Disseminated Intravascular Coagulation in Dogs: Review of the Literature

Retrospective comparison of thromboelastography results to postmortem evidence of thrombosis in critically ill dogs: 39 cases (2005-2010)

OBJECTIVE

To determine whether there is an association between thromboelastography (TEG) data and necropsy evidence of thrombosis in a cohort of critically ill dogs.

DESIGN

Retrospective study (2005-2010).

SETTING

University teaching hospital.

ANIMALS

Thirty-nine client-owned critically ill dogs for which TEG was performed within 7 days of complete necropsy.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Thrombi were found in 26 (67%) dogs. Spayed females (n = 20) were significantly more likely to have thrombosis (P = 0.0127). No significant association was found between presence of thrombosis and any TEG parameter, the calculated coagulation index, results of coagulation testing, type of vascular access, or clinical diagnosis. D-dimers were significantly higher in dogs with thrombosis (P = 0.0207) and a weak positive correlation was found between D-dimer value and number of sites of thrombosis (ρ = 0.18, P = 0.0045). Dogs with WBC > 16 × 10(3) /μL were more likely to have thrombosis compared to others (odds ratio 5.56, 95% confidence interval 1.2-25.7, P = 0.025).

CONCLUSIONS

This study found no association between any TEG parameter and the presence of thrombosis on postmortem examination.

Topical allogeneic platelet-rich plasma treatment for a massive cutaneous lesion induced by disseminated intravascular coagulation in a toy breed dog

A 2-year-old intact female miniature Pinscher weighing 1.7 kg with a body condition score of 2/5 was presented for acute vomiting, lethargy for 2 days, and large petechial skin lesions on the hip region including the tail. Acute pancreatitis was diagnosed by clinical signs, strong positive cPLI test, laboratory test and ultrasound appearance. While the clinical signs associated with acute pancreatitis had improved in 3–5 days, lesion of petechial appeared on the left hip region 7 days after the presentation, with a fast progression into a necrotic tissue along the left side hip. Allogenic platelet rich plasma (PRP) with Weibrich and Kleis method was administered to promote skin healing and regeneration. Gradual and complete improvement in the dog’s wound lesions was noted approximately 1 month after applying allogeneic topical PRP. In this case report, allogeneic PRP was applied to a large regional cutaneous defect caused by coagulopathy induced by acute pancreatitis. Topical application of PRP in this case was unique in that allogeneic PRP was used instead of autologous PRP for the first time in cutaneous soft-tissue wound management in the veterinary medical field.

Systemic candidiasis in a dog

Candida albicans is a common cause of nosocomial infections in humans, but there are few reports of systemic candidiasis in dogs. This report describes an 11-year-old spayed female Scottish Terrier with systemic candidiasis. The diagnosis was made on the basis of results of microbiologic culture of specimens from urine and venous catheters and histologic examination of tissues obtained post mortem. Factors that predisposed the dog of this report to systemic candidiasis included diabetes mellitus, corticosteroid and broad-spectrum antimicrobial administration, venous and urinary catheterization, and administration of nutrition parenterally. The development of pyrexia and leukocytosis in dogs with risk factors that predispose to Candida spp infections warrants evaluation via microbial culture of specimens from urine and vascular catheters used in those dogs.

Evaluation of a canine D-dimer point-of-care test kit for use in samples obtained from dogs with disseminated intravascular coagulation, thromboembolic disease, and hemorrhage

OBJECTIVE

To evaluate a canine D-dimer point-of-care (cD-d POC) test kit for use in healthy dogs and dogs with disseminated intravascular coagulation (DIC), thromboembolic disease (TED), and hemorrhage.

ANIMALS

12 healthy dogs, 18 dogs with DIC, 23 dogs with TED (19 acute and 4 chronic), and 18 dogs with hemorrhage.

PROCEDURE

The cD-d POC, canine D-dimer ELISA (cD-d ELISA), human D-dimer latex agglutination (hD-d LA), and fibrin degradation product (FDP) tests were performed on citrated plasma.

RESULTS

All healthy dogs had negative cD-d POC test results and mean cD-d ELISA value of 0.2 U/mL. All dogs with DIC had positive cD-d POC test results and mean cD-d ELISA value of 44 U/mL. Dogs with acuteTED had a mean cD-d ELISA value of 34 U/mL, and 17 of 19 had positive cD-d POC test results. Mean cD-d ELISA value in dogs with hemorrhage was 14 units/mL, and 15 of 18 had positive cD-d POC test results. The cD-d ELISA values in dogs with hemorrhage were significantly higher than those of healthy dogs but lower than those of dogs with DIC and acute TED. The cD-d POC, cD-d ELISA, and hD-d LA tests were comparable in differentiating healthy dogs from dogs with DIC, acute TED, or hemorrhage and appeared to be superior to measurement of FDPs.

CONCLUSIONS AND CLINICAL RELEVANCE

The cD-d POC test kit can be quickly and easily used and reliably detects dogs with DIC or acute TED. Positive results may also be seen in dogs with internal hemorrhage.

Plasma D-dimer for the diagnosis of thromboembolic disorders in dogs

D-dimer is formed during thrombus formation when factor XIIIa crosslinks the terminal D-domains of fibrin. The D-dimer epitope is exposed when the thrombus is lysed by plasmin. Thus, D-dimer represents both thrombin and plasmin activation and is specific for fibrinolysis. D-dimer concentrations are increased in dogs with DIC or other thromboembolic disorders, but because D-dimer is an indicator of physiologic or pathologic fibrinolysis, values are elevated in other conditions associated with fibrinolysis, including orthopedic surgery, neoplasia, and internal hemorrhage. It can be used as an ancillary test for the diagnosis of DIC but is not recommended as a sole test for this purpose. D-dimer has the potential to be a useful laboratory test for the detection of pulmonary thromboembolism in dogs. Further studies are needed to determine the appropriate applications for this test in veterinary patients to aid in clinical decision making, treatment, and patient care.

Validation of an immunoturbidimetric D-dimer assay in canine citrated plasma

D-dimer is a neoantigen formed when thrombin initiates the transformation of fibrinogen to fibrin; it is derived from plasmin digestion of cross-linked fibrin. In human medicine, the usefulness of this analyte in diagnosing disseminated intravascular coagulation (DIC) has been assessed in patients fulfilling the clinical and laboratory requirements for this disorder. In canine medicine, the use of D-dimer is relatively new. Detailed studies are needed to understand the relationship between D-dimer concentration in plasma and DIC status in dogs. We validated a D-dimer immunoturbidimetric assay (Tina-quant [a] D-Dimer, Boehringer Mannheim) in canine citrated plasma samples. Intra-assay and interassay variability (coefficient of variation) was 5.63% and 8.82%, respectively. The assay was linear, using 2 samples with low and high D-dimer concentrations (r=.996 and.998). Accuracy was 102.2% and 95.7% based on a recovery study in which 2 samples were assessed. Reference values for D-dimer were established using 70 healthy dogs that were assessed clinically and evaluated on the basis of a complete laboratory workup. The reference range was set between 0.02 and 0.28 microgram/mL (chi-square test for normal distribution, P>.05).