Coags articles

Question 1

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

Andrew G. Burton et al, jvecc 2018

Answer 1

Acidemia results in hypocoagulability (lowered MA and alpha angle) but no change to PT or aPTT

Question 2

Multicenter in vitro thromboelastography and thromboelastometry standardization

jvecc 2018

Answer 2

To determine the comparability of results obtained by different TF-activated TEGs and ROTEMs

The overall degree of variability both within and b/w centers were unacceptably high (CV >10%)

Question 3

A prospective evaluation of oral Yunnan Baiyao therapy on thromboleastographic parameters in apparently healthy dogs

jvecc 2018

Answer 3

Dogs that received 1 capsule (250mg) PO BID for 1w had increased G, A30 and A60 values and decreased LY30 and LY60.

aka increased clot strength and reducing fibrinolytic activity although still w/in RI

Question 4

A commercial soy-based phospholipid emulsion accelerates clot formation in normal canine whole blood and induces hemolysis in whole blood from normal and dogs with inflammatory leukograms

Erica L. Behling-Kelly et al jvecc 2018

Answer 4

Soy-based lipid emulsions (intralipid) cause hemolysis that is more severe in blood from dogs with inflammatory leukograms and accelerate clot formation in canine blood

Intralipid breaks down to lysolecithin = have direct hemolytic effect

Question 5

In vitro hemolysis of stored units of canine packed red blood cells

Rui R. F. Ferreira et al jvecc 2018

Answer 5

Canine pRBC stored for >35d should be tested to ensure <1% hemolysis
-almost 51% units at 36-42d had >1% hemolysis

Question 6

Ex vivo evaluation of the efficacy of canine fresh-frozen plasma thawed using a microwave plasma defroster

Turner jvecc 2018

Answer 6

MPD effectively thawed plasma quickly and maintained adequate clotting factors + fibrinogen concentrations

None fell below 40%
No evidence of excessively heated plasma (safety)

Question 7

A pilot study evaluating the effects of prestorage leukoreduction on markers of inflammation in critically ill dogs receiving a blood transfusion.

Luis Bosch Lozano, et al jvecc 2019

Answer 7

total WBC the same at 2h post but incr at 24h post

No other diff b/w inflammatory parameters, survival rate, or acute transfusion rx

Question 8

A prospective evaluation of oral Yunnan Baiyao therapy on thromboelastographic parameters in apparently healthy cats.

Jeffrey E Patlogar, et al jvecc 2019

Answer 8

1 cap PO BID for 1w

YB caused sig. decr in HCT and RBC count, no changes to TEG

Question 9

Inaccurate point-of-care blood glucose measurement in a dog with secondary erythrocytosis

Erin R. McQuinn et al jvecc 2020

Answer 9

Erythrocytosis affects handheld glucometers

WB glucose 10-15% lower than plasma BG d/t difference in water content

Corrected PBGM glucose = PGBM glucose + (1.6xPCV -81.3)

Question 10

Comparison of native and citrated whole blood samples for rapid thromboelastography in Beagles

Hyebin Wang et al jvecc 2020

Answer 10

rapid TEG vs kaolin-activated TEG

1. r-TEG decreased meant time to MA
2. Native WB is better than citrated WB samples

Question 11

In vitro effects of lactated Ringer’s solution, hypertonic saline, hydroxyethyl starch, hypertonic saline/hydroxyethyl starch, and mannitol on thromboelastographic variables of canine whole blood

Chan JVECC 2020

Answer 11

Citrated WB diluted with fluids - not infused then collected

All fluid types caused dose-dependent hypercoagulable changes on TEG

Viscoelastic changes also influenced by tonicity and osmolarity
-HTS 7% + mannitol both affected variables more than just dilution (prolonged R+K time, decr alpha angle + MA, incr LY60)

HTS 3.4% have less effect on coag than HTS 7%

Question 12

Purification of canine albumin by heat denaturation in a plasma bag

Edwards jvecc 2020

Answer 12

Sodium caprylate is able to stabilize canine albumin enabling it to withstand heating that denatures other plasma proteins

Question 13

Acute hemolytic reaction due to A-B mismatched transfusion in a cat with transient AB blood type

Koenig jvecc 2020

Answer 13

Unknown initial blood type + received untyped matched blood –> developed acute hemolytic transfusion reaction -> immunochromatography blood type suggested AB but crossmatch from donors suggest type B –> gave type B blood, did fine

~Trasient AB type showed that crossmatch should be performed to aid identification

Question 14

Effect of 7.5% hypertonic saline solution on whole blood coagulation in healthy dogs using thromboelastography

Kim jvecc 2020

Answer 14

No diff in TEG but diff in Na, Cl, osmolality levels b/w 7.5% HTS and salien

Question 15

Development and assessment of a formal learning module to educate veterinary students in an intensive care unit about transfusion reactions

Haines jvecc 2020

Answer 15

Teaching module can be delivered successfully

Those who took course did better up to 6w after module

Question 16

The influence of packed cell volume versus plasma proteins on thromboelastographic variables in canine blood

Lynch jvecc 2020

Answer 16

Plasma proteins, not PCV, affected TEG variables – anemic TEG changes are likely related to available fibrinogen

Question 17

The use of smartphone-obtained images to extrapolate canine packed cell volume

Brehency jvecc 2020

Answer 17

Most accurate in predicting PCV in normal erythrocyte mass or polycythemic samples

Question 18

Retrospective evaluation of fresh frozen plasma use in 121 cats: 2009–2016

lane jvecc 2020

Answer 18

Coagulopathy, hemorrhage, hypotension
Liver dz, cancer
Mean 6mL/kg 
ATR 16%- mild, similar to pRBC rate (elevated temp, tachypnea/dyspnea)
Mortality 54% 

BP + coagulopathy improved post-transfuison

Question 19

Incidence of hospital-acquired anemia in hospitalized dogs and cats

Jennie L. Hiratzka javma 2018

Answer 19

Incidence: 34% at 24h and 43% at 48h
(Overall 70% in cats and 43% in dogs)

Increased odds of developing HAA if underwent sx or if cumulative phlebotomy volume >3% of total blood volume

Question 20

Postoperative thrombocytosis and thromboelastographic evidence of hypercoagulability in dogs undergoing splenectomy for splenic masses

Whitney E. Phipps JAVMA 2020

Answer 20

Thrombocytosis along with TEG hypercoagulability peaked at 7 days but most common during first 2w of sx

(Peri-op mortality rate 7.6%; 22% PST and 10% PTE)

Question 21

Effect of cross-match on packed cell volume after transfusion of packed red blood cells in transfusion-naïve anemic cats

-AMC paper

Brittany Sylvane jvm 2018

Answer 21

No sig. diff b/w transfusion rx or delta PCV b/w those who had cross-match vs those didn’t in AB typed transfusion

Major cross-match test might not be sensitive enough to detect all pRBC antibody incompatibilities between donor and recipient cats, which precludes its value as a pretransfusion test.

Question 22

Prevalence of naturally occurring non-AB blood type incompatibilities in cats and influence of crossmatch on transfusion outcomes

-UPENN

Megan E. McClosky jvim 2018

Answer 22

15% cats had alloantibodies outside of AB system

Admin of cross-matched pRBC didn’t change delta PCV

Febrile transfusion rx more common in non-crossmatched blood

Crossmatch didn’t impact outcome @ 30 or 60-d post transfusion

Question 23

Effects of 6% tetrastarch or lactated Ringer’s solution on blood coagulation in hemorrhaged dogs

Miriely S. Diniz, jvim 2018

Answer 23

Tetrastarch didn’t change primary hemostasis

Both TS + LRS induced transient dilution coagulopathy

Question 24

Pharmacokinetics of tranexamic acid in healthy dogs and assessment of its antifibrinolytic properties in canine blood

Katie E. Osekavage AJVR 2018

Answer 24

Admin of TXA improved clot strength (incr MA) and decreased fibrinolysis (LY30) in healthy dogs

TXA 15-20 mg/kg PO

Question 25

Effects of storage over a 36-month period on coagulation factors in a canine plasma product obtained by use of plasmapheresis

Margret E. Donahue DVM AJVR 2019

Answer 25

Plasma collected by plasmapheresis instead of traditional centrifugation

all labile factors remained at > 50% activity for longer than 1 year.
Apheresis may have helped preserve them

Question 26

Effect of packed red blood cell transfusion on thromboelastographic tracings in dogs with naturally occurring anemia

Aimee C. Brooks AJVR 2020

Answer 26

pRBC transfusion had only small effects on the TEG tracings of hemodynamically stable dogs.

Question 27

Influence of canine donor plasma hemostatic protein concentration on quality of cryoprecipitate.

Macy Drinkhouse, jvim 2019

Answer 27

No breed difference was found in mean CRYO FV8 content, but vWF and fibrinogen levels lower in greyhounds

cryo from greyhounds still within acceptable limits

Question 28

Detection of naturally occurring alloantibody by an in-clinic antiglobulin-enhanced and standard crossmatch gel column test in non-transfused domestic shorthair cats.

Isabelle Goy-Thollot, jvim 2019

Answer 28

AB typing using immunochromatographic strip is as accurate as laboratory flow cytometry.

feline antiglobulin-enhanced gel column (AGC) XM tests identified outside of AB incompatibilities

Question 29

Therapeutic monitoring of rivaroxaban in dogs using thromboelastography and prothrombin time.

Junwoo Bae jvim 2019

Answer 29

Therapeutic Anti-Xa in dogs correlated to 1.5-1.9x PT and T values of TEG 3h after rivaroxaban admin

Question 30

Primary hemostatic function in dogs with acute kidney injury.

Duana McBride jvim 2019

Answer 30

AKI group had lower PCV, higher plt, lower plt aggregatory, and higher vWF:collagen binding activity

AKI = decreased collagen-activated platelet aggregation and appear to have a type II von Willebrand disease-like phenotype

BMBT = not an appropriate test in AKI

Question 31

Alloimmunization of a dog erythrocyte antigen 1- dog transfused with weakly dog erythrocyte antigen 1+ blood.

Maryline Guidetti, jvim 2019

Answer 31

Strong and durable (16-1657d) alloimmunization occurs when DEA 1- dog receives blood from weak DEA 1+ dog

Weakly DEA 1+ is still immunogenic
Must crossmatch all previously transfused dog

Question 32

Neutrophil extracellular traps in stored canine red blood cell units

Erin R. McQuinn jvim 2020

Answer 32

More NETs in non-LR units but can be attenuated by LR before storage