Plasma D-dimer concentration in sick newborn foals

BACKGROUND: Septicemia is associated with a systemic inflammatory response, hemostatic activation, and disseminated intravascular coagulopathy (DIC). HYPOTHESIS: Increased plasma d-dimer concentration occurs in septic neonates and can reliably detect sepsis or DIC, and predict death in ill neonatal foals. ANIMALS: 40 septic, 41 nonseptic hospitalized foals, and 22 healthy neonates. METHODS: Prospective observational clinical study. Blood samples were collected on admission, at 24-48 hours after admission, and at the time of discharge or euthanasia. Plasma d-dimer concentration, clotting times, antithrombin activity, and fibrinogen concentration were determined. RESULTS: On admission, d-dimer concentration values were significantly higher in septic foals (median, 25-75th percentiles; 568, 245-2013 ng/mL) compared with the nonseptic and healthy groups (386, 175-559 and 313, 152-495 ng/mL, respectively), and in septic foals at the age of 2-7 days compared with similar-age nonseptic foals. By means of samples taken at 24-48 hours of hospitalization and a cut-off value of > 2000 ng/mL, D dimer concentration was significantly associated with the diagnosis of septicemia (odds ratio [OR] = 19.6, 95% confidence interval [95% CI] 1.9-203) and death (OR = 8.7, 95% CI 1.8-43). Owing to a high false-positive prediction rate (71%), a normal d-dimer concentration is better at eliminating the diagnosis of sepsis than an increased d-dimer concentration at predicting sepsis. Fifty percent of septic foals had a diagnosis of DIC, but d-dimer concentration was not significantly associated with the diagnosis of DIC. CONCLUSIONS AND CLINICAL IMPORTANCE: Septic foals showed a marked activation of coagulation and fibrinolytic systems and a high prevalence of DIC. Increased plasma d-dimer concentration is significantly associated with the diagnosis of sepsis.     

Neutrophilic myeloperoxidase index and mean light absorbance in neonatal septic and nonseptic foals

Background: Two neutrophilic indices reported by the ADVIA 120 Hematology Analyzer, neutrophilic myeloperoxidase index (MPXI), and mean light absorbance (neutrophil X mean [NXM]) have been proposed as indicators of systemic inflammatory disease in horses and of neutrophil activation in coronary ischemic syndromes in people. Objective: The aim of this study was to evaluate NXM and MPXI in healthy, sick nonseptic, and sick septic foals to determine whether conditions likely associated with neutrophil activation result in decreases in these variables. Methods: In this retrospective study, CBC data from 61 neonatal foals presented to the Equine Teaching Hospital of Barcelona were evaluated for correlations between MPXI, NXM, percentage of large unstained cells, neutrophil count, and percentage of band neutrophils. Results obtained in septic (n=32), sick nonseptic (n=22), and healthy foals (n=7) were compared. In addition, results recorded in septic/neutropenic (n=12), septic/non‐neutropenic (n=20), nonseptic/neutropenic (n=8), nonseptic/non‐neutropenic (n=14), and healthy foals (n=7) were also compared. Results: A weak negative correlation was found between MPXI and neutrophil count and between NXM and percentage of band neutrophils. Septic/neutropenic foals had significantly higher MPXI values (median 17.9, minimum–maximum 4.7–42.5) than did septic/non‐neutropenic (1.5, ?24.4 to 22.3), nonseptic/neutropenic (6.6, 0.6–17.9), and nonseptic/non‐neutropenic foals (8.8, ?10.1 to 16.8) but did not differ significantly from controls (12.8, ?8.5 to 20.4). Conclusions: Significant differences in NXM or MPXI were not found when disease groups were compared with controls; however, septic/neutropenic foals had significantly higher median MPXI than other groups of sick foals. Further prospective studies are needed to clarify if this finding is related to decreased neutrophil function or activation in septic/neutropenic foals.     

Evaluation of flow cytometric and automated methods for detection of activated platelets in dogs with inflammatory disease

OBJECTIVE: To evaluate platelet surface-associated P-selectin, mean platelet component concentration (MPC), mean platelet component distribution width (MPCDW), mean platelet volume (MPV), and platelet distribution width (PDW) for detection of activated platelets in dogs with septic and nonseptic inflammatory disease. ANIMALS: 20 healthy dogs and 20 dogs with septic and nonseptic inflammatory disease. Procedures-Platelet surface-associated P-selectin (expressed as the median fluorescence intensity [MFI] of the platelet population), MPC, MPCDW, MPV, and PDW were determined in 20 healthy adult dogs, and reference ranges were calculated. These parameters were also determined in 11 dogs with nonseptic and 9 dogs with septic inflammatory disease and evaluated to determine which parameters were useful for detection of activated platelets. Results-12 dogs with inflammatory disease had P-selectin greater than the upper limit of the reference range, whereas 16 dogs with inflammatory disease had MPC lower than the lower limit of the reference range. All dogs in which P-selectin was greater than the upper limit of the reference range had MPC lower than the lower limit of the reference range. The correlation coefficient for P-selectin and MPC was 0.62. Differences in the MPCDW, MPV, and PDW in most dogs with inflammatory disease (compared with healthy dogs) were found; however, the correlation coefficients for P-selectin and MPCDW, MPV, and PDW were low. CONCLUSIONS AND CLINICAL RELEVANCE: Platelet surface-associated P-selectin and MPC appeared to be useful to detect activated platelets in most dogs with septic and nonseptic inflammatory disease.     

Fibrin deposits and organ failure in newborn foals with severe septicemia

Background: Septicemia in human neonates frequently is complicated by activation of the coagulation system, disseminated intravascular coagulation (DIC) and multiple organ failure syndrome, which may contribute to high mortality. In adult horses with DIC, the lung has been the organ most frequently affected by fibrin deposits. In addition, in vivo studies suggest that hemostatic mechanisms may be immature in foals <1‐day old. Hypothesis: Newborn foals with severe septicemia have fibrin deposits in their tissues independently of their age, and these fibrin deposits are associated with organ failure. Animals: Thirty‐two septic and 4 nonseptic newborn foals euthanized for poor prognosis. Methods: Tissue samples (kidney, lung, and liver) collected on postmortem examination were stained with phosphotungstic acid hematoxylin (PTAH) and immunohistochemistry (IHC) for blind histologic examination. A fibrin score (grades 0–4) was established for each tissue sample and for each foal. Medical records were reviewed for assessing clinical evidence of organ failure during hospitalization. Results: Fibrin deposits were found in most septic foals (28/32 when using IHC and 21/32 when using PTAH), independently of the age of the foal. The lung was the most affected tissue (97% of the septic foals). Additionally, organ failure was diagnosed in 18/32 septic foals (8 with respiratory failure, 14 with renal failure), although a statistical association with severe fibrin deposition was not identified. Conclusions and Clinical Importance: Nonsurviving septic foals have fibrin deposits in their tissues, a finding consistent with capillary microthrombosis and DIC.     

Plasma colloid osmotic pressure and total protein trends in horses during anesthesia

OBJECTIVE: To investigate the changes in colloid osmotic pressure (COP) and total protein concentrations during routine general anesthesia in horses. STUDY DESIGN: Prospective, clinical study. ANIMALS: Twelve adult healthy horses aged 9.1 +/- 4.7 years and weighing 474 +/- 79 kg presented for elective surgery and 14 adult horses aged 8.7 +/- 7.3 years and weighing 510 +/- 85 kg. METHODS: All horses were premedicated with xylazine and anesthesia induced with ketamine, diazepam and guaifenesin, and maintained with isoflurane for 2.5 hours. Lactate Ringer's solution was administered at 11 mL kg(-1) hour(-1). Osmolality, COP, electrolytes, glucose, and lactate were measured with specific commercial analyzers. Total protein (TP) was determined with a refractometer and packed cell volume with centrifuged capillary tubes. In the second group of 14 horses samples were taken from both venous and arterial sites simultaneously and the above measurements performed. RESULTS: Before anesthesia, COP and TP were 22.2 +/- 2 mmHg and 6.9 +/- 0.4 g dL(-1), respectively. Within 15 minutes of anesthetic induction, COP and TP decreased significantly (19.9 +/- 1.9 mmHg and 6.3 +/- 1.9 g dL(-1); p < 0.01). During anesthesia COP and TP decreased in a linear form (COP r2 = 0.96 and TP r2 = 0.97). The COP and TP were 15 +/- 1.3 mmHg and 5.1 +/- 0.2 g dL(-1) at the end of anesthesia. Calculation of COP from TP values failed to accurately predict measured COP. Simultaneous arterial and venous samples in the 14 anesthetized horses yielded no differences for COP or TP. CONCLUSIONS AND CLINICAL RELEVANCE: The data indicate that COP, like TP, decreases over the course of routine anesthetic management of horses and venous versus arterial samples should reveal comparable information.     

A Fresh Look at the Process of Arriving at a Clinical Prognosis. Part 3: Neonatal Illness

Determining the prognosis in a sick newborn foal is complicated by the following three factors: the normal transition from maternal/placental dependence to independence, intrauterine conditions before birth, and the birth process itself. In addition, there are several vulnerabilities and unique characteristics of the neonatal foal that are not shared by older foals or adult horses. However, the same principles of assessing homeostasis apply to establishing a prognosis in a sick neonate, as previously described for the adult. Overall, survival rates for septic critically ill foals generally vary between 60% and 80%. In noncritical yet seriously ill foals—a diverse group sometimes referred to as the “sick, nonseptic foal”—survival rates typically range from 75% to 95% with proper medical care. Long-term survival rates are lower for all categories of sick foals, and subsequent athletic performance may be adversely affected by sepsis or septic arthritis/osteomyelitis.     

Tenoscopy in 33 horses with septic and nonseptic digital tenosynovitis (1997–2001)

Tenoscopy is the use of an arthroscope to access tendon sheaths. This article reports clinical findings, treatments, and outcomes of 33 horses with either septic or nonseptic digital tenosynovitis submitted to 36 tenoscopies during 34 occasions at the Marion duPont Scott Equine Medical Center (1997–2001). Two of the 16 horses with septic tenosynovitis were euthanized at the hospital. From the 32 horses discharged from the hospital, outcome was obtained in 31 cases: 12 horses (6 septic) could work at the same level. No difference was detected between the outcome groups regarding clinical and laboratory variables. In nonseptic cases, lameness grade, circulating white blood cells, and plasma fibrinogen before surgery were lower, while the period between the onset of clinical signs and surgery was longer and duration of phenylbutazone treatment and hospitalization was shorter. No difference in the outcome was detected when septic and nonseptic cases were compared. Tenoscopy was useful for diagnosis and treatment of nonseptic and septic digital tenosynovitis. The small number of cases and the lack of accurate information due to the retrospective nature of the study may have prevented detection of a difference between the outcomes of horses with septic versus nonseptic tenosynovitis.     

Cochet-Bonnet aesthesiometer-determined corneal sensitivity in neonatal foals and adult horses

Corneal touch threshold (CTT) was measured in sick neonatal foals, healthy foals, and healthy adult horses with a Cochet-Bonnet aesthesiometer. The mean overall CTT for the adult horses, sick foals, and healthy foals was 4.82 +/- 0.87 cm, 3.21 +/- 0.24 cm, and 5.01 +/- 0.61 cm, respectively. The central cornea of adult horses was more sensitive than the limbal cornea. Corneal sensitivity was significantly reduced in sick neonatal foals compared to adults. The mean Schirmer I tear test values were significantly lower in foals than adults, and were 14.2 +/- 1.0 mm, 12.8 +/- 2.4 mm, and 18.3 +/- 2.1 mm wetting in sick neonatal foals, normal neonatal foals, and adult horses, respectively. Reduced corneal sensation and lower tear production may be associated with ulcerative keratitis and slow corneal healing in some foals.     

Preliminary evaluation of hemostasis in neonatal foals using a viscoelastic coagulation and platelet function analyzer

Objectives – To compare coagulation and platelet function parameters measured using a viscoelastic analyzer in 3 groups: foals presenting to a neonatal intensive care unit with presumed sepsis, normal foals, and adult horses. Design – Preliminary prospective trial. Setting – Veterinary teaching hospital. Animals – Ten clinically healthy foals, 13 clinically healthy adult horses, and 17 foals sequentially admitted for suspected sepsis. Intervention – A single citrated (3.8%) blood sample collected at admission was submitted for coagulation evaluation using a viscoelastic analyzer. Measurements and Main Results – Time to initial clot formation (ACT), clot rate (CR), platelet function, and time to peak parameters were collected from the signature generated with the associated software. Peak clot strength was collected manually from signature tracings. Signalment, presenting complaint, blood culture results, clinical progression, and outcome were collected from the medical record. Kruskal‐Wallis testing was used to determine differences in coagulation parameters between groups, as well as to identify any associations between coagulation variables, foal variables, and outcome. Normal foals were more likely to have increased platelet function (P=0.04) compared with normal adult horses. Prolonged ACT (P=0.004) and decreased CR (P=0.03) were associated with foals with positive blood culture. There was a trend toward prolonged ACT and increased likelihood of death (P=0.06). Conclusions – Healthy foals differ in values measured by the viscoelastic coagulation and platelet function analyzer compared with healthy adult horses. ACT and CR abnormalities were more likely to be observed in foals with positive blood cultures. The viscoelastic coagulation and platelet function analyzer may be useful in identifying early hemostasic and platelet dysfunction in critically ill foals, particularly those that are septic.     

Evaluation of peritoneal fluid pH, glucose concentration, and lactate dehydrogenase activity for detection of septic peritonitis in horses

OBJECTIVE: To determine whether peritoneal fluid pH, glucose concentration, and lactate dehydrogenase activity can be used to differentiate horses with septic peritonitis from those with nonseptic peritonitis. DESIGN: Prospective study. ANIMALS: 46 horses, including 10 healthy horses, 15 horses with septic peritonitis, and 21 horses with nonseptic peritonitis. PROCEDURE: Peritoneal fluid and blood samples were analyzed for pH, glucose concentration, and lactate dehydrogenase activity. Complete blood cell counts were performed, and peritoneal fluid samples were submitted for bacterial culture. RESULTS: Horses with septic peritonitis had significantly lower peritoneal fluid pH and glucose concentrations than horses with nonseptic peritonitis and healthy horses. Compared with other tests, serum-to-peritoneal fluid glucose concentration differences > 50 mg/dl had the highest diagnostic use for detection of septic peritonitis. Peritoneal fluid pH < 7.3, glucose concentration < 30 mg/dl, and fibrinogen concentration > 200 mg/dl were also highly indicative of septic peritonitis. CLINICAL IMPLICATIONS: Peritoneal fluid pH and glucose concentration can be used to assist in the identification of horses with septic peritonitis. These measurements can provide an early indication of sepsis, especially if cytologic evaluation of peritoneal fluid is unavailable or results are equivocal and peritoneal fluid bacterial culture results are pending.     

Blood arginine vasopressin, adrenocorticotropin hormone, and cortisol concentrations at admission in septic and critically ill foals and their association with survival

BACKGROUND: Sepsis is an important cause for neonatal foal mortality. The hypothalamic-pituitary-adrenal axis (HPAA) responses to sepsis are well documented in critically ill humans, but limited data exist in foals. The purpose of this study was to evaluate the HPAA response to sepsis in foals, and to associate these endocrine changes with survival. HYPOTHESIS: Blood concentrations of arginine vasopressin (AVP), adrenocorticotropin hormone (ACTH), and cortisol will be higher in septic foals as compared with sick nonseptic and healthy foals. The magnitude of increase in hormone concentration will be negatively associated with survival. ANIMALS: Fifty-one septic, 29 sick nonseptic, and 31 healthy foals of < or =7 days of age were included. METHODS: Blood was collected at admission for analysis. Foals with positive blood culture or sepsis score > or =14 were considered septic. Foals admitted with disease other than sepsis and healthy foals were used as controls. AVP, ACTH, and cortisol concentrations were measured using validated immunoassays. RESULTS: AVP, ACTH, and cortisol concentrations were increased in septic foals. Septic nonsurvivor foals (n = 26/51) had higher plasma ACTH and AVP concentrations than did survivors (n = 25/51). Some septic foals had normal or low cortisol concentrations despite increased ACTH, suggesting relative adrenal insufficiency. AVP, ACTH, and cortisol concentrations were higher in sick nonseptic foals compared with healthy foals. CONCLUSIONS AND CLINICAL IMPORTANCE: Increased plasma AVP and ACTH concentrations in septic foals were associated with mortality. Several septic foals had increased AVP : ACTH and ACTH : cortisol ratios, which indicates relative adenohypophyseal and adrenal insufficiency.     

Partial pressures of oxygen and carbon dioxide, pH, and concentrations of bicarbonate, lactate, and glucose in pleural fluid from horses

Samples of pleural fluid from 20 horses with effusive pleural diseases of various causes were evaluated; samples from 19 horses were used for the study. There were differences for pH (P = 0.001) and partial pressure of oxygen (PO2) between arterial blood and nonseptic pleural fluid (P = 0.0491), but there were no differences for pH, PO2, partial pressure of carbon dioxide (PCO2), and concentrations of bicarbonate (HCO3-), lactate, and glucose between venous blood and nonseptic pleural fluid. Paired comparisons of venous blood and nonseptic pleural fluid from the same horse indicated no differences. There were differences (P = 0.0001, each) for pH, PO2, PCO2, and concentrations of HCO3- between arterial blood and septic pleural fluid. Differences also existed for pH (P = 0.0001), PCO2 (P = 0.0003), and concentrations of HCO3- (P = 0.0001), lactate (P = 0.0051), and glucose (P = 0.0001) between venous blood and septic pleural fluid. Difference was not found for values of PO2 between venous blood and septic pleural fluid, although 4 samples of septic pleural fluid contained virtually no oxygen. Paired comparisons of venous blood and septic pleural fluid from the same horse revealed differences (P less than 0.05) for all values, except those for PO2. These alterations suggested functional and physical compartmentalization that separated septic and healthy tissue. Compartmentalization and microenvironmental factors at the site of infection should be considered when developing therapeutic strategies for horses with septic pleural disease.     

Serum free cortisol fraction in healthy and septic neonatal foals

Background: Relative cortisol insufficiency occurs in septic foals and impacts survival. Serum free (biologically available) cortisol concentration might be a better indicator of physiologic cortisol status than serum total cortisol concentration in foals. Hypotheses: In septic foals, (1) low free cortisol concentration correlates with disease severity and survival and (2) predicts disease severity and outcome better than total cortisol concentration. Animals: Fifty‐one septic foals; 11 healthy foals; 6 healthy horses. Methods: In this prospective clinical study, foals meeting criteria for sepsis at admission were enrolled. University‐owned animals served as healthy controls. Basal and cosyntropin‐stimulated total cortisol concentration and percent free cortisol (% free cortisol) were determined by chemiluminescent immunoassay and ultrafiltration/ligand‐binding methods, respectively. Group data were compared by ANOVA, Mann‐Whitney U‐tests, and receiver operator characteristic curves. Significance was set at P < .05. Results: Basal % free cortisol was highest in healthy foals at birth (58±8% mean±SD), and was higher (P≤.004) in healthy foals of all ages (33±6 to 58±8%) than in adult horses (7±3%). Cosyntropin‐stimulated total and free cortisol concentrations were lower (P≤.03) in foals with shock (total = 6.2±8.1 μg/dL; free = 3.5±4.8 μg/dL versus total = 10.8±6.0 μg/dL; free = 6.9±3.3 μg/dL in foals without shock) and in nonsurvivors (total = 3.8±6.9 μg/dL; free = 1.9±3.9 μg/dL versus total = 9.1±7.7 μg/dL; free = 5.5±4.4 μg/dL in survivors). Free cortisol was no better than total cortisol at predicting disease severity or outcome in septic foals. Conclusions and Clinical Importance: Serum free cortisol is impacted by age and illness in the horse. There is no advantage to measuring free over total cortisol in septic foals.     

Synovial fluid D-dimer concentration in foals with septic joint disease

Background: Increased synovial fibrinolytic activity (detected by increases in synovial D‐Dimer concentrations) has been observed in different joint diseases in humans and adult horses, presumably in order to minimize fibrin deposition within the joint and thus avoid its detrimental effects. Objective: To investigate fibrinolytic pathway activation in joint sepsis in foals by measuring synovial D‐Dimer concentrations. Animals: Eighteen septic foals with septic joints, 9 septic foals without septic joints, 9 systemically healthy foals with septic joint, and 3 controls are included. Methods: Prospective observational clinical study of foals admitted for septic arthritis. Synovial D‐Dimer concentration and routine synovial fluid analysis were performed. Diagnosis of joint sepsis was made whenever synovial total nucleated cell count was >30,000 cells/μL, synovial total protein >4 g/dL, and neutrophil percentage of >80%, or synovial fluid culture resulted positive. Results were compared among groups by general lineal models. Results: Synovial D‐Dimer concentration was significantly (P < .001) higher in the foals with septic joints compared with foals without joint disease (P < .001). Conclusions and Clinical Importance: Septic joint disease is associated with a marked increase of synovial D‐Dimer concentration (marked activation of the fibrinolytic activity) within the affected joint. Although further studies are needed, the measurement of synovial D‐Dimer concentration may be considered a complementary diagnostic marker of septic joint disease.     

Plasma colloid osmotic pressure and total protein in horses during colic surgery

OBJECTIVE: To assess the changes in colloid osmotic pressure (COP) in horses undergoing surgery for colic. STUDY DESIGN: Prospective clinical evaluation. ANIMALS: Twenty-nine adult horses presented for emergency laparotomy. METHODS: Horses were premedicated with intravenous (IV) xylazine and anesthesia was induced with ketamine, diazepam and guaifenesin and was maintained with isoflurane as required. Lactated Ringer's solution (LRS) was given to all horses during anesthesia. Blood was collected in heparin before, and every 30 minutes during, anesthesia to measure COP, total protein concentration (TP), osmolality, packed cell volume, electrolytes, glucose and lactate. In addition, COP was estimated using different formulas previously described for horses. RESULTS: Before anesthesia, COP and TP were 18.7 +/- 2.2 mmHg (2.49 +/- 0.29 kPa) and 6.3 +/- 0.7 g dL(-1), respectively. The horses received a mean +/- SD of 19.5 +/- 3.9 mL kg(-1) hour(-1) (range 15-25 mL kg(-1)hour(-1)) of LRS during anesthesia. The COP and TP decreased linearly (R(2) = 0.99, p < 0.01) during anesthesia and reached the lowest point at the end of anesthesia with a COP of 11.6 +/- 1.6 mmHg (1.55 +/- 0.21 kPa) and TP of 4.4 +/- 0.4 g dL(-1). The Pearson correlation coefficient for COP versus TP was r(2) = 0.78. Calculation of COP from TP concentrations showed that two formulas could predict COP to within 1 mmHg (0.13 kPa) (Thomas & Brown 1992; Boscan et al. 2007). CONCLUSIONS AND CLINICAL RELEVANCE: Colloid osmotic pressure, like TP, decreased greatly over the course of crystalloid fluid infusion during anesthesia for laparotomy in horses with colic. This change may predispose the animal to tissue edema with subsequent morbidity.     

Detection of fibrin deposits in tissues from horses with severe gastrointestinal disorders

BACKGROUND: In humans and experimental animals, disseminated intravascular coagulation (DIC) causes fibrin deposition in several organs, which eventually leads to ischemia and multiorgan failure. HYPOTHESIS: Horses who died or were euthanized for severe gastrointestinal disorders could have fibrin deposits in different tissues. ANIMALS: Tissue-organ samples collected during postmortem examinations on 66 colic horses with poor prognoses (eg, severe intestinal ischemia, enteritis, peritonitis), from 11 colic horses with good prognoses (eg, large-colon obstruction or displacement), and from 16 slaughter horses. METHODS: Tissue samples (kidney, lung, liver) were stained with hematoxylin and eosin, and phosphotungstic acid hematoxylin for a blinded histologic examination. A fibrin score (grades 0 to 4) was established for each tissue sample and for each horse. RESULTS: Fibrin deposits were found in tissue specimens of 11 of 27 of horses (40.7%) in the ischemic group, 8 of 21 in the enteritis group (38.1%), and 7 of 18 in the peritonitis group (39.0%), whereas none of the horses in the obstructive group (n = 11) and only 1 horse in the slaughter group (n = 16) had fibrin deposits in their tissues. In addition, the mean fibrin score values for the ischemic, enteritis, and peritonitis groups (1.3 +/- 1.7, 1.1 +/- 1.6, and 0.9 +/- 1.3, respectively) were statistically higher than those for the obstructive and slaughter groups (0.0 +/- 0.0 and 0.1 +/- 0.5, respectively). The largest fibrin deposits were found in the lungs. Conclusions and Clinical Importance: Horses with severe gastrointestinal disorders have fibrin deposits that are consistent with capillary microthrombosis, multiorgan failure, and DIC.     

Disseminated Intravascular Coagulation Associated with Colic in 23 Horses (1984–1989)

Disseminated intravascular coagulation (DIC) secondary to colic was diagnosed in 23 horses. Each horse was categorized retrospectively as to the cause of the colic based on surgical and/or necropsy findings: group 1 consisted of 14 horses with compromised intestine that required resection and anastomosis; group 2 consisted of 3 horses with nonstrangulating intestinal displacement and/or impactions; and group 3 consisted of 6 horses with colic associated with enteritis and/or colitis. Horses were considered to be affected with DIC if at least three of five hemostatic parameters were significantly abnormal: decreased antithrombin III (AT III) values, increased level of fibrin degradation products (FDP), thrombocytopenia, prolonged activated partial thromboplastin time, and prolonged prothrombin time. The most consistent hemostatic abnormalities were decreased AT III activity, increased FDP titers, and thrombocytopenia. Clotting times were more variable and did not always correlate with the presence of excessive hemorrhage. Excessive hemorrhage was present during surgery in seven horses and occurred within 1 to 12 hours after surgery in nine other horses. In addition to treatment of the primary disease, 19 horses received treatment for DIC consisting of heparin and/or plasma or fresh whole blood transfusions. Heparin alone was used in 12 horses. Heparin, in addition to fresh whole blood transfusions or fresh plasma, was administered to four horses. Three horses were treated with plasma alone. Four other horses were not treated specifically for the DIC. Eight horses (34%) survived the acute coagulopathy. Although a greater proportion of the surviving horses received heparin therapy (87.5%; 7/8) than did those that died (60%; 9/15), the difference was not statistically significant (P = 0.345).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of short-term racing activity on platelet and neutrophil activation in dogs

OBJECTIVE: To determine whether platelets and neutrophils become activated in dogs during short-distance sled-pulling activity. ANIMALS: 18 physically fit adult Siberian Huskies. PROCEDURE: Dogs were allocated into 2 teams (9 dogs/team). Each team ran a course of approximately 6.4 km while pulling a sled that contained 2 people. Blood samples were collected immediately before and within 10 minutes after completion of sled-pulling activity. Blood was aspirated into sterile syringes and immediately transferred to evacuated tubes containing EDTA solution. Platelet activation status was evaluated by determining cell-surface P-selection expression, number of platelet aggregates and platelet microparticles, mean platelet-component (MPC) concentration, and mean platelet-component distribution width (MPCDW) concentration. Neutrophil activation status was evaluated by determining cell-surface CD11/CD18 expression, neutrophil size, and neutrophil granularity. RESULTS: Short-duration strenuous sled-pulling activity was associated with lower MPC concentration, higher MPCDW concentration, and higher cell-surface P-selectin expression after activation with phorbol myristate acetate. An increase in neutrophil CD11/CD18 expression and a decrease in neutrophil granularity were also observed after exercise. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study provide evidence of priming and activation of platelets and activation of neutrophils after strenuous short-duration sled-pulling activity. Additional studies will be needed to determine whether these changes have adverse effects on animal performance or induce tissue injury.     

Effect of hemolysis on canine kaolin‐activated thromboelastography values and ADVIA 2120 platelet activation indices

Background: The impact of hemolysis on thromboelastography (TEG) and platelet activation indices has not been evaluated. Objective: The aim of this study was to investigate the influence of hemolysis induced mechanically (HM) and hemolysis induced by freezing (HF) on TEG, platelet counts (PLT), and platelet activation indicators. Methods: Blood from 17 dogs was divided into the following samples: controls, HM, and HF. HM was induced by 20 repetitions of expulsion of blood through a 23 g needle. Freezing was at −80°C, followed by warming to 37° and dilution with equal parts room temperature blood at 22°C. TEG variables that were examined included reaction time (R), coagulation time (K), angle (α), maximum amplitude (MA), and clot rigidity (G). Platelet indices were measured with the ADVIA 2120 hematology analyzer. Results: Hematocrit (HCT) (mean±SD) for controls, HM, and HF were 0.41±0.02, 0.39±0.03, and 0.25±0.02 L/L, respectively, consistent with decreases in HCT of 4.8% (HM) and 39.0% (HF). HM resulted in decreased R (2.5±0.9 minutes compared with 5.2±1.9 minutes for controls; P<0.001), and HF resulted in increased K (15.2±8.6 minutes compared with 5.3±4.0 minutes in controls; P<0.01) and decreased α (20±11° compared with 46±17° in controls; P<0.001). MA was decreased more in HF samples (26±2 mm) than in HM (38±8 mm) or control samples (49±9 mm; P<0.0001). The same applied to G values. PLT decreased after HM but not after HF. Hemolysis of both types resulted in decreased mean platelet component (MPC) concentration: control, 19.3±2.0, HM 15.5±3.4, and HF 14.3±0.7 g/dL (P<0.0001). Conclusion: In hemolyzed samples decreased MPC and R suggested activated primary and secondary hemostasis, respectively, but decreased MA and G indicated reduced clot firmness, possibly due to hyporeactive platelets. TEG and platelet activation indices should be interpreted cautiously after hemolysis.     

Serum IgM concentrations in normal,fit horses and horses with lymphoma or other medical conditions

The purposes of this study were to (1) prospectively establish serum IgM and IgG concentrations in normal, fit, adult horses over time and (2) determine the accuracy of serum IgM concentrations for diagnosing lymphoma. Serial IgM and IgG concentrations were measured with a radial immunodiffusion assay in 25 regularly exercised horses at 6-week intervals. Horses had serum IgM concentrations ranging from 50 to 242 mg/dL over 5 months, with 20% of horses having IgM < or = 60 mg/dL. The normal range for IgM in fit horses should be considered 103 +/- 40 mg/dL and a cut-point for an IgM deficiency, < or = 23 mg/dL. IgG concentrations ranged from 1,372 to 3,032 mg/dL. Retrospectively, medical records of adult horses (n = 103) admitted to the Cornell University Hospital for Animals for which serum IgM was measured were examined. Horses were categorized as "lymphoma negative" (n = 34) or "lymphoma positive" (n = 18). The sensitivity and specificity of a serum IgM concentration (< or = 60 mg/dL) for detecting equine lymphoma was 50 and 35%, respectively. At the new cut-point (< or = 23 mg/dL), the sensitivity was low at 28% and the specificity improved to 88%. The negative predictive values at various population prevalences indicate that a horse with a high serum IgM (> 23 mg/dL) is unlikely to have lymphoma, whereas the positive predictive value (70%) does not allow for reliable determination of lymphoma in a horse with serum IgM < or = 23 mg/dL. Therefore, serum IgM concentrations should not be used as a screening test for equine lymphoma.