Retrospective evaluation of the prevalence and risk factors associated with red blood cell transfusions in cats with urethral obstruction (2009-2019): 575 cases.

OBJECTIVE: To evaluate the prevalence of red blood cell (RBC) transfusions and factors associated with the need for transfusion in cases of feline urethral obstruction (FUO). Secondarily, to compare survival to discharge in cats receiving an RBC transfusion versus those that did not. DESIGN: Retrospective, multi-institutional study from 2009 to 2019. SETTING: Four university teaching hospitals. ANIMALS: Six hundred twenty-two total occurrences of FUO in 575 cats. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records were retrospectively reviewed for pertinent information. The overall prevalence of severe anemia (PCV < 0.20 L/L [<20%]) at presentation was 1.0% (6/622). The prevalence of RBC transfusions during hospitalization was 2.1% (13/622). Cats that received an RBC transfusion weighed significantly less than those that did not (4.9 vs 5.8 kg; P = 0.034) and had a lower PCV at presentation (0.30 L/L [30%] vs 0.41 L/L [41%]; P < 0.001). Hospitalization time (240 vs 72 h) and indwelling urinary catheter time (168 vs 48 h) were significantly longer in cats receiving a transfusion compared with those that did not (P < 0.001). Creatinine concentrations were not significantly associated with transfusion administration, while BUN was higher in cats receiving a transfusion (15.35 mmol/L [43 mg/dL] vs. 11.78 mmol/L [33 mg/dL]; P = 0.043). Transfusion rates were significantly higher in cats undergoing perineal urethrostomy (5.5%) compared with those that did not undergo surgery (0.97%; P < 0.001). The overall survival to discharge rate was 96%. Cats not receiving an RBC transfusion were significantly more likely to survive to discharge than those that did (odds ratio: 14.7, 95% confidence interval: 1.8-37; P < 0.001). CONCLUSIONS: FUO is rarely associated with severe anemia and the need for RBC transfusions. In this study, cats receiving an RBC transfusion were less likely to survive to discharge; therefore, requiring a blood transfusion may be associated with a worse prognosis. In addition, the need for surgical intervention was associated with a higher prevalence of RBC transfusions.

Retrospective evaluation of admission total plasma protein as a predictor of red blood cell transfusion requirement in dogs diagnosed with traumatic and nontraumatic hemoabdomen: 90 dogs (2009-2019).

OBJECTIVE: To evaluate the association of admission total plasma protein (TPP) and the administration of red blood cell transfusions in dogs with diagnosed hemoabdomen. To secondarily evaluate additional point-of-care parameters associated with red blood cell transfusion administration. DESIGN: Retrospective study between 2009 and 2019. SETTING: University veterinary teaching hospital. ANIMALS: Ninety dogs admitted to a university veterinary teaching hospital after a diagnosis of traumatic or nontraumatic hemoabdomen (NTH). MEASUREMENTS AND MAIN RESULTS: Medical records were retrospectively reviewed; signalment, point-of-care diagnostics, and transfusion administration information was recorded. A total of 47 dogs (traumatic hemoabdomen 11/26; NTH 36/64) received packed red blood cell transfusions. For each 1 g/dL unit decrease in TPP, dogs had an increased odds ratio (OR) of 2.14 (95% confidence interval [CI]: 1.44-3.40, P < 0.001) of receiving a red blood cell transfusion. Dogs diagnosed with NTH were more likely to receive a red blood cell transfusion than dogs with a traumatic hemoabdomen (OR: 2.78, 95% CI: 1.11-7.141, P = 0.03). Lower PCV values (OR: 1.08, 95% CI: 1.04-1.12, P < 0.001), bicarbonate values (OR: 1.3, 95% CI: 1.09-1.56, P = 0.003), and base excess (OR: 1.27, 95% CI: 1.1-1.49, P = 0.003) were associated with a higher likelihood of red blood cell transfusion. Additionally, higher lactate (OR: 1.35, 95% CI: 1.16-1.63, P < 0.001) and Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast scores (OR: 1.10, 95% CI: 1.04-1.17, P < 0.001) were associated with increased red blood cell transfusion administration. CONCLUSIONS: Low admission TPP, independent of low PCV, was associated with red blood cell transfusions regardless of underlying cause. For each 1 g/dL unit decrease in TPP on presentation, dogs were approximately 2 times more likely to receive a red blood cell transfusion during hospitalization. Other factors that were associated with increased transfusion administration included presenting PCV, PCV/TPP ratio, bicarbonate, base excess, lactate, and APPLEfast scores.

Retrospective evaluation of the clinical course and outcome of zinc toxicosis due to metallic foreign bodies in dogs (2005-2021): 55 cases.

OBJECTIVE: To describe the overall clinical course of zinc toxicosis in dogs including source, time to source control, incidence of hemolytic anemia, acute liver injury (ALI), acute kidney injury (AKI), and pancreatitis. DESIGN: Retrospective case series from 2005 to 2021. SETTING: Six university veterinary teaching hospitals. ANIMALS: Fifty-five client-owned dogs with known zinc toxicosis due to metallic foreign body (MFB) ingestion. MEASUREMENTS AND MAIN RESULTS: The most common source of zinc was US pennies minted after 1982 (67.3%). Forty-five of 55 (81.8%) dogs survived and 10 of 55 (18.2%) died or were euthanized. Median length of hospitalization for survivors and nonsurvivors was 3 days. The most common clinical sequelae of zinc toxicosis were anemia (87%), ALI (82%), coagulopathy (71%), thrombocytopenia (30.5%), AKI (26.9%), and acute pancreatitis (5.5%). Most dogs (67.3%) required blood products and 83% of dogs achieved a stable HCT or PCV in a median of 24 hours after MFB removal. The median duration of illness prior to presentation was 48 hours for both survivors and nonsurvivors and there was no impact of time to presentation on the incidence of ALI, AKI, or pancreatitis. CONCLUSIONS: Zinc toxicosis secondary to MFB ingestion should be considered a differential diagnosis for dogs with gastrointestinal signs, hemolytic anemia, ALI, hemostatic abnormalities, AKI, and pancreatitis. AKI may be a more common sequela of zinc toxicosis than previously suspected. Acute pancreatitis is a rare but potentially serious sequela to zinc toxicosis.

The successful use of a subcutaneous catheter in the management of severe subcutaneous emphysema in a dog with laryngeal crush injury and tracheostomy tube placement.

OBJECTIVE: To describe the placement of a subcutaneous catheter in a dog for the management of severe subcutaneous emphysema secondary to severe laryngeal crushing injury and temporary tracheostomy tube placement. CASE SUMMARY: A 6-year-old male neutered Kelpie suffered a severe laryngeal crushing injury following a dog attack. Case management included the placement of a temporary tracheostomy tube due to severe respiratory compromise and inspiratory dyspnea associated with the crush injury. During hospitalization, the patient developed severe subcutaneous emphysema, pneumomediastinum, and a pneumothorax as a complication of the laryngeal crushing injury and temporary tracheostomy. A subcutaneous catheter was placed to manage the recurrent subcutaneous emphysema while the tracheostomy stoma healed. Five months posttrauma, the dog returned to normal with mild stridor during excitement and while panting. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report in veterinary medicine describing the use of a subcutaneous catheter for the management of subcutaneous emphysema secondary to laryngeal crush injury and temporary tracheostomy tube placement.

Retrospective comparison of outcomes in septic peritonitis with or without closed-suction abdominal drainage in 115 dogs (2009-2019).

Septic peritonitis is a serious medical condition affecting veterinary patients and post-operative care remains controversial. This study aimed to evaluate and compare post-operative outcomes of dogs treated for septic peritonitis with and without surgically placed closed-suction abdominal drains. Medical records were retrospectively searched from the years 2009 through 2019 and one hundred and fifteen dogs with confirmed septic peritonitis treated with exploratory laparotomy were included. Twenty-two dogs had closed suction drains placed and ninety-three dogs were managed without post-operative drainage. Overall survival to discharge rate of patients in this study was 72%. The survival rate of patients with an abdominal drain was 53% compared to 77% in patients without a drain (P < 0.0001). Dogs with a higher APPLEfast score were significantly more likely to have a drain placed at the time of surgery (P = 0.0277). Dogs that had a closed-suction drain were significantly more likely to be given colloidal support compared to dogs managed without drainage (P = 0.0342). Based on this data, closed-suction drainage post-operatively for treatment of septic peritonitis was not associated with a more favorable survival outcome. The use of a severity of illness score, APPLEfast, did not show a correlation between severity of illness and survival outcome but did demonstrate a correlation between illness severity and placement of a closed-suction drain. Closed-suction drainage post-operatively increased the likelihood of receiving colloidal support, but due to the retrospective nature of the study and the lack of standardized post-operative nutritional support, definitive conclusion that post-operative drainage alone led to increased colloidal support cannot be made in this study.

Diagnosis and successful management of an extradural compressive hematoma secondary to diphacinone poisoning in a dog.

OBJECTIVE: To describe the successful case management of an extradural hematoma secondary to anticoagulant rodenticide toxicity causing spinal compression and paraplegia. CASE SUMMARY: A 3-month-old, female intact, mixed breed dog was presented for a 12-hour history of paraplegia. CBC and biochemistry results were unremarkable, and a coagulation panel revealed prolonged prothrombin time with normal activated partial thromboplastin time. Magnetic resonance imaging revealed an extradural compressive lesion within the vertebral canal extending from T6 to T11, most consistent with an extradural hematoma. Further coagulation testing revealed a coagulopathy caused by vitamin K1 deficiency and confirmed exposure to the anticoagulant rodenticide, diphacinone. The dog was medically managed with fresh frozen plasma, aminocaproic acid, and oral vitamin K1 therapy. A right-sided T6 to T11 hemilaminectomy was later performed for removal of the extradural hematoma and spinal decompression. The dog's neurological status gradually improved postoperatively and, at the time of discharge, was nonambulatory paraparetic with voluntary micturition. Four weeks postoperatively, the dog had normal prothrombin and activated partial thromboplastin times and was nonambulatory paraparetic with strong motor function. NEW OR UNIQUE INFORMATION PROVIDED: This is the first reported case of a dog with an extradural hematoma secondary to anticoagulant rodenticide causing spinal cord compression and neurological deficits. Surgical management of this case was successful and resulted in improvement of neurological signs. Extradural hematoma should be considered as a potential location of bleeding in rodenticide toxicity as well as a differential diagnosis in patients with neurological deficits.

Suspected benzodiazepine withdrawal-associated seizures in 3 young dogs undergoing mechanical ventilation.

OBJECTIVE: To describe new onset of generalized seizures in 3 young dogs following cessation of a benzodiazepine-containing sedation protocol to facilitate mechanical ventilation (MV) for hypoxemia. SERIES SUMMARY: Three dogs under 5 months of age underwent MV due to severe hypoxemia. All 3 dogs were sedated with a constant rate infusion of benzodiazepines as part of their sedation protocol to facilitate MV. All 3 dogs had an acute onset of generalized seizures within 36 hours of sedation cessation and weaning from MV. All 3 dogs' seizures were successfully managed with a slow, tapering course of benzodiazepines. One dog was additionally treated with levetiracetam at the time of initial seizure activity, which was discontinued 1 year following discharge and absence of ongoing seizure activity. All 3 dogs were discharged successfully with no reports of ongoing seizures or neurologic deficits after discharge. NEW OR UNIQUE INFORMATION PROVIDED: Young dogs managed with benzodiazepines to facilitate MV may have acute onset of generalized seizures following cessation, which can be successfully managed with short-term benzodiazepine therapy. The 3 cases in this series demonstrated a positive outcome and were successfully managed following acute onset of generalized seizure activity post-MV.

Successful management of severe carprofen toxicity with manual therapeutic plasma exchange in a dog.

OBJECTIVE: To report the use of manual therapeutic plasma exchange (TPE) in a dog with severe carprofen toxicity. SUMMARY: A 12-year-old neutered female Pembroke Welsh Corgi weighing 20 kg was evaluated after ingesting 223 mg/kg of carprofen. Emesis was attempted with apomorphine at the primary care veterinarian but was unsuccessful, and a dose of activated charcoal with sorbitol was administered. On presentation to the referral center, approximately 8 hours after ingestion, the dog's physical examination revealed mild abdominal discomfort but was otherwise unremarkable. Treatment consisted of a combination of supportive care including activated charcoal with sorbitol, cholestyramine, IV lipid emulsion, and manual TPE. Blood samples were collected prior to the initiation of manual TPE and at the completion of 12 exchange cycles. Carprofen levels were determined by high-pressure liquid chromatography. A 57% decrease in carprofen levels was achieved with the combination of activated charcoal, cholestyramine, IV lipid emulsion, and manual TPE. The dog did not develop organ dysfunction secondary to toxicity and was discharged 4 days after ingestion. NEW OR UNIQUE INFORMATION PROVIDED: This report describes the successful decrease of plasma carprofen in a dog with the combination of decontamination techniques and manual TPE. While TPE has been previously reported as a successful therapeutic in dogs with nonsteroidal anti-inflammatory toxicity, including carprofen, equipment and expertise of this platform is not readily available. Manual TPE is technically simple and can be performed in any hospital with a large blood centrifuge.

Pathology in Practice.

In collaboration with the American College of Veterinary Pathologists.

Successful management and recovery of a dog with immune-mediated thrombocytopenia following vincristine overdose.

OBJECTIVE: To describe the management and outcome of a dog following a 10-fold dosing error of vincristine. CASE SUMMARY: A 2-year-old neutered female Toy Fox Terrier presenting for immune-mediated thrombocytopenia was administered an accidental overdose of vincristine (0.2 mg/kg [2.71 mg/m2 ]). The dog was managed for severe gastrointestinal signs, neutropenia, and neurological consequences secondary to the overdose. Neurological signs included diffuse muscle tremors, limb hyperextension, and myalgia during the dog's hospitalization. Medical management consisted of aggressive supportive care in addition to novel strategies, including folinic acid, glutamic acid, and Tbo-filgrastim. The dog was discharged from the hospital after 12 days of hospitalization and recovered completely within a month of the overdose with no lasting consequences. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report of the successful management of severe vincristine overdose in a dog. Therapy included the use of Tbo-filgrastim, folinic acid, and glutamic acid along with aggressive supportive care.

Distribution of histopathologic types of primary pulmonary neoplasia in dogs and outcome of affected dogs: 340 cases (2010-2019).

OBJECTIVE: To provide updated information on the distribution of histopathologic types of primary pulmonary neoplasia in dogs and evaluate the effect of postoperative adjuvant chemotherapy in dogs with pulmonary carcinoma. ANIMALS: 340 dogs. PROCEDURES: Medical records of dogs that underwent lung lobectomy for removal of a primary pulmonary mass were reviewed, and histopathologic type of lesions was determined. The canine lung carcinoma stage classification system was used to determine clinical stage for dogs with pulmonary carcinoma. RESULTS: Pulmonary carcinoma was the most frequently encountered tumor type (296/340 [87.1%]), followed by sarcoma (26 [7.6%]), adenoma (11 [3.2%]), and pulmonary neuroendocrine tumor (5 [1.5%]); there was also 1 plasmacytoma and 1 carcinosarcoma. Twenty (5.9%) sarcomas were classified as primary pulmonary histiocytic sarcoma. There was a significant difference in median survival time between dogs with pulmonary carcinomas (399 days), dogs with histiocytic sarcomas (300 days), and dogs with neuroendocrine tumors (498 days). When dogs with pulmonary carcinomas were grouped on the basis of clinical stage, there were no significant differences in median survival time between dogs that did and did not receive adjuvant chemotherapy. CLINICAL RELEVANCE: Results indicated that pulmonary carcinoma is the most common cause of primary pulmonary neoplasia in dogs; however, nonepithelial tumors can occur. Survival times were significantly different between dogs with pulmonary carcinoma, histiocytic sarcoma, and neuroendocrine tumor, emphasizing the importance of recognizing the relative incidence of these various histologic diagnoses. The therapeutic effect of adjuvant chemotherapy in dogs with pulmonary carcinoma remains unclear and warrants further investigation.

Management of severe burn injuries with novel treatment techniques including maggot debridement and applications of acellular fish skin grafts and autologous skin cell suspension in a dog.

CASE DESCRIPTION: A 3-year-old 27-kg female spayed American Bulldog with severe burn injuries caused by a gasoline can explosion was evaluated. CLINICAL FINDINGS: The dog had extensive partial- and full-thickness burns with 50% of total body surface area affected. The burns involved the dorsum extending from the tail to approximately the 10th thoracic vertebra, left pelvic limb (involving 360° burns from the hip region to the tarsus), inguinal area bilaterally, right medial aspect of the thigh, and entire perineal region. Additional burns affected the margins of the pinnae and periocular regions, with severe corneal involvement bilaterally. TREATMENT AND OUTCOME: The dog was hospitalized in the hospital's intensive care unit for 78 days. Case management involved provision of aggressive multimodal analgesia, systemic support, and a combination of novel debridement and reconstructive techniques. Debridement was facilitated by traditional surgical techniques in combination with maggot treatment. Reconstructive surgeries involved 6 staged procedures along with the use of novel treatments including applications of widespread acellular fish (cod) skin graft and autologous skin cell suspension. CLINICAL RELEVANCE: The outcome for the dog of the present report highlighted the successful use of maggot treatment and applications of acellular cod skin and autologous skin cell suspension along with aggressive systemic management and long-term multimodal analgesia with debridement and wound reconstruction for management of severe burn injuries encompassing 50% of an animal's total body surface area.

Comparison of venous hemoglobin saturation measurements obtained by in vivo oximetry and calculated from blood gas analysis in critically ill dogs.

OBJECTIVE: To compare in vivo central venous hemoglobin saturation measurement (ScvO2 ) using a fiber optic catheter with saturation calculated from blood gas analysis in critically ill dogs. DESIGN: Prospective observational study. SETTING: University veterinary teaching hospital intensive care unit. ANIMALS: A convenience sample of 20 dogs with severe illness. INTERVENTIONS: Dogs were instrumented with either a central venous catheter with an integrated fiber optic cable or a conventional catheter with a fiber optic probe inserted through its distal port. Baseline saturation was measured with the fiber optic system (FSO2 ), then monitored continuously. Central venous blood was collected for analysis and FSO2 was recorded by the principal investigator (PI) or nursing staff participating in data collection (staff) at baseline and at 1, 2, 3, and 6 hours. Hemoglobin oxygen saturation (SO2 ) values calculated using human Bohr coefficients were taken directly from the analyzer (GPSO2 ), and were also calculated using temperature-correction and canine Bohr coefficients (RSO2 ). MEASUREMENTS AND MAIN RESULTS: Ninety-seven paired measurements from 20 dogs were analyzed. FSO2 obtained by the PI (n = 41) had better agreement with both GPSO2 (concordance correlation coefficient ρc = 0.926 vs 0.5562) and RSO2 (ρc = 0.75 for PI vs 0.54) than did staff (n = 56). RSO2 values were always smaller than GPSO2 . FSO2 - GPSO2 differences were smaller when measurements were collected by the PI versus Staff (mean difference 0.21 vs -6.6, respectively, P < 0.02). Thirty-six of 41 FSO2 values obtained by PI were within 5% of GPSO2 . CONCLUSIONS: Concordance between FSO2 and either calculation method was low, but was better when performed by PI. The larger difference between methods when using RSO2 suggests a positive bias by FSO2 . Difficulty obtaining stable measurements may have contributed to the poor concordance between methods within Staff.

Preliminary Investigation of Bovine Whole Blood Xenotransfusion as a Therapeutic Modality for the Treatment of Anemia in Goats.

Anemia requiring whole blood transfusion for appropriate treatment is a common clinical presentation of caprine patients to veterinary practitioners; however, identifying suitable blood donors in goat herds can be challenging. In other veterinary species, the practice of xenotransfusion, where blood from 1 species is transfused to another, is used in emergency settings. Due to their ability to donate large volumes of whole blood, cattle could be an ideal source for xenotransfusion of goats. In this study 2 healthy goats were transfused with bovine whole blood. The goats were then monitored for adverse effects and the presence of bovine erythrocyte post-xenotransfusion. Afterward, 15 caprine-bovine combinations were evaluated for compatibility via cross-matching. Both goats tolerated xenotransfusion, although transient reactions were observed. Of the 15 cross-match combinations, 11 of the major cross matches were compatible, and all minor cross matches were also compatible. While future work is necessary to refine this technique, xenotransfusion of goats with cattle blood may be a therapeutic modality for the treatment of caprine anemia.

Feline cardiopulmonary resuscitation: Getting the most out of all nine lives.

PRACTICAL RELEVANCE: Cardiopulmonary arrest (CPA) can occur in any veterinary or animal care setting and is a particular risk in scenarios involving ill, injured or anesthetized patients. Education of all staff on the prevention and recognition of CPA, as well as the performance of cardiopulmonary resuscitation (CPR), is vital to influencing outcome. EVIDENCE BASE: While there is a plethora of information regarding CPA and CPR in human medicine, there are comparably few studies in the veterinary literature. Many of the current veterinary guidelines are extrapolated from human medicine or studies based on animal models. Ongoing work is needed to tailor guidelines and recommendations to our domestic feline (and canine) patients in a clinical setting. AIM: The aim of this article, which is intended for veterinarians in all areas of small animal practice, is to provide an evidence-based review of CPA and CPR in feline patients. The authors have drawn heavily on detailed recommendations published by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative - one of the few resources specific to the veterinary clinical setting - as well as reviewing the available peer-reviewed literature studies, in constructing this article. Among the topics discussed are recognizing and preventing CPA, staff training and clinic preparedness, basic life support and advanced life support interventions, and appropriate post-cardiac arrest care.

Venous oxygen saturation in critical illness.

OBJECTIVE: To review clinically relevant features of systemic oxygen delivery and consumption and the technique and use of venous oxygenation monitoring in human and veterinary medicine. DATA SOURCES: Veterinary and human peer-reviewed medical literature including scientific reviews, clinical and laboratory research articles, and authors' clinical research experience. SUMMARY: Measurement of venous hemoglobin oxygen saturation (venous oxygenation) provides insight into the balance between oxygen supply and tissue demand. In people, measurement of venous oxygen saturation can reveal decompensation that is missed by physical examination and other routinely monitored parameters. Therefore, measurement of mixed or central venous oxygenation measurement may help guide therapy and predict outcome of critically ill patients. In dogs, low central venous oxygen saturation has been associated with impaired cardiopulmonary function and poor outcome in several small studies of experimental shock or severe clinical illness, suggesting that monitoring this variable may assist the treatment of severe illness in this species as well. CONCLUSION: Venous oxygenation reflects systemic oxygenation status and can be used to guide treatment and estimate prognosis in critically ill patients. Measurement of venous oxygenation in veterinary patients is feasible and is a potentially valuable tool in the management of patients with severe disease. This review is intended to increase the understanding and awareness of the potential role of venous oxygen measurement in veterinary patients.

A retrospective study of anti-inflammatory use in dogs with pulmonary blastomycosis: 139 cases (2002-2012).

OBJECTIVE: To determine the effect of anti-inflammatory medications on 30-day survival of dogs treated for pulmonary blastomycosis. DESIGN: Retrospective study. SETTING: University teaching hospital. ANIMALS: One hundred thirty nine client-owned dogs with confirmed pulmonary blastomycosis. MEASUREMENTS AND MAIN RESULTS: The medical records of dogs diagnosed with pulmonary blastomycosis between May 2002 and October 2012 were identified. Of 139 dogs, 85 (61%) survived to 30 days, 38 (27%) were euthanized due to progressive clinical disease, 13 (10%) died secondary to respiratory or cardiac arrest, and 3 (2%) did not survive to 30 days but had an unknown cause of death. Cases were classified based on the anti-inflammatory therapy that was used: nonsteroidal anti-inflammatory drugs (NSAID), corticosteroids, both, or none. Controlling for the effects of itraconazole dose, sex, age, and pretreatment with anti-inflammatory medication, the odds for survival to 30 days was not statistically different between dogs who received no anti-inflammatory medication and the dogs who received NSAIDs (P = 0.86), corticosteroids (P = 0.65), or both (P = 0.27). The need for supplemental oxygen was associated with decreased survival (P < 0.0001). CONCLUSIONS: In this population of dogs with pulmonary blastomycosis, the use of anti-inflammatory medications during therapy did not impact 30-day survival; however, the need for oxygen supplementation was associated with significantly lower survival.