Lit Hemolymphatic Flashcards
What were the findings & conclusions in a study that evaluated IgG and phosphatidylserine (PS) positivity of RBCs/nRBCs in dogs with IMHA & PIMA?
Lucidi JVIM 2021
IgG & PS may promote destruction of nRBCs in PIMA dogs (incr nRBC IgG positivity in mid-late stage fractions, incr PS positivity in mid-late stage erythyroid precursors in BM).
PS may promote RBC destruction in IMHA dogs (incr RBC IgG & PS positivity in IMHA dogs but not healthy dogs).
What were the effects of leukoreduction on neutrophil extracellular traps (NETs) activity and concentrations in canine pRBCs?
McQuinn JVIM 2020
NETosis (increased NET markers) occurs in stored canine non-LR RBC units, and is attenuated by LR before storage. NETs might be mediators of transfusion reactions.
NETs evaluated in this study - cell-free DNA (cfDNA) (non-specific marker) & citrullinated histones (specific marker as NETosis requires histone citrullination).
What were the effects/differences in acute transfusion reactions & outcome (survival) in dogs receiving LR vs non-LR pRBCs?
Radulescu JVIM 2021
No clinical advantage of using LR over non-LR pRBC - no sig diff in incidence of acute TRs, increases in PCV post-transfusion, survival to discharge.
What were the effects of leukoreduction of canine whole blood & blood products prior to transfusions?
Stefani JVIM 2021
Benefits - positive effects on lactate, blood pH, and K+.
IL-8 (pro-inflammatory cytokine) were increased in non-LR units.
LR blood recommended to critically ill dogs with marked inflammation. reduces risk of transfusion reactions & storage lesions.
What is the significance of erythrocyte phosphatidylserine (PS), and what do increased concentrations reflect?
What were the effects of leukoreduction on erythrocyte PS expression & eicosanoid concentrations in canine blood?
Muro JVIM 2017
PS = membrane marker on RBCs that can serve as a marker of quality/ cell removal; increased PS concentrations are considered a storage lesion.
LR, storage, and simulated transfusion do not alter RBC PS expression. LR caused an immediate increase in [ ] of eicosanoids TXB2 & PGF2α, but these decreased to non‐LR [ ] with storage.
LR does not decrease accumulation of 6‐keto‐PGF1α during storage.
In dogs receiving vincrisine for IMTP, what was a) the incidence of neutropenia, b) major risk factor for development of neutropenia, and c) effects on clinical outcome?
LaQuaglia JVIM 2021
a) 19% (ranged from grades 1-4)
b) Cyclosporine administration (OR 12.97).
c) No effect on median time to achieve ≥40 000 platelets/μL (av 4days).
Prolonged duration of hospitalisation (median 6d vs 4d in non-neutropeni dogs).
No diff in survival to discharge (95%).
What is the gold standard method of cross-matching?
What was the level of agreement between POC and laboratory methods of cross-matching?
Dogs that had received a previous transfusion had increased risk of cross-matching incompatibility compared to transfusion-naïve dogs (T/F).
Marshall JVIM 2020
Tube agglutination assay
No agreement
False – similar rates (25% in naïve dogs, 35% in dogs with transfusion hx)
Elthrombopag - MOA & indication?
Kelly JVIM 2020
Thrombopoietin receptor agonist
Idiopathic aplastic pancytopenia in dog (case report) - used in humans in combo with immunosuppressants - improves overall response rate & complete response (clinical remission) rates.
What hematologic & echocardiographic parameters change in dogs & cats following blood transfusions?
How did patients with volume overload compare with patients without overload following blood transfusion(s)?
Donaldson JVIM 2020
PCV increased (cats & dogs), HR decreased (dogs), fractional shortening decreased (cats), LVIDs increased (cats), LVIDd(n) & LVIDs(n) increased (dogs).
Comparable, transfusion well tolerated. Incidence of volume overload did not differ before or after transfusion.
What are the logistical advantages of lyphophilized platelets compared to cryopreserved platelets?
How did the outcomes between lyphophilized & (DMSO-stabilised) cryopreserved platelets compare when administered to thrombocytopenic dogs?
Goggs JVIM 2020
Lyphophilized platelets (LPs) = freeze-dried. Long shelf-life, easily transported, stored, and administered.
LPs were non-inferior to DMSO-stabilized canine CPP for change in DOGiBAT score at 24hrs post-transfusion, change in platelet count, requirement for additional RBC units, survival to discharge.
The use of AUS to evaluate dogs with non-traumatic haemoabdomen had the highest sensitivity of ….. when identifying ……., but was least sensitive (…..% and ……%) when dogs were identified to have …….. and …… respectively.
Cudney JAVMA 2021
87%, splenic masses.
37% & 31%; liver masses & mesenteric masses respectively. (0/6 dogs with diffuse nodular mets had lesions detected by AUS).
What changes & incidence of haematologic/coagulation variables were observed in dogs that had undergone splenectomy for splenic masses within the past 2 weeks?
What clinical implications do these findings have?
Phipps JAVMA 2020
Marked thrombocytosis (69-81%)
Hypercoagulability (TEG evaluation) (84-89%)
Higher platelet ccounts correlated with hypercoagulable readings on TEG.
Increases risk for portal venous thrombosis & PTE.
What canine breed has congenital methemoglobinemia been identified in?
Causal gene mutation reported?
Jozani JVIM 2019
Pomeranians
CYB5R3 mutation - resulting innicotinamide adenine
dinucleotide (NADH)-cytochrome b5 reductase (CYB5R3) deficiency
Do canine whole blood units have a good sanitary shelf life during commercial storage (42 days)?
Miglio JVIM 2016
Yes. Most organisms detected via PCR were common bacteria & not implicated in septic transfusion reactions. Very low numbers of genome equivalents (<80 GE/uL).
What is the prevalence of hospital acquired anemia?
What are the associated risk factors?
Is it prognostically significant?
Lynch JVIM 2016
Anemia at admission in 32%, during hospitalisation 56% (+24%). Associated with surgery (vs medical patients), increased blood draws & being a cat.
Anemic dogs less likely to survive to discharge.
What marker of oxidative stress was different between anemic & non-anemic dogs?
What is the role of this marker?
Kendall JVIM 2017
Anemic dogs had significantly lower glutathione peroxidase (GPx) activity, but this was not different between haemolytic vs non haemolytic anemia.
Total antioxidant capacity (TAC) & urinary 15-F2-isoprostane (F2-IsoP) were not significantly different between anemic/non-anemic dogs.
GPx = antioxidant enzyme; plays an important role in protecting hemoglobin, RBC enzyme activity & biological cell membranes against oxidative damage by increasing the concentration of reduced glutathione (GSSG-R) in the process of aerobic glycolysis. RBCs rely on antioxidant defenses (primarily the glutathione pathway & small molecule antioxidants (selenium)) to protect themselves from injury. Depletion of these antioxidants can lead to disruption of the glutathione pathway with generation of excessive ROS.
What is the utility of measuring urinary 15-F2 isoprostanes (F2-IsoP)?
Kendall JVIM 2017
Urine isoprostanes are prostaglandin-like compounds produced by ROS-catalyzed peroxidation of arachidonic acid. Increased concentrations of isoprostanes in tissue & urine correlate with disease severity (oxidative injury) in people & animals.
Name another blood group in dogs apart from DEA & Dal.
What is the most common form in North America of this blood group? Does it come with alloantibodies?
Euler JVIM 2016
Kai 1 & Kai 2. Unrelated to DEA (1,3,4,7) & Dal.
Kai 1+ Kai 2- most common in this study (95%). No dogs positive for both. No alloantibodies identified for this group.
What is the mode of inheritance of the Dal antigen expression in dogs?
Which 2 breeds commonly have the Dal+ blood type and at what prevalence?
How common is the Dal- phenotype; predominantly identified in which breeds? What is the significance of this phenotype?
Goulet JVIM 2017
Autosomal dominant.
Dal+ mostly Dalmatians (85-100%) & Dobermans (43–78%) with geographical variation.
Dal- most commonly in Dobermans (42%), Dalmations (11%), Shih Tzus (57%); mixed breeds 2.5%. Only 2.4% of donors negative overall.
Dal- dogs can become sensitised through transfusion with a Dal+ donor. Extended Dal typing recommended in these breeds + dogs when blood incompatibility problems arise after initial transfusions.
(2 papers)
Name a feline blood type other than A/B.
What was the incidence of major cross-match incompatibilities in cats which were transfusion naive?
What is the clinical impact of performing (or not performing) a major crossmatch on transfusion negative cats?
McClosky JVIM 2018
Mik group.
Major X-match incompatibilities in 14.9% of transfusion naive cats (vs 27% in those not naive).
Febrile reactions more common in non-X-matched (10%) vs X-matched cats (2.5%).
X-matching did not improve survival or PCV increase.
High prevalence of non-AB incompatibilities - recommend X-matching in cats prior to every blood transfusion (including 1st).
Sylvane JVIM 2018
No difference in % of transfusion reactions (17% vs 29% but not statistically different). No difference in mean change in PCV. Results did nott support use of the major cross-match to increase efficacy of transfusions and/or to decrease adverse reactions in AB blood typed transfusion-naïve cats.
Does rivaroxaban require special administration in regards to food and gastroprotectants? When does its peak effect occur after administration?
What can be used to monitor its activity?
Lynch JVECC 2021
Given without food did increase anti-Xa activity at 36hrs but not at other time points. No impact on feeding overall & gastroprotectants not significant.
Peak effect at 2-4hrs post dose.
Rivaroxaban calibrated anti-Xa activity assay (RIVA) used to monitor
anticoagulant effect in this study.
What is the gold standard method for monitoring rivaroxaban activity? What is an alternative point-of-care test used in 1 study, and what findings correlated with therapeutic drug concentrations?
Bae JVIM 2019
Gold standard = chromogenic anti-Xa assay (measures plasma RIV [ ]).
POC PT assay & TEG used, and compared to chromogenic anti-Xa assay in this study. TEG used specific tissue factors (RapidTEG, TF100, TF3700).
1.5-1.9x delay in POC PT & R values of TEG @ 3hrs after RIV administration required to achieve therapeutic plasma anti-Xa concentrations of RIV.
(2 papers)
What is the gold standard method for monitoring rivaroxaban activity?
What alternative point-of-care tests have been explored, and which tests had good correlation with therapeutic anti-Xa concentrations (RIV activity) in dogs?What is the recommended change in parameters?
Bae JVIM 2019
Gold standard = chromogenic anti-Xa assay (measures plasma RIV [ ]).
POC PT assay & TEG used, and compared to chromogenic anti-Xa assay in this study.
1.5-1.9x delay in POC PT @ 3hrs after RIV administration required to achieve therapeutic plasma anti-Xa concentrations of RIV. R value of TEG could also be used, but need to use specific tissue factors.
Lynch JVECC 2020
Evaluated tests. PT correlated best with RIVA (may be a good 2nd-line monitoring option; but assay dependent). aPTT moderately correlated, and TEG poorly correlated with anti-Xa activity.
What does CTAD anticoagulant stand for? What can or can’t it be used for?
Spada JFMS 2017
Citrate, theophylline, adenosine & dipyridamole.
CAN be used for routine haematology, biochemistry (with some limitations; -ve proportionately - AST, ALKP; +ve proportionately - albumin, CK) & coags.
NOT for evaluation of primary hemostasis (e.g. platelet aggregrometry) & above biochemical variables.
(2 papers)
What are the effects of Yunnan Baiyao PO BID on coagulation as per TEG in HEALTHY dogs vs cats? Adverse effects noted?
Tansey JVECC 2018 (DOGS)
Increases clot strength. Increased G, A30 & A60 values. After 1 week decreased LY30 & LY60.
Well tolerated (mild D+ in 1 dog)
Patlogar JVECC 2017 (CATS)
No significant changes in TEG parameters, but did significantly reduce Hct & RBC count (none became anemic).
Well tolerated, though 17.6% transient V+.
What were the clinical benefits of administering Yunnan Baiyao & epsilon aminocaproic acid in dogs with R atrial masses & pericardial effusion?
Murphy JVECC 2016
Safe administration, but did not significantly delay recurrence of clinical signs or improve survival (vs dogs treated with pericardiocentesis alone).
What were the hemostatic effects of volume replacement with tetrastarch on haemorrhaged dogs?
Diniz JVIM 2018
No effect on BMBT, increased APTT 4 hours post. TEG changes with both TS & LRS (increased clot formation time & decreased maximum clot firmness).
Conclusion: TS does not impair primary haemostasis. Caused a transient dilution coagulopathy similar to LRS.
What ROTEM variable correlated well with fibrinogen activity using the Clauss method?
Enk JVIM 2019
FIBTEM used in this study.
Maximum clot firmness (MCF) strongly correlated with fibrinogen(Clauss) - could be used instead to evaluate the effect of fibrinogen on homeostasis.
