scott@vtx-cpd.com

Replying to Felipe M. 14/06/2024 - 15:44

Hi Felipe,

Thanks for your insightful contribution! You make excellent points about the challenges and practicalities of using blood products in veterinary practice, particularly regarding availability and cost.

I appreciate you highlighting the use of synthetic colloids as a temporary measure when blood products are not immediately accessible. It’s a pragmatic approach, especially in resource-limited situations.

The reference to the CellSaver device is intriguing as well. It would indeed be a game-changer, albeit with the mentioned cost and caseload considerations.

Great discussion all around!

Best,
Scott

Replying to Neus E. 13/06/2024 - 18:20

Thank you so much, Neus, for your insightful input and detailed explanation! Your expertise is greatly appreciated, and you’ve provided valuable information on managing haemorrhagic shock in these patients. Thanks again for taking the time to share your knowledge with us!

Best regards,

Scott

Hello again.

Here are some thoughts on this topic from one of our ECC specialists Neus:

“So… yes I would use them in dogs with severe haemorrhagic diarrhoea/gastroenteritis a lot. I think I may be biased to the ones we see, so I am talking about the ones that come unwell with signs of hypovolaemic shock and severe dehydration/haemoconcentration. These ones typically come with high PCV and “normal” TS so for example 65%/60g/L, in these ones I know that if hypovolaemic I will need to fluid resuscitate so may end up needing 5-20mL/kg over a few boluses and then I will need high rates of IVFT to account for on going losses, rehydration and maintenance and when you calculate this sometimes is as high as 6-8mL/kg/h. There is two sides to this and one is that we know that actually the use of crystalloids itself will damage the glycocalyx and you will gave shedding and then this will lead to increased vascular permeability etc. and the second side to this is that when my PCV is normalised when the patient is rehydrated, say comes from 65 to 45%, I know my solids will ave tanked and probably be from 60 to 30-40g/L and at this stage this becomes a problem also with on going increased permeability, increased oncotic pressure etc. So that is why I tend to come in early with plasma to prevent this from happening, and when plasma is used as is a colloid… you can also allow yourself to use lower fluid rates so in the same example if you calculated you may need 6-8mL/kg/h if you combine plasma and crystalloids you may get away with 4-5mL/kg/h instead.

For the hypoalbuminaemic GI patients… I don’t think there is a number really. So if I think PLE that I have treated alongside medicine; these patients are different as stable so unless I had to fluid resuscitate or need IVFT I would not consider it, even if their albumin is really low. Now for a PLE patient who isn’t great and is now third spacing and say it has abdominal effusion, and that is increasing the abdominal pressure which is compromising the gut blood supply and they are not doing great. I tend to remove abdominal fluid really slowly over a few hours, then replace with plasma – and the times we have done this they tend to have really low alb on low teens.”

I hope that helps!

Scott 🙂

Hello.

I hope you are well. Hopefully this information is helpful! Let us know if you have any more questions!

Scott 🙂

Replying to scott@vtx-cpd.com 07/06/2024 - 20:16

Great question!

When dealing with a haemoabdomen, stabilizing hypovolemia and hypotension is critical. While crystalloids are commonly used, there are specific situations where fresh frozen plasma (FFP) can be particularly beneficial.

Using Fresh Frozen Plasma (FFP):

Crystalloid Sparing: In cases where patients have significant protein loss, such as septic peritonitis with high protein abdominal exudates, plasma can be very helpful. These patients often develop hypoproteinemia and decreased colloid osmotic pressure (COP). In such situations, plasma can provide oncotic support, allowing for smaller fluid volumes and reducing the need for large amounts of crystalloids, which can further damage the glycocalyx and worsen TP/albumin/COP, potentially causing interstitial edema and other issues.

Glycocalyx Protection: The glycocalyx is a crucial barrier that maintains vascular integrity. Shedding of the endothelial glycocalyx occurs in response to ischemia, hypoxia, ROS, inflammation, sepsis, and trauma (including hemorrhagic shock). Research shows that resuscitation with plasma can partially restore the glycocalyx, whereas crystalloids do not. This restoration is likely due to the albumin in plasma, which helps preserve endothelial integrity, reduces glycocalyx shedding, and mitigates interstitial edema. Albumin also reduces neutrophil adhesion to the endothelium and has anti-inflammatory properties.

Coagulopathy: Another specific indication for using plasma products is in patients with coagulopathy. Fresh frozen plasma can provide necessary clotting factors to help manage bleeding disorders, which is particularly important in patients with haemoabdomen who may be experiencing coagulopathy secondary to their condition.

When to Use Plasma:

If PCV is maintained but TP is low, plasma can be useful to support oncotic pressure and provide necessary proteins.
Plasma is particularly indicated when there’s a need to avoid large volumes of crystalloids due to potential damage to the glycocalyx or worsening of interstitial edema.
Use plasma when you need to provide additional oncotic support in patients with significant protein loss or low COP.
Consider plasma products for patients with coagulopathy to provide clotting factors and manage bleeding disorders effectively.
In summary, while crystalloids are typically used for initial resuscitation, FFP has specific benefits in certain clinical scenarios, especially where maintaining oncotic pressure, protecting the glycocalyx, and addressing coagulopathy is critical. Plasma can be a valuable tool in your arsenal, particularly for patients with significant protein loss, hypoproteinemia, or coagulopathy.

If you need more detailed information or have additional questions, feel free to ask!

Best regards,

Scott

Hi Helen,

Thank you so much for sharing this information. It’s fantastic to see opportunities like the How To Thrive event being made available to us. The focus on empowering individuals and teams with the skills needed to thrive in veterinary practice is incredibly valuable. I appreciate the 20% discount offer for VTX members and course delegates—it’s a great incentive to attend.

Looking forward to the event!

Best regards,
Scott

Hi Liz,

Thanks for sharing these exciting updates from ACVIM!

And I have to say, cardiology studies always have the best names! The REPAIR study sounds like something out of a sci-fi movie. 😂

The potential use of aficamten in cats with HCM is particularly intriguing, especially given its shorter half-life and fewer drug interactions compared to mavacamten. It’s great to hear about advancements that could make a real difference in treatment options.

Looking forward to hearing more about these studies and any other interesting findings you come across.

Watch this space indeed!

Scott x