Incidence of blood transfusion requirement and factors associated with transfusion following liver lobectomy in dogs and cats: 72 cases (2007-2015)

Same story, different endings: clinical course and outcomes of two dogs treated differently for delayed fulminant pulmonary haemorrhage 20 h after eastern brown snake (Pseudonaja textilis) envenomation

This report presents the clinical course and outcomes of two dogs that were treated differently upon recognition of respiratory distress due to delayed fulminant pulmonary haemorrhage (DFPH) 20 h after eastern brown snake envenomation. Two dogs from the same household were likely envenomated at the same time. Pulmonary haemorrhage was diagnosed based on pleural and lung ultrasound, decreasing packed cell volume and haemoptysis. Case 1 received a total of 7000 units of brown snake antivenom within the first 10 h after envenomation. The dog developed severe respiratory distress and anaemia approximately 20 h after envenomation. A decision to administer fresh whole blood was made, however, a marked deterioration in clinical signs occurred during the acquisition of blood. The dog was euthanased due to hypoxemic and hypercapnic respiratory failure. Case 2 received similar treatment to case 1 before DFPH. Case 2 developed moderate pleural effusion along with pulmonary haemorrhage after hospital admission. The dog was noticed to have respiratory distress approximately 1 h after case 1. Fresh frozen plasma was administered within 30 min, followed by packed red blood cells and autotransfusion, and the dog survived. These two cases are used as a foundation to discuss the pathophysiology of DFPH and its relation to the clinical signs. Furthermore, retrospective analysis of diagnostics and alternative approaches proposed, may assist clinicians in early recognition and optimal treatment of DFPH.

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.

Hepatic lobectomy in dogs using a stapling device with a vascular cartridge: a retrospective study of 13 cases

CASE HISTORY

Medical records of two veterinary hospitals in Canada were reviewed to identify cases of dogs that underwent liver lobectomy via open laparotomy using the Endo GIA surgical stapling device with a vascular cartridge (height of open and closed staples: 2.5 and 1.0 mm, respectively) between January 2016 and June 2018. Mean age at the time of surgery of the dogs (n = 13) included in the study was 10.4 (SD 1.5; min 7.9, max 12.8) years and mean body weight was 14 (min 3.9, max 37.8) kg.

CLINICAL FINDINGS

Liver masses requiring hepatic lobectomy were identified in 12 dogs by abdominal ultrasound examination. The remaining dog required a lobectomy of the right medial liver lobe to address leakage from the right medial lobe hepatic duct that occurred as a complication of cholecystectomy to treat a ruptured gallbladder mucocoele.

TREATMENT AND OUTCOME

Complete liver lobectomy of 14 lobes (11 from the left hepatic division) in 12 dogs and partial lobectomy of one lobe in one dog was performed via open laparotomy using the Endo GIA device. The mean surgical time, including concurrent procedures, was 50 (SD 17; median 45, min 28, max 91) minutes. The most common intra-operative complication was oozing from the transected liver parenchyma in 6/13 dogs, which was mild in all cases. Five dogs experienced minor post-operative complications. No major peri- or post-operative complications occurred, and no patients required surgical re-exploration. All patients survived until discharge and were alive at the 2-week follow-up for suture removal.

CLINICAL RELEVANCE

Use of the Endo GIA stapling device with a vascular cartridge is feasible for liver lobectomy of the left hepatic division and in this study had low rates of intra-operative and post-operative complications. The Endo GIA stapling device is a viable option for this type of liver lobectomy in dogs. Though successful, the small number of central (two lobes) and right (one lobe) hepatic division lobectomies in this study precludes us from drawing definitive conclusions about the feasibility of this technique on these divisions.

Association between divisional location and short-term outcome of liver mass resection in 124 dogs

OBJECTIVE

To evaluate the association between divisional location of liver masses on short-term outcomes after surgical excision.

STUDY DESIGN

Retrospective case series.

ANIMALS

Client-owned dogs (n = 124).

METHODS

Records were reviewed for demographics, surgical findings, and outcomes. The associations between mass location and mortality, intraoperative complications, and postoperative complications were tested with multivariable logistic regression models.

RESULTS

Liver masses (124) were more common in the left (72) division than the central (34) and right (18) divisions. Median follow up was 286 (range: 14 to 2043) days. Intraoperative complications occurred in 14/124 dogs (11.3%) and postoperative complications in 35/122 dogs (28.7%). No association was detected between mass location and mortality in 8/124 dogs (6.5%). Postoperative complications were more likely if the incision extended to the thorax (P < .001), which was more common during resection of right divisional masses (P = .020). Postoperative complications were less likely when surgery was performed with a thoracoabdominal (TA) stapler (P = .005), by a specialist surgeon (P = .033), and in heavier dogs (P = .027). The odds of intraoperative complications were 19 times higher when surgery was performed without a TA stapler (P = .006). Intraoperative complications were less commonly associated with left (P = .007), but not central (P = .0504) divisional masses than right divisional masses.

CONCLUSION

Right divisional masses were prone to intraoperative but not postoperative complications.

CLINICAL SIGNIFICANCE

Clinicians should anticipate an increased risk of intraoperative complications when planning treatment of right divisional masses.

Perioperative outcomes in dogs and cats undergoing pancreatic surgery: 81 cases (2008-2019)

OBJECTIVES

To identify and describe the type and frequency of perioperative factors in dogs and cats undergoing pancreatic surgery under referral care.

METHODS

Medical records from a small animal surgical referral practice were retrospectively reviewed to identify dogs and cats that underwent pancreatic surgery between 2008 and 2019. Inclusion criteria included complete medical record, histopathology results and follow-up of at least 14 days postoperatively or until death. Variables collected included signalment, history, presenting complaint, preoperative diagnostic results, intraoperative complications, surgical findings/procedures, postoperative complications and histopathology results. Cases were excluded if pertinent information or a histopathology report was missing from the medical record. The frequency of these variables was reported.

RESULTS

There were 81 client-owned animals identified that met the inclusion criteria (57 dogs and 24 cats). The most common pancreatic procedure performed in dogs was partial pancreatectomy 63.2% (36/57) and in cats was pancreatic biopsy 62.5% (15/24). The most common histologic diagnosis in dogs was pancreatic islet cell carcinoma 50.9% (29/57) and in cats was pancreatitis 41.7% (10/24). The overall mortality rate was 13.6% (11/81), with a 10.5% (6/57) mortality rate in dogs and a 20.8% (5/24) mortality rate in cats.

CLINICAL SIGNIFICANCE

In this series of dogs and cats, pancreatic surgery under referral care carried a low to moderate mortality rate.

Factors associated with survival in dogs with a histopathological diagnosis of hepatocellular carcinoma: 94 cases (2007-2018)

Background:

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer in dogs. Despite this, relatively few reports of this disease exist pertaining to prognostic factors and outcome.

Aim:

To evaluate factors associated with survival in dogs with all subtypes of HCC diagnosed on histopathology.

Methods:

A retrospective single institutional study was carried out on 94 client-owned dogs with a histopathologic diagnosis of HCC between 2007 and 2018 obtained by biopsy (21/94) or attempted definitive resection (73/94). Signalment, preoperative features, surgical findings, and postoperative outcomes were recorded. Associations between survival to discharge data were collected and univariable logistical regression was carried out. Kaplan–Meier survival analysis was carried out to identify negative risk factors for long-term prognosis.

Results:

The median survival time (MST) for all patients was 707 days (95% CI = 551–842). MST was not significantly different (p > 0.05) between patients who had suspected versus incidentally diagnosed HCC (695 vs. 775 days), between complete versus incomplete surgical margins (668 vs. 834 days), or between patients with massive subtype versus nodular/diffuse subtype (707 vs. 747 days). Logistical regression identified an association with the excision of the right medial lobe and risk of perioperative death (OR = 9.2, CI 1.5–55.9, p = 0.016). An American Society of Anesthesiologists score ≥4, disease present within the quadrate lobe, and elevated blood urea nitrogen, potassium or gamma-glutamyltransferase were identified as negative prognosticators during multivariable Cox regression. Preoperative imaging (ultrasound or CT) agreed with the surgical location in 91% of the cases. Preoperative cytology was consistent with a diagnosis of HCC in 15/32 (46.9%) cases.

Conclusion:

Type of diagnosis (incidental vs presumed), completeness of excision, and subtype were not associated with MST in this study. Preoperative identification of tumors within the central division may be related to a less favorable outcome. Results of preoperative cytology were not highly sensitive for identifying a malignancy.

Development of a severity scoring system for acute haemorrhage in anaesthetized domestic cats: the CABSS score

OBJECTIVE

To determine whether physiological, haematological, biochemical or electrolyte variables can predict severe haemorrhage in cats.

STUDY DESIGN

Randomized crossover study whereby each cat underwent mild and severe haemorrhage, with a 2 month period between events.

ANIMALS

A group of six domestic cats aged 21 ± 1 months and weighing 4.9 ± 1.2 kg, mean ± standard deviation.

METHODS

Cats were anaesthetized (buprenorphine, alfaxalone, isoflurane in oxygen at a fixed end-tidal concentration of 1.7%) before the haemorrhage event. In total, 34 variables were measured twice (prehaemorrhage and posthaemorrhage). The difference and percent change for each variable were compared between haemorrhage events (paired t test). Significant variables were placed into 13 different ratios (posthaemorrhage value of one variable divided by a posthaemorrhage value of a second variable) and compared (paired t test), and Cohen's d (d) was calculated. Receiver operating characteristic curves were plotted and cut-off values for weak, moderate and strong indicators of severe haemorrhage were obtained.

RESULTS

The blood loss was 4.5 ± 1.1 mL kg^-1 and 26.8 ± 5.5 mL kg^-1 for mild and severe haemorrhage events, respectively. The most significant variables with large effect sizes were heart rate (HR), systolic arterial blood pressure (SAP), end-tidal carbon dioxide (Pe'CO₂), serum albumin, haematocrit and actual bicarbonate ion concentration [HCO₃^-(act)]. The most robust ratios were: 1) shock index (d = -2.8; HR:SAP); 2) HR:Pe'CO₂ (d = -2.9); 3) serum albumin: haematocrit (d = 1.5); and 4) HR:HCO₃^-(act) (d = -1.6). These ratios were included in the final proposed Cat Acute Bleeding Scoring System (CABSS).

CONCLUSIONS

and clinical relevance Cats subjected to mild and severe haemorrhage demonstrated statistically and clinically relevant changes whereby four ratios could be created to make up the CABSS. The ratios detected and quantified the presence of severe haemorrhage in anaesthetized cats.

Diaphragmotomy to aid exposure during hepatobiliary surgery: a multi-centre retrospective review of 31 dogs

OBJECTIVES

To report surgical technique, intra- and post-operative complications, and short- and long-term outcome following canine hepatobiliary surgery in which exposure of intra-abdominal hepatobiliary lesions was aided by diaphragmotomy.

MATERIALS AND METHODS

Clinical records from four multi-disciplinary UK-based small animal referral hospitals were retrospectively reviewed for dogs in which diaphragmotomy was performed between January 2014 and May 2019. Signalment, diagnosis, surgery performed, diaphragmotomy technique, management of diaphragmotomy and pneumothorax, intra- and post-operative complications, short-term outcome and long-term outcome were recorded.

RESULTS

Thirty-one cases were identified. The most common hepatobiliary surgeries performed alongside diaphragmotomy were single hepatic lobectomy (14/31) and cholecystectomy (11/31). The most common diagnoses were hepatocellular carcinoma (10/31), gall bladder mucocoele (7/31) and hepatic nodular hyperplasia (4/31). Peri-operative mortality rate was 9.7% (3/31 cases) though none of these deaths were considered attributable to diaphragmotomy. Post-operative complications were encountered in 67.9% (19/28) cases that survived the peri-operative period, of which 25.0% (7/28) suffered complications that were considered attributable or likely attributable to diaphragmotomy. These seven complications resolved following non-surgical intervention. Follow-up was available for 26 of 28 patients that survived to discharge at a median of 4-months (range 10 days to 24 months) following surgery and revealed no evidence of complications related to diaphragmotomy.

CLINICAL SIGNIFICANCE

Diaphragmotomy appears safe and increases abdominal exposure of hepatobiliary lesions. The benefit of improved exposure must be carefully weighed up against the risks inherent in inducing pneumothorax.

Use of a cavitron ultrasonic surgical aspirator for parenchyma-sparing and complex liver resections in dogs

OBJECTIVE

To report the clinical use of a cavitron ultrasonic surgical aspirator (CUSA) for the resection of hepatic lesions in dogs.

STUDY DESIGN

Clinical prospective study.

ANIMALS

Eleven client-owned dogs.

METHODS

Dogs requiring a hepatic nodulectomy, segmentectomy, and/or a lobectomy (including complex lobectomies) were enrolled. The number and location of procedures, blood loss, duration of surgery, and short-term complications were recorded.

RESULTS

Dogs underwent a mean of 2.3 ± 1.1 procedures. All masses were amenable to surgical excision regardless of their location and their relationship with major hepatic vessels. Dogs lost a median of 77 mL of blood (9.9-161), which corresponded to 4.3% of blood volume (0.8%-23.2%). The dog with the highest blood loss survived without requiring transfusion. The median duration of all CUSA procedures was 33.5 minutes (15-82). Short-term outcomes were assessed for the first 15 days, during which two complications were diagnosed. Cholangiohepatitis was diagnosed in one dog and resolved after medical management, and another dog developed necrotic pancreatitis and died.

CONCLUSION

Liver parenchyma-sparing nodulectomies and segmentectomies and liver lobectomies including complex lobectomies were achieved with a CUSA in all dogs.

CLINICAL SIGNIFICANCE

Use of a CUSA can be considered as an alternative for the removal of hepatic lesions in dogs.

Clinicophysiological, haematobiochemical and electrocardiographic effects of homogenous and heterogenous blood transfusion in traumatized dogs

Twenty four clinical cases of dogs having the history of the accidents irrespective of their age and sex were included in this study. The definite diagnosis was made on the basis of haematobiochemical, radiographic, ultrasonographic and laparoscopic findings. The animals were divided randomly into 3 groups, viz. A, B and C comprising equal number of animals. After the definite diagnosis, patients were subjected to surgical intervention i.e. splenectomy. The animals of groups A, B, and C were subjected to the administration of anaesthetic combination of atropine sulphate, diazepam and thiopental sodium just to pass endotracheal tube followed by either isoflurane (2–2.5%) or sevoflurane (3–3.5%) and also subjected to whole blood transfusion of cattle, buffalo and dogs in groups A, B & C respectively either during the operation or just after the operation.The efficacy of blood transfusion was judged on the basis of effects on various clinicophysiological and haematobiochemical parameters recorded before and after the administration of blood. Electrocardiographic studies were also made. It was concluded that in case of the trauma of spleen, homogenous transfusion of the blood in traumatized patient is most beneficial however in case of the emergency condition, heterogenous blood transfusion from cattle and buffaloes may also be made to save the life of the patients.

Carbon Monoxide-Releasing Molecule Enhances Coagulation and Decreases Fibrinolysis in Normal Canine Plasma

The dog is an important companion animal and also purpose-bred for research studies. Coagulopathies in dogs are common, although the availability of blood products for therapy is inconsistent throughout the profession. A pro-coagulant therapeutic that is readily available and easily stored would be useful for the treatment of coagulopathies. Tricarbonyldichlororuthenium (II) dimer [Carbon monoxide-releasing molecule-2 (CORM-2)] acts as a prothrombotic agent in plasma by increasing the velocity of clot formation and clot strength, and by decreasing the clot's vulnerability to fibrinolysis. We sought to test CORM-2's effect on coagulation and fibrinolysis in vitro in canine plasma using thromboelastography. Measures of the rate of clot formation and clot strength in plasma without CORM-2 were highly correlated with fibrinogen concentration. We found that CORM-2 significantly enhanced the rate of clot formation and clot strength and significantly reduced the rate of fibrinolysis and the clot lysis time. The per cent change in rate of clot formation and clot strength was not significantly correlated with fibrinogen concentration, indicating that CORM-2's pro-coagulant effect is not dependent on fibrinogen concentration. This study corroborates studies in other species that show that CORM-2 is pro-coagulant in plasma, and lays the groundwork for developing CORM-2 as a therapeutic agent for canine coagulopathies. Future studies will evaluate the effect of CORM-2 on whole blood both in vitro and in vivo.