Immune-Mediated Hemolytic Anemia in a Bitch Triggered by Drugs

Background: Immune-mediated hemolytic anemia (IMHA) is characterized by an autoimmune response with production of auto-antibodies and destruction of erythrocytes resulting in anemia. Primary IMHA is referred to a condition when the cause is unknown (idiopathic), whereas secondary IMHA involves changes in red blood cells caused by the action of drugs, neoplasms, or infectious diseases. The diagnosis can be made through changes in the blood count, usually of a regenerative character, Coombs test, and autoagglutination test. The present study aimed to report a case of drug-induced hemolytic anemia, with emphasis on the clinical signs, diagnostic methods, and treatment, in a female dog.Case: A 9-year-old mixed-breed bitch weighing 29.6 kg was referred to the Veterinary Medical Teaching Hospital (HCV-UFRGS) with a previous diagnosis of gallbladder mucocele that was unresponsive to clinical treatment. After laboratory tests, cholecystectomy was performed, and the procedure required conversion from laparoscopic to open cholecystectomy. Therapy included administration of amoxicillin, dipyrone, tramadol hydrochloride, and meloxicam. Three days after surgery, the dog presented with apathy, lethargy, hyporexia, and a pale and subicteric mucosa. The patient developed hypochromic macrocytic anemia with reticulocytosis, spherocytosis, anisocytosis, and leukocytosis with neutrophilia. The result of the autoagglutination test was positive, confirming the diagnosis. All medications were suspended, and immunosuppressive treatment with dexamethasone was included, with a subsequent switch to prednisolone. After 10 days of treatment, the patient experienced significant improvement, and therapy was discontinued.Discussion: Based on the patient's history, the cause of the IMHA was secondary to drug administration, and it is not possible to distinguish if it was due to one or a combination of drugs, as they were all started and stopped simultaneously. The patient had hypothyroidism, which may have contributed to the production of antibodies against TSH receptors, blocking the hormone's action, thereby causing tissue damage due to T cell-mediated cytotoxicity and the effect of cytokines. The pale and subicteric mucosa, apathy, weakness, lethargy, exercise intolerance, and dyspnea resulted from extravascular hemolysis and bilirubin released from erythrocyte rupture with a subsequent decrease in the number of red blood cells, leading to oxygen transport deficiency. The diagnosis is based on the blood count and results of autoagglutination supported by the response to immunosuppressive therapy. Anemia results in increased production and release of precursor cells from the bone marrow, accompanied by reticulocytosis and increased mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC). The treatment of IMHA consists of supportive care and immunosuppressive therapy with corticosteroids to ensure suppression of the immune system, preventing response against erythrocytes. Initially, tramadol hydrochloride, dipyrone, and amoxicillin with potassium clavulanate were suspended to interrupt the cause of IMHA, and administration of dexamethasone in an immunosuppressive dose was started. Therefore, it is important to include drug-induced IMHA in the differential diagnosis of patients who present with anemia after using medications. Early diagnosis, initiation of therapy, and adequate care were important factors for the recovery of the animal.Título: Anemia hemolítica imunomediada medicamentosa em uma cadelaKeywords: dog, hypochromic macrocytic anemia, erythrocyte, hemoglobin, spherocyte.Descritores: cão, anemia macrocítica hipocrômica, eritrócito, hemoglobina, esferócito.

Uretrostomia pré-púbica vídeo-assistida : modelo experimental em coelhos

The purpose of this study was to develop a laparoscopic-assisted prepubic urethorstomy (PPU) technique using rabbits as an experimental model. Six male New Zealand rabbits (Oryctolagus cuniculus) over six months old and weighing between 3 and 4kg (3.5kg ± 0.4) were used in this study. The animals underwent laparoscopic dissection of the pelvic urethra, which was then exposed for the laparoscopicassisted urethrostomy procedure. The proposed model for training of laparoscopic-assisted PPU in rabbits was considered effective and feasible. It proved to be a simple technique even for surgeons under basic endosurgery skills training, with possibilities of employing the technique for the treatment of cats with loss of function of the distal urethra.Este estudo objetivou o desenvolvimento de uma técnica de uretrostomia pré-púbica (UPP) vídeo-assistida, utilizando coelhos como modelo experimental. Foram utilizados seis coelhos Nova Zelândia (Oryctolagus cuniculus), machos, com peso médio de 3.5kg (± 0.4), com idade acima de seis meses. Os animais foram submetidos à dissecação laparoscópica da uretra pélvica e posterior exposição desta para a realização de uretrostomia vídeo-assistida. O modelo proposto para treinamento de UPP vídeo-assistida em coelho foi considerado eficaz e factível, mostrando-se uma técnica exequível mesmo por videocirurgiões iniciantes, havendo possibilidade de seu emprego no tratamento de gatos com perda na função da uretra distal

Elective Laparoscopic Ovariectomy in Domestic Swine (Sus scrofa domesticus)

Background:In the last years the number of exotic company animals has been increased, and the demand for neutering services for these animals has become greater. By the author’s knowledge, there are no records of elective ovariectomy in domestic swine (Sus scrofa domesticus). The current paper reports a case of elective laparoscopic ovariectomy in a domestic swine (Sus scrofa domesticus).Case:A 4-month-old domestic swine (Sus scrofa domesticus), weighing 45 kg was referred to elective video-laparoscopic ovariectomy at the Veterinary Clinics Hospital of the Federal University of Rio Grande do Sul (HCV - UFRGS). Physical examination and laboratory tests, including hemogram and biochemistry (alanine aminotransferase - ALT, serum albumin and creatinine), were within normal range for the species. Ketamine hydrochloride (Cetamin®) 10 mg.kg-1, xylazine hydrochloride (Xilazin®) 2 mg.kg-1, and midazolam (Midazolam®) 0.5 mg.kg-1 were administered intramuscularly (IM) as pre-anesthetic medication. The anesthetic induction was performed with intravenous (IV) propofol (Propovan®) and anesthesia was maintained with isoflurane (Isoforine®) diluted in O2 by a universal vaporizer with a partial gas rebreathing anesthetic system. Throughout the procedure, were monitoring constantly the invasive blood pressure (IBP), electrocardiogram (ECG) in lead II, peripheral arterial saturation with O2 (SpO2), end-tidal carbon dioxide concentration (ETCO2), and esophageal temperature. The abdominal cavity was accessed through the insertion of three portals (one of 10 mm of diameter and other two of 5 mm of diameter). The cavity was inflated with medicinal CO2 until the pressure of 10 mmHg was achieved. The uterine body and ovaries were identified. The right ovary was suspended and, by a bipolar clamp, the ovarian vessels were occluded through electrocoagulation in three distinct locations with approximately 0,5 cm between themselves, and cut off. The right ovary was removed from the cavity. An identic maneuver was used for the realization of the surgical steps and removal of the left ovary. By the end, the cavity was deflated and the cannulas were removed. The abdominal wall was sutured with Sultan pattern with 3-0 polyglycolic acid thread, and the skin was sutured with simple interrupted suture with 3-0 nylon monofilament. The post-operative evaluations were subjective and fitting with the patient's behavior. The patient didn't show any clinical signs of pain, discomfort and returned to its usual eating habits on the second day after the procedure. No signs of infection, dehiscence, cicatrization retard or other complications were observed in the surgical wound. The stitches were removed after seven days.Discussion: This case report shows the applicability of the video-laparoscopic ovariectomy technique by three portals in other species than dogs and cats, and serves as bibliographic support to the veterinary endosurgery field. Based on previous studies, it has been concluded that minimally invasive procedures represent the most beneficial sterilization methods to the patient due to its diagnostical and surgical capacity, as well as minor surgical trauma and shorter recovery time. The most common indication for the video-laparoscopic technique in veterinary routine is the elective sterilization. Pyometra, urinary incontinence and weight gain are complications that are not diagnosed more frequently after ovariectomy when compared to ovariohysterectomy. The laparoscopic ovariectomy is a viable technique to be applied to the swine, with the most difficult aspect being the anatomical peculiarities of the animal

Dioctophyma renale in gestant female dog : case report

O Dioctophyma renale é um nematódeo de ocorrência mundial que parasita os rins de cães e de outras espécies de animais domésticos. O parasito adulto localiza-se no rim do hospedeiro definitivo e, desse modo, os ovos podem ser eliminados com a urina, o que faz da urinálise um dos principais métodos diagnósticos, assim como o ultrassom. Por ser um nematódeo muito grande, e comumente destruir o órgão parasitado, a remoção cirúrgica do órgão é o principal tratamento. O trabalho teve como objetivo relatar o caso de uma cadela gestante parasitada por Dioctophyma renale. Durante avaliação para ovariohisterectomia eletiva, foi detectada a prenhez e o parasitismo por Dioctophyma renale, através de ultrassonografia abdominal e urinálise. A paciente completou a gestação no tempo correto, parindo um filhote saudável. Trinta dias após o parto, a paciente foi submetida à nefrectomia total do rim acometido, recuperando-se completamente. O tempo de espera até o final da gestação para o tratamento cirúrgico não comprometeu a recuperação da paciente, assim como o parasitismo não afetou feto.Dioctophyma renale is a worldwide occurring nematode that parasites the kidneys of dogs and other domestic animal species. The adult parasite is located in the kidney of the definitive host and, thus, the eggs can be eliminated with the urine, which makes urinalysis one of the main diagnostic methods, as well as the ultrasound. Because it is a very large nematode, and commonly destroys the parasited organ, surgical removal of the organ is the main treatment. The objective of this study was to report the case of a pregnant female dog parasitized by Dioctophyma renale. During evaluation for elective ovariohysterectomy, pregnancy and parasitism were detected by Dioctophyma renale, through abdominal ultrasonography and urinalysis. The patient completed the gestation at the correct time, giving birth to a healthy pupy. Thirty days after delivery, the patient underwent complete nephrectomy of the involved kidney, recovering completely. The waiting time until the end of gestation for the surgical treatment did not compromise the recovery of the patient, just as the parasitism did not affect the fetus

Evaluation of the accuracy and precision of the GE Dash 4000 oscillometric monitor for blood pressure measurement in anesthetized female dogs

Background: Indirect measurement of arterial blood pressure, such as the oscillometric method, is the most commonly used in clinical practice of dogs and cats. This method measures blood pressure values that are estimates of direct (invasive) arterial blood pressure values. Oscillometric devices are easy to use even for non-experienced personnel. However, there is considerable variation in accuracy and precision of blood pressure values measured by different oscillometric monitors. The present study aimed to determine the accuracy and precision of the GE Dash 4000 oscillometric monitor for arterial blood pressure measurement in anesthetized female dogs. Materials, Methods & Results: Sixteen healthy adult female dogs received 0.3 mg/kg morphine as premedication and were anesthetized with propofol and isoflurane. A 22-gauge catheter was introduced into the dorsal pedal artery and connected to a rigid tubular system and a pressure transducer filled with heparinized solution to allow direct (invasive) measurement of systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP). A blood pressure cuff was positioned proximal to the carpus and connected to the oscillometric device (GE-DASH 4000 monitor) in order to obtain indirect measurements of SAP, MAP and DAP. Cuff width was 40% of limb circumference. During anesthesia, invasive arterial blood pressure values were measured and recorded simultaneously with the oscillometric method. The Bland Altman method was used to evaluate agreement between the methods by calculating the bias (invasive - oscillometric) and limits of agreement. Percentages of differences between the methods with an error ≤ 10 mmHg and ≤ 20 mmHg were calculated. Results were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of noninvasive blood pressure methods Weight and age of dogs were 7.6 ± 2.2 kg and 20 ± 17 months, respectively. A total of 195 pairs of measurements were obtained from 16 animals. Of these pairs, 146 were classified as normotension (SAP: 90 to 140 mmHg), 28 as hypertension (SAP > 140 mmHg) and 21 as hypotension (SAP < 90 mmHg). Bias values ± SD (95% limits of agreement) were: SAP, 5.0 ± 16.5 mmHg (-27.3 to 37.4 mmHg); MAP, -3.4 ± 14.3 mmHg (-31.4 to 24.6 mmHg); and DAP, 4.2 ± 11.8 mmHg (-18.9 to 27.4 mmHg). According to the ACVIM criteria, maximum values accepted for bias (± SD) are 10 ± 15 mmHg. Percentages of differences ≤ 10 mmHg and ≤ 20 mmHg were: SAP, 41% and 80%; MAP, 54% and 84%; and DAP, 64% and 91%. ACVIM recommendations are ≥ 50% for errors within 10 mmHg and ≥ 80% for errors within 20 mmHg. Discussion: MAP and DAP values obtained by the GE-DASH 4000 monitor matched the ACVIM criteria for validation of noninvasive methods. Conversely, SAP values did not meet all the criteria, and were not considered reliable. Limitations of the study include: a) most dogs were of low weight; b) the ACVIM criteria refer to SAP measurements, but in the present study, the same criteria were applied to MAP and DAP measurements; c) the majority of observations were obtained during normotension. We conclude that MAP and DAP measurements obtained by the GE Dash 4000 monitor met the ACVIM criteria for validation of noninvasive blood pressure monitors. Therefore, this monitor was considered to have adequate accuracy and precision for MAP and DAP measurements in anesthetized normotensive dogs. Under the conditions of this study, SAP measurements obtained by this monitor were not reliable

Evaluation of the accuracy of the Delta Life DL 1000 oscillometric monitor for blood pressure measurement in anesthetized dogs of different weight ranges

Background: Arterial blood pressure is one of the most commonly variables monitored during anesthetic procedures in veterinary patients. The most reliable method for measuring arterial blood pressure in dogs and cats is the direct (invasive) method. However, the oscillometric method is less complex and more practical for clinical routine in small animals. Nevertheless, oscillometric monitors present great variability in accuracy. The present study aimed to determine the accuracy of the Delta Life DL 1000 oscillometric monitor for measurement of systolic, mean and diastolic blood pressures (SAP, MAP and DAP, respectively) in anesthetized dogs of different weight ranges. Materials, Methods & Results: This study was approved by the Institutional Ethics Committee of Animal Use. Fifteen female dogs of different breeds, weighing 11.6 ± 10.0 kg and with a mean age of 48 ± 51 months were used. All animals were scheduled for elective surgery under general anesthesia in the Institution Veterinary Hospital. Dogs were anesthetized with morphine, propofol and isoflurane and had a 20 or 22 gauge catheter introduced into the dorsal pedal artery for continuous, invasive monitoring of SAP, MAP and DAP. A blood pressure cuff was positioned over the middle third of the radius and connected to Delta Life DL 1000 monitor. Oscillometric readings of SAP, MAP and DAP were registered every 5 minutes, and invasive values were simultaneously recorded. Values obtained with both methods were compared (invasive versus oscillometric) by use of the Bland Altman method to determine the bias, standard deviation of bias and 95% limits of agreement. The percentages of errors between the methods within 10 mmHg and within 20 mmHg were calculated. The results obtained were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of indirect methods of arterial blood pressure measurement. Data were stratified into two groups according to the weight: 140 mmHg). Bias (± SD) values in Group 1 were as follows: SAP, 5.2 ± 18.1 mmHg; MAP, -3.4 ± 17.2 mmHg; and DAP, 12.0 ± 17.5 mmHg. The percentages of errors within 10 mmHg were 40.3% for SAP; 45.4% for MAP and 28.6% for DAP. The percentages of errors within 20 mmHg were 72.3% for SAP, 84.0% for MAP and 68.1% for DAP. In Group 2, 66 paired measurements were obtained, nine of which classified as hypotension, 56 as normotension and one as hypertension. Bias (± SD) in Group 2 were as follows: SAP, 13.6 ± 14.3 mmHg; MAP, -1.1 ± 13.5 mmHg; and DAP, 8.2 ± 16.0 mmHg. The percentages of errors within 10 mmHg were 33.3% for SAP, 77.3% for MAP and 33.3% for DAP. The percentages of errors within 20 mmHg were 65.1% for SAP, 92.4% for MAP and 83.4% for DAP. Discussion: Based on the results of this study and reference criteria from the ACVIM, the Delta Life DL 1000 monitor had a poor accuracy for SAP, MAP and DAP and did not meet the criteria from the ACVIM in anesthetized dogs under 10 kg. Measurements of MAP in dogs ≥ 10 kg met the ACVIM criteria, but measurements of SAP and DAP did not. Based on the findings in this study, the DL 1000 oscillometric monitor is not recommended for blood pressure measurement in anesthetized dogs < 10 kg. In dogs ≥ 10 kg, measurements of MAP yielded acceptable values, but SAP and DAP measurements did not

Evaluation of the Accuracy and Precision of the GE Dash 4000 Oscillometric Monitor for Blood Pressure Measurement in Anesthetized Female Dogs

Background: Indirect measurement of arterial blood pressure, such as the oscillometric method, is the most commonly used in clinical practice of dogs and cats. This method measures blood pressure values that are estimates of direct (invasive) arterial blood pressure values. Oscillometric devices are easy to use even for non-experienced personnel. However, there is considerable variation in accuracy and precision of blood pressure values measured by different oscillometric monitors. The present study aimed to determine the accuracy and precision of the GE Dash 4000 oscillometric monitor for arterial blood pressure measurement in anesthetized female dogs.Materials, Methods & Results: Sixteen healthy adult female dogs received 0.3 mg/kg morphine as premedication and were anesthetized with propofol and isoflurane. A 22-gauge catheter was introduced into the dorsal pedal artery and connected to a rigid tubular system and a pressure transducer filled with heparinized solution to allow direct (invasive) measurement of systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP). A blood pressure cuff was positioned proximal to the carpus and connected to the oscillometric device (GE-DASH 4000 monitor) in order to obtain indirect measurements of SAP, MAP and DAP. Cuff width was 40% of limb circumference. During anesthesia, invasive arterial blood pressure values were measured and recorded simultaneously with the oscillometric method. The Bland Altman method was used to evaluate agreement between the methods by calculating the bias (invasive - oscillometric) and limits of agreement. Percentages of differences between the methods with an error ≤ 10 mmHg and ≤ 20 mmHg were calculated. Results were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of noninvasive blood pressure methods. Weight and age of dogs were 7.6 ± 2.2 kg and 20 ± 17 months, respectively. A total of 195 pairs of measurements were obtained from 16 animals. Of these pairs, 146 were classified as normotension (SAP: 90 to 140 mmHg), 28 as hypertension (SAP > 140 mmHg) and 21 as hypotension (SAP < 90 mmHg). Bias values ± SD (95% limits of agreement) were: SAP, 5.0 ± 16.5 mmHg (-27.3 to 37.4 mmHg); MAP, -3.4 ± 14.3 mmHg (-31.4 to 24.6 mmHg); and DAP, 4.2 ± 11.8 mmHg (-18.9 to 27.4 mmHg). According to the ACVIM criteria, maximum values accepted for bias (± SD) are 10 ± 15 mmHg. Percentages of differences ≤ 10 mmHg and ≤ 20 mmHg were: SAP, 41% and 80%; MAP, 54% and 84%; and DAP, 64% and 91%. ACVIM recommendations are ≥ 50% for errors within 10 mmHg and ≥ 80% for errors within 20 mmHg.Discussion: MAP and DAP values obtained by the GE-DASH 4000 monitor matched the ACVIM criteria for validation of noninvasive methods. Conversely, SAP values did not meet all the criteria, and were not considered reliable. Limitations of the study include: a) most dogs were of low weight; b) the ACVIM criteria refer to SAP measurements, but in the present study, the same criteria were applied to MAP and DAP measurements; c) the majority of observations were obtained during normotension. We conclude that MAP and DAP measurements obtained by the GE Dash 4000 monitor met the ACVIM criteria for validation of noninvasive blood pressure monitors. Therefore, this monitor was considered to have adequate accuracy and precision for MAP and DAP measurements in anesthetized normotensive dogs. Under the conditions of this study, SAP measurements obtained by this monitor were not reliable