Assessment of clinical and laboratory variables as a guide to packed red blood cell transfusion of euvolemic anemic dogs.

BACKGROUND: There are no standardized guidelines for determining the likelihood that euvolemic anemic dogs will benefit from transfusion of packed red blood cells (pRBC). OBJECTIVES: To report clinical and laboratory variables of dogs receiving pRBC transfusion, which could guide transfusion of other anemic dogs. ANIMALS: Twenty-four client-owned anemic dogs receiving pRBC transfusion. METHODS: Prospective study; 30 transfusions assessed. Clinical findings (mucosal color, pulse quality, heart rate, respiratory rate, mentation/exercise tolerance) before and after transfusion were evaluated by the anemic dog clinical assessment score (ADCAS). Hemoglobin concentration, hematocrit, venous oxygen content (CvO2 ), and lactate concentration were measured from blood samples taken before and after transfusion. These results were not used for case management. RESULTS: All ADCAS variables decreased significantly with transfusion (P < .001); the total score was ≥5/12 before transfusion, and ≤3/12 in all cases that were deemed to no longer require transfusion. Hematocrit and CvO2 were <17% and <5 mL/dL, respectively, in 83% of cases before transfusion and hemoglobin concentration was <5.8 g/dL in 80%. Hemoglobin concentration, hematocrit, and CvO2 increased significantly with transfusion (P < .001); lactate concentration decreased significantly (P = .006). CONCLUSIONS AND CLINICAL IMPORTANCE: Clinical and laboratory variables improved significantly after transfusion of pRBC. By identifying how transfusion affected these variables, it was possible to recognize clinical (ADCAS) and laboratory (hemoglobin, CvO2 , lactate) variables, which could be useful in guiding the decision to transfuse dogs with similar presentations.

Use of arterial blood gas analysis as a superior method for evaluating respiratory function in pet rabbits (Oryctolagus cuniculus).

A retrospective study compared invasive (arterial blood gas analysis) and non-invasive (capnography and pulse oximetry) methods of monitoring respiratory function in conscious rabbits. Arterial samples from 50 healthy dwarf lop rabbits, presenting for routine surgical neutering, were analysed on a point-of-care blood gas analysis machine. Reference intervals were obtained for pH (7.35-7.54), PaCO2 (mm Hg) (25.29-40.37), PaO2 (mm Hg) (50.3-98.2), base excess (mmol/l) (6.7-6.5), HCO3 (mmol/l) (17.96-29.41), TCO2 (mmol/l) (18.9-30.5). SaO2 (per cent) (88.8-98.0), Na (mmol/l) (137.6-145.2), K (mmol/l) (3.28-4.87), iCal (mmol/l) (1.64-1.94), glucose (mmol/l) (6.23-10.53), haematocrit (per cent) (23.3-40.2) and haemoglobin (mg/dl) (7.91-13.63). Pulse oximetry (SPO2) and capnography (ETCO2) readings were taken concurrently. There was no statistically significant relationship between SPO2 and SaO2 with a mean difference between SPO2 and SaO2 of 8.22 per cent. There was a statistically significant relationship between ETCO2 vs PaCO2, but a wide range of ETCO2 values were observed for a given PaCO2. The mean difference between these was 16.16 mm Hg. The study has provided reference intervals for arterial blood gas analysis in rabbits and demonstrated that capnography and pulse oximetry readings should not be relied upon in conscious rabbits as a guide to ventilation and oxygenation.

An unusual morphology of patent ductus arteriosus in a dog.

A 12-week old, entire female Border terrier weighing 3·5 kg was presented for investigation of a continuous left heart base murmur. The clinical presentation and preoperative echocardiogram were consistent with a standard morphology of patent ductus arteriosus (PDA) but a discrete ductal vessel was not identified during surgical dissection. Surgery had to be abandoned due to deterioration of the patient's condition under general anaesthesia which led to cardiorespiratory arrest and death despite attempts at resuscitation. Necropsy identified a recess within the wall of the aorta communicating with the pulmonary artery via an ostium at the heart base which determined this structure as an intramural PDA. This morphology of PDA is previously unreported. This report demonstrates that an intramural PDA is not readily identifiable surgically because of the absence of a discrete ductal vessel and it is important to appreciate that unusual morphologies of PDA may occur.

Effect of muscle injection site on preanaesthetic sedation in dogs.

The demeanour of 122 dogs was assessed, and a mixture of 0.025 mg/kg acepromazine and 0.3 mg/kg morphine was injected intramuscularly into one of four randomly assigned muscle sites (cervical epaxial, triceps brachii, middle gluteal and quadriceps femoris) and the dogs' reactions to the injections were assessed. The development of sedation and the occurrence of side effects were assessed after 10, 20 and 30 minutes, and each dog's reaction to venous catheterisation was scored. All the dogs became similarly sedated after 30 minutes. The degree of sedation and the incidence of side effects were independent of the injection site, but the dogs receiving intragluteal injections had lower sedation scores after 10 minutes. The dogs' demeanour had no effect on their response to venous catheterisation. The dogs receiving an injection into the postural quadriceps and triceps muscles showed more marked reactions than those injected into the non-postural cervical epaxial and gluteal muscles.

The healthy start renal clinic: benefits of tracking and early intervention in pre-end stage renal disease patients.

Several studies have demonstrated a strong association between the benefits of pre-end stage renal disease (ESRD) education and decreased length of hospital stay (LOS) and hospital charges, delay of renal replacement therapy (RRT), and a smooth transition to RRT. The Ochsner Healthy Start Renal Clinic (HSRC) is a multidisciplinary early education and tracking program for pre-ESRD patients and their families. We identified and educated pre-ESRD patients about kidney disease, allowing them to discuss and make informed decisions about their treatment and be better prepared to cope with the transition to RRT and the changes in their lives resulting from kidney failure. HSRC patients demonstrated a significant decrease in length of hospital stay (p = 0.05), a trend towards decreased hospital episodes and charges, decreased use of temporary venous access, and a smooth transition to RRT. The control group was made up of patients who had either refused the structured education or had been referred to HSRC late and received only conventional instruction by a social worker at the point where dialysis was imminent. We compared the number of episodes of hospitalization, LOS, and overall hospital charges for the period immediately surrounding initiation of chronic dialysis (2 months before and 1 month following onset) of all 36 patients who began chronic hemodialysis in our facility between November 1997 and November 1998. HSRC patients had LOS half as long (p=0.05), fewer hospital episodes, and hospital charges of $5,000 less per patient than the non-HSRC group. Initial data strongly suggest that early education and intervention through the coordination of a multidisciplinary team maximize the continuity of patient care.

Sexual development in malarial parasites: gametocyte production, fertility and infectivity to the mosquito vector.

Using cloned lines of Plasmodium berghei producing mixed asexual and sexual (clone 234L) and purely asexual (clone 233L) parasitaemias, the courses of parasitaemia, gametocytogenesis, exflagellation, ookinete production in vitro and mosquito infectivity have been followed. For clone 234L mosquito infectivity is maximal at day 3 and has ceased by day 6 post-infection. Conversely, gametocytogenesis, exflagellation and ookinete production are at minimal levels at day 3 and rise to peaks between days 10 and 15 of infection (in TO mice infected with blood at mechanical blood passage 3). Sexual potential declines progressively with sustained mechanical passage (up to P14). Gametocyte conversion is highest early in infection and declines exponentially; however, upon each mechanical passage conversion is again raised but decreases more rapidly with succeeding passages. For practical mosquito transmission in the laboratory we consider P8 to be the useful limit for mechanical transmission for this parasite clone. Asexual parasite growth (virulence) is more rapid with increased mechanical passage inducing a rapid fall in haematocrit. By P14 the course of infection closely parallels that of the purely asexual clone 233L.