The use of High-Flow Nasal Oxygen Therapy in 4 dogs undergoing bronchoscopy.

Introduction: High-Flow Nasal Oxygen Therapy is a method to deliver warmed, humidified air-oxygen blended at high flow rates to patients through a nasal cannula using a specialized, commercially available machine. This is a well-tolerated, safe and effective method for oxygen delivery to healthy and hypoxemic dogs. Patients undergoing bronchoscopic procedures frequently develop hypoxemia. Human trials have shown a reduction in incidents of hypoxemic events and higher pulse oximeter oxygen saturation during bronchoscopies in patients on High-Flow Nasal Oxygen. Materials and methods: This is a single-centre, prospective case series. All dogs weighing between 5 and 15 kg and undergoing bronchoscopy during the study period (03/07/2022-01/10/2022) were eligible. Results: Twelve patients were eligible for inclusion of which four were enrolled. No clinically significant complications related to the use of High-Flow Nasal Oxygen Therapy were recorded. Two of the patients were re-intubated post bronchoscopy due to clinician preference for recovery. One of the patients had a self-limiting period of severe hypoxemia with a pulse oximeter oxygen saturation of 84% for < 1 min during bronchoalveolar lavage, and whilst undergoing High-Flow Nasal Oxygen administration. Another patient had a self-limiting episode of mild hypoxemia (SpO2 of 94% lasting < 1 min) 5 min after completion of bronchoalveolar lavage. Conclusion: No clinically relevant complications relating to High-Flow Nasal Oxygen Therapy were recorded in this case series, although further studies are required to confirm this conclusion. This initial data suggests that the use of High-Flow Nasal Oxygen therapy during bronchoscopy is feasible and potentially safe, although it may not prevent hypoxemia in these patients. The use of High-Flow Nasal Oxygen Therapy during bronchoscopy in small patients carries multiple potential benefits and further studies to compare its efficacy against other traditional oxygen delivery systems are warranted in this patient population.

The use of high-dose immunoglobulin M-enriched human immunoglobulin in dogs with immune-mediated hemolytic anemia.

BACKGROUND: The IV use of human immunoglobulin (hIVIG) in dogs with primary immune-mediated hemolytic anemia (IMHA) has been described previously, but herein we describe the use of high-dose IgM-enriched hIVIG (Pentaglobin). HYPOTHESIS/OBJECTIVES: Dogs treated with high-dose Pentaglobin will experience shorter time to remission and hospital discharge and have decreased transfusion requirements compared to dogs receiving standard treatment alone. ANIMALS: Fourteen client-owned dogs diagnosed with primary IMHA at specialist referral hospitals in the United Kingdom. METHODS: All prospectively enrolled dogs received prednisolone, dexamethasone or both along with clopidogrel. Patients were randomized to receive Pentaglobin at 1 g/kg on up to 2 occasions, or to serve as controls. No additional immunosuppressive drugs were allowed within the first 7 days of treatment. Remission was defined as stable PCV for 24 hours followed by an increase in PCV. RESULTS: Ten of 11 dogs from the treatment group and 2 of 3 dogs from the control group achieved remission and survived until hospital discharge. Survival and time to remission were not significantly different between groups. The volume of packed red blood cells transfused, normalized for body weight, was not significantly different between groups. Potential adverse reactions to Pentaglobin occurred in 2 dogs, but their clinical signs may have been related to the underlying disease. CONCLUSIONS AND CLINICAL IMPORTANCE: Treatment with high-dose Pentaglobin was well tolerated by dogs with primary IMHA but no significant advantage was found in this small study. Additional studies examining larger groups and subpopulations of dogs with primary IMHA associated with a poorer prognosis are warranted.

Clinical findings in dogs diagnosed with leptospirosis in England.

BACKGROUND: Leptospirosis is a zoonotic disease of worldwide importance. This study describes the clinical findings and outcome of dogs diagnosed with leptospirosis in England. METHODS: Retrospective review of medical records of dogs diagnosed with leptospirosis from a single referral hospital located in Eastern England. RESULTS: Thirty-eight dogs met the inclusion criteria. Clinical signs included inappetence (76%), vomiting (68%), lethargy (58%), polydipsia and polyuria (18%) and abdominal pain (16%). Disease manifestations included hepatic and renal involvement (47%), hepatic only (37%), renal only (16%); no dogs were found to have respiratory involvement. Clinicopathological findings at presentation included anaemia (42%), thrombocytopenia (43%), increased alanine transaminase activity (ALT) (66%), hyperbilirubinemia (55%), azotaemia (68%), hypoalbuminaemia (49%) and glucosuria (32%). Seven serovars of Leptospira interrogans or Leptospira kirschneri were detected; the most prevalent was Copenhageni (48%). Seventy-one percent survived to discharge. Dogs in the non-surviving group had a higher creatinine at presentation compared to survivors (p = 0.02). CONCLUSIONS: Copenhageni was the most prevalent serovar in this population. This supports the use of a vaccine including this serovar, in this region. Renal involvement was associated with reduced survival to discharge. A hepatic only form was common in this population, and leptospirosis should be included as a differential diagnosis for dogs suffering with a hepatopathy. No cases had significant pulmonary involvement, but ongoing clinical vigilance for this disease manifestation is essential.

Resting and postprandial serum bile acid concentrations in dogs with liver disease.

BACKGROUND: Serum bile acids (SBAs) are frequently measured in dogs. However, there is limited data comparing SBAs in different liver diseases diagnosed according to standardized histological criteria. OBJECTIVES: To compare resting and postprandial SBAs, and determine their sensitivity and specificity, for various liver diseases in dogs. ANIMALS: Three hundred and forty-one client-owned dogs with suspected liver disease that had a liver biopsy and SBAs measured. METHODS: Multicenter retrospective study. Cases were classified according to standardized histological criteria. The sensitivity and specificity of resting and postprandial SBAs for the diagnosis of each liver disease, and all liver diseases combined, were calculated. RESULTS: The median resting SBAs were highest in dogs with cirrhosis (98.8 µmol/L; range, 6-135) and congenital circulatory anomalies (CCa; 79.45 µmol/L; 0.3-705). The highest median postprandial concentrations were found in CCa (126 µmol/L; 0-726) and chronic hepatitis (CH; 54.3 µmol/L; 0-260). Using the cut-off value of 10 µmol/L, the highest sensitivities of resting SBAs were recorded in dogs with CCa (87.5%; 95% confidence interval, 76.8-94.4) and CH (81.1%; 71.5-88.6). The sensitivities of postprandial SBAs were the highest in cholangitis (100%; 47.8-100.0) and CCa (91.1%; 78.8-97.5). The specificities of resting and postprandial SBAs for all diseases were 49.3% (37.6-61.1) and 29.7% (15.9-47.0), respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Postprandial SBAs are more sensitive but less specific than resting SBAs for the diagnosis of liver disease. There were dogs in all categories of liver disease with resting SBAs <10 and >90 µmol/L. Therefore, careful interpretation of both normal and elevated values is required.

Surgical attenuation of spontaneous congenital portosystemic shunts in dogs resolves hepatic encephalopathy but not hypermanganesemia.

Hypermanganesemia is commonly recognized in human patients with hepatic insufficiency and portosystemic shunting. Since manganese is neurotoxic, increases in brain manganese concentrations have been implicated in the development of hepatic encephalopathy although a direct causative role has yet to be demonstrated. Evaluate manganese concentrations in dogs with a naturally occurring congenital shunt before and after attenuation as well as longitudinally following the changes in hepatic encephalopathy grade. Our study demonstrated that attenuation of the shunt resolved encephalopathy, significantly reduced postprandial bile acids, yet a hypermanganasemic state persisted. This study demonstrates that resolution of hepatic encephalopathy can occur without the correction of hypermanganesemia, indicating that increased manganese concentrations alone do not play a causative role in encephalopathy. Our study further demonstrates the value of the canine congenital portosystemic shunt as a naturally occurring spontaneous model of human hepatic encephalopathy.

Plasma cytokine concentrations in dogs with a congenital portosystemic shunt.

Congenital portosystemic shunts (cPSS) are a well-recognised vascular anomaly in dogs. Recent studies have shown an association between inflammation and hepatic encephalopathy (HE), which is a common clinical syndrome in dogs with a cPSS. Pro-inflammatory cytokines such as interleukin (IL)-6 and tumour necrosis factor (TNF)-α are frequently increased in the plasma of human patients with liver disease and have been implicated in the development of HE. In the current study, plasma concentrations of IL-2, IL-6, IL-8 and TNF-α were measured using a multiplex electrochemiluminescence immunoassay in 36 dogs with a cPSS and compared to 25 healthy dogs. There were no significant differences in plasma IL-2, IL-8 and TNF-α concentrations between the two groups; however, plasma concentrations of IL-6 were significantly higher in dogs with a cPSS compared to healthy dogs (P=0.02).

Serum protein electrophoresis in 155 cats.

All serum protein electrophoresis (SPE) results obtained between 2002 and 2009 from clinical cases presented to the University of Bristol Feline Centre were examined retrospectively. One hundred and fifty-five results met the inclusion criteria. Signalment and final diagnoses were obtained from the case records. Clinical cases were classified as having normal or abnormal SPE results by comparison to reference intervals for SPE created using 77 clinically normal cats. Abnormal results were then further divided according to the specific SPE abnormality. Cases were also categorised, according to the final diagnosis, using the DAMNITV classification system. Of the 155 cases, 136 (87.7%) had abnormal SPE results, most commonly due to a polyclonal increase in gamma globulins. A monoclonal gammopathy occurred in four cats; one with feline infectious peritonitis (FIP), one with lymphoma and two cases of splenic plasmacytoma (one suspected, one confirmed). The most common DAMNITV classification associated with SPE abnormalities was infectious/inflammatory disease (80/136; 58.8%), including 39 cats diagnosed with FIP.

Measurement of ionized calcium in canine blood samples collected in prefilled and self-filled heparinized syringes using the i-STAT point-of-care analyzer.

BACKGROUND: Heparinized syringes are commonly used with point-of-care analyzers (eg, i-STAT) to measure ionized calcium (iCa(2+)); however there is little information about the validity of their use in canine patients. OBJECTIVE: To examine the suitability of prefilled (40 IU heparin/mL) and self-filled (150 IU heparin/mL) heparinized syringes for iCa(2+) measurements using the i-STAT analyzer. METHODS: Forty-seven blood samples were collected from 41 canine patients. Two milliliters of blood were collected into a 2-mL nonanticoagulated (NA) syringe, a commercially available preheparinized (PH) syringe (dry calcium-balanced lithium heparin, 40 IU/mL), and a 2-mL self-filled heparinized (SH) syringe (liquid sodium heparin, 150 IU/mL). iCa(2+) was measured in the sample using the i-STAT analyzer and a wet-reagent analyzer (KoneLab 30i) used as the reference instrument. Data were analyzed using paired t-tests, Pearson correlation coefficient, and Bland-Altman difference plots. RESULTS: There was no significant difference between the results obtained from NA and PH syringes using the i-STAT analyzer, and the correlation was excellent (r =.97). The i-STAT values from the SH syringes (mean, 1.07 mmol/L) were significantly lower (P<.001) than those from the NA syringes (mean, 1.38 mmol/L). iCa(2+) was significantly higher with the i-STAT analyzer than with the KoneLab analyzer for both the PH (mean i-STAT, 1.38 mmol/L vs mean KoneLab, 1.30 mmol/L) and SH (mean i-STAT, 1.07 mmol/L vs mean KoneLab, 1.03 mmol/L) samples. CONCLUSIONS: Blood samples collected in the PH syringes used in this study can be used interchangeably with those collected in NA syringes for measuring iCa(2+) using the i-STAT analyzer. SH syringes with high-concentration heparin products (5000 IU/mL) are unsuitable for measuring iCa(2+) because they cause clinically significant underestimations. Although there was good correlation between the i-STAT and KoneLab analyzers, the results should be interpreted using analyzer-specific reference intervals.

Thrombocytosis in cats: a retrospective study of 51 cases (2000-2005).

Feline haematology profiles of patients presented to the University of Bristol Small Animal Hospital from January 2000 to October 2005 were evaluated for thrombocytosis (defined as a platelets count of >700x10(9)/l and confirmed on smear evaluation). Thrombocytosis was found in 79 cats (4.64% of the hospital feline population), with values ranging from 703 to 1895x10(9)/l. Signalment, clinical presentation, concurrence of other haematological abnormalities, diagnoses and outcome were evaluated in 51 cases in which complete medical records were available. Other variables (feline immunodeficiency virus/feline leukaemia virus status, thyroxine level, haemoplasma PCR, toxoplasma antibody titres) were also evaluated. No association was found between the presence of thrombocytosis and breed or gender. Gastrointestinal signs were the most common clinical presentation. Lymphopenia was the most common concurrent haematological abnormality. Based on final diagnosis reached, cats were grouped both according to the DAMNITV classification and according to the body system affected. Amongst the DAMNITV classification, inflammatory/infectious conditions were most commonly associated with thrombocytosis. According to body systems, gastrointestinal involvement was most represented, followed by endocrine cases. No association was found between the severity of thrombocytosis and outcome.