VetScan® Thyroxine (T4) - Abaxis | Better at Point of Care
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VetScan® Thyroxine (T4) - Abaxis | Better at Point of Care
Pre-Surgical Coagulation Testing. Why Your Practice Can’t Live Without It. Contributing Author: Andrew J. Rosenfeld, DVM, DABVP Case Study Read this case study submitted by Andrew Rosenfeld, DVM, DABVP. Cocoa Marshmallow, a 1 year old female Boxer Mixed Breed dog presented for a routine ovariohysterectomy. The following are a series of standard pre-anesthetic questions that were asked to Cocoa’s owner. 2011 2011 Sept/Oct 9 Pr e - S u r g i c a l Co a g u l at ion Testing Questions to ask. Q. When did Cocoa last eat? A. Last night’s dinner at 6 pm. Q.Any recent coughing, sneezing, diarrhea, vomiting, excessive urination or excessive drinking? A. None Q.Any history of anesthetic issues or concerns? A. None Q. Any history of previous disease? A. None Q. Are vaccines up to date? A. Yes Table 1: Pre-surgical CBC Test Result Normal WBC 10,250 5,500-19,500 Lymphocytes 1725 1500-7000 Monocytes 500 0-850 Neutrophils 7025 2500-12500 Eosinophils 1000 0-1500 Basophils 0 0-100 RBC 6000 5500-8500 Hemoglobin 11 9.5-15 Platelet 245,000 200000-500000 Table 2: Pre-surgical Chemistry Panel Test Result Normal Albumin 3.4 2.5-4.4 g /dl Alk Phos 65 20-150 IU/L ALT 70 10-118 IU/L Amylase 1200 200-1200 IU/L T Bilirubin 0.2 0.1-0.6 mg/dl BUN 14 7-25 mg/dl Calcium 9.2 8.6-11.8 mg/dl No abnormalities were noted on Cocoa’s physical and her pertinent clinical data was as follows: Phosphorus 4.6 2.9-6.6 mg/dl Creatinine 0.8 0.3-1.4 mg/dl Glucose 108 60-110 mg/dl • Temp: 100.3°F Na 139 138-160 mEq/l • Pulse: 125 bpm K 3.9 3.7-5.8 mEq/l TP 6.6 5.4-8.2 g/dl • Resp: 20-30 breaths/min Globulin 3.2 2.3-5.2 g/dl • CRT: <2 secs • MM: Pink • Hydration: WNL Q. Are other pets in the house OK? A. There are no other pets in the house. Q. Is Cocoa currently on an over-the-counter, prescription or homeopathic medication? A. Heartworm prevention Cocoa’s pre-surgical CBC was performed on the Abaxis Vetscan HM5 and the chemistry panel was performed on the Abaxis Vetscan VS2. No abnormalities were noted (Tables 1, 2). Urinalysis results were unremarkable (Table 3) and her pre-surgical systolic blood pressure was 105 mmHg. 10 Sept/Oct 2011 Table 3: Pre-surgical Urinalysis Test Result Normal Urine specific gravity 1.044 >1.035 Protein Neg Neg Blood Neg Neg Glucose Neg Neg pH 6.5 7.0 Sediment No significant findings P re -Surg ical Coag u l at io n T e s t in g Cocoa was pre-medicated with 0.1 mg glycopyrollate and 0.05 mg acepromazine. She was induced with 50 mg ketamine and 2.5 mg Valium IV and maintained on isoflurane during the procedure. The procedure was routine except that mild to moderate bleeding was noted throughout the procedure. Postoperatively, she was given 2.2 mg/kg Carprofen IM for pain management. During recovery, it was noted that the incision continued to ooze blood and there was light bruising around the surgical site. Post operative physical examination and TPR were unremarkable and her systolic blood pressure was 125 mmHg. Because of the continued bleeding and bruising, additional postoperative blood work was performed. This included acid-base status evaluation using a Vetscan i-STAT 1 analyzer and a coagulation profile utilizing a Vetscan VSpro Coagulation specialty analyzer (Table 4). Table 4: Post-operative Blood Values Test Value Normal PCV 25 (L) 25-55% TP 5.2 mg/dl 5-7.5 mg/dl ALB 1.8 mg/dl (L) 2.5-3.5 mg/dl PT 22 (H) 12-17 sec aPTT 95 90-110 sec GLU 115 60-115 BUN 15 10-26 Na 143 142-150 K 3.8 3.4-4.9 Cl 125 106-127 tCO2 19 17-25 Anion Gap 8 8-25 Hct 23 (L) 35-50 HgB 8 (L) 12-17 pH 7.37 7.35-7.45 PCO2 35 34-40 HCO3 22 20-40 Base Excess -1 -5-0 Why pre-surgical coagulation testing is necessary. Results of these tests indicated that bleeding was actively occurring in this patient and this was likely due to a problem with the extrinsic side of the coagulation cascade (factor VII). Because factor VII is highly sensitive to the effects of coumadin type compounds, the owner was again queried. Upon more direct questioning the owner now reported that Cocoa had ingested rodenticide two days before the procedure. However, because she was acting fine, the owner wasn’t concerned and forgot to mention it. Cocoa was transferred to an emergency care facility to be monitored overnight. She received 2 units of plasma and was released the following day on vitamin K supplementation. Her owner’s cost after the ovariohysterectomy was more than $2,100. Coagulation testing is an important part of the overall pre-surgical testing protocol in a growing number of veterinary facilities. Genetic hemophilia, potential exposure to unknown medications and toxins as well as, elective and high risk surgical patients, evaluation of bleeding patients and snake bite victims are excellent candidates for coagulation testing. There are many breeds with known genetic or familial hemophilia and regardless of their purported incidence, factor deficiencies of any cause are an issue when they occur on your patient. 2011 Sept/Oct 11 Pr e - S u r g i c a l Co a g ul at ion Testing Coagulation testing is readily accepted by clients. Offering a test that reduces the chance of surgical complication is easy to justify and a negative test result is good news. Cost is obviously important to the client as well, and the test must be offered at a reasonable price to increase compliance. Many practices offer the pre-surgical coagulation profile at a price of $30-$40, while the price on the test for the patients presenting for a bleeding disorder is higher. This tiered pricing system is used in many areas of the hospital, such as different prices for critical exams versus wellness exams, or for initial radiographic series versus recheck films. The procedure is the same, but the purpose and time spent on interpretation is different; moreover, the perceived value to your client is also different. Common Breeds Affected by Genetic or Familial Coagulation Disorders Factor VII2 Factor VIII2 (Hemophilia A) Factor IX2 (Hemophilia B) Factor X2 Factor XI2 (Hemophilia C) Factor XII2 Beagle1 German Shepherd1 Many Dogs1 Boxer1 Kerry Blue Terrier1 Dogs (Especially Poodles)1 Alaskan Malamute1 Mixed Breed Dogs1 British Shorthair1 Cocker Spaniel1 German Shepherd1 Cats1 Mixed Breed Cats1 Siamese1 Jack Russell Terrier1 DSH1 DSH1 1 2 BSAVA Manual of Canine and Feline Clinical Pathology, Second Edition: Villers and Blackwood Veterinary Hematology and Clinical Chemistry: Thrall 12 Sept/Oct 2011