Critical Care Literature Flashcards
Can COP be affected by general anesthesia?
YES, • COP in healthy dogs under GA decreased by 5mmHg (not predicted by IVF volume given or concurrent TS measurement)
How do axillary and rectal temps compare?
• Axillary and rectal temp are correlated but large gradient 3-4 degree F
○ Axillary and auricular are much less stressful!
Is a low refractometric TPP a good prediction of hypoAlb?
Not great
suboptimal for prediction of hypoalbuminemia (high proportion of false negatives)
○ Refractometric TPP
During hospitalization, what was seen with ascorbic acid?
It increased in dogs
What was the effect of IV dextrose (similar to parenteral nutrition) in healthy dogs on coagulation?
mildly interfere with coagulation but NOT clinically significant
○ MA lower, higher D-dimers, prolonged PT/PTT
Can you perform BMBT in cats?
YES
• 55 sedated cats for BMBT (primary hemostasis): Reference values of 34-105 sec
○ Consecutive readings in cats can vary up to 87sec!
Can the Anticoagulant Rodenticide Test detect second generations rodenticides (brodifacoum, bromethalin)?
No, Only detects warfarin
When should you consider vWD in cats?
• VWD has been reported in a few cats!!! Consider when platelet count and coags are normal
What was a major determinant of thrombin generation in healthy dogs?
Canine platelet membrane derived microparticles
In ex vivo models, does HES affect platelets?
YES, longer closure times - suggesting platelet dysfunction
What is see in dogs with trhombosis?
Normo and hypercoag state are common
Activated Protein C resistance is common
Based on TEG, what is predictive of survival in sepsis?
Higher Protein C and AT, and hypercoag for survival in sepsis (elevated MA)
What happens to PT/PTT in citrated blood that sits out?
• Stored citrated whole blood at room temp for 24 and 48 hrs did not significantly alter PT but it significantly shorted PTT - meaning that samples can be sent out to measure PT BUT NOT for PTT
What is seen with hemoabdomen in cats?
Evenly distribution of neoplasia (46%, most HAS of spleen) and non-neoplasia (54%)
○ Anemia, prolonged PT/PTT, most hypovolemic
○ Poor prognosis
What factor def should be considered in a dog that has excessive bleeding but normal coags?
Factor 13
What is the prognosis of dogs with hemophilia A?
Hemophilia A (Factor VIII def) - Had a good long term prognosis ○ Severity of FVIII:C activity did NOT predict CS, transfusion needs, or long term prognosis ○ Mixed breed, GSD, Labs most common (most
Is severity of FVIII:C activity predict CS, transfusion needs, or outcome?
NO :)
After trauma in dogs, what is poor prognostic indicator regarding coag?
hypocoaguable were more likely NOT to survive
○ Prolonged PTT correlated with nonsurival (also with APPLE score, lactate, and base excess)
What is seen on coag panel in healthy BMD?
Healthy Bernese Mountain Dogs have prolonged PTT - May be related to high lupus anticoagulants and antiphospholipid antibodies in these dogs (importance = unknown)
What is true regarding Antithrombin Activity
Increased mortality risk, which progressively increased as ATA decreased (sen: 58%, Spec 85% = 85% not sole factor)
○ Low AT: IMHA, pancreatitis, hepatopathy, neoplasia
More dogs had Leukocytosis, hemostatic changes, hypoalbuminemia, hyperbilirubinemia
What happened to feline monocytes after exposure to LPS?
• Surface expressed and intracellular TF can be measured in feline monocytes
○ Treatment with LPS induced dose dependent TF expression on feline monocytes
§ Response was inhibited by giving fetal bovine serum
How do NSAIDs affect platelet function?
• Common NSAIDs did NOT significantly affect platelet function (aspirin (at anti-infalmmatory, 10mg/kg q12hrs), carprofen, meloxicam), HOWEVER, deracoxib had a mild decrease in platelet aggregation
○ No changes in plasma thromboxane or prostanglandins noted
What is post trauma coagulopathy?
• Post-trauma coagulopathy resulting in hemorrhage leadings to preventable deaths within 24 hrs
Resulting from endothelial dysfunction and inflammation - systemic hypocoag and hyperfibrinolysis!! = BLEEDING
What are platelet inhibitors that result in thrombocytopathia during hepatobiliary disease?
Bile and FDPs (they accumulate)
How does hepatobiliary disease affect primary and secondary hemostatsis?
○ Primary hemostasis:
§ Thrombocytopenia: GI bleeding, thrombosis, DIC consumption, hypersplenism from portal hypertension, decreased thrombopoeitin
□ Exception in hepatoceullar carcinomas if tumor makes TPO
§ Thrombocytopathia: Changes in platelet membrane, decreased thromboxane synthesis, storage pool defects in ATP and seronotin, circulating ihibitors - bile acids and FDPs (not cleared by liver)
§ Effects on vasculature: Esp with portal hypertension - increased shear stress that then leads to endothelial cell dysfunction (hypocoag, esp with NO and increased endotoxin)
○ Secondary Hemostasis
§ Coag defs (esp Vit K) and changes in anticoagulants
§ Chronic hepatitis: Decreased fibrinogen
DIC looks the same as changes with liver dz, in humans they look at platelets and Factor VIII then
In acute and chronic hepatitis what is the prognosis with prolonged PT/PTT?
Worse prognosis
IN aflatoxin and cycad seed ingestion what is predictive of nonsurvival?
Prolonged PT/PTT and low protein C and AT
What are the 3 main imbalances that occur in coagulation with hepatobiliary disease?
Impaired hemostasis (low plt, dysfunctional plts, decreased coag factors, decreased vit K, dysfibrinogenemia) Promote hypercoag (increased vWF, portal hypertension, decreased protein C,S, AT, abnormal endothelial function) Promote fibrinolysis (increased tPA, decreased TAFI)
What is seen on TEM when hetastarch is added?
hypocoagubility - Effects appear to be related to dose dependent alternation in fibrinogen and inhibition of platelet function
What effect did venipuncture trauma have on TEG?
• Mild to moderate venipuncture trauma had little effect on TEG overall (R significantly affected = shorter) - More rapid initation of clot formation
What is true regarding monitoring heparin with TEG?
Progressive changes in TEG tracing (prolonged R and decreased angle and MA); maximal change at 3-5 hrs after dosing
○ Extensive prolongation of R (even with little heparin (0.075U/ml) may indicate that TEG is too sensitive to be used to monitor heparin
§ This is below lower limit of AntiXa Activity
Why should we do cautious about using protamine to reverse heparin?
• Protamine in healthy dogs: Prolonged clot formation time and decreased overall clot strength based on TEG in dose dependent manner (Hypocoag state)
May need to cautious about using to reverse effect of heparin
What affects did pred have on TEG?
• Prednisone (2mg/kg/day for 7 days) +/- with aspirin (0.5mg/kg/day) resulted in increased clot strength (increased MA) and decreased clot lysis in healthy dogs
What are the 3 main effects of pred on coag?
increased MA, elevated fibrinogen, and decreased AT levels)
○ When low dose aspirin given with steroids no effect on TEG results
○ Lots of variation when used in clinical cases
If you have a low HCT what happens to TEG?
HYPERcoag
Thought that normally RBCs act as a dilute for plasma coag factors, so then they are gone = hyper
Did sedation affect TEG in cats?
Yes!shorter clotting time, and greater alpha angle, BUT no difference in MA (unlikely to be clinical significant)
Is TEG good screening for dogs given LPS endotoxin?
NO! D-dimers was the earliest indication of coag changes
Do dogs with antiphospholipid antibodies play a role in thrombosis?
NO! • Antiphosphosolipid Antibodies do NOT play strong role in thrombosis in dogs (spontaneous thrombosis, HAC, and IMHA dogs)
○ No dogs had lupus anticoagulants
What happens to platelets at very HIGH doses of cyclosporine?
alter platelet plasma membranes (flow P-selectin and phosphatidylserine, COX expression) AND increased thromboxane production in dogs at immmunosuppressive dose (19 mg/kg PO q12hrs)
○ Suggesting that hypercoagulability is possible at this dose
What should cats with renal infarcts be screened for?
Need to be screened for occult cardiomyopathy
○ If renal infarcts: More likely to have HCM (4.5X) and have distal aortic thrombi (8X); Less likely to have neoplasia (0.7X)
In cats with renal infarcts what is the role of hyperT4?
None, no association noted
In acutely paralyzed dogs and cats what is an accurate diagnostic marker of acute ATE?
• ΔGlucose and %Δglucose (from peripheral to central venus) are accurate diagnostic marker of acute ATE in acutely paralyzed dogs and cats
○ Δglu cutt offs: 30 mg/dl (cats); 16 mg/dl (dogs)
§ Sen: 100%, Spec 90% (cats), 100% (dogs)
○ Compared to controls with ortho/neuro dz resulting in acute limb paralysis
What is known about TEGs in ITP patients?
At start all dogs were hypocoaguable based on TEG but over the treatment all dogs had TEG tracing suggestive of hypercoagubility (unknown clinical risk of thrombosis)
What do dogs with PLN have besides hypercoag?
High protein C
What is the prognosis of dogs with aortic thrombosis?
MST significantly longer in dogs with chronic disease compared to acute disease (chronic MST 30 days, 0-959 vs acute MST 1.5 days, 0-120)
§ Overall poor outcomes, but protracted periods
§ Acute (45%), chronic (48%)
§ Weak pulses (19%), Absent pulses (55%)
What concurrent diseases are see with aortic thrombi in dogs?
Neoplasia. Steroids, renal dx, cardiac dz