Читать книгу Point-of-Care Ultrasound Techniques for the Small Animal Practitioner - Группа авторов - Страница 237

There is only a single report of which we are aware in the human literature of an AX‐related hemoabdomen (Borahay et al. 2011). The case involved a near‐term pregnancy in a woman, interestingly from Galveston, Texas, with previous AX to contrast agents. She was anemic and received a blood transfusion prior to a scheduled C‐section and tubal ligation. During the procedure, she was given a cephalosporin antibiotic and complained of pruritus and had cutaneous and vital signs supporting a diagnosis of AX. She was started on epinephrine as a constant‐rate infusion. Postoperatively she became hypotensive and bedside point‐of‐care ultrasound was performed and she was positive for free fluid. Coagulation profile supported an acquired coagulopathy and disseminated intravascular coagulopathy (DIC) was diagnosed. She was reoperated after receiving histamine‐1 and histamine‐2 receptor blockers and glucocorticoids. At surgery, no discrete bleeding was found but only generalized oozing; topical hemostatic agents were placed intraoperatively and FFP was administered. She survived and her coagulopathy corrected within 24 hours (Borahay et al. 2011).

The case is interesting because likely the acquired coagulopathy in these dogs is complex and multifactorial and variable depending on what factor(s) is the major player in each case. However, heparin must play a role because some dogs have obvious discordance in coagulation times with a much higher aPTT than PT time (consistent with heparinization). Mast cell granules contain heparin. Additional factors likely playing a role include histamine, bradykinin, tryptase, platelet‐activating factor, and others (Lisciandro 2016b; Caldwell et al. 2018; Hnatusko et al. 2019).