VSSF Welcomes Our Newest Associates

September
2006
VSSF Welcomes Our Newest Associates
Michael G. Aronsohn, VMD
Diplomate American College
of Veterinary Surgeons
Practice Limited to General
& Orthopedic Surgery
Peter Bondy DVM
Diplomate, American College of
Veterinary Internal Medicine
Practice Limited to
Internal Medicine
Ronald L. Burk, DVM, MS
Diplomate, American College
of Veterinary Radiology
Practice Limited to Radiology
& Radiation Oncology
James R. Cook, DVM, PhD
Diplomate American College
of Veterinary Internal Medicine
Practice Limited to Neurology
& Neurosurgery
Lisa DiBernardi DVM
Practice Limited to Oncology
Tacy Rupp, DVM, MS
Diplomate American College
of Veterinary Internal Medicine
Practice Limited to Cardiology
Nick Schroeder DVM
Diplomate American College
of Veterinary Internal Medicine
Practice Limited to Cardiology
& Pulmonology
David Spranklin DVM
Practice Limited to Surgery
Jeffrey Toll, VMD
Diplomate American College
of Veterinary Internal Medicine
Practice Limited to
Internal Medicine
We are pleased to welcome once again Dr. Nick Schroeder. Dr.
Schroeder completed his internship with us in 2003. He then
earned a residency position in cardiology with Dr. Steve Ettinger
at the California Animal Hospital in Los Angeles. Dr. Schroeder
successfully achieved board-certified status this year! He sees
referral appointments for cardiac and pulmonary disease, Tuesday
through Saturday.
Dr. David Spranklin joins our surgery
department after completing a residency
in small animal surgery at Washington
State University. His practice is limited
to surgery, with a special interest in
surgical oncology and minimally
invasive surgeries including arthroscopy,
laparoscopy, and thoracoscopy.
Nick Schroeder DVM
Another alumnus of VSSF’s internship
program is Dr. Lisa DiBernardi. She
graduated LSU with the class of 1999
and then went on to do the first of two
David Spranklin DVM
residencies in oncology; one at Purdue
University in medical oncology and a second at LSU in
radiation oncology.
Dr DiBernardi recently passed the ACVIM (Oncology) certifying
examination and is awaiting final credential approval for her
boards. She is currently accepting referrals of cancer patients.
Lisa DiBernardi DVM
Coming Soon...
Degenerative Myelopathy, James Cook, DVM, DACVIM
Degenerative myelopathy (DM) has been recognized as a clinical entity for over 30
years. Initially it was a disease primarily of German Shepherd dogs (GSD) and GSD
crossbreeds but it is actually found in all breeds and has been diagnosed in cats
and food animals as well. Attempts have been made to link this condition to
multiple sclerosis and ALS/Lou Gehrig’s disease as an animal model for the human
diseases but is not an exact model for either. In fact, there is no true confirmation
at this point that it is the same disease in all breeds. ...More in our next issue.
Animal Emergency & Critical Care Services (AECCS)
Brian K. Roberts, DVM
Jason Horgan DVM
Diplomate, American College of
Resident
Corinne Rehmann DVM
Resident
Veterinary Emergency and Critical Care
Emergency and Critical Care
Emergency and Critical Care
and Director, AECCS
Phone: 954-437-9630 • Fax: 954-437-7207 • www.amccc.com
Canine Transfusion Medicine
The purpose of writing this brief is to provide
the reader with some important guidelines when
deciding to perform and administer a blood
transfusion.
Anemias can be caused by various disorders
which can be summarized as decreased red cell
production, increased red cell destruction and
loss(Table 1).
Table 1: Anemia Classification
Decreased production
Increased Destruction
Loss
Bone marrow disease
(myelodysplasia)
Immune mediated
hemolysis
Trauma
Iron deficiency
Neoplasia (lymphoma)
Chronic disease
Chemotherapy
Sepsis
Zinc toxicity
Ehrlichia/Babesia
Lead toxicity
Neoplasia
DIC
Snake envenomation
Surgery
Thrombocytopenia
Neoplasia
Hemophelia
Coagulopathy
Drugs (NSAIDS,
heparin,
thrombolytics)
There are many “triggers” that are considered
which determine the need for a transfusion.
Some reach a certain target hematocrit and
hemoglobin and others rely on physical and
clinical parameters. In general, a transfusion
should be considered needed in patients with
hematocrit levels of 21% or less and hemoglobin
levels of 7 g/dl or less. In addition to the target
levels, one should consider the following clinical
implications (Table 2).
Table 2: Transfusion Triggers
Loss of 30% or more blood volume
Tachycardia and/or hypotension
Collapse
Respiratory distress
Acute vs. chronic loss
Inability to stabilize with IV fluids
Cause of anemia
Products available for red blood cell transfusion
include packed red blood cells and whole or
“fresh” blood. Packed red blood cells are
produced by centerfugation or sedimentation of
whole blood. They have a lifespan of 21 to 42
days and have higher hemoglobin levels of 6080% than whole blood. Whole blood contains all
blood components such as red blood cells,
plasma proteins, and clotting factors. Table 3
provides guidelines for dose and administration.
Brian K. Roberts, DVM, DACVECC
Table 3: Dosing, Rates and Testing
Dose
Adminstration time
Post transfusion PCV
Dose rate
Whole Blood
Packed Cells
20 mls/kg or
13-22 mls/kg
4 hours
2 hours
3-4 ml/kg/hr
10 mls/kg or
6-10 mls/kg
4 hours
2 hours
4-6 ml/min
Both packed red blood cells and fresh blood are
stored long-term in bags which allow the transfer
of air to allow the cells to perform cellular
respiration. These methods of storage also
require the use of citrate-based anticoagulants
which typically contain phosphate and dextrose.
Blood collected in vacuum glass bottles must be
used within a few hours of collection and should
not be stored.
Dogs have at least 13 different blood types
known as dog erythrocyte antigens or DEA’s.
Of those 13 known types, only DEA 1.1 has
been shown to be very important when
considering immune-mediated transfusion
hemolysis. Due to limited availability, blood
products are available as either DEA 1.1 positive
or DEA 1.1 negative. By banking both of these
types, more blood products are available. This
makes it necessary to know the blood type of a
patient that is to receive blood. Blood typing is
available by submitting samples to laboratories
or blood banks. Test card kits (Rapid Vet-H®)
are also available which can be run in-house.
Major crossmatching is another method to
determine the compatibility between the donor
and recipient. In general, crossmatching is not
necessary in a recipient that has no previous
transfusion history as long as DEA typing is
performed. The major crossmatch tests the
recipient’s serum with the donor cells.
Hemolysis will occur in non-compatible donors
and recipients. The procedure to perform
crossmatching is lengthy and can be found in the
reference list, internal medicine texts, the
Veterinary Information Network (VIN), and local
blood bank web sites. It is important to note that
antibody formation against DEA’s and cell
membranes can occur as soon as 4 days after a
transfusion. Therefore crossmatching should be
performed in patients previously transfused who
require additional blood.
Transfusion reactions can be divided into four
main categories which include acute
immunologic and non-immunologic reactions
Phone: 954-437-9630 • Fax: 954-437-7207 • www.amccc.com
and delayed immunologic and non-immunologic reactions.
The most important reactions are acute in nature and occur
in 20-25% of dogs in which the type of neither the donor
nor the recipient is known. Table 4 provides a review of
the reaction types, cause and method of prevention.
Table 4: Transfusion Reactions and Prevention
Reaction Type
Acute
immunologic
Causes
Symptoms
Method of prevention
Recipient antibodies
react with donor
cells, complement
and cytokines
Occurs in minutes to Blood typing and
hours Hemolysis,
crossmatching
shock, Fever,
urticaria, vomiting
Recipient antibody
development vs. cell
antigens
Occurs in 3 days to
weeks Progressive
drop in PCV
Fever and jaundice
Positive coombs test
None.
Crossmatching will
not prevent
Acute nonimmunologic
Volume overload,
blood clots, air
embolism,
contamination,
hypocalcemia
encephalopathy
(older blood NH3)
Tachypnea, jugular
pulse. Dyspnea and
crackles. Tremors,
hyperthermia.
Seizures, blindness,
altered mentation
Decrease volume
and rate in patients
with heart disease
Pathogen free
product use. Check
serum calcium levels
Do not use older
stored blood
Delayed nonimmunogenic
Typically infectious
agents, i.e. Ehrlichia,
Babesia, RMSF,
heartworms,
Leishmania. Lyme,
Leptospirosis, etc.
Based on infection
Use of pathogen
free product.
Proper donor
screening for
infectious agents
Delayed
immunologic
After initiating a transfusion, the patient should be
monitored closely for an acute transfusion reaction.
Pre-treatment physical parameters (temperature, pulse rate,
respiratory rate, mucus membrane color, capillary refill
time, and heart/lung auscultation) should be compared with
those same parameters at 15, 30, and 60 minutes after a
transfusion has begun. If a reaction is suspected or
documented, the transfusion should be stopped
immediately and symptomatic treatment given such as
Diphenhydramine (1-2 mg/kg) and Dexamethasone
sodium-phosphate (0.5-1 mg/kg). Patients that develop
symptoms of shock (pallor, hypothermia, tachycardia)
should also receive appropriate intravenous fluid therapy.
Patients that develop evidence of fluid overload
(tachypnea, dyspnea, cough, crackles) should be treated
with supplemental oxygen and diuretics. Fluid therapy is
contra-indicated in these patients.
Blood products are available from the following sources
Blood Bank . . . . . . . . . . . . . . . . . . . . .Phone Number
Eastern Veterinary Blood Bank . . . . .1-800-949-3822
Animal Blood Bank . . . . . . . . . . . . . .1-800-243-5759
Midwest Animal Blood Services . . . .1-517-851-8244
Sun States Animal Blood Bank . . . . .954-630-2231
References:
1
2.
3.
4.
5.
6.
Hoenhaus AE, Rentko V. Blood transfusions and blood substitutes. In
Dibartola SP Fluid Therapy in Small Animal Practice. W.B. Saunders Co.
Philadelphia. 2000.
Jutkowitz LA, et. al. Massive transfusion in dogs: 15 cases (1997-2002)
JAVMA 2002; 220: 1664-1669.
Wardrop JK. Storage and handling tips for transfusion of blood products.
Proceedings Western States Veterinary Conference. 2004
Hale AS. Canine blood groups and their importance in veterinary transfusion
medicine. Vet Clin N Amer Sm Anim Pract. 1995; 25: 1323-1332
Schlam’s Veterinary Hematology, 5th ed., Philadelphia, Lippincott, Williams
and Wilkins, 2002.
Stegeman JR, et al. Transfusion associated Babesia gibsoni infection in a
dog. JAVMA 2003; 222(7): 959-963.
Attention Parents...
Attention Parents & Teachers: Schedule
a Tour For Your Childrens’ Class!
Responsible pet ownership begins at an early age.
We would be pleased to host a tour of our
hospital for your child's class, scout troop, or other
similar organization. Please contact Lisa at
954-432-5611 or [email protected] to discuss the
details and arrange a convenient time to visit us.
We look forward to seeing you!
9410 Stirling Road, Cooper City, Florida, 33024-8157
Veterinary Specialists of South Florida
9410 Stirling Road
Cooper City, Florida
33024-8157
VSSF: About Our Practice
VSSF is a 24 hour full-service animal hospital servicing the South Florida community for over 12 years.
All major veterinary specialties are represented including internal medicine, surgery, cardiology, neurology,
neurosurgery, radiology, radiation oncology, and emergency/critical care. VSSF offers state-of-the-art
veterinary diagnostic and therapeutic modalities including…
• Full clinical laboratory services
• 24 hour fully staffed Intensive Care Unit
• On site advanced diagnostic imaging – ultrasound,
CT, MRI, fluoroscopy
• Digital video endoscopy – gastrointestinal,
respiratory, urogenital
• Radiation therapy – radioactive iodine, orthovoltage,
linear accelerator
• Advanced orthopedic procedures, e.g. TPLO
• Neurosurgery (brain and spinal cord surgery)
• Hemodialysis (continuous renal replacement
therapy)
• Blood typing, crossmatching, and transfusion
services
• Ventilatory support
Referral Guidelines for Practitioners and Specialists
Here at VSSF, we want to do everything possible to
ensure that your clients and patients are treated to the
very best care and service. To assist us with this mission
and to establish and maintain the best possible
professional relationships with you, our colleagues, the
following suggestions are offered...
1. Provide all medical records and radiographs to our
clinic or to the client in advance of their appointment.
We would like to be as prepared as possible to assist
your Clients. Unnecessary repetition of routine tests can
be avoided as well.
2 Communicate with our office prior to your client’s
arrival - this is especially important if there are
extenuating circumstances not reflected in the medical
record, when you are unsure of which specialist is most
appropriate to evaluate your patient, or when patients are
being sent to our emergency service.
3. Discuss finances with clients prior to referral particularly when referring patients for relatively costly
procedures such as surgery or critical illness. We do not
offer financing but we can submit a CareCredit
application prior to referral to facilitate smooth referral
and to ensure that the funds are available to provide care.
4. Tell us how best to serve you - if you have specific
needs for your patients and clients, specify in writing or
by phone how to help. Some referring colleagues are
happy with a referral letter, whereas some want daily
updates during hospitalization or copies of the entire
medical record including radiographs and other data.
Also, some vets want us to perform all follow-up care
and some want to do it themselves.
5. We take great care in the service we provide you and
your clients. If you have suggestions or comments you
may e-mail them to [email protected].