Читать книгу Point-of-Care Ultrasound Techniques for the Small Animal Practitioner - Группа авторов - Страница 236

Let's look at a couple of case scenarios of large‐volume canine AX‐related heparin‐induced bleeders. For example, if the high normal aPTT is 102 seconds, then an acceptable elevation not requiring FFP would be up to 129 seconds. The author has managed many cases with an AFS of 3 and 4 on admission that responded favorably to resuscitation with epinephrine, intravenous crystalloid fluid therapy, histamine‐1 and histamine‐2 receptor blockers, and glucocorticoids (see Table 7.7). These cases are continued on a short course of antiinflammatory glucocorticoids and histamine‐2 receptor blockers for the next several days with documented hemorrhagic effusion (and others highly suspected that fit the canine AX clinical profile). Often the AFS 3 and 4 is completely resolved (AFS 0) or nearly resolved (AFS 1) the following day on patient rounds. An excellent up‐to‐date anaphylaxis webinar and additional information regarding this unique and fascinating medically treated canine AX‐related complication is available free of charge at www.FASTVet.com

In uncommon to rare instances, packed red blood cells (pRBCs) are additionally needed. In the author's experience, some general guidelines for a clinical course and need for transfusion products would be that 1 in 5–7 AX‐hemoabdomen dogs (of any positive AFS) require replacement of clotting factors, 1 in 15 AX‐hemoabdomen dogs require a second round of FFP, and 1 in >25 AX‐hemoabdomen dogs require pRBCs treating as in Table 7.7, with the caveat that glucocorticoids and histamine‐2 receptor blockers are administered initially without delay. A recent case report documented a canine AX‐hemoabdomen without gallbladder wall edema, which in our experience is the vast exception rather than the rule (Caldwell et al. 2018; Lisciandro and Lisciandro 2019). Without saving the ultrasound gallbladder image for radiologist review, more subtle sonographic striation could have been missed (Caldwell et al. 2018; Lisciandro and Lisciandro 2019) (see Figure 7.11B).

Lastly, nearly all of our canine AX cases (100+) have had Global FAST performed and we have found a couple more important observations: pericardial and pleural hemorrhage has not been documented as a complication of the acquired AX‐related heparin‐induced hemoabdomen coagulopathy, and lung has always been “dry” with “absent B‐lines All (Vet BLUE) views (ABAV)” initially and on serial Global FAST examinations (Lisciandro et al. 2016; Hnatusko et al. 2019), in contrast to a single case report in the literature of massive bee envenomation accompanied by marked pulmonary edema (Walker et al. 2005). Importantly, these AX cases are single witnessed or witnessed Hymenoptera sp. envenomation and not massive bee envenomations, a much different subset of dogs. Anecdotally, AX‐related hemabdomen has occurred with vaccine‐induced AX.