Investigação do risco de óbito em pacientes caninos com o perfil hemostático alterado

O sistema hemostático previne a perda de sangue excessiva, mantem o fluxo sanguíneo adequado, permite o reparo e recuperação dos vasos danificados, preservando assim a integridade vascular, além de remover os coágulos sanguíneos. Avaliação laboratorial da coagulação sanguínea é muito importante, permitindo identificar as causas e definir a intensidade das lesões no sistema hemostático ocasionadas por doenças hemorrágicas e trombóticas, que são ameaças a vida do paciente. Neste presente estudo foram avaliados três parâmetros hemostáticos, TP (tempo de protombina), TTPA (tempo de tromboplastina parcial ativada) e contagem plaquetária de 218 pacientes caninos atendidos no Hospital de Clínicas Veterinárias do Rio Grande do Sul. Eles foram divididos em sete grupos conforme o tipo de alteração que apresentavam nos exames laboratoriais utilizados. O grupo um eram pacientes que não apresentavam alterações no perfil hemostático, grupo dois pacientes com trombocitopenia, grupo três pacientes com TP prolongado, grupo quatro pacientes com TTPA prolongado, grupo cinco pacientes com trombocitopenia e TTPA prolongado, grupo seis com TP e TTPA prolongado e grupo sete com trombocitopenia, TP e TTPA prolongados. Foi verificado que os grupos cinco (Trombocitopenia e TTPA prolongado), seis (TP e TTPA prolongado) e sete (Trombocitopenia, TP e TTPA prolongados) apresentaram uma diferença significativa na proporção de óbitos, e foi verificado 3,061; 5,17 e 4,13 vezes mais risco de óbito quando comparados aos pacientes do grupo um, que não apresentavam alterações hemostáticas. Esse risco de óbito pode ser relacionado com diversos distúrbios hemostáticos hereditários ou adquiridos, como a CID (coagulação intravascular disseminada), falência hepática, distúrbios da vitamina K e coagulopatias hereditárias. Foi possível concluir no presente estudo, que os distúrbios relacionados com a hemostasia são muito importantes para definir o prognóstico e o tratamento adequado, e um perfil hemostático completo pode direcionar para o diagnóstico correto. Não foi possível identificar com certeza as causas primárias ou disfunções especificas devido ao estudo ter analisado apenas três testes laboratoriais de hemostasia sem o histórico clínico dos pacientes caninos, entretanto foi possível observar um risco de óbito significantemente aumentado naqueles que possuíam um, dois ou três parâmetros alterados em relação aos cães sem alterações hemostáticas. Os óbitos podem ter ocorrido por complicações decorrentes da causa primária, ou como consequência dos distúrbios hemostáticos, que predispõe o paciente a eventos hemorrágicos.The hemostatic system prevents excessive blood loss, keeps an adequate blood flow, allows the healing of blood vessels preserving vascular integrity, and removes the blood clogs from circulation. The blood clotting laboratorial evaluation is very important because identifies the causes and defines the intensity of the damage to the hemostatic system, caused by life-threatening hemorrhagic and thrombotic diseases. In this present study three laboratorial parameters were evaluated, PT (prothrombin time), APTT (activated partial thromboplastin time) and platelet count of 219 canine patients attended at the Veterinary Hospital of the Rio Grande do Sul state university. They were initially divided into eight groups according to the presenting alterations on the laboratorial analyses but between the select dogs, there was no one presenting thrombocytopenia and prolonged PT. The remaining groups were group one with no hemostatic alterations, group two with thrombocytopenia, group three with prolonged PT, group four with prolonged APTT, group five with thrombocytopenia and prolonged APTT, group six with prolonged PT and APTT and group seven with thrombocytopenia, prolonged PT and APTT. The groups five (Thrombocytopenia and prolonged APTT), six (prolonged PT and APTT) and seven (Thrombocytopenia, prolonged PT and APTT) showed a significant difference at the death rate, and 3,061, 5,17 and 5,13 times more death risk than the patients in the group one with no hemostatic alterations. This death risk can be associated with various hemostatic diseases and syndromes, like DIC (Disseminated intravascular coagulation), liver failure, disturbances on Vitamin K and hereditary coagulopathies. In conclusion, the coagulopathies are very important to define the patient prognosis and the adequate treatment, and a through hemostatic profile can help achieve the correct diagnosis. It was not possible to clearly identify the primary causes or specific dysfunctions because there were only three laboratorial parameters being evaluated, and there was no clinic history of the patients, however it was possible to observe a significantly higher death risk in those canines that had one, two or three altered parameters compared to those with no hemostatic alterations. The deaths could be caused by complications on the primary cause or as consequence of the hemostatic disorders, that predispose the patient to hemorrhagic events

Riesgo de muerte en perros hospitalizados con desordenes del perfil hemostático

Identifying patients who have a higher risk of death is crucial to define appropriate risk classification, treatment and prognosis, which can result in a favorable outcome. The objective of this retrospective study was to evaluate whether the prolongation of prothrombin times, activated partial thromboplastin, and thrombocytopenia are indicators of death risk in hospitalized canine patients. A retrospective study using medical records (2014-2018) of the Laboratory of Veterinary Clinical Analysis at the Federal University of Rio Grande do Sul identified 218 patients. Dogs having a single disorder in laboratory tests did not differ from the control. Groups presenting patients with multiple changes showed three times more death risk than the control group and a cumulative incidence of death higher than 29%.Identificar pacientes que possuem um risco maior de morte é crucial para definir a classificação de risco apropriada, tratamento e prognóstico, os quais podem resultar em um resultado favorável. O objetivo deste estudo foi avaliar se o prolongamento dos tempos de protrombina, tromboplastina parcialmente ativada e trombocitopenia são indicadores para o risco de óbito de pacientes caninos hospitalizados. O estudo retrospectivo utilizando os registros médicos (2014 a 2018) do Laboratório de Análises Clínicas Veterinárias na Universidade Federal do Rio Grande do Sul identificou 218 pacientes. Cães que apresentavam uma única alteração em exames laboratoriais não diferiram do controle. Grupos compostos de pacientes com múltiplas alterações mostraram um risco de óbito três vezes maior que o grupo controle e uma incidência cumulativa de óbito maior que 29%.Identificar a los pacientes con mayor riesgo de muerte es crucial para definir la clasificación de riesgo, el tratamiento y el pronóstico adecuados, lo que puede dar lugar a un resultado favorable. El objetivo de este estudio fue evaluar si la prolongación de los tiempos de protrombina, la tromboplastina parcialmente activada y la trombocitopenia son indicadores del riesgo de muerte en perros hospitalizados. El estudio retrospectivo con registros médicos (2014 a 2018) del Laboratorio de Análisis Clínico Veterinario de la Universidad Federal de Rio Grande do Sul identificó a 218 pacientes. Los pacientes con un solo cambio en las pruebas de laboratorio no difirieron del control. Los grupos que presentaron pacientes con múltiples cambios mostraron un riesgo de muerte tres veces mayor que el grupo control y una incidencia acumulada de muerte mayor al 29%

Approach to Classification of Cavitary Effusion and Comparison between Manual and Automatic Methods for Total Nucleated Cell Count

Background: Two classifications are used to categorize cavitary effusions using total nucleated cell count (TNCC): protein concentration and pathophysiology of its formation. The aims of the present study were to evaluate the correlation between the TNCC values of cavitary effusions obtained in the automatic and the manual method, and also evaluating the classification methodology. Materials, Methods & Results: Cavitary effusions were analyzed for physical, chemical and cytological aspects, as well as manual and automatic cell counts for the correlation between the traditional methods and those suggested by Stockham & Scott. Bland-Altman regression and Spearman correlation analysis were performed. Of the total, 44 were abdominal effusions (73.3%), 15 thoracic (25%) and 1 pericardial (1.7%). According to the traditional classification, most of the effusions were classified as modified transudates (40%) and according to the classification of Stockham and Scott, as transudates poor in protein (31.7%). The correlation between cell counting techniques between pure, modified and exudate transudates was 0.94, 0.97 and 0.94, respectively, indicating an excellent correlation between the parameters (p = 0.95%).Discussion: Considering the concentration of proteins and CCNT, the effusions classified as modified transudate were mainly caused by neoplastic processes (carcinomas/adenocarcinomas), since there are several mechanisms of their formation, such as large variation of protein concentration. According to the Stockham & Scott classification a unique classification is considered for exfoliative neoplastic effusions, the variation of the protein concentration of the effusion does not alter its classification. In neoplastic effusions, classified as exudates, lymphomas were the most prevalent, and hypercellularity (approximately 150,000 cells / μL) allowed this classification. When considering low-protein transudates, the findings related to low concentrations did not differ much from the traditional classification. In the ruptures of viscera and vessels, the hemorrhagic ones were the most frequent, thus, the cytological diagnosis is essential, since it can give information about the contamination with blood during the collection. Most of these were due to neoplasia as the underlying cause. A case of chylotorax was diagnosed by comparing cholesterol and triglyceride values of effusion and serum. In cases of uroperitoneum, the presence of urine in the abdominal cavity promotes the dilution of the fluid from the cavity, being initially classified as pure transudate and, with its permanence in the cavity, increasing the CCNT, becomes an exudate. As in cases of exfoliative neoplastic effusions, the classification of the uroperitoneum, according to Stockham & Scott, is classified directly into effusion due to rupture of the viscera, giving a quick and clear diagnosis. According to Stockham & Scott, cases classified as nonseptic exudates (n = 3), two of which resulted from feline infectious peritonitis (PIF). The effusive form of PIF presents with accumulations of fluid in the abdomen, having an inflammatory character, but according to the traditional classification, they enter the category of modified transudates, because, despite containing protein concentrations close to or above the serum level, they present a CCNT lower than an exudate. Cavitary effusions were classified as septic exudates when intracellular bacteria were present and in the present study, two effusions were classified as such in two patients, one with septic peritonitis and in the other the final diagnosis was not found. The high values of Spearman correlation coefficients found when comparing the automatic counts with the manual demonstrate that there is an excellent correlation between the methods and, the Bland-Altman test showed significant agreement between them

Approach of cavitary effusion classification and comparison between manual and automatic methods for total nucleated cell count

Background: Two classifications are used to categorize cavitary effusions using total nucleated cell count (TNCC): protein concentration and pathophysiology of its formation. The aims of the present study were to evaluate the correlation between the TNCC values of cavitary effusions obtained in the automatic and the manual method, and also evaluating the classification methodology. Materials, Methods & Results: Cavitary effusions were analyzed for physical, chemical and cytological aspects, as well as manual and automatic cell counts for the correlation between the traditional methods and those suggested by Stockham & Scott. Bland-Altman regression and Spearman correlation analysis were performed. Of the total, 44 were abdominal effusions (73.3%), 15 thoracic (25%) and 1 pericardial (1.7%). According to the traditional classification, most of the effusions were classified as modified transudates (40%) and according to the classification of Stockham and Scott, as transudates poor in protein (31.7%). The correlation between cell counting techniques between pure, modified and exudate transudates was 0.94, 0.97 and 0.94, respectively, indicating an excellent correlation between the parameters (P = 0.95%). Discussion: Considering the concentration of proteins and CCNT, the effusions classified as modified transudate were mainly caused by neoplastic processes (carcinomas/adenocarcinomas), since there are several mechanisms of their formation, such as large variation of protein concentration. According to the Stockham & Scott classification a unique classification is considered for exfoliative neoplastic effusions, the variation of the protein concentration of the effusion does not alter its classification. In neoplastic effusions, classified as exudates, lymphomas were the most prevalent, and hypercellularity (approximately 150,000 cells / μL) allowed this classification When considering low-protein transudates, the findings related to low concentrations did not differ much from the traditional classification. In the ruptures of viscera and vessels, the hemorrhagic ones were the most frequent, thus, the cytological diagnosis is essential, since it can give information about the contamination with blood during the collection. Most of these were due to neoplasia as the underlying cause. A case of chylotorax was diagnosed by comparing cholesterol and triglyceride values of effusion and serum. In cases of uroperitoneum, the presence of urine in the abdominal cavity promotes the dilution of the fluid from the cavity, being initially classified as pure transudate and, with its permanence in the cavity, increasing the CCNT, becomes an exudate. As in cases of exfoliative neoplastic effusions, the classification of the uroperitoneum, according to Stockham & Scott, is classified directly into effusion due to rupture of the viscera, giving a quick and clear diagnosis. According to Stockham & Scott, cases classified as nonseptic exudates (n = 3), two of which resulted from feline infectious peritonitis (PIF) The effusive form of PIF presents with accumulations of fluid in the abdomen, having an inflammatory character, but according to the traditional classification, they enter the category of modified transudates, because, despite containing protein concentrations close to or above the serum level, they present a CCNT lower than an exudate. Cavitary effusions were classified as septic exudates when intracellular bacteria were present and in the present study, two effusions were classified as such in two patients, one with septic peritonitis and in the other the final diagnosis was not found. The high values of Spearman correlation coefficients found when comparing the automatic counts with the manual demonstrate that there is an excellent correlation between the methods and, the Bland-Altman test showed significant agreement between them