Use of Thromboelastography in Clinical Practice.

Viscoelastic testing, such as thromboelastography or thromboelastometry, is performed on whole-blood samples, which include both soluble plasma factors as well as blood cells and platelets bearing tissue factor and phospholipid. This methodology allows identification of fibrinolysis and can provide analysis of platelet function. Viscoelastic testing has become increasingly accessible and popular in emergency and critical care settings in recent years and can provide important information for the diagnosis and management of patients with hemostatic disorders. This article discusses the principles and interpretation of viscoelastic testing, application to small animal emergency and critical care medicine, and potential advantages and disadvantages.

Hyponatremia in dogs and cats.

OBJECTIVE: To review the pathophysiology, diagnostic approach, and treatment recommendations for hyponatremia in dogs and cats. ETIOLOGY: Hyponatremia almost always results from an increase in total body water (TBW), and not from loss of sodium. Abnormalities in antidiuretic hormone (ADH) are commonly part of the etiology of hyponatremia. DIAGNOSIS: Diagnosis of hyponatremia focuses on the cause of the increase of TBW. Assessment of the patient's volume status and measurement of urine sodium concentration are important factors. Measurement or calculated estimation of plasma osmolality can also guide the assessment of hyponatremia. THERAPY: Too rapid correction of serum sodium can precipitate osmotic demyelination syndrome. As a general rule, serum sodium concentration should be raised ≤10 mmol/L over 24 hours, but rapid increases in serum sodium are indicated if neurologic abnormalities are evident. Serum sodium can be increased using hypertonic saline, with dosing based on the patient's calculated sodium deficit. Treatment of the underlying cause of water ingestion or retention is also required to fully resolve hyponatremia. PROGNOSIS: Mortality rates are significantly higher in dogs and cats with hyponatremia compared to those with normal serum sodium concentrations, even in patients with mild hypontremia (<5 mmol/L below the lower value of the reference interval). Hyponatremia is also associated with increased risk of death if present during specific disease states in dogs.

In vitro assessment of the effect of acidemia on coagulation in dogs.

OBJECTIVE: Minimal data are available assessing the effect of acidemia on coagulation in dogs. The objective of this study was to assess the effect of in vitro acidification of canine blood on coagulation as measured via thromboelastography (TEG) and traditional tests of coagulation. We hypothesized that worsening acidemia would lead to progressive impairment on coagulation. DESIGN: Prospective study. SETTING: University teaching hospital. ANIMALS: Six client-owned dogs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Blood was collected into 3.2% sodium citrate vacutainer tubes. The pH of blood was adjusted from baseline using hydrochloric acid to create weak acidemia and strong acidemia. Coagulation was assessed using TEG, prothrombin time, and activated partial thromboplastin time. Kruskal-Wallis tests with Dunn's post hoc comparison tests were used to compare groups. Strong acidemia samples were significantly more acidic than baseline based on pH (P < 0.0005), HCO3- (P < 0.0062), pCO2 (P < 0.0001), and base excess (P < 0.0001). Using TEG, in vitro acidification of blood caused significant, progressive impairment of maximum amplitude (P = 0.0282) and alpha angle (P = 0.0312). Acidification of blood had no significant effect on prothrombin time (P = 0.345) or activated partial thromboplastin time (P = 0.944). CONCLUSIONS: In vitro acidification of canine whole blood results in hypocoagulability as measured by some TEG variables.

Bilateral Aural Adenocarcinoma in a Congo African Grey Parrot ( Psittacus erithacus erithacus).

A 28-year-old female Congo African grey parrot ( Psittacus erithacus erithacus) was evaluated because of a mass in the left external auditory meatus. Results of a computed tomography scan revealed an osteolytic left hemimandibular mass with irregular bone production and a soft tissue mass in the left external auditory meatus. Results of cytologic examination of fine needle aspirates of the hemimandible were interpreted as adenocarcinoma with reactive osteoblasts. The owner chose palliative treatment, and a debulking procedure was performed on the left external auditory meatus mass 52 days after initial presentation to control self-trauma. Euthanasia was elected 67 days after initial presentation because of poor prognosis associated with the development of bilateral masses of the external auditory meatus and lateral deviation of the mandible, findings that were confirmed by postmortem examination. Histopathologic results confirmed the diagnosis of bilateral aural adenocarcinoma with invasion of both temporal bones and hemimandibles.

Management of an invasive and metastatic Sertoli cell tumor with associated myelotoxicosis in a dog.

We describe the surgical and post-operative management of a large, invasive, and metastatic functional Sertoli cell tumor in a 9-year-old cryptorchid male Labrador retriever dog. Despite residual disease after surgery, bone marrow recovery occurred without administration of bone marrow stimulants and serum estradiol accurately predicted tumor recurrence.

Gestion d'une tumeur à cellules de Sertoli invasive et métastatique avec une myélotoxicose secondaire chez un chien. Nous décrivons la gestion chirurgicale et postopératoire d'une tumeur à cellules de Sertoli fonctionnelles, de grande taille, invasive et métastatique chez un chien Labrador retriever cryptorchide âgé de 9 ans. Malgré une maladie résiduelle après la chirurgie, le rétablissement de la moelle osseuse s'est produit sans l'administration de stimulants de la moelle osseuse et l'œstradiol sérique a fidèlement prédit la récurrence de la tumeur.(Traduit par Isabelle Vallières).

Implant-associated neoplasia in dogs: 16 cases (1983-2013).

OBJECTIVE: To characterize clinical and pathological features of implant-associated neoplasms in dogs. DESIGN: Retrospective case-control study. ANIMALS: 16 dogs with implant-associated neoplasia and 32 control dogs with osteosarcoma without implants. Procedures: Medical records of dogs with tumors associated with metallic implants (cases) treated between 1983 and 2013 were reviewed. Two dogs with naturally occurring osteosarcoma (controls) were matched to each case on the basis of tumor location, age, and sex. RESULTS: Median time from implant placement to diagnosis of neoplasia was 5.5 years (range, 9 months to 10 years). Pelvic limbs were most frequently affected, including the tibia (8/16) and femur (5/16), with 1 neoplasm involving both the femur and pelvis. Implant: associated tumors most commonly affected the diaphysis (15/16), with osteosarcomas significantly more likely to involve the long bone diaphysis in case dogs than in control dogs with naturally occurring osteosarcomas. Osteosarcoma was the most common tumor, accounting for 13 of 16 implant-associated tumors. For 7 of these osteosarcoma cases, review of histopathology results enabled subclassification into osteoblastic nonproductive (n = 3), chondroblastic (2), osteoblastic productive (1), and fibroblastic (1) groups. Three case dogs had a diagnosis of histiocytic sarcoma, fibrosarcoma, and spindle cell sarcoma. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study highlighted important anatomic differences between spontaneous and implant-associated neoplasia in dogs.

Equine bone marrow volume reduction, red blood cell depletion, and mononuclear cell recovery using the PrepaCyte-CB processing system.

BACKGROUND: Volume reduction and RBC depletion of equine bone marrow specimens are necessary processing steps for the immediate therapeutic use of bone marrow (BM)-derived mesenchymal stem cells (MSC), and for MSC expansion in culture. OBJECTIVES: The purpose of the study was to evaluate the ability of the PrepaCyte-CB processing system to reduce volume, deplete RBC, and recover mononuclear cells (MNC) from equine BM specimens. METHODS: One hundred and twenty mL of heparinized BM were obtained from each of 90 horses. A CBC was performed on the BM pre- and post-PrepaCyte-CB processing. Volume and RBC reduction, and total nucleated cell (TNC) and MNC recoveries were determined. RESULTS: Bone marrow volume was reduced from 120 mL to 21 mL with a median RBC depletion of 90.1% (range, 62.0-96.7%). The median preprocessing total TNC count was 2.2 × 10(9) (range, 0.46-7.9 × 10(9)) and the median postprocessing TNC count was 1.7 × 10(9) (range, 0.3-4.4 × 10(9); P < .0001), with a median recovery of 73.5% (range, 22.4-216.7%). The median preprocessing total MNC count was 0.9 × 10(9) (range, 0.1-4.7 × 10(9)) and median postprocessing total MNC count was 0.8 × 10(9) (range, 0.1-2.7 × 10(9); P = .06), with a median recovery of 83.7% (range, 15.4-413.9%). CONCLUSIONS: The PrepaCyte-CB processing system can be used to deplete both volume and RBC, and recover MNC from equine BM specimens. Further studies assessing the viability of MSC and the efficacy of MSC expansion after using the PrepaCyte-CB processing system are warranted.

Poikilocytosis in rabbits: prevalence, type, and association with disease.

Rabbits (Oryctolagus cuniculus) are a popular companion animal, food animal, and animal model of human disease. Abnormal red cell shapes (poikilocytes) have been observed in rabbits, but their significance is unknown. The objective of this study was to investigate the prevalence and type of poikilocytosis in pet rabbits and its association with physiologic factors, clinical disease, and laboratory abnormalities. We retrospectively analyzed blood smears from 482 rabbits presented to the University of California-Davis Veterinary Medical Teaching Hospital from 1990 to 2010. Number and type of poikilocytes per 2000 red blood cells (RBCs) were counted and expressed as a percentage. Acanthocytes (>3% of RBCs) were found in 150/482 (31%) rabbits and echinocytes (>3% of RBCs) were found in 127/482 (27%) of rabbits, both healthy and diseased. Thirty-three of 482 (7%) rabbits had >30% acanthocytes and echinocytes combined. Mild to moderate (>0.5% of RBCs) fragmented red cells (schistocytes, microcytes, keratocytes, spherocytes) were found in 25/403 (6%) diseased and 0/79 (0%) healthy rabbits (P = 0.0240). Fragmentation and acanthocytosis were more severe in rabbits with inflammatory disease and malignant neoplasia compared with healthy rabbits (P<0.01). The % fragmented cells correlated with % polychromasia, RDW, and heterophil, monocyte, globulins, and fibrinogen concentrations (P<0.05). Echinocytosis was significantly associated with renal failure, azotemia, and acid-base/electrolyte abnormalities (P<0.05). Serum cholesterol concentration correlated significantly with % acanthocytes (P<0.0001), % echinocytes (P = 0.0069), and % fragmented cells (P = 0.0109), but correlations were weak (Spearman ρ <0.02). These findings provide important insights into underlying pathophysiologic mechanisms that appear to affect the prevalence and type of naturally-occurring poikilocytosis in rabbits. Our findings support the need to carefully document poikilocytes in research investigations and in clinical diagnosis and to determine their diagnostic and prognostic value.

Thymoma-associated lymphocytosis in a dog.

A 9-year-old female spayed English Springer Spaniel was evaluated for a cranial mediastinal mass and lymphocytosis. Flow cytometric immunophenotyping of peripheral blood lymphocytes revealed 97% as CD3 positive, confirming a T-cell lineage. Additionally, T-cell subset assessment showed 53.2% to be double-negative T-lymphocytes, expressing neither CD4 nor CD8 surface markers. The number of double-negative lymphocytes in circulation coincided with the number of T-cell receptor (TCR) γδ-expressing T-cells in circulation. Molecular T-cell clonality analysis of TCR Gamma (TCRG) gene rearrangement showed a polyclonal expansion of T-lymphocytes. Histopathology confirmed the mass to be a thymoma, supporting the diagnosis of thymoma-associated T-cell lymphocytosis. Resolution of the lymphocytosis after removal of the thymoma provided further evidence for this diagnosis. To the authors' knowledge, this case is only the second report of thymoma-associated peripheral lymphocytosis in the veterinary literature, and is the first to report a confirmed thymoma-associated peripheral γδ T-cell lymphocytosis in a dog.

Mycotic Keratitis in a Khaki Campbell Duck ( Anas platyrhynchos domesticus).

A 1.5-year-old, intact female khaki Campbell duck (Anas platyrhynchos domesticus) was evaluated for lethargy and a swollen left eye (OS). Mucoid discharge, chemosis, and conjunctival hyperemia with trace aqueous flare, indicating anterior uveitis, in the anterior chamber were evident on ophthalmic examination. There was no fluorescein stain uptake by the cornea. Initial topical antibiotic therapy and systemic anti-inflammatory treatments were unsuccessful, and the lesion progressed to a diffuse, yellow-white plaque, which covered 90%-95% of the cornea 4 days later. There was moderate blepharospasm, mild blepharedema, and epiphora OS. The mobility of the nictitating membrane was impaired because of the presence of the plaque over the cornea. Cytologic examination of a corneal scraping revealed fungal hyphae, and aerobic culture confirmed Aspergillus species. Treatment with topical voriconazole (1 drop OS q4h-q6h) was initiated and was switched to oral voriconazole (20 mg/kg PO q12h) 6 days after initiating treatment. The ocular disease improved during the antifungal treatment period. Eighty-four days after initial presentation (9 days after discontinuation of treatment), there was no clinical evidence of mycotic keratitis on ophthalmic examination.