombocyte counts, ROTEM parameters, clinical signs of bleeding, therapy, and survival to discharge were retrospectively retrieved from patient records and compared between dogs with and without clinical signs of bleeding. RESULTS: Evaluation by ROTEM showed hyperfibrinolysis in 8 of 12 (67%; 95% CI, 40-86%) dogs with and 1 of 9 (11%; 95% CI, 2-44%) dogs without clinical signs of bleeding (P = .016). Hyperfibrinolysis was associated with severe hypofibrinogenemia in 6 of 10 (60%; 95% CI, 31-83%) of the cases. Hyperfibrinolysis decreased or resolved after treatment with 10-80 mg/kg tranexamic acid. Fresh frozen plasma (range, 14-60 mL/kg) normalized follow-up fibrinogen function ROTEM (FIBTEM) maximal clot firmness in 6 of 8 dogs (75%; 95% CI, 41-93%). Survival to discharge was 67% (14/21 dogs; 95% CI, 46-83%) and was not different between dogs with and without clinical signs of bleeding (P = .379). CONCLUSION AND CLINICAL IMPORTANCE: Hyperfibrinolysis and hypofibrinogenemia were identified as an important pathomechanism in angiostrongylosis-associated bleeding in dogs. Hyperfibrinolysis and hypofibrinogenemia were normalized by treatment with tranexamic acid and plasma transfusions, respectively.

Changes in Serum Creatinine Concentration and Acute Kidney Injury (AKI) Grade in Dogs Treated with Hydroxyethyl Starch 130/0.4 From 2013 to 2015.

BACKGROUND: Hydroxyethyl starch (HES) solutions may cause acute kidney injury (AKI) in humans. OBJECTIVE: To compare AKI grades in 94 dogs exposed and 90 dogs that were unexposed to 6% HES-130/0.4. ANIMALS: Dogs receiving 6% HES-130/0.4 (HES cohort) or crystalloids (unexposed cohort) between 2013 and 2015. METHODS: Historical cohort study. Diagnosis, total cumulative dose and total mL/kg of HES administered, time frame of HES administration and serum creatinine concentrations up to 90 days after initiation of HES treatment were retrospectively reviewed. The AKI grades were retrospectively determined by IRIS guidelines. RESULTS: Exposed dogs received a median cumulative dose of 69.4 mL/kg (range, 2-429 mL/kg) HES over a median of 4 (range, 1-16) days, resulting in a median dose of 20.7 (range, 2-87) mL/kg/d. Although the cohorts differed in terms of age and diagnosis, AKI grades were not significantly different at the evaluated short- and long-term time points. Results of ordinal logistic regression identified the number of days of HES administration as significantly associated with an increase in AKI grade within 10 days (P = .038), whereas there was no significant association among HES exposure, HES mL/kg/d, and an increase in AKI grade. CONCLUSIONS AND CLINICAL IMPORTANCE: HES-130/0.4-treated dogs were not more prone to develop AKI than HES-untreated, but the number of HES days was significantly associated with an increase in AKI grade within 10 days post-HES administration. The time frame of HES treatment should be kept short. Prospective, randomized clinical trials are required to assess the effect of HES on renal function in dogs.

Unexplained bleeding as primary clinical complaint in dogs infected with Angiostrongylus vasorum.

INTRODUCTION: Unexplained bleeding was the primary clinical complaint in 15 dogs diagnosed with A. vasorum and was observed in the mouth, as external bleeding, as large subcutaneous hematoma, as hemoptysis, in the brain, post ovariectomy, as epistaxis, in the anterior ocular chamber and on a tracheal intubation tube. In 8 dogs the cause of bleeding initially was suspected to be a minor trauma or a surgical complication, and various surgical approaches had been undertaken to eliminate the problem. In only 3 dogs respiratory signs were observed before the bleeding prompted referral. The median time elapsed between the first recognized clinical signs attributed to A. vasorum until diagnosis was 2 weeks (range1 day to 4 months). Four dogs died, 3 on the day of admission and 1 dog 4 days after admission. Suspected causes of death were respiratory failure and cerebral hemorrhage in 2 dogs each. Four dogs had been pre-treated with NSAIDs; of these, 2 dogs developed severe hemoptysis (1 died), 1 dog developed brain hemorrhage (and died), and 1 dog developed a large subcutaneous hematoma with marked anemia. Bleeding at various sites may be the only recognized abnormality in A. vasorum infection. Without a high index of suspicion, the diagnosis and appropriate therapy may be delayed to the point of a fatal outcome. Tests of coagulation were quite variable and the cause of bleeding likely multifactorial.

INTRODUCTION: Un saignement inexplicable a été le symptôme clinique primaire chez 15 chiens chez lesquels une infestation à A. vasorum a été diagnostiquée par la suite. Ces saignements ont été observés sous forme d'hémorragies dans la gueule, de saignements externes, de gros hématomes sous-cutanés, d'hémoptysie, de saignements cérébraux, de saignements abdominaux après ovariectomie, de saignements dans la chambre antérieure de l'oeil ou sur le trachéotube lors d'intubations. Chez 8 chiens, on a supposé que le saignement était initialement dû à un petit traumatisme ou à une complication opératoire et diverses mesures chirurgicales ont été prises pour résoudre le problème. Chez trois chiens, des symptômes respiratoires ont été observés avant que le saignement n'amène à l'envoi dans un centre de référence. Le temps moyen écoulé entre les premiers symptômes causés par A. vasorum et le diagnostic était de 2 semaines (1 jour à 4 mois). Quatre chiens sont décédés, 3 le jour de leur arrivée et un 4 jours plus tard. Les causes probables de la mort étaient dans deux cas une déficience respiratoire et dans deux une hémorragie cérébrale. Quatre chiens avaient été traités précédemment avec des AINS; deux d'entre eux ont développé une hémoptysie massive et un en est mort, un chien a présenté une hémorragie cérébrale fatale et le dernier a développé un volumineux hématome sous-cutané avec une anémie massive. Un saignement à un endroit quelconque peut être la seule anomalie constatée lors d'une infestation par A. vasorum. Si on n'a pas d'importants soupçons de cette affection, le diagnostic et le traitement adéquat peuvent être tellement retardés qu'une issue fatale survient. La cause pathophysiologique des hémorragies est vraisemblablement multifactorielle.

AK2 deficiency compromises the mitochondrial energy metabolism required for differentiation of human neutrophil and lymphoid lineages.

Reticular dysgenesis is a human severe combined immunodeficiency that is primarily characterized by profound neutropenia and lymphopenia. The condition is caused by mutations in the adenylate kinase 2 (AK2) gene, resulting in the loss of mitochondrial AK2 protein expression. AK2 regulates the homeostasis of mitochondrial adenine nucleotides (ADP, ATP and AMP) by catalyzing the transfer of high-energy phosphate. Our present results demonstrate that AK2-knocked-down progenitor cells have poor proliferative and survival capacities and are blocked in their differentiation toward lymphoid and granulocyte lineages. We also observed that AK2 deficiency impaired mitochondrial function in general and oxidative phosphorylation in particular - showing that AK2 is critical in the control of energy metabolism. Loss of AK2 disrupts this regulation and leads to a profound block in lymphoid and myeloid cell differentiation.

Influence of pre-anaesthetic thoracic radiographs on ASA physical status classification and anaesthetic protocols in traumatized dogs and cats.

The purpose of this study was to evaluate if pre-anaesthetic thoracic radiographs contribute to the anaesthetic management of trauma patients by comparing American Society of Anesthesiologists Physical Status Classification (ASA grade) with and without information from thoracic radiography findings. Case records of 157 dogs and cats being anaesthetized with or without post-traumatic, pre-anaesthetic chest radiographs were retrospectively evaluated for clinical parameters, radiographic abnormalities and anaesthetic protocol. Animals were retrospectively assigned an ASA grade. ASA grades, clinical signs of respiratory abnormalities and anaesthesia protocols were compared between animals with and without chest radiographs. The group of animals without pre-anaesthetic radiographs was anaesthetized earlier after trauma and showed less respiratory abnormalities at presentation. The retrospectively evaluated ASA grade significantly increased with the information from thoracic radiography. Animals with a higher ASA grade were less frequently mechanically ventilated. Pre-anaesthetic radiographs may provide important information to assess the ASA grade in traumatized patients and may therefore influence the anesthesia protocol.

Acute compartment syndrome complicating an intramuscular haemangiosarcoma in a dog.

Acute compartment syndrome in dogs is a rare complication of muscle trauma, but it has not been previously reported as a consequence of neoplasia in dogs. This case report describes the occurrence of a compartment syndrome of the femoral compartment in an 11-year-old, male, mixed-breed dog caused by acute bleeding of an intramuscular haemangiosarcoma. The compartment syndrome was relieved by immediate fasciotomy. The dog was euthanased following acute recurrence of clinical signs seven weeks after surgery.

Endogenous nitric oxide production in canine osteoarthritis: Detection in urine, serum, and synovial fluid specimens.

OBJECTIVE: To measure nitric oxide (NO) concentrations in serum, urine, and synovial fluid (SF) of dogs with naturally occurring cranial cruciate ligament (CCL) rupture and normal dogs, and to compare these with clinical and histologic changes of osteoarthritis (OA). STUDY DESIGN: Prospective clinical study including 2 groups of animals selected from the hospital population. ANIMALS: Forty-three dogs (CCL group) with OA secondary to CCL rupture; 30 healthy dogs (control group) without CCL rupture. METHODS: Serum, urine, and SF were collected before and during surgery in the CCL group or immediately after euthanasia in the control group. Articular cartilage and synovial membrane tissue specimens were prepared for routine histologic examination. The stable end products of NO, total nitrite and nitrate (NOt) activity, were measured in body fluids and compared with macroscopic and histologic degrees of OA. Urinary NOt concentration was compared with urinary creatinine concentration and stated as urinary NOt:creatinine ratio (UNCR). RESULTS-SF NOt concentrations were not significantly different between the 2 groups. Serum NOt concentrations (45.6 vs 28.9 micromol/L; P =.042) and the UNCR (0.007 vs 0.004; P =.035) were significantly higher in dogs of the CCL group compared with the control population. An association between UNCR and histologic and macroscopical OA grades could be demonstrated. CONCLUSION: UNCR might be a useful indicator of nitrite and nitrate production and, therefore, osteoarthritic changes in joints. CLINICAL RELEVANCE: UNCR could be used as a tool to evaluate the NOt production by joint tissues over time and might therefore provide a method of evaluating the effects of drugs in the control of osteoarthritis.

Nitric oxide metabolite production in the cranial cruciate ligament, synovial membrane, and articular cartilage of dogs with cranial cruciate ligament rupture.

OBJECTIVE: To measure concentrations of nitric oxide metabolites (nitrite-nitrate [NOt]) in cartilage, synovial membrane, and cranial cruciate ligament (CCL) in dogs and evaluate associations with osteoarthritis in dogs with CCL rupture. ANIMALS: 46 dogs with CCL rupture and 54 control dogs without joint disease. PROCEDURE: Tissue specimens for histologic examination and explant culture were harvested during surgery in the CCL group or immediately after euthanasia in the control group; NOt concentrations were measured in supernatant of explant cultures and compared among dogs with various degrees of osteoarthritis and between dogs with and without CCL rupture. RESULTS: Osteoarthritic cartilage had significantly higher NOt concentration (1,171.6 nmol/g) than did healthy cartilage (491.0 nmol/g); NOt concentration was associated with severity of macroscopic and microscopic lesions. Synovial membrane NOt concentration did not differ between dogs with and without CCL rupture. Ruptured CCL produced less NOt than did intact ligaments. In control dogs, NOt concentrations were similar for intact ligaments (568.1 nmol/g) and articular cartilage (491.0 nmol/g). Synthesis of NOt was inhibited substantially by coincubation with inhibitors. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that NOt in canine joint tissues originates from the inducible nitric oxide synthase pathway. Nitric oxide metabolite production in cartilage was greater in dogs with osteoarthritis than in healthy dogs and was associated with lesion severity, suggesting that nitric oxide inhibitors may be considered as a treatment for osteoarthritis. The CCL produces substantial concentrations of NOt; the importance of this finding is unknown.