Portorož, 31.3. – 1.4.2017

ZBORNIK REFERATOV

Univerza v LjubljaniVeterinarska fakulteta

XXX. SIMPOZIJAo aktualnih boleznih malih `ivali

ZBORNIK REFERATOV

XXX. SIMPOZIJA O AKTUALNIH

BOLEZNIH MALIH ŽIVALI

Portorož, 2017 http://www.zdruzenje-szvmz.si/

XXX. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH ŽIVALI ZBORNIK REFERATOV

Portorož, 31. marec – 1. april 2017

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Izdalo: Slovensko združenje veterinarjev za male živali

Oblikovanje:AKTA DESIGNwww.aktadesign.si

270 izvodov

Vsebina

Giger U. Bleeding Disorders ...................................................................................................... 8

Giger U. Diagnostic Approach to IMHA & Other Hemolytic Anemias ....................................... 11

Giger U. Therapeutic Considerations for Immune-mediated & Other Hemolytic Anemias ........ 13

Zemljič T. Elektroretinografija ................................................................................................... 15

Pavlin D. Prehoden Fanconijev sindrom pri psu........................................................................ 16

Pogorevc E. Okužba s Crenosoma vulpis pri psih – klinični primeri .......................................... 17

Iglič J. Naraven način zdravljenja vseh vrst ran v veterini......................................................... 18

Pogorevc E. Slikovne tehnike v diagnostiki obolenj prebavnega trakta ................................... 19

Giger U. Feline Anemias - Peculiarities of Regenerative (Blood Loss and Hemolysis) and Non-Regenerative Anemias .............................................................................................. 20

Giger U. Canine Transfusion Therapy ........................................................................................ 29

Giger U. Feline Transfusion Therapy ......................................................................................... 33

Hirt R. Swallowing Disorders- from pharynx way down to the stomach, part 1 and 2 ............. 36

Hirt R. Signs of gastric disease -what might be the cause? part 1 and 2 ................................. 45

Brložnik M. Ultrazvočni pregled prebavil ................................................................................. 49

Žel J. Vloga veterinarskega tehnika pri endoskopski diagnostiki prebavil ................................ 57

Nemec A. Ustna higiena: kaj naj priporočim skrbniku psa ali mačka ....................................... 59

Mohar P. Veterinarska ambulanta skozi pasje in mačje oči ...................................................... 66

Suhadolc Scholten S. Pogosta vprašanja in dvomi o kužnih boleznih ....................................... 69

Erjavec V. Brahicefalični sindrom pri psih, zgodnje zdravljenje je nujno potrebno .................... 75

Černe Ž. Podkožni limfom pri mački ......................................................................................... 78

Dolinar Paulič K. Uporaba in učinkovitost antiparazitikov pri psih ........................................... 78

Hodnik P. Hepatozoonoza – nova klopna bolezen v sloveniji ................................................... 78

Knez M. Primer kožne astenije (Ehlers-Danlosovega sindroma) pri psu ................................... 79

Matko M. Kirurško zdravljenje degenerativne lumbosakralne stenoze (DLSS) z dekompresijo, distrakcijo in stabilizacijo pri psih ............................................................................................ 79

Praprotnik Borko Š. Okužba z Mycoplasmo haemofelis pri mačkah ......................................... 80

Šimundić M. Kolizijski tumor ustne votline z zasevkom v mandibularno bezgavko ................. 80

Šušterič P. Sekundarni (nutricijski) hiperparatireoidizem pri mačku.......................................... 80

Zajc A.L. Primarni hipoadrenokorticizem pri mački ................................................................. 81

Brložnik M. Contrast enhanced ultrasound for assessment of perfusion of Murine melanoma B16F10 treated with irradiation and electrotransfer of plasmid encoding shRNA against MCAM ............................................................................................................. 82

Bajo A. Short-term evaluation of bleomycin-based electrochemotherapy as a single-modality treatment of a cobblestone colorectal carcinoma in a dog ...................................................... 83

Lowe J. R. Safety and efficacy of intraoperative electrochemotherapy of soft tissue sarcoma in 26 dogs .................................................................................................................. 83

Bajo A. Superficial squamous cell carcinoma succesfully treated with bleomycin-based electrochemotherapy in three cats ........................................................................................... 84

Campigli M. Clinical outcome in a dog affected by subcutaneous soft tissue sarcoma (SSTS) treated with: surgical therapy, intravenous bleomycin intraoperatoryelectrochemotherapy (IO-ECT) and flap reconstruction ..................................... 84

ZBORNIK REFERATOV XXX. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH ŽIVALI

Portorož, 31. marec – 1. april 2017

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Simpozij so omogočili

Animalis d.o.o., Tržaška cesta 135, 1000 Ljubljana

BAYER Animal Health d.o.o., Celovška cesta 135, 1000 Ljubljana

EVG molekularna diagnostika d.o.o., Taborska ulica 8, 2000 Maribor

Farmina in DJ Plus d.o.o., Tovarniška c. 15, 3312 Prebold

FELIVET, Nina Cizej s.p., Mladinska ulica 20, 2000 Maribor

Genera SI d.o.o., Parmova ulica 53, 1000 Ljubljana

IDEXX Laboratories Italia, Via Guglielmo Silva 36, 20149 Milano, Italija

IRIS MEDNARODNA TRGOVINA, d.o.o., Cesta v gorice 8, 1000 Ljubljana

Kemofarmacija d.d., Cesta na Brdo 100, 1000 Ljubljana

Krka d.d., Šmarješka cesta 6, 8501 Novo mesto

MELISA VETERINA d.o.o., Zgornji Petelinjek 5a, 1223 Blagovica

Merck MSD AH, Intervet international B.V. Boxmeer, Podružnica Ljubljana

Šmartinska cesta 140, 1000 Ljubljana

MM Surgical d.o.o., Galjevica 81, 1000 Ljubljana

Protektor d.o.o., Resljeva cesta 10, 1000 Ljubljana

Royal Canin Ljubljana d.o.o., Letališka c. 29/A, 1000 Ljubljana

SALUS, Ljubljana, d.d., Litostrojska 46A, 1000 Ljubljana

Vetconsult Pharma d.o.o., Gerbičeva ulica 50, 1000 Ljubljana

Vetpet d.o.o., Letališka cesta 29, 1000 Ljubljana

Vetpromet d.o.o., Cesta na Brdo 100, 1000 Ljubljana

XXX. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH ŽIVALI ZBORNIK REFERATOV

Portorož, 31. marec – 1. april 2017

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ORGANIZACIJSKI IN UREDNIŠKI ODBOR SZVMŽ (UO SZVMŽ)

Prof. dr. Nataša Tozon, dr. vet. med. (predsednica)

Milan Matko, dr. vet. med. (podpredsednik - bodoči predsednik)

Doc. dr. Alenka Seliškar (podpredsednica – prejšnja predsednica)

Barbara Celinšek, dr. vet. med. (tajnik)

Tjaša Pukl, dr. vet. med. (blagajnik)

Doc. dr. Joško Račnik, dr. vet. med. (član)

Mag. Jure Pipp, dr. vet. med. (član)

ČASTNI ČLANI ZDRUŽENJA:

Prof. dr. Vjekoslav Simčič, dr. vet. med.

Prof. dr. Boyd R Jones, BVSc, FACVSc, DECVIM-Ca, MRCVS

Emil Mlinarič, dr. vet. med.

WORLD SMALL ANIMAL VETERINARY ASSOCIATION - WSAVA

OFFICERS

Dr. Walt Ingwersen, Executive Board Member, President

Prof. Colin Burrows, Executive Board Member, Past President

Dr. Shane Ryan, Executive Board Member, President Elect

Dr. Siraya Chunekamrai, Executive Board Member, Vice President

Dr. Ellen van Nierop, Executive Board Member, Honorary Treasurer

Dr. Nicola Neumann, Executive Board Member

Dr. Renée Chalmers Hoynck van Papendrecht, Executive Board Member, Honorary Secretary

FEDERATION OF EUROPEAN COMPANION ANIMAL VETERINARY ASSOCIATIONS - FECAVA

OFFICERS

Dr. Jerzy Gawor, President

Dr. Wolfgang Dohne, Vice President

Dr. Denis Novak, Treasurer

Dr. Ann Criel, Honorary Secretary

Dr. Monique Megens, Senior Vice-President

ZBORNIK REFERATOV XXX. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH ŽIVALI

Portorož, 31. marec – 1. april 2017

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ČETRTEK, 30. marec 2017PREDKONGRESNI DAN

Dermatološka sekcija dvorana Pharos08.30 – 09.00 PRIJAVA UDELEŽENCEVModerator: Rostaher A. 09.00 – 09.45 Mayer U. Otitis: etiopathogenesis and diagnostics09.45 – 10.30 Mayer U. Otitis: therapy10.30 – 11.00 ODMORModerator: Rostaher A.11.00 – 11.45 Mayer U. Video otoscopy and ear flushing11.45 – 12.30 Kostatos X. (MSD AH) Update on the treatment of demodectic, sarcoptic & otodectic mange in companion animals12.30 – 14.00 KOSILOModerator: Bizjak M.14.00 – 14.45 Kotnik T. Pseudomonas otitis14.45 – 15.30 Kotnik T. Otitis: Klinični primeri15.30 – 16.00 ODMOR16.00 – 16.45 Srečanje članov dermatološke sekcije

VOG-Veterinary Orthopaedics and Neurology Group dvorana Adria08.30 – 09.00 PRIJAVA UDELEŽENCEVModerator: Matko M. 09.00 – 10.30 Baroni M. An easy approach to the neuro patient: neurological examination10.30 – 11.00 ODMOR11.00 – 12.30 Baroni M. An easy approach to the neuro patient: neurological localization12.30 – 14.00 KOSILO14.00 – 15.30 Baroni M. Spinal emergencies: from diagnosis to treatment15.30 – 16.00 ODMOR16.00 – 16.45 Baroni M. How to treat vertebral malformations16.45 – 17.30 Case reports17.30 – 18.15 Porenta K. Rehabilitacija in fizioterapija nevrološkega pacienta

ElektrokemoterapijaModerator: Tozon N..14.00 – 14.45 Introduction lecture14.45 – 15.30 Campigli M., Baio A., Brložnik M., Milevoj N. Case reports15.30 – 16.00 ODMOR16.00 – 16.45 Round table

PETEK, 31. marec 2017, dvorana Emerald

08.30 – 09.00 PRIJAVA UDELEŽENCEV09.00 – 09.15 OTVORITEV SIMPOZIJAModerator: Seliškar A.09.15 – 10.45 Giger U. Bleeding Disorders – Diagnosis & Management of thrombocytopenias, von Willebrand disease, and acquired and hereditary coagulopathies including case examples10.45 – 11.15 ODMORModerator: Ravnik U.11.15 – 12.45 Giger U. Hemolytic Anemias – Diagnosis & Management of immunemediated hemolytic, infectious, toxic and hereditary hemolytic anemias with case discussion12.45 – 14.15 KOSILOModerator: Tozon N.14.15 – 14.30 Zemljič T. Elektroretinografija14.30 – 14.45 Pavlin D. Prehoden Fanconijev sindrom pri psu14.45 – 15.15 Pogorevc E. Okužba s Crenosoma vulpis pri psih15.15 – 15.30 Iglič J. Naravni način zdravljenja vseh vrst ran v veterini (Protektor d.o.o.)15.30 – 16.00 ODMORModerator: Pipp J.16.00 – 16.45 Pogorevc E. Slikovna diagnostika prebavnega trakta16.45 – 17.30 Giger U. Feline Anemias - Peculiarities of Regenerative (Blood Loss and Hemolysis) and Non-Regenerative Anemias17.30 – 18.30 SKUPŠČINA SZVMŽ, dvorana Pharos20.00 SVEČANA VEČERJA, dvorana Emerald

SOBOTA, 1. april 2017

Program za VETERINARJE, dvorana EmeraldModerator: Pavlin D.09.30 – 11.00 Giger U. Canine Transfusion Medicine – Indications, blood groups, blood donor screening, blood collection and administration, components and transfusion reactions with case examples11.00 – 11.30 ODMORModerator: Matko M.11.30 – 13.00 Hirt R. Swallowing Disorders- from pharynx way down to the stomach, part 1 and 213.00 – 14.30 KOSILOModerator: Matko M.14.30 – 15.45 Hirt R. Signs of gastric disease -what might be the cause? part 1 and 215.45 – 16.00 ODMORModerator: Domanjko Petrič A.16.00 – 16.45 Brložnik M. Ultrazvočni pregled prebavil17.00 ZAKLJUČEK SIMPOZIJAOTA, 9. april 2016 Program za VETERINARSKE TEHNIKEModerator: Pavlin D. - dvorana Emerald09.30 – 11.00 Giger U. Canine Transfusion Medicine – Indications, blood groups, blood donor screening, blood collection and administration, components and transfusion reactions with case examples11.00 – 11.30 ODMORModerator: Nemec A. - dvorana Adria11.30 – 12.15 Žel J. Vloga veterinarskega tehnika pri endoskopski diagnostiki prebavil12.15 – 13.00 Nemec A. Ustna higiena: kaj naj priporočim skrbniku psa ali mačka13.00 – 14.30 KOSILOModerator: Pipp J. - dvorana Adria14.30 – 15.00 Suhadolc Scholten S. Pogosta vprašanja in dvomi o kužnih boleznih15.00 – 15.45 Mohar P. Veterinarska ambulanta skozi pasje in mačje oči15.45 – 16.00 ODMORModerator: Suhadolc Scholten S. - dvorana Adria16.00 – 16.45 Erjavec V. Brahicefalični sindrom pri psih: zgodnje zdravljenje je nujno potrebno17.00 ZAKLJUČEK SIMPOZIJA

POSTERJI

1. Černe Ž. Podkožni limfom pri mački2. Dolinar Paulič K. Izdelava domačega pripravka, namenjenega zniževanju

glukoze v krvi psov in mačk3. Dolinar Paulič K. Uporaba in učinkovitost antiparazitikov pri psih4. Hodnik P. Hepatozoonoza – nova klopna bolezen v Sloveniji5. Knez M. Primer kožne astenije (Ehlers-Danlosovega sindroma) pri psu6. Matko M. Kirurško zdravljenje degenerativne lumbosakralne stenoze z

dekompresijo, distrakcijo in stabilizacijo pri psih7. Praprotnik Borko Š. Okužba z Mycoplasmo haemofelis pri mačkah8. Šimundić M. Kolizijski tumor ustne votline z zasevkom v podčeljustno

bezgavko9. Šušterič P. Sekundarni (nutricijski) hiperparatireoidizem pri mačku10. Zajc A.L. Primarni hipoadrenokorticizem pri mački

PROGRAM XXX. SIMPOZIJA O AKTUALNIH BOLEZNIH MALIH ŽIVALI, Portorož, 31. marec – 1. april 2017

XXX. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH ŽIVALI ZBORNIK REFERATOV

Portorož, 31. marec – 1. april 2017

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BLEEDING DISORDERS

Urs Giger

Bleeding disorders are a common presentation in dogs and less commonly in cats and may be inherited or ac-quired. Furthermore, thrombotic conditions are being in-creasingly recognized. This lecture will focus on the clinical diagnostic approach to a bleeding animal. There are sev-eral point-of-care and reference laboratory tests permit-ting the separation between primary and secondary he-mostatic defects as well as a specific diagnosis. Particularly challenging is the diagnosis of Disseminated Intravascular Coagulation (DIC), a syndrome observed with a variety of disorders.

Bleeding diatheses are generally separated into prima-ry and secondary hemostatic disorders and in some cases both systems are affected, such as in disseminated intra-vascular coagulation (DIC). Primary hemostatic disorders include not only the common thrombocytopenias but also thrombopathias, vasculopathies, and von Willebrand dis-ease. Secondary hemostatic disorders include all coagula-tion factor deficiencies involved in fibrin formation and are strictly speaking the coagulopathies. Platelet and vascular problems often present with surface hemorrhage, while coagulopathies generally cause hematomas and cavity bleeds. Excessive hemorrhage at an injury or surgery site and bleeding from multiple places are suggestive of bleed-ing disorder, and there are a several breed predilections for specific hereditary defects.

Hemostatic tests are indicated whenever an animal is bleeding excessively, prior to surgery when an increased bleeding tendency is suspected, to monitor therapeutic in-terventions, and for genetic screening in certain breeds or families with a known bleeding disorder. Hemostatic ab-normalities should be assessed prior to instituting therapy whenever possible or at least appropriate blood samples should be collected pretreatment. Excellent venipunc-ture with discarding of the first few drops of blood (to avoid platelet activation and tissue factor) and extended

compression over jugular, saphenous or femoral vein is required. The cuticle bleeding time crudely assesses overall hemostasis, but is not standardized and painful and is, therefore, not recommended. A minimal database includes a packed cell volume and total protein evaluation, and evaluation of a blood smear can provide a platelet estimate and identify platelet size and clumping as well as schistocytes. The results can also provide some measure of the extent of blood loss and red blood cell transfusion requirement.

Tools for Primary Hemostastic Defects

Platelet counts can be estimated on a blood smear or specifically counted by a hematology instrument. Since 8-15 platelets (1 platelet equals 20,000/μl) are normally found per high power oil emersion microscopic field, an

Urs Giger, Prof. Dr. med. vet. MS FVH Dipl. ACVIM & ECVIM-CA (Internal Medicine) & Dipl. ECVCP (Clinical Pathology) School of Veterinary Medicine, University of Pennsylvania, Philadelphia Veterinary Hospital of the University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104-6010 USA. Phone: 215-898-8830; Fax: 215-573-2162; Email: giger@vet.upenn.edu; Website: http://research.vet.upenn.edu/penngen.

ZBORNIK REFERATOV XXX. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH ŽIVALI

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absence to low number of platelets suggests a severe thrombocytopenia. Various modern impedance and laser hematology instruments have the ability to count platelets and measure their mean size including platelet size dis-tribution and platelet crit; they may have been validated, but some have difficulties in differentiating large platelets from erythrocytes (particularly in cats). Furthermore, plate-lets can readily be activated which results in platelet aggre-gation, hence, platelet counts need to be confirmed by a careful review of a blood smear including the feather edge for platelet clumps (preferably on fresh non-anticoagulat-ed blood). Hemorrhage is generally not observed unless the platelet count is <40,000/μl (normal 150-500,000/μl) or there is also a coagulopathy like DIC.

Thrombocytopenia, a common cause of surface hem-orrhage in dogs, can result from impaired thrombopoiesis, increased platelet destruction and consumption, and se-questration of platelets (splenomegaly). Reduced platelet production may be isolated or associated with an over-all decreased hematopoiesis due to many drug reactions (estrogens, chemotherapeutics, azathioprine), infections (Ehrlichia spp.), and myelophthisis (leukemia, myeloma, myelofibrosis), but remains often idiopathic (immune-me-diated?). Accelerated platelet destruction is commonly as-sociated with immune-mediated thrombocytopenia (IMT, including idiopathic thrombocytopenia purura [ITP]), but enhanced platelet consumption may also be observed with neoplasia, vasculitis and disseminated intravascular coagulation (DIC). IMT can be divided into primary, also known as idiopathic thrombocytopenia purpura (ITP), and secondary forms triggered by infections (Ehrlichia, Rickett-sia, and Babesia spp., Anaplasma spp., vaccines), drugs, and cancer. Anticoagulant rodenticide poisoning can also be associated with mild to moderate thrombocytopenia. However, acute and chronic blood loss is not resulting in any significant consumptive thrombocytopenia unless there is concomitantly a vasculopathy or DIC present. Thrombocytopenia occurs rarely in cats and is generally as-sociated with drug exposure (griseofulvin, methimazole), viral infections, or malignant diseases.

A diagnosis of thrombocytopenia is made by a platelet estimate on a blood smear or complete blood cell count, but any thrombocytopenia must be verified by a review of a blood smear. Spurious thrombocytopenia may due to instrument limitations; e.g. megaplatelets in Cavalier King Charles and few other breeds, and platelet aggre-gates with many illnesses and collection techniques; also Greyhounds have generally a mild thrombocytopenia. Classic signs of thrombocytopenia include petechiation, ecchymosis, epistaxis, and gastrointestinal blood loss. The most severe thrombocytopenias, seen with IMT/ITP, often cause only mild hemorrhage. Following a careful history, a search for an underlying cause is warranted to identify an infection (blood smear, serology, PCR) or cancer (also involving lymphnodes and spleen). Bone marrow examina-tion is safe, but may rarely reveal a specific cause on initial presentation. A diagnosis of ITP is mostly based upon ex-cluding other causes of thrombocytopenia, but platelet-associated antibodies can also be determined to support an immune mechanism for thrombocytopenia. Detection of platelet-associated antibodies further supports an im-

mune-mediated thrombocytopenia, but this test is rarely available. Serum titer, antigen and PCR tests for tick-born (ehrlichiosis, babesiosis, leishmaniasis, Rocky mountain spotted fever) and other infectious diseases are indicated in certain countries or areas. The presence of schistocytes and thrombocytopenia suggests intravascular dissemi-nated coagulation, where intravascular fibrin strands frag-ment erythrocytes. Because von Willebrand disease is such a common mild primary hemostatic defect in dogs, plasma vWF measurements by ELISA through a commercial labo-ratory are indicated. For breeding purposes, DNA testing is also available for some canine breeds.

Finally, in light of normal platelet count and plasma vWF values, a prolonged buccal mucosal bleeding time (BMBT) indicates a thrombopathia. Disposable devices are available that facilitate making 1-2 standard 1 mm deep mucosal incisions. The platelet function analyzer (PFA100) is a simple tool to functionally assess primary hemostasis. Electron microscopic and platelet aggregation and nucleo-tide studies allow further characterization of platelet dys-functions in specialized laboratories. For a couple of he-reditary thrombopathias even a DNA test is now available such as for Glanzmann thrombasthenia in Great Pyrenees and Otterhound, and thrombopathia in the Spitz, Basset, Landseer and Swiss Mountain dog, and macrothrombocy-topenia in Cavalier King Charles (Auburn University).

Coagulation Tests

Whereas the whole blood clotting time test is insen-sitive and mostly inaccurate, there are several standard-ized coagulation screening tests that are useful to define coagulopathies in clinical practice. Nearly all coagulation tests assess the function of certain parts of the coagula-tion system in fresh whole blood or fresh (or frozen) plas-ma to generate fibrin in a fibrometer; recalcified citrated plasma is used and many tests are comparing a patient sample directly with a simultaneously obtained control or pooled plasma (plasma from 10 animals). Generally co-agulation times, which is measuring the time to clotting (fibrin formation), are much shorter in small animals than in humans; thus, every coagulation test needs to be run on an instrument for animals and validated for the animal species.

XXX. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH ŽIVALI ZBORNIK REFERATOV

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The intrinsic and common pathways are assessed by either the activated coagulation time (ACT) or activated partial thromboplastin time (aPTT or PTT). Factor XII of the intrinsic cascade is activated by diatomaceous earth (celite) in the ACT test and by kaolin or other contact phase sub-strates in the aPTT test. The extrinsic and common path-ways can be assessed by the prothrombin time (PT) test. In these two assays different tissue factors (thromboplastins) are activating factor VII, which in turn will lead to fibrin formation.

Until recently the ACT tube test was the only point-of-care test available for clinical practice, whereas PTT and PT tests were performed in commercial laboratories. There are now new point-of-care coagulation instruments (e.g. IDEXX Coag DX and the Abaxis VetScan VSpro) introduced

that are capable of determining without delay on small amounts (50 μl) of fresh citrated whole blood the aPTT and PT, thereby making separation of citrated plasma and ship-ment of frozen plasma to the laboratory for initial coagula-tion screening unnecessary. In practice, a reasonable and simple approach for a bleeding animal to be screened for a coagulopathy would be to measure the ACT or PTT first as either test detects all coagulopathies (except for heredi-tary factor VII deficiency in Beagles, Scottish Deerhounds and Alaskan Klee Kais), but the aPTT is more standardized and the ACT can only be run on fresh whole blood. If the aPTT (or ACT) is prolonged, a PT test would be indicated to differentiate between an intrinsic and common pathway defect or a combined coagulopathy involving several co-agulation factors.

Hemostatic screening tests and groups of bleeding disorders

Platelets BMBT PTT PT TT

Thrombocytopenia D I N N N

Thrombocytopathia & vWD N I N N N

Intrinsic coagulopathy N N I N N

Extrinsic coagulopathy (FVII) N N N I N

Combined coagulopathies

(DIC, liver, rodenticide) D I/N I/N I/N I/N

N = normal; I = increased (prolonged) time; D = decreased

Although hereditary coagulopathies can be suspected based upon the pattern of coagulation test abnormalities, specific factor analyses are needed to confirm a diagnosis. A young male animal who is bleeding and has a mildly prolonged aPTT but normal PT likely has hemophilia A or B (factor VIII or IX deficiency), an X-chromosomal recessive disorder. However, factor XI deficiency is associated with the same test abnormalities and is inherited by an auto-somal recessive trait (e.g. Kerry blue terriers). For several hereditary coagulopathies DNA tests are already available (http://research.vet.upenn.edu/penngen), while for others the specific plasma factor deficiency can be determined through the Comparative Hemostasis Laboratory at Cor-nell University. Finally, factor XII deficiency, particularly common in domestic shorthair cats, and prekallikrein defi-ciency causes marked aPTT prolongations but no excessive bleeding tendency. Rodenticide poisoned animals that are bleeding or are at risk for bleeding will have severe pro-longations in all of the above coagulation tests, but would have a normal thrombin time (TT). The thrombin time is independent of vitamin K-dependent coagulation factors and is a functional assay for fibrinogen to form fibrin. The protein induced by vitamin K antagonism or absence (PIV-KA) test is a modified PT test and not diagnostic for roden-ticide poisoning, but a toxicological investigation (product identification, blood toxicology analysis) may confirm the

rodenticide poisoning. Moderate thrombocytopenia may be associated with rodenticide poisoning. All liver diseases may result in varied coagulopathies due to impaired co-agulation factor synthesis and vitamin K malabsorption.

Similarly, disseminated intravascular coagulopathies due to many different disorders is associated with variably prolonged coagulation times. More helpful to the diag-nosis of DIC are the recognition of schistocytes, thrombo-cytopenia, low fibrinogen and antithrombin III levels, and increased D-dimers and fibrin split (degradation) products. Finally, thromboelastography (TEG or ROTEM) techniques can now be used in the emergency room, intensive care units, and referral centers to assess overall hemostasis and particularly thrombotic/fibrinolytic tendencies of citrated whole blood.

Supported in part by a grant from the NIH (OD 010939). The author’s laboratory PennGen is offering some advanced hemostatic testing.

ZBORNIK REFERATOV XXX. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH ŽIVALI

Portorož, 31. marec – 1. april 2017

11

DIAGNOSTIC APPROACH TO IMHA & OTHER HEMOLYTIC ANEMIAS

Urs Giger

Introduction

Immune-mediated hemolytic anemia (IMHA) is one of the most common and serious hemolytic anemias in dogs, but occurs rarely in other animal species. In IMHA an im-mune response, including anti-erythrocytic antibodies, complement and macrophages, targets directly or indi-rectly erythrocytes and a hemolytic anemia ensues. There are many triggers for IMHA such as infections, drugs and other agents, and cancer leading to secondary IMHA, but in many dogs no cause is identified (so-called idiopathic, autoimmune or primary IMHA) or a genetic predisposition has been proposed (Cocker spaniels). Furthermore, alloim-mune hemolytic anemias, such as hemolytic transfusion reactions, both acute and delayed, and neonatal isoeryth-rolysis (only litters from transfused bitches), are caused by specific anti-erythrocytic alloantibodies. In contrast to other species, dogs with IMHA also develop an often over-whelming inflammatory response resulting in thrombosis and necrosis of various organs. And while the anemia can be corrected with transfusions, these complications in dogs are causing severe morbidity and mortality despite aggressive immunosuppression and antithrombotic inter-ventions.

Immune Destruction of Erythrocytes

Regardless of the underlying cause, IMHA results from a breakdown in immune self-tolerance or from a deficit in the control mechanism that regulates B and T lymphocyte activity as well as macrophage reactivity. Immune destruc-tion of erythrocytes is initiated by the binding of IgG or IgM antibodies to the surface of erythrocytes. Under most

clinical circumstances, immune destruction is an extravas-cular process that depends on recognition of erythrocytes opsonized with IgG, IgM and/or complement by specific receptors on reticuloendothelial cells. Macrophages with engulfed erythrocytes may be noted on cytological exami-nation of blood and tissue aspirates as erythrophagocyto-sis, but this is not definitive proof of an immune-mediated process. Antibody-coated erythrocytes may also be lysed by complement fixation and the membrane attack com-plex, which is clinically noted as intravascular hemolysis.

A diagnosis of IMHA must demonstrate accelerated im-mune destruction of erythrocytes. Evidence of a hemolytic anemia is suggested clinically by icterus and a regenerative anemia with hyperbilirubinuria, and hemoglobinemia and hemoglobinuria refers to an intravascular process. How-ever, the erythroid response in the bone marrow may be blunted by the immune and inflammatory process or the underlying disease thereby leading to non-regenerative anemias. Besides documenting a hemolytic anemia, one or more of the following three hallmarks must be present to support a diagnosis of immune-mediated hemolysis: persistent autoagglutination, marked spherocytosis and a positive direct Coombs’ test result. As in human medicine, the Coombs’ test should be considered the best test to de-finitively diagnose IMHA, although marked spherocytosis and persistent/true autoagglutination (after 3x washing of EDTA blood with saline) are other important parameters indicating immune-destruction of erythrocytes.

Autoagglutination

Anti-erythrocytic IgM and in large quantities IgG an-tibodies may cause direct erythrocyte autoagglutination. The autoagglutination may be seen by naked eye in an EDTA tube or on a glass slide or may become apparent as small clumps of erythrocytes on blood smears. For yet unexplained reasons, canine erythrocytes have a tendency to unspecifically agglutinate in the presence of plasma and colder temperatures as well as possibly with excessive EDTA anticoagulant. Mixing blood with one drop of saline may break up rouleaux formation but not other forms of un-specific red cell agglutination. It is, therefore, important to determine whether the agglutination persists after “saline washing”, which has been coined persistent or true auto-

Urs Giger, Prof. Dr. med. vet. MS FVH Dipl. ACVIM & ECVIM-CA (Internal Medicine) & Dipl. ECVCP (Clinical Pathology) School of Veterinary Medicine, University of Pennsylvania, Philadelphia Veterinary Hospital of the University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104-6010 USA. Phone: 215-898-8830; Fax: 215-573-2162; Email: giger@vet.upenn.edu; Website: http://research.vet.upenn.edu/penngen.

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agglutination. This is accomplished by adding physiologic saline to the tube containing a small amount of EDTA-an-ticoagulated blood, mixing, centrifuging and removing the supernatant including the plasma and repeating this saline washing 3 times. True or persistent autoagglutination is indicative of an immune process, but precludes the perfor-mance of Coombs’ test or blood typing and crossmatching procedures which are based upon an agglutination reac-tion as result. Those based upon chromatographic tech-niques do not seem to be affected by autoagglutination as free red cells can move along the strip. If the agglutination breaks up after washing, the Coombs’ test is expected to be positive, if it is a case of IMHA. There is no evidence for washing away red cell bound antibodies in dogs.

Spherocytosis

If erythrocytes are only partially phagocytized or lysed by complement in circulation, erythrocytes with reduced surface area to volume ratio, known as spherocytes, are formed. They appear spherical and microcytic with no cen-tral pallor and are considered fragile. Note proper areas on the blood smear needs to be reviewed to find spherocytes in between single regular discoid red cells. Large numbers of spherocytes (>20/microscopic high power field) are nearly diagnostic for IMHA, whereas small numbers may be seen with other conditions including DIC, endotox-emia and zinc intoxication. In our experience all dogs with marked spherocytosis and suspected to have IMHA also had a positive Coombs’ test. However, only 60-80% of dogs with a positive Coombs’ test or clinically diagnosed with IMHA had marked spherocytosis. Hereditary sphero-cytosis due to genetic membrane defects has rarely been seen in dogs, but should be considered as a differential diagnosis in dogs with negative Coombs’ test results.

Because of the difficulties with the Coombs’ test (see below), Slappendale had proposed to use the erythrocytic osmotic fragility test at specific saline concentrations as a mean to diagnose IMHA and this test is currently used in various clinics in Europe. However, there are many other reasons for increased fragility of erythrocytes beside IMHA including hereditary red cell defects. This test is not used in human medicine and has not been shown to be supe-rior to determination of marked spherocytosis and a posi-tive Coombs’ test in dogs with IMHA. The osmotic fragil-ity test is also a cumbersome and not well standardized technique.

Positive Direct Coombs’ Test Result

The direct Coombs’ test is also known as direct anti-globulin test (DAT) and is used to detect antibodies and complement on the surface of erythrocytes when the anti-erythrocyte antibody strength or concentration is too low to cause spontaneous agglutination (subaggluti-nating titer). Separate canine-specific IgG, IgM, and C3b antibodies as well as polyvalent antiglobulin reagents are available. They are added at various concentrations after washing the patient’s erythrocytes free of plasma (3x as shown above) and mixtures are generally incubated at room temperature or 37°C (cold agglutinins appear to be

rarely of clinical importance and rarely cause hemolysis). The strength of the Coombs’ reaction does not necessarily predict the severity of hemolysis, but reaction changes are useful in monitoring the disease.

Typically tube or microtiter methods have been used exclusively in the reference or teaching laboratory setting, but a flow cytometric method has also been introduced in a couple of places. A standardized, sensitive, and sim-ple gel column method was available by DiaMed (Swit-zerland), but unfortunately the company was sold to an-other company which decided to not pursue the veterinary market. A novel standardized antiglobulin test method has just been developed by Alvedia (France) similar to the immunochromatographic strip technique for blood typ-ing of dogs and cats (see updates on blood typing and crossmathing). Although many commercial laboratories offer Coombs’ testing for dogs, clinicians have ques-tioned the tests sensitivity and specificity and often forgo the test and/or use response to therapy as a diagnostic. However, negative Coombs’ test results may be seen be-cause of technical reasons, insufficient quantities of bound antibodies, the presence of weakly bound antibodies, or the disease in remission. The Coombs’ test stays positive for days to months after initiating treatment. A few days of immunosuppressive therapy will likely not reverse the Coombs’ test result, as unlikely a transfusion would cause a positive Coombs’ test result. Thus, dogs with negative Coombs’ test results should be reevaluated for other caus-es of hemolytic anemia.

In a recent prospective study of anemic and non-ane-mic dogs we compared various direct Coombs’ test meth-ods including microtiter plate assays, gel column, capillary, and immunochromatographic techniques using polyvalent antiglobulins in a laboratory setting and found excellent correlations between tests and with spherocytosis and without noticeable interference by immunosuppressive or transfusion therapy in anemic dogs.

In conclusion, a diagnosis of IMHA requires the docu-mentation of red blood cell destruction and an immune process. While regenerative anemia, icterus, and hyper-bilirubinuria are suggesting a hemolytic anemia, evidence of true autoagglutination, spherocytosis, and/or a positive direct Coombs’ test are required to document immune de-struction. The authors also recommend monitoring IMHA patients for the disappearance of these immunological pa-rameters to adjust and taper therapy.

Author’s studies were supported in part by grants from the National Institutes of Health (OD010939) and the AKC Canine Health and other Foundations. Alvedia, Lyon, France provided the immunochromatographic strips for the studies. The author is the director of the non-for-profit PennGen Laboratory offering genetic and hematological testing.

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THERAPEUTIC CONSIDERATIONS FOR IMMUNE-MEDIATED & OTHER HEMOLYTIC ANEMIAS

Urs Giger

Immune-mediated hemolytic anemia (IMHA) is a com-mon hematological disorder in dogs, may be primary (idiopathic, autoimmune) or occur secondarily to underly-ing diseases and is often associated with life-threatening complications. The diagnostic approach was covered in a previous session. Its management with immunosuppres-sion and transfusion support will be discussed here with emphasis on evidence and controversies.

A diagnosis of IMHA requires the documentation of red blood cell destruction and an immune process. While regenerative anemia, icterus, and hyperbilirubinuria are indicating the presence of a hemolytic anemia, evidence of (1) true autoagglutination after washing, (2) marked spherocytosis, and/or (3) a positive direct Coombs’ test are required to document immune destruction. The prognos-tic factors for IMHA are poorly defined unless IMHA is sec-ondary to an underlying disease. Severe anemia, icterus, leukocytosis, hypoalbuminemia and thrombotic evidence are unfavorable findings. Because the severity of IMHA ranges from indolent to life-threatening disease and seri-ous complications seen with IMHA, therapy has to be tai-lored for each patient and depends in part on whether the IMHA is primary or secondary in nature. Removal of the triggering agent or treatment of the underlying condition can bring the IMHA rapidly under control.

Fluids, Blood Transfusions, Oxygen and Oxyglobin in IMHA

Restoration and maintenance of tissue perfusion with crystalloid fluids is important, even when it results in fur-ther lowering of the hematocrit. When severe anemia and a dropping hematocrit lead to signs of tissue hypoxia,

packed red blood cell transfusions appear beneficial. The increased oxygen-carrying capacity provided by the trans-fused red blood cells may be sufficient to maintain the animal’s hematocrit for a few days, while other treatment modalities have time to become effective. The notion that transfusions pose an increased hazard to animals with IMHA has been overemphasized and is not supported by retrospective clinical studies. Fresher blood products are possibly an advantage. However, the common occurrence of autoagglutination may make blood typing and cross-matching of the patient impossible. In these cases DEA 1- blood should be transfused. Additional blood types are being recognized which may be also important.

If compatible blood is not available, the bovine hemo-globin solution Oxyglobin, a highly purified bovine he-moglobin solution, if available, may be administered and provides increased oxygen-carrying capacity and plasma expansion. The original FDA study documented the ben-eficial effects of Oxyglobin in dogs, whereas recent retro-spective studies do not allow any conclusions. In contrast to blood and Oxyglobin, oxygen inhalation therapy is of little benefit, unless the animal with IMHA is suffering form pulmonary disease such as pulmonary thromboem-bolism. Thanks to adequate transfusion support, animals with IMHA rarely die because of anemia, but because of secondary complications such as thromboemboli and in-fections.

Immunosuppressive Therapy for IMHA

The insufficient understanding of the pathogenesis, the generally guarded prognosis, the lack of good thera-peutic trials, the serious drug side effects, and the high costs of intensive care greatly hamper the successful man-agement of dogs with IMHA. The main goal of immu-nosuppressive therapy is to reduce (1) phagocytosis, (2) complement activation, and (3) anti-erythrocytic antibody production. Glucocorticoids are the initial treatment of choice for canine, feline and human IMHA. They interfere with both the expression and function of macrophage Fc receptors and thereby immediately impair the clearance of antibody-coated erythrocytes by the macrophage system. In addition, glucocorticoids reduce the degree of antibody binding and complement activation on erythrocytes, and only after weeks, diminish the production of autoantibod-

Urs Giger, Prof. Dr. med. vet. MS FVH Dipl. ACVIM & ECVIM-CA (Internal Medicine) & Dipl. ECVCP (Clinical Pathology) School of Veterinary Medicine, University of Pennsylvania, Philadelphia Veterinary Hospital of the University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104-6010 USA. Phone: 215-898-8830; Fax: 215-573-2162; Email: giger@vet.upenn.edu; Website: http://research.vet.upenn.edu/penngen.

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ies. Thus, oral prednisolone at a dose of 1-2 mg/kg twice daily is the mainstay treatment. Alternatively, oral or par-enteral dexamethasone at an equipotent dose of 0.6 mg/kg daily can be used, but is likely not more beneficial.

There is no evidence that other immunosuppressive agents are effective. They should not be used initially as they are associated with severe side effects. Additional im-munosuppressive therapy is warranted when prednisone fails, only controls the disease at persistently high doses, or when it causes unacceptable side effects. They are gener-ally used together with prednisolone, but may eventually be used independently. Historically, cytotoxic drugs such as cyclophosphamide were added, however a small ran-domized study and several retrospective surveys failed to show any beneficial effects, but may be associated with greater morbidity and mortality in the acute management of IMHA. Retrospective studies and anecdotal reports with azathioprine, cyclosporine, danazol, mycophenylate, and human intravenous immunoglobulin suggest some effica-cy, but controlled prospective clinical trials that document their efficacy are lacking. For instance, there is no evidence that azathioprine is effective and from a mechanistic view point it only inhibits antibody production and as it is an antimetabolite, it is only effective after a few weeks. Fur-thermore, the side effects of acute pancreatitis and agran-ulocytosis to aplasia makes this in most cases unsuitable. Cyclosporine at 5-10 mg/kg is likely the best and safest second agent but blood drug levels have to be determined in order to avoid toxicity and underdosing. Highly immu-nosuppressive agents from transplantation medicine such as mycophenylate and leflunamide are other agents which have been tried but no definitive beneficial effects have been reported. Finally, human intravenous immunoglobu-lin at 2 x 1 g/kg may rescue a non-responding IMHA pa-tient but relapses are common.

One other agent is melatonin which has been added as immunotherapy which is begin but it is unclear if this has any beneficial effects. Splenectomy may be considered particularly in refractory cases with large spleen, but even a normal spleen may excessively clear antibody-coated red blood cells. Furthermore, splenic histopathology, toxicol-ogy and infectious disease screens may offer a diagnosis of an underlying disease. Finally, because of the apparently severe agglutination and the inflammatory and necrotic process, plasma exchange therapy has been used in a few cases and appeared to be helpful in expediting response and avoiding serious complications.

It should be noted that an apparent therapeutic re-sponse to immunosuppressive therapy is insufficient evi-dence for the diagnosis of IMHA. Response to therapy may be indicated by a hematocrit that rises or stabilizes, an ap-propriate reticulocytosis, diminished autoagglutination, and fewer spherocytes; this response can be expected to be seen within days to weeks. The subsiding of au-toagglutination would allow the performance of a direct Coombs’ test and thereby permit the direct documenta-tion of anti-erythrocytic antibodies. As glucocorticosteroid therapy is associated with well-known side effects, the ini-tial dose will be tapered by reducing the amount by one-third every 7-14 days and moving toward every other day therapy. In secondary IMHA with appropriate control of

the underlying disease, the tapering can be accomplished more rapidly.

Thromboembolic and Other Complications with IMHA

Because of the potential of gastrointestinal ulceration by glucocorticosteroids and other immunosuppressives, gastrointestinal protectants such as sucralfate may be considered. Because dogs with IMHA suffer from an im-mune deregulation which may have been triggered by an infection and are treated with immunosuppressive agents, these patients are prone to experience infections; it is, therefore, prudent to administer preventative as well as therapeutic antibiotics to these dogs with IMHA on im-munosuppressive therapy.

Thromboemboli and DIC are unique serious complica-tions that greatly contribute to the morbidity and mortality of dogs with IMHA which are not typically seen in humans and cats with IMHA. Although the pathogenesis remains unknown, venipuncture, catheters, confinement, and glucocorticosteroids as well as other immunosuppressive agents may be contributing factors. Thus far, no study has definitively documented any successful prevention and/or management protocol for these life-threatening hemostat-ic problems in canine IMHA. Predisposing factors should, whenever possible, be limited, and adequate perfusion and tissue oxygenation should be provided with fluids and transfusions or Oxyglobin. Generally, anticoagulation ther-apy is instituted after there is some evidence or suspicion of thromboemboli. Unfractionated Heparin (dose of 50-300 IU/kg subcutaneously every 6 hours or by continuous intravenous infusion) or Low Molecular Weight Heparin (LMWH; Dalteperin 150 IU/kg sc every 12 hours) are the most commonly used drugs and is used. The replacement of coagulation factors and antithrombin III has not been proven to be beneficial. Antiplatelet agents may also be used and for instance an ultralow dose of aspirin (1 mg kg once daily) has been advocated by a couple of groups, but other studies question its efficacy. Other antithrombotic agents such as modern antithrombotic agents have been used occasionally, but their efficacy and safety remain also unproven.

In conclusion, the successful management of IMHA remains a challenge; immunosuppressive therapies be-yond glucocorticosteroids have not been proven to be effective but can be associated with serious side effects. Furthermore, the tendency to inflammation, necrosis and thromboembolism of dogs with IMHA contributes greatly to the morbidity and mortality of dogs with IMHA and ef-fective preventative and therapeutic interventions have not yet been established.

Author’s studies were supported in part by grants from the National Institutes of Health (OD010939) and the AKC Canine Health and other Foundations. Alvedia, Lyon, France provided the immunochromatographic strips for the studies. The author is the director of the non-for-profit PennGen Laboratory offering genetic and hematological testing.

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ELEKTRORETINOGRAFIJA

Tadej Zemljič

Elektroretinografija (ERG) je preiskava, pri kateri se beležijo električni potenciali, ki se ustvarijo v mrežnici ob stimulaciji s svetlobo. Nastali potenciali se izmeri-jo s pomočjo elektrod, ki se namestijo na roženico in v podkožje na področju glave. Ker so vrednosti (amplitude) teh potencialov zelo nizke, na meritve pa vplivajo tudi električni potenciali, ki se istočasno pojavijo v okolici očesa (kot npr. posledica kontrakcije vek ali obraznih mišic), je za izvedbo preiskave velikokrat potrebna sedacija.

V praksi se najpogosteje uporablja tako imenovana flash ERG, s katero ocenjujemo delovanje zunanjih plasti mrežnice. Indicirana je v primeru, kadar zaradi neproso-jnosti očesnih medijev (zlasti roženice in leče) ni mogoče direktno pregledati mrežnice in oceniti njenega delovanja. Tako je ERG potrebna v primeru napredovane katarakte, ko se odloča o ekstrakciji leče. ERG je nujna za razliko-vanje slepote, ki nastane kot posledica motenj v delovanju mrežnice, od postretinalne slepote, ko mrežnica ne kaže morfoloških sprememb, ki bi razložile izgubo vida. Lahko se uporabi tudi za zgodnje odkrivanje retinalne distrofije (PRA), še preden se pojavijo klinični znaki in morfološke spremembe na očesnem ozadju, ali pa so ti zelo blagi oz. nespecifični.

Tadej Zemljič Veterinarske storitve s.p., Milčinskega ulica 62, 1000 Ljubljana zemljita@yahoo.com

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PREHODEN FANCONIJEV SINDROM PRI PSU

Darja Pavlin

V prispevku želimo predstaviti primer prehodnega Fanconijevega sindroma pri psu, ki je najverjetneje nastal zaradi uživanja priboljškov iz posušenega perutninskega mesa. V letu 2007 je namreč AVMA izdala opozorilo zara-di množičnega pojava Fanconijevega sindroma pri psih v ZDA, ki so jedli tovrstne priboljške, proizvedene na Kita-jskem, v Evropi pa je v strokovni literaturi opisanih samo peščica primerov.

Na Kliniki za male živali Veterinarske fakultete smo sprejeli osemletno psičko pasme pritlikavi pinč zaradi akut-nega nastopa poliurije, polidipsije, zmanjšanega apetita in izgube telesne teže. Hematološke in biokemijske preiskave niso razkrile klinično pomembnih odstopanj, ki bi pojas-nila njene težave, v urinu pa smo ugotovili hudo gluko-zurijo kljub normalni koncentraciji glukoze v krvi. Ker je glukozurija ob normoglikemiji perzistirala, smo postavili sum Fanconijevega sindroma, končno diagnozo pa smo postavili s potrditvijo hude generalizirane aminoacidurije. Z natančnejšo anamnezo smo poskušali determinirati vzrok Fanconijevega sindroma (npr. uporaba določenih antibio-tikov in drugih zdravil) in ugotovili, da je psička v zadn-jih dveh letih redno prejemala priboljške iz posušenega račjega mesa, ki so bili proizvedeni na Kitajskem.

Zdravljenje psičke je zajemalo prekinitev prehranjevan-ja s priboljški in uporabo prehranskih dopolnil (vitaminsko mineralna mešanica, dodatek aminokislin in bikarbonat zaradi blage metabolne acidoze). Psički se je klinično stan-je sicer izboljšalo, vendar je v naslednjem mesecu razvila kronično ledvično bolezen (IRIS stopnja 3-P-AP0). Gluko-zurija je popolnoma izzvenela v približno štirih mesecih od prvega obiska. Z ledvično dieto se je kronična ledvična bolezen v naslednjih dveh letih stabilizirala na IRIS stopnji 2-P-AP0, psička pa je klinično v odličnem zdravstvenem stanju.

Darja Pavlin Klinika za male živali, Veterinarska fakulteta, Gerbičeva 60, Ljubljana darja.pavlin@vf.uni-lj.si

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OKUŽBA S CRENOSOMA VULPIS PRI PSIH – KLINIČNI PRIMERI

Estera Pogorevc

Crenosoma vulpis je pljučni parazit iz razreda Nema-todi, družina Crenosomatidae, ki ga najdemo v sapniku in sapnicah okuženih živali. Pogosto so z njim okužene lisice in drugi gozdni mesojedi, ugotovljen pa je tudi pri psih. V literaturi je malo opisanih primerov okužbe psov z omen-jenim parazitom.

Okužba lahko poteka popolnoma asimptomatsko, lahko pa se klinično kaže v različnih oblikah - od blagih respiratornih obolenj kot so bronhitis z blagim mukopuru-lentnim izcedkom do kroničnega kašlja.

Živali se okužijo preko polža kot vmesnega gostitelja v katerem so ličinke L3. V gostitelju se razvije v odraslega parazita, ki naseljuje pljuča in izloča ličinke L1.

Na Kliniki za male živali Veterinarske fakultete v Lju-bljani, smo v obdobju enega leta obravnavali 4 primere okužbe s Crenosomo vulpis (3 psice in 1 psa, pasme mejni ovčar, nemški prepeličar, kanarska doga in labradorec).

Pri vseh so lastniki opisovali kašelj, ki se je stopnjeval do te mere, da so psi začeli izkašljevati belo sluz s primesmi gnoja. Pri kliničnem pregledu smo pri treh psih ugotovili občutljivost sapnika na palpacijo, pri dveh pa so bili tudi avskultatorno slišni glasnejši dihalni toni.

Preiskave krvi so pri vseh pokazale eozinofilijo brez lev-kocitoze. Rentgensko smo ugotovili bronhointersticialen vzorec pljuč predvsem v perihilusnem področju in v kavdal-nih delih pljuč. Diagnoza je bila pri vseh psih potrjena z dokazom L1 ličink v blatu s parazitološko preiskavo po Baermannu.

Dva psa smo terapirali s kombinacijo prazikvantel/fen-bendazol (Zantel®) 10 oziroma 14 dni. Enega psa smo terapirali s kombinacijo prazikvantel/pirantel/febantel (Cazitel®) 7 dni in enega s kombinacijo milbemicin oxim/prazikvantel (Milbemax®) 1x/teden 4 tedne zapored. Vse pse smo zdravili do negativnih parazitoloških preiskav bla-ta.

Preiskovanje okužb s srčno-pljučnimi paraziti poteka zelo intenzivno zaradi njihovega vpliva na zdravje ljudi in živali, saj se okužbe pojavljajo v mnogih evropskih državah in se hkrati širijo izven svojih endemičnih področij. Zato je potrebno pri akutnem in kroničnem kašlju pomisliti tudi na možnost invazije s pljučnimi črvi. Parazitološka preiskava blata ni vedno pozitivna, zato jo je smiselno večkrat pono-viti po tro-dnevnem zbiranju iztrebkov, ali pa po potrebi izvesti endoskopsko preiskavo dihal.

Estera Pogorevc, Barbara Celinšek, Darja Pavlin, Aleksandra Domanjko Petrič Klinika za male živali, Veterinarska fakulteta, Univerza v Ljubljani, Gerbičeva 60, 1000 Ljubljana; estera.pogorevc@vf.uni-lj.si

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NARAVEN NAČIN ZDRAVLJENJA VSEH VRST RAN V VETERINI

Iglič Janko

Tako kot pri ljudeh se tudi pri živalih srečujemo z razn-imi ranami, od povsem enostavnih odrgnin do kompleksih kroničnih ran ter po operativnih komplikacij , ki lahko celo ogrozijo življenje živali. Zaradi kompleksnosti celjenja ( več med seboj prepletenih faz ) rane je zdravljenje zahtevno in zahteva točno določene medicinske produkte v točno določeni fazi. Tato potrebujemo veliko različnih produktov ( razkužila, antibiotiki, hidrokoloidi,srebrovi produkti…) in stalno kontrolo medicinskega osebja. Takšen način pa ima za posledico drago zdravljenje in pa dolgotrajen postopek, ki povzroča stres pri živali.

Z uporabo naravnih sestavin ( že tisočletja ), pa so us-peli izdelati produkt, ki je uporaben pri vseh ranah in to v vseh fazah zdravljenja. Produkt je mešanica dveh naravnih olj neem olje( Azadirachta indica ) in olje šentjanževke (Hy-pericum perforatum) in je združen pod komercialnim im-enom Hypermixvet. Natančno določeno razmerje obeh olj tvori enovito olje, ki ima zelo širokim spektrom delovan-ja. S kliničnimi preizkušanji so potrdili uporabnost olja od začetka do konca procesa zdravljenja in s tem opustitev ve-liko konvencionalnih metod med tem tudi antibiotičnega zdravljena, pri tem pa se je čas zdravljenja zmanjšal za 3X. Učinkovitost je potrdil tudi v primerih kjer zdravljenje po klasičnih do sedaj poznanih metodah ni bilo uspešno. Dokazano ne povzroča alergij, živali ga zaradi okusa in vonja ne ližejo ( če rane ni možno zaviti ), odganja mrčes in ne povzroča rezistence ne glede na količino in čas zdrav-ljenja. Ne potrebujemo razkužil, ker ima olje Hypermixvet tudi antimikrobno in antibakterijsko delovanje. Uporablja se ga lahko tudi na sluznicah. Primeren je za vse živali med drugim tudi za vodne živali, divjad, zveri , ptice, tekmov-alni in domači konji in vse vrste reptilov. Zaradi enostavne uporabe ( samo nanesemo na rano ) je možno zdravljenje v domači oskrbi brez pogostih obiskov v ambulanti. Nekaj lastnosti, ki jih ima Hypermixvet in zato ga imenujejo »vse v enem, hitro,enostavno in cenovno ugodno«.

protivnetno,

protimikrobno,

protiedemotozno,

pomirjujoče (na tkivo),

spodbuja prekrvavitev ran-celjenja,

nadzira količino in kvaliteto izcedkov na površino rane,

pomaga oblikovati granulacijo tkiva in reepitelizacijo lezije,

preprečuje nastanek krast in brzgotin,

ni potrebno razkuževanje,

v večini primerov ni potrebno uporabljati lokalnih anti-biotikov ali celo sistematskega zdravljenja z antibiotiki.

Produkt je klinično testiran in registriran v EU v skladu z veljavno zakonodajo.

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SLIKOVNE TEHNIKE V DIAGNOSTIKI OBOLENJ PREBAVNEGA TRAKTA

Estera Pogorevc

Prikaz trebušne votline je lahko zahteven in izbira slikovne metode je odvisna od posameznega primera. Najpogostejši klinični znaki, ki zahtevajo slikovno diag-nostiko so bruhanje, abdominalna bolečina, nezmožnost uriniranja, napenjanje na blato, močno povečan obseg trebuha.

Ne glede na izbiro metode, so prikazane lastnosti različnih mas v trebuhu nespecifične in je nadalje potrebna patohistološka preiskava za določitev vzroka nastanka.

Večinoma se najprej opravlja rentgensko slikanje, saj je metoda relativno poceni, hitra in enostavna. Omogoča splošni pregled trebušne votline, določimo lahko velikost in (medsebojen) položaj notranjih organov. Glavna slabost je slab kontrast mehkih tkiv in otežena interpretacija slike zaradi prekrivanja organov. Bolezni povezane z majhnimi strukturami, kot so bezgavke, nadledvični žlezi in trebušna slinavka, so rentgensko nediagnostične. Zelo dobro so vidne že najmanjše količine prostega zraka v trebušni votlini, kot tudi vzorci razporeditve zraka/plina znotraj prebavnega trakta. Z rentgenskim slikanjem lahko dobro prikažemo področja mineralizacije (različni kamni) in rent-gensko vidne tujke.

Ultrazvok je zelo spremenil slikovno diagnostiko trebu-ha malih živali, saj omogoča odličen kontrast med struk-turami mehkega tkiva – razlikujemo lahko med organi in tekočino, hkrati pa lahko prikažemo dodatne strukture (npr. žolčnik). Omogoča natančno merjenje organov in sprememb, prekrivanje organov predstavlja manjši prob-lem in med pregledom lahko ocenimo gibanje prebavnega trakta. Pri velikih in debelih psih je natančen pregled po-gosto omejen in tudi diagnostičnost metode je odvisna od izkušenosti pregledovalca. Kadar je v prebavnem traktu prisotna večja količina zraka/plina, je ocena le –tega kot tudi manjših okolnih struktur lahko zelo omejena. Najdene spremembe so pogosto nespecifične,vendar nam metoda omogoča natančen ultrazvočno voden odvzem materiala za nadaljnje preiskave.

Pri boleznih, ki se širijo v medenično votlino ali iz nje izvirajo, sta rentgenska in ultrazvočna preiskava omejeni zaradi kostnih struktur, ki jo obdajajo. Pri sumu sprememb tega področja sta primerni računalniška tomografija in magnetna resonanca. Omogoča nam natančno in hitro oceno celotne trebušne votline tudi pri debelih pacientih. Pregled stene prebavnega trakta tako kot z ultrazvokom ni mogoč. Pregled trebušne votline z računalnišlko tomo-grafijo bi moral vedno obsegati slikanje brez in nato z jod-nim kontrastnim sredstvom.

Najbolj natančen kontrast mehkih tkiv je viden pri slikanju s pomočjo magnetne resonance, vendar je me-toda dražja, poteka dlje časa in zahteva slikanje v splošni anesteziji. Velik problem pri interpretaciji predstavljajo ar-tefakti gibanja (peristaltika, pulziranje aorte, premik dia-fragme ob dihanju).

Enotnega pravila, katero tehniko najprej uporabiti, ni. Poznavanje tehnik in njihovih omejitev je nujno za ciljano in smotrno uporabo le teh na poti do končne diagnoze.

Estera Pogorevc Klinika za male živali, Veterinarska fakulteta, Univerza v Ljubljani, Gerbičeva 60, 1000 Ljubljana; estera.pogorevc@vf.uni-lj.si

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FELINE ANEMIAS - PECULIARITIES OF REGENERATIVE (BLOOD LOSS AND HEMOLYSIS)

AND NON-REGENERATIVE ANEMIAS

Urs Giger

Anemia is an extremely common clinical problem in cats and is associated with many different conditions, many very different from those in dogs. Bleeding disor-ders are less common than in dogs, but may frequently complicate hepatic disorders. Hemolysis has many differ-ent causes in cats, but is rarely caused by IMHA. Non-re-generative anemias are most common. The approach to anemias will covered and illustrated with case examples, while the hemolytic anemias will presented in the next talk. Moreover, specific treatments including transfusion therapy will be addressed.

Despite severe anemia many cats may only show mild clinical signs or only pallor particularly when chronic. In or-der to recognize the type, degree, and regeneration of the anemia in cats, it is important to appropriately appreciate the hematological peculiarities of cats. When compared to dogs, the normal packed cell volume in cats is lower (PCV 32-48%), feline red blood cells are considerably smaller (MCV 38-50fl), central red cell pallor is small, bone mar-row iron stores are lacking, and there are mostly mild re-generative responses observed.

There are aggregate reticulocytes which are short-lived in circulation (like the typical reticulocytes in dogs), but cats also have punctate reticulocytes, which may linger around in circulation for a couple of weeks. The best parameter to assess a regenerative bone marrow response is the abso-lute reticulocyte count; normally <50,000/μl, which refers to the presence of aggregate reticulocytes and is equal to the degree of polychromasia observed on a regularly stained blood smear. Note nucleated red blood cells may be proportionally seen with reticulocytes or may occur in-dependently due to bone marrow endothelial damage as in lead poisoning and sepsis.

While the evaluation of PCV, total protein, and blood smear is most valuable, a complete blood cell count and specific tests are generally required to reach a definitive diagnosis and monitor the response to therapy. The he-matology analyzer or reference laboratory used should be carefully considered to assure they are capable to ac-curately assess feline blood cells. These may include for instance chemistry screen, urinalysis, bone marrow cy-tology or core biopsy, hemostatic tests, iron parameters, infectious disease screenings, toxicological analyses, and Coombs’, and specific genetic tests.

Although kidney failure and some infections (flea in-festation, FeLV infection and hemobartonellosis) are likely the most common causes of anemia, there are many other differential diagnoses to consider, such as bleeding disor-ders, toxicity, metabolic disturbances, hereditary defects, and immune-mediated hemolytic anemias. It is crucial to carefully assess the feline patient by history taking, physi-cal exam and specific laboratory tests in order to deter-mine the cause and offer the most appropriate treatment.

In contrast to dogs, external blood loss anemias are less commonly observed in cats, albeit they happen with trauma and surgery. In fact, many cats drop their PCV dur-ing and shortly after surgery which may in part be blood loss but also unexplained red cell lysis and sequestration ( which frequently resolves 1-2 days after anesthesia and surgery). Moreover, external blood loss can rapidly result in iron deficiency particularly in the very young kittens (even with repeat phlebotomies for diagnostic purposes). Micro-tainers are most suitable to collect small volumes of blood. From a newborn kitten that typically weighs 100 grams only one milliliter should be collected no more than once a week. However, the classic microcytosis and hypochro-masia with iron deficiency may be very difficult to appreci-ate due to small feline red blood cells. Another reason for microcytosis is hepatic shunt in cats. The most common reason for blood loss is flea infestation, while ticks, mag-gots, and intestinal hookworms are less likely leading to major blood loss. Skin and other tumors may also cause local bleeding. Blood loss anemias are generally regenera-tive after 3-4 days and remain regenerative until the cat becomes severely iron deficient. While in the above cases hemorrhage was caused by vascular injury, there are also a variety of bleeding disorders to consider in cats, most notably hepatic failures.

Urs Giger, Prof. Dr. med. vet. MS FVH Dipl. ACVIM & ECVIM-CA (Internal Medicine) & Dipl. ECVCP (Clinical Pathology) School of Veterinary Medicine, University of Pennsylvania, Philadelphia Veterinary Hospital of the University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104-6010 USA. Phone: 215-898-8830; Fax: 215-573-2162; Email: giger@vet.upenn.edu; Website: http://research.vet.upenn.edu/penngen.

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Thrombocytopenia is rare in cats but may be in-duced by drugs (methimazol) and rarely infection and can-cer. Also, immune-mediated thrombocytopenia seems to occur rarely in cats and occurs likely due to a secondary trigger. Accurate platelet counts can be difficult to obtain due to the large size of feline platelets (versus small red cell size) and their tendency to aggregate. Thus, any plate-let count needs to be confirmed with an estimate from a blood smear examination (20,000 platelets/μl equals 1 platelet seen on a high power microscopic field). Cats with any thrombocytopenia rarely bleed unless they have other bleeding tendencies (vasculopathy and coagulopathy). It should also be noted that healthy cats often have high platelet counts reaching 750,000/µl, which are inconse-quential.

Thrombopathia – impaired platelet function - may be triggered by aspirin or similar more potent drugs inhibit-ing platelet function. Cats appear particularly sensitive to platelet injury, but less likely develop aspirin- or steroid-induced ulcerations. Hereditary thrombopathias occur ex-tremely rare. Note cats do not develop any von Willebrand disease. The diagnosis of a thrombosis can be difficult as the cuticle and buccal mucosal bleeding times are gen-erally not performed in cats. Thus special platelet studies may need to be set up.

Similarly coagulopathies are less common in cats than dogs. Compared to dogs anticoagulant rodenticide poisoning is less commonly observed in cats, however, co-agulopathies due to hepatic failure are much more severe in cats than dogs. The liver is the major or only site for co-agulation factor synthesis. Most feline hepatopathies are diffuse such as hepatic lipidosis, cholangiohepatitis, and those hepatopathies associated with amyloidosis, lym-phoma, mast cell tumor, and feline infectious peritonitis. Hence diagnostic liver biopsies are, while needed for a de-finitive diagnosis, frequently associated with serious hem-orrhage unless surgically done or as an ultrasound guided or laparoscopic biopsy. Part of the coagulopathy may be due to an inability to absorb vitamin K and thus parenteral vitamin K1 supplementation for a few days may improve hemostasis.

Furthermore, there are several hereditary coagulopa-thies such as hemophilia A and B in male domestic short-hair and purebred cats as well as a vitamin K-dependent coagulopathy in Devon Rex and Sphinx cats. Interestingly, domestic and exotic shorthair cats often have a coagula-tion factor XII deficiency; while this causes a markedly pro-longed partial thromboplastin time, this is not associated with a bleeding tendency. Generally the prothrombin and partial thromboplastin times provide sufficient information to differentiate the coagulopathies, although specific fac-tor analyses may be needed. Those tests can now be done in clinics or in reference laboratories.

Hemolytic anemias in cats are often hard to recog-nize as the degree of regeneration and the evidence of bilirbinuria and hyperbilirubinemia are often mild. Note any degree of bilirubinuria is important in a cats. However, icterus in cats is much more likely due to hepatic failure than hemolysis in cats. In addition hemoglobinemia and

hemoglobinuria are hallmarks for intravascular hemolysis which should not be confused with hematuria or an ar-tifactually hemolyzed sample. Except for the first couple of days hemolytic anemias should be regenerative unless there is also bone marrow disease. Polychromasia on a regularly stained blood smear indicates the presence of regeneration. With respect to reticulocytosis, the aggre-gated reticulocytes are the best indicator for regeneration whereas the punctate reticulocytes linger in circulation up to 3 weeks. While the normal feline spleen is very small, it can get fairly enlarged in cases of hemolytic anemia (like increased osmotic fragility or cancer). In contrast to dogs immune-mediated hemolytic anemia seems rare in cats. Nevertheless, there are several important differential diag-noses, and, thus, treatment options depend on the cause of hemolysis (Table).

Various triggers such as drugs and chemicals can be often readily implicated based upon the history and they can be rapidly removed. Sometimes organisms (mycoplas-ma, cytauxzoon) or (refractile) Heinz bodies may be recog-nized on a regular blood smear or after special vital stain-ing However, other diagnoses may require special tests at reference laboratories, such as for infectious disease screening by serology and real-time PCR, direct Coombs’ test, toxicology screen, and genetic red cell tests. Note PCR tests for infectious organisms turn quickly negative after treatment and thus samples for diagnostics should be collect prior to treatment even if only submitted later. It is, therefore, not unusual to start with the treatment of hemolytic cats with prednisolone and doxycycline to cover the bases until test results are back and the proper therapy can be instituted. For hereditary hemolytic anemias, it is most important to avoid harmful treatments as these cats may in fact have a good life-expectancy.

Table - Feline hemolytic anemias

• Infections - Mycoplasma hemofelis, hemominutum, turicensis - Cytauxzoon felis - Feline Leukemia Virus infection (A type) - Feline Infectious Peritonitis

• Immune-mediatedhemolyticanemia - Primary or Autoimmune hemolytic anemia - Secondary (drugs [methimazol], infection, cancer) - Alloantibody induced hemolytic transfusion reactions - Neonatal isoerythroysis (hemolysis of the newborn)

• Toxic - Drugs: Acetaminophen, lidocain spray, propofol,etc. - Chemicals and zinc - Onions

• Metabolic - Hypophosphatemia (Diabetes mellitus, hepatopathy, hyperalimentation)

• Hereditary - Pyruvate kinase deficiency (Abyssinian, DSH cats & other breeds)

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- Increased osmotic fragility (Abyssinian, Somali, DSH cats) - Porphyria (Siamese, DSH cats)

The major feline blood group system thus far generally recognized is known as the feline AB blood group system and contains 3 alleles: type A, type B, and the extremely rare type AB. Type A is dominant over B. Thus, cats with type A blood have the genotype a/a or a/b, and only ho-mozygous b/b cats express the type B antigen on their erythrocytes. AB cats are not produced by mating of a type A to a type B cat unless the A cat carries the rare AB allele. Cats with type AB blood have been seen in many breeds and domestic shorthair cats. In Italy 90% of the domestic cat population are expected to have type A blood while 10% have type B blood. In addition there are large varia-tions in blood types in purebred cats from 100% type A in the Siamese to 50% Type A and B in Turkish Angora/Van. All blood donors must be typed. Naturally-occurring alloantibodies have been well documented in type A and type B cats and require that blood typing be performed prior to both blood transfusion and breeding to assure appropriate blood compatibility. Cats have naturally-occurring alloantibodies. All type B cats have very strong naturally-occurring anti-A alloantibodies, which can be de-tected by hemolysis and hemagglutination assays. Kittens receive alloantibodies through the colostrum from type B queens during the first 16 hours of nursing and develop high naturally-occurring alloantibody titers (>1:32) after a few weeks of age. These alloantibodies are strong hemo-lysins and hemagglutinins, and are of the IgM and, to a lesser extent, IgG classes. They are responsible for serious hemolytic transfusion reactions (A-B mismatch) and neo-natal isoerythrolysis in type A or AB kittens born to type B queens. Furthermore additional blood group systems are being identified such as the Mik red cell antigen in domes-tic shorthair cats which may also cause hemolytic transfu-sion reactions particularly in previously transfused cats.

Lastly, non-regenerative anemias due to decreased erythro- or overall hematopoiesis can be associated with a variety of disorders. Indeed, mild non-regenerative normo-chromic normocytic anemia is commonly seen with many organ diseases and is well tolerated. However, many mid-dle-aged to older cats with chronic renal failure develop a moderate to severe anemia.

The main cause is a lack of renal production of eryth-roproietin, but uremic toxins affecting red cell stability and bone marrow production as well as blood loss from ulcers also play a role. Transfusion or human recombinant eryth-ropoietin can reverse the anemia and associated clinical signs. However, repeat transfusions are generally needed and cats may become refractory, as they develop alloan-tibodies against the transfused red cells. Moreover, cats can develop antibodies against the recombinant human erythropoietin, which cross-reacts with feline endogenous erythropoietin and leads to a severe and hardly reversible pure red cell aplasia. Darbepoetin is seemly preferred over epogen because it causes less autoantibodies). Some may appear resistant to erythropoietin supplementation only to be found to also be iron deficient. Renal transplantation

from a carefully selected donor cat has effectively reversed not only the anemia, but also restored kidney function. While rarely truly deficient, iron, folate, and cobalamin may be replenished as needed. FeLV infections may end in a pure red cell aplasia (C type) or myelodysplasia to apla-sia, while FIV exhibits less effects on the bone marrow. Cancer associated anemias may have many causes, but may result in aplastic or myelophistic bone marrows.

Transfusion therapy is critical for the feline patient, most commonly to correct anemia and less often bleed-ing. Nevertheless, blood transfusions are overall still less frequently administered to cats than dogs for a variety of reasons. Compared to canine transfusion medicine, cats can tolerate anemia better, they still get somewhat less medical attention, except for rodenticide toxicity and hepatopathies they bleed less severely, recruiting healthy donors is more difficult (occult heart disease, viral infec-tions), blood collection requires sedation and special small bag collection systems, component therapy is less com-monly practiced in clinics because of small unit size (50ml), cats have important naturally occurring alloantibodies (AB blood group system) and may experience life-threatening complications with a first transfusion, and the anemic cat is more sensitive to volume overload. In Italy ~90% have blood type A and 10% have blood type B with an ex-tremely rare cat with type AB. There is no specific trigger PCV, but rather the overall clinical picture with a PCV of <20% is used.

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CANINE TRANSFUSION THERAPY

Urs Giger

Veterinary clinicians and clinical pathologists play a key role in providing safe and effective transfusion therapy. Blood typing is clinically important to ensure blood com-patibility and therefore is recommended for any dog in need of a transfusion or considered to become a blood donor. Moreover, previously transfused dogs also should be crossmatched. Unless blood typing is performed regu-larly in practice, blood may be sent to a clinical pathology laboratory for typing. Different viewpoints exist regarding the extent and methods used for compatibility testing.

Canine Blood Types

Blood types are genetic markers on erythrocyte surfac-es that are antigenic and species specific. A set of blood types of two or more alleles makes up a blood group sys-tem. Dogs have likely more than a dozen blood group systems mostly known as dog erythrocyte antigens (DEA). However, there is no DEA 2 blood group and some may be rather labeled high frequency or common red blood cell (RBC) antigens (e.g. DEA 4) and some have not yet received a DEA designation (e.g. Dal). Canine erythrocytes are either positive or negative for a blood type (e.g., DEA 4+ or DEA 4-), and these blood types are likely codomi-nantly inherited. The DEA 1 system was thought to be an exception with DEA 1.1 (A1), DEA 1.2 (A2) and poten-tially DEA 1.3 (A3) being allelic. Thus, a dog could appar-ently be DEA 1.1+ or DEA 1.1- and DEA 1.1- dogs can be DEA 1.2+ or DEA 1.2-. However, these studies were based upon weak polyclonal antibodies (DEA 1.1 and 1.X) requiring Coombs’ reagents. Recent studies with a mono-clonal antibody showed that the DEA 1 blood group is a continuum from DEA 1- to weakly to strongly DEA 1+; hence DEA 1.2 typing is no longer offered. The degree of DEA 1 expression is constant and DEA 1+ appears to be dominantly inherited. A recent survey in North America

indicates that most dogs are either DEA 1- or strongly DEA 1+ with fewer dogs being weakly to moderately DEA 1+. The biochemical structure of the DEA 1 remains still un-known, but a genome wide association study has identi-fied a likely single locus.

Recent surveys revealed that the Dal- type is not re-stricted to Dalmatians but is also seen in Doberman Pin-schers, Lhasa Apsos and Shih Tzus and thus typing for this blood type is becoming more important particularly for those requiring multiple transfusions. In a related study dogs from North America were screened for two new blood types, preliminarily called Kai 1 and Kai 2. Most dogs were Kai 1+ and only few dogs were Kai 2+ or Kai 1-/Kai2-. The clinical importance is yet to be determined albeit anecdotally dogs can develop anti-Kai 1 alloantibod-ies. The PennGen Laboratory currently offers Dal and Kai 1 and Kai 2 typing.

The clinically most important canine blood type is DEA 1, which elicits a strong alloantibody response after sen-sitization of a DEA 1- dog by a transfusion and thus can be responsible for a transfusion reaction in a DEA 1- dog previously transfused with DEA 1+ blood. It is currently un-known if DEA 1- dogs are equally sensitized by weakly to strongly DEA 1+ blood, or if weakly DEA 1+ dogs are sen-sitized by strongly DEA 1+ blood. Furthermore, transfusion reactions against other blood types or common antigens have rarely been observed and reported. They include re-actions against the DEA 4, Dal, Kai 1 and other common RBC antigens; other clinically important blood types may be found in the future. No reagents currently are avail-able against several antigens or are only available on a limited basis, and additional blood types continue to be recognized. Only limited surveys on the frequency of these blood types have been reported, which suggest possible geographic and breed-associated differences.

Strongly antigenic blood types are of great clinical importance because they can elicit a potent alloantibody response. These alloantibodies may be of the immuno-globulin G (IgG) or IgM class and may be hemagglutinins or hemolysins. Based upon experimental and clinical data, dogs can become sensitized after receiving a mismatched transfusion (i.e., a blood unit positive for one or more blood types not found on the recipient’s RBCs). There are no clinically important, naturally occurring alloantibodies (also known as isoantibodies) present before sensitization

Urs Giger, Prof. Dr. med. vet. MS FVH Dipl. ACVIM & ECVIM-CA (Internal Medicine) & Dipl. ECVCP (Clinical Pathology) School of Veterinary Medicine, University of Pennsylvania, Philadelphia Veterinary Hospital of the University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104-6010 USA. Phone: 215-898-8830; Fax: 215-573-2162; Email: giger@vet.upenn.edu; Website: http://research.vet.upenn.edu/penngen.

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of a dog with a transfusion. Sensitizing dogs in experimen-tal studies in the 1950s led to the documentation of some transfusion reactions caused by blood group incompatibili-ties and to the characterization of new blood types.

Clinically the most antigenic blood type in dogs is the DEA 1. Transfusion of DEA 1+ RBCs to a DEA 1- dog in-variably elicits a strong alloantibody response. Following a first transfusion, anti-DEA 1 antibodies develop after more than 4 days and may cause a delayed transfusion reaction (rarely clinically documented). However, a previously sensi-tized DEA 1- dog can develop an acute hemolytic reaction after a second transfusion of DEA 1+ blood. Transfusion reactions also may occur after a sensitized dog receives blood that is mismatched for a RBC antigen other than DEA 1 (e.g. DEA 4 and Dal). However, in most cases the in-compatible blood type has not been determined. Because administration of a small (<1 ml) amount of incompatible blood can result in life-threatening reactions, the practice of giving small “test volumes” of donor blood to assess blood-type compatibilities is unacceptable. In contrast, pregnancy does not cause sensitization in dogs, because of a complete placenta, and does not induce alloantibody production; thus dogs with prior pregnancies can be used safely as blood donors.

Canine Blood-Typing Procedures

Because of the strong antigenicity of DEA 1, typing of donors for DEA 1 is recommended. Whenever possible, the recipient also should be typed to allow the use of DEA 1+ blood for DEA 1+ recipients. Canine blood typing tests are generally based on serologic identification by aggluti-nation reactions but chromatographic strip methods are also offered. Originally serum from sensitized dogs has been used for typing, but such polyvalent alloantibodies vary from batch to batch, may require Coombs’ reagent to enhance agglutination, and may not be always available and are therefore not optimal. Two monoclonal antibodies against DEA 1 have been developed. The gel column tech-nology, widely used in human blood banking, was found to be an excellent standardized laboratory method (Dia-Med), but is unfortunately no longer commercially avail-able. A blood typing card has been available with modi-fications since the mid-1990s as a simple in-practice kit to classify dogs as DEA 1- or DEA 1+ (degree of reaction can vary). a standardized simple immunochromatographic technique became available in the mid-2000s from Alve-dia. Another cartridge with a similar strip technique was introduced by DMS/AgroLabo, but has not been evalu-ated. Moreover, a third cartridge method in which blood flows through the cartridge is also available (DMS/Abaxis) but seems to produce inconsistent results.

Polyclonal reagents against other DEA types are cur-rently only available on a limited bases for DEA 3, 4 and 7 from Animal Blood Resource International (prior Michigan state University and Midwest Blood Services). And only limited anti-Dal reagents from sensitized dogs are cur-rently available in a couple of laboratories like Montreal University and PennGen, monoclonal anti-Kai 1 and anti-Kai 2 alloantibodies have been developed in South Korea.

DEA 1 typed and matched patients in need of a transfu-sion may be typed for DEA 4, Dal and Kai 1/2, which may then permit the localization of a type-matched donor dog.

Caution should be exercised whenever the patient’s blood is autoagglutinating or has a low hematocrit (<10%). If autoagglutination is not too severe, it does not appear to affect the Alvedia strip technique because only free RBCs are moving up the strip. Clinicians and tech-nicians should check for autoagglutination of blood with buffer/saline on a slide or the card. Autoagglutinating blood may be first washed three times with ample physio-logical saline to overcome the apparent autoagglutination similar to what is done for the Coombs’ and crossmatch testing. However, if autoagglutination after three washes persists at more than 1+, it is considered to reflect true autoagglutination, which may preclude typing (as well as Coombs’ testing and crossmatching), because it always looks like DEA 1+ blood. In such circumstances, DEA 1- blood should be used, until the patient does not aggluti-nate anymore and can be retyped. DEA 1+ blood from se-verely anemic animals may not agglutinate when exposed to the anti-DEA 1 or other reagents because of a prozone effect. In these cases, some of the patient’s plasma may be discarded before applying a drop of blood onto the card. Finally, recently transfused dogs may display a mixed field reaction, with only the transfused or recipient cells agglu-tinating if they were DEA 1 mismatched.

Blood Crossmatching Test

Whereas blood typing tests reveal the blood group an-tigens on the red blood cell surface, blood crossmatching tests assess the serologic compatibility or incompatibility between donor and recipient. Thus the crossmatch test checks for the presence or absence of naturally occurring and induced alloantibodies in serum (or plasma) without determining the blood type and thus does not replace blood typing. These antibodies may be hemagglutinins and/or hemolysins and can be directed against known blood groups or other RBC surface antigens. Many labo-ratories commonly use a standardized tube crossmatch-ing procedure, but the interpretation of the agglutination reaction is highly variable. The crossmatching test requires some technical expertise, may be accomplished through a veterinary laboratory along with blood typing, and is done with washed EDTA-anticoagulated blood from recipient and potential donor(s). The DiaMed gel column technique and more recently the in-clinic DMS gel tube assay have been evaluated and were found to be simple, sensitive, and standardized methods to crossmatch dogs and cats. In addition, Alvedia introduced a simple strip crossmatch test with a Coombs’ phase.

The major crossmatch tests search for alloantibodies in the recipient’s plasma against donor cells, whereas the minor crossmatch test looks for alloantibodies in the do-nor’s plasma against the recipient’s RBCs. Generally tube segments from collection bags are used for this purpose in dogs. The presence of autoagglutination or severe he-molysis may preclude the crossmatch testing. A major crossmatch incompatibility is of greatest importance, be-

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cause it predicts that the transfused donor cells will be attacked by the patient’s plasma, thereby causing a poten-tially life-threatening acute hemolytic transfusion reaction. Because fatal reactions may occur with less than 1 ml of incompatible blood, compatibility testing by administering a small amount of blood is not appropriate; this has been shown in experimental studies to potentially result in fatal reactions. A minor crossmatch incompatibility should not occur in dogs if canine donors have not been transfused previously and is of lesser concern because donor’s plasma volume is small, particularly with packed red cell products, and is diluted markedly in the patient. Do not use previ-ously used dogs as donors.

The initial blood crossmatch between two dogs that have never before received a transfusion should be com-patible, because dogs do not have naturally occurring alloantibodies. Therefore, a crossmatch may be omitted before the first transfusion in clinical practice for dogs. Because the crossmatch does not determine the blood type of the patient and donor, a compatible crossmatch does not prevent sensitization of the patient against do-nor cells within 1 to 2 weeks. Thus, previously transfused dogs should always be crossmatched, even when receiving again blood from the same donor. The time span between the initial transfusion and incompatibility reactions may be as short as 4 days and the induced alloantibody can last for many months to years (i.e., years after the last transfu-sion alloantibodies may be present). Again, a blood donor never should have received a blood transfusion to avoid sensitization. The practice of transfusing patients with the least compatible unit does not have any scientific basis. Nevertheless, some minor agglutination results in cross-matching a patient may be unrelated to alloantibodies and unspecific (e.g., patient’s RBC damage by uremia and other illnesses, donor cells after extended storage of unit in the refrigerator). Of course, any patient with true/persis-tent autoagglutination may not be matched to any donor.

Although transfusion of blood and its components is usually a safe and temporarily effective form of therapy, there is always a risk for potential hazards. Adverse reac-tions usually occur during or shortly after the transfusion and can be due to any component of whole blood. Most transfusion reactions can be avoided by carefully selecting only healthy donors; using appropriate collection, storage, and administration techniques; performing blood typing and crossmatching; and administering only the needed blood components.

Transfusion Reactions

While transfusion of blood and its components is usually a safe and temporarily effective form of therapy, there is always a risk for potential hazards. Adverse reac-tions usually occur during or shortly after the transfusion and can be due to any component of whole blood. Most transfusion reactions can be avoided by carefully selecting only healthy donors, using appropriate collection, storage, and administration techniques, performing blood typing and crossmatching, and administering only needed blood components. The most common clinical sign of transfu-

sion reaction is fever, followed by vomiting and hemoly-sis. Hemolytic transfusion reactions can be fatal and are, therefore, most important, while fever and vomiting are usually self-limiting. Adverse effects of transfusions can be divided into non-immunologic (pyrogen-mediated fever, transmission of infectious agents, vomiting, mechanical hemolysis, congestive heart failure, hypothermia, citrate toxicity, pulmonary complications) and immunologic reac-tions (acute and delayed hemolytic transfusion reactions, urticaria to anaphylaxis, acute respiratory distress, graft versus host disease). Note that some clinical signs may be caused by both mechanisms. Despite the variety of blood types and the limited degree of compatibility testing in clinical practice, transfusion reactions are rarely reported.

Blood Donors and Sources

Many larger veterinary hospitals have permanent ca-nine and/or feline blood donors to cover their transfusion requirements or in case fresh whole blood or platelet-rich plasma (concentrate) is needed. Several larger voluntary blood donor programs have emerged with client or staff owned dogs. More than a dozen commercial canine blood banks have been established in the United States and de-liver overnight blood products. Autologous (self) trans-fusion refers to the donation of blood by a patient four weeks to a few days prior to surgery when major surgical blood loss is anticipated. Blood can also be collected im-mediately prior to surgery. The patient will be hemodiluted with crystalloid and colloid solution and receives the blood when excessive bleeding occurs or after surgery. Au-totransfusion is another autologous transfusion technique in which freshly shed blood salvaged intra-operatively or following trauma can be reinfused after careful filtering.

Blood donors should be young adult, lean, and good tempered animals, and weigh at least 23 kg for dogs (to donate 450ml); have no history of prior transfusion; have been regularly vaccinated and are healthy as determined by history, physical examination, and laboratory tests (complete blood cell count, chemistry screen, and fecal parasite examination every 6-12 months) as well as free of infectious diseases (testing depends on geographic area but may include regular microfilaria, Brucella, Hemomyco-plasma, Babesia, Ehrlichia, Anaplasma, Borrelia, Leishma-nia spp. testing in dogs. Donors should receive a well-bal-anced, high performance diet, and may be supplemented twice weekly with ferrous sulfate (Feosal, 10 mg/kg), if bled frequently. Packed cell volume (PCV) or hemoglobin (Hb) should be >40% and >13 g/dl in canine donors.

Blood Collection and Component Preparation

Canine donors are generally not sedated. Blood is col-lected aseptically by gravity or blood bank vacuum pump from the jugular vein over 5 to 10 minute period. Plas-tic bags containing citrate-phosphate-dextrose-adenine (CPD-A1) with or without satellite bags for blood com-ponent separation are optimal. These commercial blood bags represent a closed collection system in which the blood does not come into contact with the environment at any time during collection or separation into blood com-

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ponents, thus minimizing the risk of bacterial contamina-tion and allowing storage of the blood products. The max-imal blood volume to be donated is 20 ml blood/kg or one regular blood bag unit of 450 ± 45 ml per ≥ 25 kg dog.

Blood components are prepared from a single dona-tion of blood by centrifugation generally within 8 hours from collection; thereby, fresh whole blood can be sepa-rated into packed red cells, platelet-rich plasma or con-centrate, fresh frozen plasma, and cryoprecipitate and cryo-poor plasma. Fluctuations in storage temperature significantly alter the length of storage; thus, temperature needs to be monitored and the refrigerator/freezer are not too frequently opened. Partially used or opened blood bags should be used within 24 hours because of the risk of contamination.

Administration of Blood Products

For routine transfusion in the treatment of anemia, it is not necessary to warm blood after removal from the refrigerator. A temperature-controlled waterbath (37°C) is ideal to warm frozen blood products. A warm water bowl in which the water is periodically changed may be used to warm blood products. Care should be taken to maintain absolute sterility and to not overheat the blood products.

Blood bags are connected to blood infusion sets that have an in-line microfilter. A long (85 cm) blood infusion set with a dripping chamber and a short infusion set for small dogs to connect with syringes are available. Use a latex-free infusion sets for platelet administration to avoid aggregation. Microfilter with 170 μm pores are commonly used to remove clots and larger red cell and platelet ag-gregates. Finer filters with 40 μm pores will remove most platelets and microaggregates and clog after 100 ml. Leukocyte reduction filters (expensive) may be used to de-crease febrile adverse reactions to WBC components prior to storage.

Blood components are best administered intravenously with an indwelling catheter (16-22 gauge depending on size of animal). An intramedullary (or intraosseous) infu-sion at the trochanteric fossa (or other sites) may be used when no venous access can be obtained while the in-traperitoneal administration is not recommended. Avoid concurrent administration of drugs or fluids other than physiologic saline through the same catheter in order to prevent lysis of erythrocytes and blood coagulation.

Rate of transfusion depends on the hydration status, degree of anemia, and general health condition of an animal. Initial rate is slow, starting with 1-3 ml over the first 5 minutes to observe for any transfusion reactions, even with blood typed and/or crossmatched transfusions. In animals with cardiac failure, do not exceed 4 ml/kg/hr. Transfusion of a single bag should be completed within 4 hours to prevent functional loss or bacterial growth. Vol-ume of blood component to be administered depends on the type of deficiency and size of the animal. In anemia: Volume (ml) of whole blood = 2 x PCV rise desired (%) x body weight (kg) or in other words, administration of 2 ml whole blood/kg body weight raises the PCV by 1%. If

packed red cells are used without prior resuspension in a red cell preservative, closer to half the volume is admin-istered, since packed red cells have a PCV of 70-80%. In the absence of bleeding and hemolysis, at least 80% of transfused erythrocytes survive 24 hours (required blood bank standard) and transfused erythrocytes may be there-after expected to have a normal life-span (~110 days in dogs). Response to transfusion is carefully monitored by obtaining PCV/TP readings prior to, immediately, 2, 4, 6 and 24 hours post-transfusion, and observing the clinical parameters of a patient.

In thrombocytopenia or thrombopathia, platelet trans-fusions are only used with life-threatening bleeding. One unit of Platelet Concentrate, Platelet Rich Plasma or Fresh Whole Blood will increase the platelet count by 10,000/μL in a recipient weighing 30 kg. Platelet counts are moni-tored prior, 1 hour and 24 hours after the platelet transfu-sion.

In coagulopathies and von Willebrand’s disease, Fresh Frozen Plasma at 6-10 ml/kg is an initial dose to stop bleed-ing or avoid excessive bleeding during surgery. In some cases, larger volumes may be needed to control bleeding. Depending on the coagulopathy, repeated administration of FFP may be required. Because of the short half-life of factor VII and VIII and von Willebrand factor, deficient ani-mals need to be treated twice to four times daily. Other coagulopathies may be treated daily. Cryoprecipitate at a dose of 1 Cryoprecipitate unit/10 kg or 2-4 ml/kg body weight twice daily is ideal to treat hemophilia A and von Willebrand’s disease. Plasma support should be provided for an additional 1-3 days after the bleeding has been con-trolled to allow for healing and prevent rebleeding.

Supported in part by a grant from the NIH (OD 010939). The author’s laboratory PennGen is offering quantitative DEA 1, Dal and Kai typing. Alvedia and DMS Laboratories kindly provided reagents and kits for the authors’ studies.

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FELINE TRANSFUSION THERAPY

Urs Giger

Transfusion support is also critical for the feline patient, most commonly to correct anemia and less often bleed-ing. Nevertheless, blood transfusions are overall still less frequently administered to cats than dogs for a variety of reasons. The peculiarities of feline blood types, blood col-lection and transfusion will be presented.

Compared to canine transfusion medicine, cats can tol-erate anemia better, they still get somewhat less medical attention, except for rodenticide toxicity and hepatopa-thies they bleed less severely, recruiting healthy donors is more difficult (occult heart disease, viral infections), blood collection requires sedation and special small bag collection systems, component therapy is less commonly practiced in clinics, cats have important naturally occur-ring alloantibodies and may experience life-threatening complications with a first transfusion, and the anemic cat is more sensitive to volume overload. There is no specific trigger PCV, but rather the overall clinical picture with a PCV of <20% is used.

Blood Typing: The major feline blood group system is known as the feline AB blood group system and contains 3 alleles: type A, type B, and the extremely rare type AB (except Ragdolls). Type A is dominant over B. Thus, cats with type A blood have the genotype a/a or a/b, and only homozygous b/b cats express the type B antigen on their erythrocytes. In the extremely rare AB cat, a third allele recessive to the a allele and/or codominant to b allele leads to the expression of both A and B substances. AB cats are not produced by mating of a type A to a type B cat unless the A cat carries the rare AB allele. Cats with type AB blood have been seen in many breeds and domestic shorthair cats.

Most domestic shorthair cats have type A blood, but the proportion of type B cats can be substantial in certain geographical areas. The frequency of A and B blood types varies greatly between different breeds, but likely not much geographically in purebred cats. Kitten losses due to A-B incompatibility and changes in breeding practices influence the frequency of A and B in various breeds. Most blood donors have type A blood, but some places also keep cats with the rare type B and type AB as donors. All blood donors must be typed. Naturally-occurring alloanti-bodies have been well documented in type A and type B cats and require that blood typing be performed prior to both blood transfusion and breeding to assure appropri-ate blood compatibility.

Cats have naturally-occurring alloantibodies. All type B cats have very strong naturally-occurring anti-A alloanti-bodies, which can be detected by hemolysis and hemag-glutination assays. Kittens receive alloantibodies through the colostrum from type B queens and develop high alloantibody titers (>1:32) after a few weeks of age. These alloantibodies are strong hemolysins and hemagglu-tinins, and are of the IgM and, to a lesser extent, IgG class-es. They are responsible for serious transfusion reactions and neonatal isoerythrolysis in type A or AB kittens born to type B queens. Type A cats have weak anti-B alloantibod-ies, and their alloantibody titer is usually very low (1:2), nevertheless they can also cause hemolytic transfusion re-actions, but have not been associated with NI. Type AB cats have no alloantibodies. Furthermore additional blood group systems have been identified such as the common Mik red cell antigen in domestic shorthair cats and Mik-negative cats may also produce naturally occurring alloan-tibodies.

Serological testing relies on identification of surface antigens, leading to agglutination and hence can distin-guish A, AB or B phenotypes. Several different reagents may be used but monoclonal antibodies against the type A and type B antigen are currently used in typing kits. A genetic test is also available for identification of the b al-lele, allowing identification of type B cats and carriers of this allele, but not distinguishing A or AB phenotypes.

Urs Giger, Prof. Dr. med. vet. MS FVH Dipl. ACVIM & ECVIM-CA (Internal Medicine) & Dipl. ECVCP (Clinical Pathology) School of Veterinary Medicine, University of Pennsylvania, Philadelphia Veterinary Hospital of the University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104-6010 USA. Phone: 215-898-8830; Fax: 215-573-2162; Email: giger@vet.upenn.edu; Website: http://research.vet.upenn.edu/penngen.

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Table. Blood type A and B frequency in cats in certain countries and breeds*

Percentage (%) Percentage (%)

Domestic shorth. cats Type A Type B Purebred cats Type A Type B

USA Northeast 99.7 0.3 Abyssinian 84 16

North Central 99.6 0.4 Am. shorthair 100 0

Southeast 98.5 1.5 Birman 82 18

Southwest 97.5 2.5 British shorthair 64 36

West Coast 95.3 4.7 Burmese 100 0

Argentina 97.0 3.0 Cornish rex 67 33

Australia 73.7 26.3 Devon rex 59 41

India (Bombay) 88.0 12.0 Exotic shorthair 73 27

Europe Himalayan 94 76

Austria 97 3 Japanese Bobtail 84 16

England 97 3 Maine Coon 97 3

Finland 100 0 Norwegian Forest 93 7

France 85 14 Oriental shorthair 100 0

Germany 94 6 Persian 86 14

Hungary 100 0 Scottish Fold 81 19

Italy 89 11 Siamese 100 0

Netherlands 96 4 Somali 82 18

Scotland 97 3 Sphinx 83 17

Switzerland 100 0 Tonkinese 100 0

Turkey 75 25 Turkish Angora/Van 50 50

*Ignoring the rare AB cats in many breeds with type B cats

There are no universal donor cats. Donor and patient need to be typed, even if it is “only” a domestic short-hair cat. Simple AB blood typing cards (DMS Laboratories, 2 Darts Mill Road, Flemington, NJ) and chromatographic strip cartridges (Alvedia DME, Lyon, France and recently DMS) are available for in practice use.

Blood crossmatching tests: Blood incompatibili-ties have been recognized related to the AB blood group system and following blood transfusion through cross-matching cats or as a result of acute hemolytic transfusion reactions. Standard laboratory tube and gel column cross-matching techniques, but also in-clinic gel tube (DMS) and strip kits are now available. Screening feline blood donors and patients for the presence of naturally occurring alloan-tibodies (AB and Mik systems) prove necessary in clinical practice. The presence of autoagglutination or severe he-molysis may preclude the crossmatch testing.

The major crossmatch tests for alloantibodies in the recipient’s plasma against donor cells, whereas the minor crossmatch test looks for alloantibodies in the donor’s plas-ma against the recipient’s red blood cells. Mixing a drop of donor/recipient blood with donor/recipient plasma will detect A-B incompatibilities if typing is not available. How-

ever, proper techniques for crossmatching and experience are required to detect other less severe incompatibilities. A major crossmatch incompatibility is of greatest impor-tance because it predicts that the transfused donor cells will be attacked by the patient’s plasma, thereby causing a potentially life-threatening acute hemolytic transfusion reaction. As fatal reactions may occur with <1ml of in-compatible blood, compatibility testing by administering a small amount of blood is not appropriate. This has been shown in experimental studies to result in fatal reactions. The major and minor crossmatch can show incompatibility prior to any transfusion due to the presence of naturally occurring alloantibodies in cats, not only for the AB but also the Mik and possibly other blood group systems.

Previously transfused cats should always be cross-matched, even when receiving blood from the same do-nor. The time span between the initial transfusion and incompatibility reactions may be as short as 4 days and lasts for many years (i.e., years after the last transfusion alloantibodies may be present). Obviously, a blood donor should never have received a blood transfusion to avoid sensitization.

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Xenotransfusion: Occasionally anemic cats are given canine blood because either no feline blood is available or the feline blood is incompatible (AB, mik and other mis-match). In a recent study by the author’s laboratory (Euler et al 2016) we determined that canine blood is incom-patible and very short-lived (<4 days) in cats. Therefore, we do not recommend such xenotransfusions (Euler et al 2016). Apparently, Oxyglobin, a highly purified bovine he-moglobin solution should be again shortly available in the USA as it has been in Europe.

Feline blood donors: There are few commercial blood bank that offer feline blood products. Many hospitals have a small in-house colony and/or involve the staff’s or client’s cats. Healthy, young adult (1-8 years), good tempered cats of at least 4 kg lean body weight can be recruited. Due to the infectious disease risks indoor cats free of fleas and intestinal parasites are selected. A freely roaming cat in a veterinary hospital would not be a good donor candidate because of the potential of having acquired some infec-tions from patients.

Blood donors must have no history of prior transfu-sion; have been regularly vaccinated and are healthy as de-termined by history, physical examination, and laboratory tests (complete blood cell count, chemistry screen, and fe-cal parasite examination every 6-12 months) as well as free of infectious diseases (testing depends on geographic area but may include regular FeLV, FIV, FIP, Hemomycoplasma, Cytauzoon testing. Donors should receive a well-balanced, high performance diet, and may be supplemented twice weekly with ferrous sulfate (Feosal, 10 mg/kg), if bled sev-eral times a year. Packed cell volume (PCV) or hemoglobin (Hb) should be >30% and >10 g/dl in cats.

Blood collection: Cats are regularly sedated e.g. with a combination of ketamine (10 mg), diazepam (0.5 mg), and atropine (0.04 mg) by intravenous injection. Some sedatives, such as acepromazine, interfere with platelet function and induce hypotension, hence they should not be used. Blood is collected aseptically by gravity or blood bank vacuum pump from the jugular vein over 5 to 10 minute period. Large plastic syringe containing 1 ml CPD-A or 3.8% citrate per 9 ml blood and connected to a 19 gauge butterfly needle is commonly used for cats. This represents an open collection system in which connections allow exposure of blood to the environment; because of the potential risk for bacterial contamination, blood col-lected via an open system should not be stored for more than 48 hours. The maximal blood volume to be donated is 40-50 ml blood (one typical feline unit) per ≥ 5 kg cat. We have developed a closed blood collection system that permits component preparation into packed red blood cells and fresh frozen plasma as well as storage (28 days of red cells, 1 year FFP). Blood components are prepared from a single donation of blood by simple physical sepa-ration methods such as centrifugation generally within 4 hours from collection.

Blood administration: The regular principles used in transfusing dogs are applied in cats. No food is given dur-ing the transfusion, and blood is administered separately without any drugs or other fluids. Because of the small

volumes shorter tubing with a small filter are used instead of the large infusion sets. Despite assuring blood compat-ibility particular attention is given to the first few milliliters infused. Monitoring is done like in dogs. Transfusion reac-tions may be related to blood type incompatibilities but also allergic reactions, physical hemolysis, hypocalcemia, and infection.

Author’s studies were supported in part by grants from the National Institutes of Health (OD010939) and the Winn Feline and other Foundations. The author is the director of the non-for-profit PennGen Laboratory which is offering genetic, hematological and blood typing and compatibility testing.

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ULTRAZVOČNI PREGLED PREBAVIL

Maja Brložnik

IZVLEČEK

Ultrazvočna diagnostika je v današnjem času široko dostopna neinvazivna metoda slikovne diagnostike in se s pridom uporablja tudi za pregled gastrointerstinalnega trakta. Glavne indikacije za pregled so bolečina v abdom-nu, bruhanja, driske ter povečan obseg trebuha.

Za ustrezno diagnostično vrednost ultrazvočne pre-iskave so izrednega pomena pravilna priprava pacienta, razumevanje ultrazvočnega aparata in nastavitev, primer-na tehnika pregleda, poznavanje anatomije in pogostejše patologije ter logično sklepanje o posledicah nekaterih bolezni. Zmogljivost novejših ultrazvočnih aparatov in vi-sokoresolucijskih sond omogočajo natančen pregled ab-dominalnega dela gastrointestinalnega trakta, delno pa tudi vratnega in torakalnega dela požiralnika. Seveda pa aparat ni dovolj za natančno diagnostiko, potrebni so znanje, vaja in izkušnje, kar je očitno tudi pri diagnostiki gastrointestinalnega trakta.

Ultrazvočno preiskavo prebavil delamo vedno v kontek-stu ultrazvočnega pregleda celotnega trebuha, saj se lahko simptomatika navezuje na povezane organe. Ciljane pre-iskave trebuha so neprimerne in nezadostne. Ultrazvočni pregled naj bo vedno natančen in sistematičen.

Zavedati se moramo tudi omejitev ultrazvočnega pregleda, še posebej pri velikih in debelih živali, ter možnosti drugih metod diagnostike kot sta npr. računalniška tomo-grafija in endoskopija.

Ključne besede: ultrazvočna preiskava, prebavila, gastro-intestinalna obolenja, pes, maček

1. UVOD

Ultrazvočni (UZ) pregled trebuha je pomemben del di-agnostike gastrointestinalnih obolenj. Glavne indikacije za pregled so akutna bolečina v abdomnu, bruhanja, driske, ter povečan obseg trebuha. Za ustrezno diagnostično vrednost UZ preiskave so izrednega pomena pravilna priprava pacienta, razumevanje ultrazvočnega aparata in nastavitev, primerna tehnika UZ pregleda z rabo anatom-skih orientacijskih znakov, poznavanje artefaktov, znanje o normalnem ultrazvočnem izgledu organov, pogostejših ultrazvočnih patoloških najdbah ter njihovih diferencialnih diagnozah (1-4).

2. PRIPRAVA PACIENTA

Živali naj bi bile za ultrazvočni pregled tešče, saj vsebi-na prebavil zaradi artefaktov otežuje pregled. Žal so pregl-edi pri naših pacientih redko vnaprej načrtovani in zato se moramo pogosto sprijazniti z neoptimalnimi pogoji. Živali za UZ pregled obrijemo, da zagotovimo kontakt med ultrazvočno sondo in kožo. Kožo zmočimo, potem pa na-nesemo ultrazvočni gel. Zelo nemirne živali je priporočljivo sedirati, saj tako zelo povečamo diagnostično vrednost preiskave. Zavedati se moramo omejitev UZ pregleda ve-likih in debelih živali. Za pse težje od 25 kg, je računalniška tomografija (CT) mnogo bolj občutljiva metoda slikovne diagnostike trebuha kot ultrazvočna preiskava. Zaradi vse zmogljivejših aparatov, ki v kratkem času pridobijo potrebne slike, vse nižje cene diagnostičnega postopka in možnosti izpeljave diagnostike v sedaciji (brez splošne an-estezije) se CT trebuha vse bolj uveljavlja tudi kot začetna presejalna diagnostična metoda (1,2).

3. ULTRAZVOČNE SONDE, NASTAVITVE UZ APARATA IN ARTEFAKTI

Za pregled prebavil so najprimernejše višje frekvence ultrazvoka (7.5 – 10 MHz ali več pri mačkah), razen pri večjih psih, kjer so za dele prebavil, ki so globoko v tre-buhu, potrebne nižje frekvence (5 MHz). Za dele prebavil blizu sonde, kjer je najbolj ustrezna visoka frekvenca ul-trazvoka, ki nam omogoča večjo ločljivost (resolucijo), uporabljamo linearno sondo. Za pregled bolj oddaljenih delov trebuha uporabljamo konveksno ultrazvočno sondo, saj potrebujemo nižjo frekvenco ultrazvoka, ki omogoča

Maja Brložnik1, Darja Pavlin1, Nina Boc2, Estera Pogorevc1, Aleksandra Domanjko-Petrič1 1 Klinika za male živali, Veterinarska fakulteta, Gerbičeva 60, Ljubljana e-naslov: jogamaja@gmail.com 2 Oddelek za radiologijo, Onkološki inštitut Ljubljana, Zaloška 2, Ljubljana

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večjo prodiranje (penetracijo), a je zato ločljivost slike manjša. V veterini je zaradi oblike, velikosti in frekvence zelo priljubljena mikrokonveksna sonda, katere frekven-ca je višja od konveksne in nižja od linearne sonde. Med omenjenimi sondami so razlike tudi v velikosti kontaktne površine sond, ki odloča o velikosti polja pregledovanja, in v razporejenosti piezoelektričnih kristalov, ki odloča o obliki slike...

Za primerno diagnostično vrednost našega pregleda so pomembne nastavitve ultrazvočnega aparata. Dobre prednastavitve shranjene v ultrazvočnem aparatu, ki jih uporabimo za pregled različnih delov naših po velikosti zelo različnih pacientov, nam bodo zelo olajšale izvedbo in tudi skrajšale čas ultrazvočnih preiskav. Med pregledovan-jem bomo spreminjali globino pregleda, globino fokusa, frekvenco in jakost ultrazvočnih signalov.

Med ultrazvočnim pregledom se moramo zavedati ar-tefaktov. Ti nas lahko zavedejo do napačne diagnoze ali pa nam pomagajo pri interpretaciji in diagnostiki. Artefakti, ki so pri pregledu prebavil najpomembnejši so reverberacije in akustične sence (1-3).

4. POSTOPEK UZ PREGLEDA IN ULTRAZVOČNA ANATOMIJA PREBAVIL

Živali pregledujemo v temnem in mirnem prostoru. Najprimerneje je, da ležijo na mehki podlagi na boku ali na hrbtu. Pogosto je potreben fleksibilen pristop glede na obliko trupa in vsebino prebavil.

UZ pregled mora biti vedno popoln pregled trebuha; ciljane UZ preiskave posameznih organov so neprimerne in nezadostne. Sistem pregleda naj bo vedno enak, saj tako skrajšamo čas pregleda in zmanjšamo možnost, da bi kak organ pozabili pogledati.

Pri UZ pregledu gastrointestinalnega trakta je nu-jno poznavanje anatomije stene prebavil ter razlik med različnimi deli prebavil in med živalskimi vrstami. Vse dele prebavil pregledamo sistematično v prečnem in vzdolžnem prerezu.

Z UZ pregledom ocenjujemo debelino stene prebavil in posamezne plasti stene. Ultrazvočno vidimo skozi celoten prebavni trakt 5 plasti: na meji z lumnom je hiperehoge-na površina mukoze, potem pa si proti zunanjosti sledijo skoraj anehogena sluznica oziroma mukoza, hiperehoge-na submukoza, skoraj anehogena mišična plast in hipere-hogena zunanja plast (subseroza in seroza) (1,2).

Poleg anatomije opazujemo tudi peristaltiko prebavil ter vsebino lumna. Normalna vsebina prebavil je različna in je lahko sestavljena iz hrane, sluzi, tekočine in plina. V želodcu so lahko deli hrane zelo nenavadnega videza in lahko izgledajo kot tujki.

V tabeli so referenčne vrednosti debeline stene prebavil, ki pa so uporabne le v kombinaciji z drugimi ultrazvočnimi najdbami, kot so slojevitost črevesa in porazdeljenost spre-memb, ter v kontekstu klinične prezentacije (1).

Tabela: Referenčne vrednosti debelin stene prebavil v mm. Debelino stene izmerimo med zunanjo stranjo seroze in notranjo stranjo mukoze (1).

Želodec Duodenum Jejunum Ileum Kolon

Pes

< 15 kg 2-5 3,8 3,0 3,0 1,5

15-30 kg 2-5 4,1 3,5 3,5 1,5

> 30 kg 2-5 4,4 3,8 3,8 1,5

Mačka 2-4 2,2 2,2 2,2 1,5

Pri manjših psih in mačkah lahko vidimo distalni del požiralnika, ki pa ga težko pregledamo zaradi zraka v pljučih. Debelina stene želodca je odvisna od napolnjenosti želodca, merimo jo vedno med rugami. Pregled želodca obsega pregled kardije, fundusa ter pilorusa. Pozorni smo na prehod iz pilorusa v duodenum. Normalna peristaltika želodca je od 4 do 6 kontrakcij na minuto (1,2).

Dvanajstnik je najravnejši del tankega črevesa in ima pri psu najdebelejšo steno oziroma mukozo. V proksimalnem delu descendentnega duodenuma ocenimo veliko dvana-jstnikovo papilo, ki izgleda v prečnem prerezu kot obroček,

v vzdolžnem prerezu pa kot tubularna struktura. Ob de-scendentnem delu dvanajstnika, ki poteka vzdolž trebušne stene, leži desni krak trebušne slinavke. Pri psu ocenimo tudi manjšo dvanajstnikovo papilo. V nekaterih primerih lahko ugotovimo v sluznici dvanajstnika hiperehogene Pe-yerjeve plošče, zaradi katerih izgleda sluznica vdolbena in paziti moramo, da jih ne zamenjamo z ulkusi. Telo pank-reasa leži ob piloričnem delu želodca oziroma na prehodu v dvanajstnik, levi krak trebušne slinavke pa v smeri proti veliki krivini želodca in v smeri proti kranialnem delu vran-ice.

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Pri pregledu jejunuma pregledamo več črevesnih zank; lahko jim sledimo, ali pa jih pregledujemo v določenem vzorcu. Pozorni smo na premer jejunuma, ki naj bi bil približno uniformen po celotni dolžini. V tankem črevesu predstavlja mukoza približno 60% debeline stene, mišična plast pa približno 15%. Normalna peristaltika tankega črevesa je od 1 do 3 kontrakcije na minuto (1,2).

V ileocekalni regiji, ki se nahaja medialno od desne led-vice, pregledamo ileum, ileocekalno zaklopko ter cekum. Plasti stene ileuma so približno enako debele. Pri mački sta submukoza in mišična plast ileuma debelejši kot v ostalih delih prebavnega trakta in zato ileocekalno zaklopko zlah-ka prepoznamo. Pri psu jo težje najdemo zaradi prisotnosti zraka v cekumu (1,2).

Debelo črevo pregledamo po celotni dolžini (ascend-entni, transverzni in descendentni kolon). Stena debelega črevesa je tanjša od stene ostalih delov prebavil. Če je de-belo črevo prazno, je stena nagubana. Peristaltike debel-ega črevesa normalno ne opazimo (1).

Med pregledovanjem gastrointestinalnega trakta smo pozorni na morebitno prosto tekočino, na izgled mezen-terija in omentuma ter abdominalne bezgavke. Prebavne organe drenirajo hepatične, gastrične, splenične, pank-reatiko-duodenalne, jejunalne, ileocekalne in količne bez-gavke. Med ultrazvočnim pregledom trebuha pregledamo tudi ostale bezgavke kot so iliakalne in renalne (1-4).

5. POGOSTEJŠE PATOLOŠKE NAJDBE IN DIFERENCIALNA DIAGNOSTIKA

Ileus je pogosta napotna diagnoza za ultrasonografijo trebuha. Večinoma so pri paralitičnem ileusu, ki je pogosto v povezavi z vnenimi boleznimi prebavil, razširjene skoraj vse zanke ozkega črevesa, medtem ko so pri obstrukci-jskem ileusu razširjene zanke pred obstrukcijo, tiste za ob-strukcijo pa so prazne, če je obstrukcija popolna. Vzrok za mehanični ileus so lahko tujki, paraziti, invaginacija, volvulus, herniacija, striktura, adhezije, granulomi, tu-morji idr. Nekatere od naštetih vzrokov za mehanični ileus lahko ugotovimo tudi brez ultrazvočnih znakov obstrukcije črevesa. Dilatiran želodec oziroma želodčno stazo lahko opazimo tudi v stanjih brez ileusa, npr. zaradi želodčnih ulceracij, gastritisa, pilorospazma, funkcionalnih motenj želodca, novotvorb, sedacije (1,2).

Če opazimo, da je črevo valovito oziroma nabrano (»corrugated«), smo pozorni na vnetne procese (pank-reatitis, enteritis, peritonitis) ter novotvorbe in ishemijo črevesne stene (1).

Tipičen ultrazvočni izgled ima invaginacija oziroma uvih dela črevesja, kjer ugotovimo en del črevesa v notranjosti drugega dela. Invaginacije se lahko pojavljajo na različnih mestih in so lahko multiple. Njihov izgled lahko oponašajo divertikli, tumorji, hiperplastična mukoza ter nagubanje (»plication«). Slednjega ugotovimo pogosto ob linearnih tujkih, ki so hiperehogene linearne površine. Tujki so lahko različnih velikosti, oblik in ehogenosti. Najpogosteje jih prepoznamo po hiperehogeni površini in akustični senci. Ultrazvočni izgled tujkov je seveda odvisen od fizikalnih

lastnosti materiala. Kopičenje zraka in tekočine kaže na ob-strukcijo. V nekaterih primerih ugotovimo tujke, ki so per-forirali črevesno steno. Lahko so zasidrani v steni prebavil, lahko pa potujejo na druga mesta. Stena prebavil, ki so jo predrli je zadebeljena, maščoba in mezenterij okrog pa sta hiperehogena, kar kaže na peritonitis. Tujki se večinoma kopičijo v ožjih delih prebavil (pred ileocekalno zaklopko, strikturo, invaginacijo, tumorjem, v pilorusu, itd.). Na tu-jke lahko spominjajo črevesni paraziti. Tujki so lahko tudi naključna najdba. Pri mačkah pogosto ugotovimo trihob-ezoarje. V primeru suma na radiolucenten tujek, ki ga ne uspemo najti z UZ, lahko opravimo še RTG preiskavo, saj se diagnostični vrednosti preiskav dopolnjujeta. Nasprotno pa se pri RTG preiskavi velik del podatkov izgubi zaradi prekrivanja in zato z UZ pregledom pridobimo več podat-kov (1,3,4).

Ko deli prebavil zdrsnejo skozi odprtino v nekem or-ganu (npr. skozi trebušno steno, diafragmo, ingvinalni obroč, perinealno regijo itd.), diagnosticiramo hernije. Ultrazvočno lahko prepoznamo znake strangulacije in ukleščenja. Ko se skozi hernijo mezenterija vrine črevo, se lahko razvije volvulus. Volvulus oziroma zasuk črevesa lahko nastane tudi brez hernije. Izjemnega pomena je njegovo takojšnje prepoznavanje, saj predstavlja zaradi ishemije kirurško urgenco. Na volvulus posumimo ob značilni anamnezi in dilatiranih delih črevesa, napolnjenih s plinom in tekočino. Stena črevesa je najprej zadebeljena, zelo kmalu pa se zaradi nekroze stanjša. V trebuhu je pros-ta tekočina. Z Dopplerjem ugotovimo ishemijo črevesa. Gastrointestinalne vaskularne motnje (infarkti, ishemije, angiodisplazije) so pogosto velik diagnostičen izziv. Stran-gulacijo in ishemijo črevesne zanke prepoznamo po negi-bljivosti in hiperehogenem okoliškem mezenteriju. Takšna črevesna zanka je lahko dilatirana, včasih je valovita (1).

Pri vnetnih obolenjih prebavil lahko ugotovimo zade-beljeno steno. Simetrija in obseg zadebelitve ter izgled posameznih plasti stene nam pomagajo pri razlikovanju vnetnih in neoplastičnih sprememb prebavil. Pri odločanju o bolj verjetni diagnozi upoštevamo tudi velikost, obliko, ehogenost ter ehoteksturo bezgavk. Pacienti z vnetnimi boleznimi gastrointestinalnega trakta imajo manj zade-beljeno steno prebavil, redkeje opazimo izgubo slojevito-sti, bezgavke so manjše in redkeje spremenjene oblike ter ehoteksture. Pri psih so za razlikovanje med vnetnimi in neoplasičnimi obolenji naštete smernice bolj zanesljive kot pri mačkah. Kadar pri psih opazimo izgubo normalne slo-jevitosti črevesa, je verjetnost za neoplastično obolenje več kot 50 krat večja kot verjetnost za vnetno obolenje. Izgubo slojevitosti so ugotovili pri 99% psov z neoplastičnim obo-lenjem črevesa. Pri 88% psov z vnetnim obolenjem črevesa pa so ugotovili normalno ali le delno spremenjeno slojevi-tost črevesa. Bezgavke psov z vnetnim obolenjem so bile debele od 0,6 do 2,6 cm (z mediano 1 cm), bezgavke psov z neoplastičnim obolenjem pa so bile debele od 0,3 do 9 cm (z mediano 1,9 cm) (1).

Med inflamatornimi stanji v želodcu lahko prepoznamo gastritis, želodčne ulkuse, edem in uremično gastropatijo (2).

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Za razlikovanje med inflamatornimi obolenji črevesa je debelina stene neobčutljiv in nespecifičen parameter, zato smo pozorni na ehogenost sluznice oziroma hiperehogene infiltracije. Hiperehogeni madeži (»speckles«) se pojavl-jajo v sluznici črevesa po obroku ali pa so znak inflama-tornega obolenja črevesa. Hiperehogene linearne spre-membe vzporedne z lumnom (»bands«) se pojavljajo pri vnetnih obolenjih, pri mačkah pa tudi v primeru sluznične fibroze. Hiperehogene linearne spremembe pravokotne na lumen (»striations«) predstavljajo dilatirane limfne ka-pilare in jih opazimo pri limfangiektaziji. Zadebeljena sub-mukoza je pogosto zelo izražena v primeru parazitarnih infestacij. Diferencialna diagnostika zadebeljene mišične plasti prebavil obsega inflamatorno obolenje črevesa (IBD), enteritis in limfom. Vnetje cekuma oziroma tifilitis prepoznamo po vozličastih zadebelitvah stene cekuma. Inflamatorne spremembe debelega črevesa so ponavadi komaj opazne; ugotovimo lahko blago zadebelitev stene z majhnimi hipoehogenimi vozliči v submukozi (1,2).

Pomembno mesto med gastrointestinalnimi obolenji zaseda tudi patologija ileocekalne regije, še posebej pri mačkah. Največkrat ugotovimo povečane količne bez-gavke in fokalno hiperehogenost maščobe mezenterija z manjšo količino proste tekočine (1).

Z ultrazvočnim pregledom lahko ugotovimo tudi post-operativne spremembe, kot kirurško mesto in šive, zade-belitev stene in dehiscenco.

Intestinalna striktura ima najpogosteje značilen ultrazvočni izgled in je največkrat posledica travme (npr. zaradi biopsije črevesa, enterotomije) (1,2).

Kongenitalne bolezni prebavil so sorazmerno redke. Ugotovimo lahko stenozo pilorusa, polipe, hipertrofijo sluznice pilorusa, duplikacijo črevesa, itd. (1).

Najpogostejša gastrointestinalni tumorja sta limfom in karcinom. Pojavljajo se tudi sarkomi in mastocitom. V prebavilih lahko včasih ugotovimo metastaze. V primeru limfoma prebavil ugotovimo najpogosteje difuzno trans-muralno zadebelitev stene z izgubo slojevitosti, zmanjšano ehogenostjo in hipoperistaltiko ter regionalno limfadeno-patijo. Pri mačkah z gastrointestinalnim limfomom je stena črevesa pogosto le malo zadebeljena z izrazito mišično plastjo. Diferenciacija z IBD in enteritisom je ultrazvočno nemogoča. Tudi bezgavke so pri mačkah povečane, okrogle in hipoehogene tako v primeru vnetnih kot neoplastičnih obolenj. Najznačilnejše ultrazvočne ugotovitve v primeru karcinoma želodca so močno zadebeljena stena s spre-menjeno slojevitostjo. Tudi za črevesni karcinom, ki ga pogosteje kot pri mačkah ugotovimo pri psih, je značilna transmuralna zadebelitev stene z izgubo slojevitosti. Po-gosto ugotovimo obstrukcijo. Intestinalni karcinom izgleda ultrazvočno podoben intestinalnemu limfomu, je pa po-navadi pri karcinomu dolžina prizadetega dela črevesa krajša, obstrukcija črevesa pa pogostejša. Med mezen-himskimi tumorji črevesa so leiomiomi, leiomiosarkomi in gastrointestinalni stromalni tumorji (GIST). Ti tumorji ras-tejo iz seroze in izgledajo kot velike ekscentrične oziroma ekstraluminalne mase. Mezenhimski tumorji večinoma ne povzročajo obstrukcije črevesa. Mastocitom so opisali

pri mačkah kot hipoehogene, ekscentrične in asimetrične nodule ali mase. Izgled visceralnih hemangiosarkomov je različen, heterogeni tumorji so lahko hipoehogeni ali hi-perehogeni (1,2).

Med obsežnimi zadebelitvami črevesne stene in more-bitno močno povečanimi bezgavkami so diferencialna diagnostika tudi granulomatozna vnetja, mačji infekci-jski peritonitis (FIP), mačja gastrointestinalna eozinofilna sklerozirajoča fibroplazija (FGESF), idr. (1-3).

Med pomembnejšimi ultrazvočno prepoznavnimi pa-tologijami pankreasa so pankreatitis, eksokrina insuficien-ca pankreasa, pankreatolitiaza, spremenjen pankreatičen vod, ciste in novotvorbe. Slednje so adenokarcinom, kar-cinomatoza, adenom, metastaze, limfom, ter pankreatični nevroendokrini tumorji (insulinom, glukagonom in gas-trinom) (1,2).

Diagnostično vrednost ultrazvočnega pregleda GI trakta dopolnjujejo tankoigelne punkcije, ki jih s pridom uporabljamo predvsem pri spremenjenih in/ali povečanih bezgavkah, spremenjeni parenhimski ehostrukturi, ter no-votvorbah.

6. ZAKLJUČEK

Izvid ultrazvočne preiskave vsebuje opis organov in ultrazvočnih ugotovitev z diferencialnimi daignozami, mnenje z morebitno končno diagnozo ter priporočila glede nadaljne diagnostike. Za diagnostiko gastrointes-tinalnih obolenj je pomembno zavedanje o omejitvah ultrazvočnega pregleda in možnostih drugih preiskav (RTG, CT, gastroskopija, kolonoskopija, idr.). Diagnostična vrednost ultrazvočne preiskave je odvisna od operaterja, pa tudi od kvalitete aparata. Neizkušenost v ultrazvočni di-agnostiki ne opravičuje neizvajanja ultrazvočnega pregle-da. Napotitev na popoln ultrazvočni pregled trebuha je v indiciranih primerih nujna.

Literatura

1. Penninck D, d’Anjou Marc-André. Gastrointestinal tract. In: Penninck D, d’Anjou Marc-André, eds. Small Animal Ultrasonography. 2nd ed. Blackwell, 2015: 259–308.

2. Nyland TG, Neelis DA, Matoon JS. Gastrointestinal tract. In: Matoon JS, Nyland TG. Small animal diagnostic ultrasound. 3rd ed. Elsevier Saunders, 2015: 468–500.

3. Thrall DE. Veterinary diagnostic radiology. 6th ed. St. Louis: Elsevier Saunders, 2013: 769–824.

4. Gaschen L. Diagnostic imaging. In: Steiner JM, ed. Small animal gastroenterology. Hannover: Schlütersche, 2008: 16–47.

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VLOGA VETERINARSKEGA TEHNIKA PRI ENDOSKOPSKI DIAGNOSTIKI PREBAVIL

Jurij Žel

Izvleček

Endoskopska diagnostika prebavil zahteva primerno izurjeno osebje, saj gre za delo z drago in občutljivo opre-mo. Veterinarski tehnik je tisti, ki opremo pripravi, med posegom asistira pri odvzemu bioptov in z njimi primerno rokuje. Po posegu je odgovoren za primerno čiščenje, razkuževanje in skladiščenje opreme. V prispevku obrav-navamo tehnične vidike rokovanja z endoskopsko opremo za diagnostiko obolenj prebavil.

Uvod

Pri obolenjih prebavil tudi v veterinarski medicini vse pogosteje uporabljamo endoskopsko diagnostiko. En-doskopski pregled zgornjih in spodnjih prebavil nam daje možnost odvzema bioptov, ki so nujno potrebni za natančnejšo diagnozo bolezenskega procesa.

Preden se odločimo za poseg, moramo odvzeti natančno anamnezo, pacienta klinično pregledati in opraviti vso manj invazivno diagnostiko, ki ne zahteva splošne anestezije. Ta vključuje hematološke, biokemijske in parazitološke preiskave, ultrazvok trebuha in po potrebi rentgensko diagnostiko.

Pri delu z občutljivo in drago opremo sodelujeta veteri-nar in veterinarski tehnik. Oba morata poznati postopek uporabe, vzdrževanja in čiščenje opreme.

Priprava pacienta

Psi in mačke, ki jih naročamo na endoskopski pregled zgornjih prebavil (ezofagoskopija, gastroskopija, duo-denoskopija), naj bodo tešči 24 ur pred posegom. Zadnji obrok hrane, ki ga žival zaužije, naj bo lahko prebavljiv. Če je predhodno ugotovljena motnja v praznjenju želodca, lahko podaljšamo post. Žival lahko pije vodo do posega. Pred endoskopskim posegom en do dva dni ne dajemo barijevega sulfata ali sukralfata (1).

Sum tujka v požiralniku je nujno stanje, pravil posta pri njih ne upoštevamo in jih obravnavamo prednostno.

Kadar imamo namen opraviti še endoskopski pregled spodnjih prebavil (kolonoskopija), svetujemo daljši post (48 ur), uporabo odvajal in dajanje klizme s fiziološko raz-topino pred posegom (1).

Vse endoskopske preglede in posege opravljamo v splošni anesteziji. Pacienta pred posegom pregleda an-estezist in oceni, ali je le-ta primeren za poseg. Anestez-ist izbere primeren protokol anestezije in s tem omogoči optimalno izvedbo posega. Pacienta zaradi nevarnosti as-piracije vsebine prebavil vedno intubiramo (1).

Priprava endoskopske opreme in pacienta

Pred vsakim posegom sestavimo endoskopsko opremo v skladu z navodili proizvajalca in preverimo delovanje vseh funkcij endoskopa. Preverimo delovanje vira svetlobe, suk-cije, izpiranja, insuflacije, gibljivost endoskopa in delovanje prijemalk. Pozorni moramo biti na brezhibno razpiranje in zapiranje ter pregledati konico prijemalk, ki ne sme biti os-tra, da pacienta med posegom ne poškodujemo. Nastavi-mo še ostrino slike in izravnavo bele barve. Pri ravnanju z endoskopom smo nežni in cevi ne zvijamo (2).

Pred začetkom endoskopskega pregleda zgornjih prebavil anesteziranemu pacientu v ustno votlino vstavimo razpiralo. Pri gastroskopiji in kolonoskopiji naj pacient leži na levem boku. Lego po potrebi prilagodimo. Pri odstran-jevanju tujkov iz požiralnika ali želodca pacienta pogosto obrnemo na hrbet (1).

Ravnanje z biopti

Za biopsijo sluznice prebavil uporabimo biopsijske pri-jemalke, ki omogočajo odvzem vzorca s čim večjo pros-tornino. Biopte takoj po odvzemu previdno odstranimo s klešč in jih namestimo na sintetično podlago v biopsijski kaseti, ki smo jo pred tem navlažili s sterilno fiziološko raz-topino. Kaseto nato zapremo in spravimo v 10% puferiran formalin. Biopsijske kasete omogočajo, da so vsi biopti obrnjeni v isto smer in ohranijo svojo obliko (3, 4, 5).

Zavedati se moramo, da so biopti črevesne in želodčne sluznice majhni in krhki ter da lahko s pregrobim ali

Jurij Žel, Martina Krofič Žel Klinika za male živali, Veterinarska fakulteta, Cesta v Mestni log 47, 1000 Ljubljana, jurij.zel@vf.uni-lj.si

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napačnim ravnanjem povzročimo pojav artefaktov. Samo s pravilno odvzetimi in pripravljeni biopti bomo dobili zanes-ljiv patohistološkegi izvid (6).

Čiščenje in shranjevanje endoskopske opreme

Čiščenje in razkuževanje endoskopske opreme je zahtevno opravilo, saj se biološki material nahaja na težko dostopnih mestih, kjer lahko pride do nastajanja biofilma, opremo pa je občutljiva na visoke temperature (2).

Za vsak kos opreme pripravimo načrt čiščenja in vzdrževanja. Priporočljivo je, da sproti beležimo nepravil-nosti in okvare, ki smo jih opazili med posegom. Pri upo-rabi čistil in razkužil upoštevamo navodila proizvajalca (2).

Po vsakem posegu endoskop najprej obrišemo z me-hko navlaženo krpo. Konico endoskopa potopimo v des-tilirano vodo in vključimo sukcijo. Izmenično sesamo des-tilirano vodo in zrak. Na ta način izperemo delovni kanal. Endoskop nato odklopimo, zavarujemo priključek za kam-ero in obvezno opravimo preizkus tesnosti instrumenta. Šele po opravljenem preizkusu lahko endoskop varno namočimo v raztopino encimskega čistila (2).

S ščetko nato očistimo delovni kanal in namestimo nastavke za spiranje opreme. Ventile in biopsijske prije-malke očistimo posebej. Po čiščenju endoskop namočimo v razkužilo. Z razkužilom napolnimo tudi vse kanale en-doskopa. Endoskop nato speremo z destilirano vodo in osušimo zunanje dele. Nato spihamo vse kanale (2).

Endoskope skladiščimo razstavljene v visečem položaju. Vse ventile in pokrove hranimo posebej. Skladiščenje v kovčku ni primerno, saj je na ta način večja verjetnost zasta-janja vlage v delovnem kanalu, s tem pa razmnoževanje mikroorganizmov. Biopsijske prijemalke osušimo, obesimo in jih hranimo odprte (2).

Zaključek

Pri endoskopski diagnostiki imamo opravka z drago in občutljivo opremo, ki pri manipulaciji in negi zahteva ve-liko časa in skrbnosti. Iz teh razlogov potrebujemo primer-no usposobljenost ekipe, ki pravilno izvede poseg, skrbi za biopte in opremo. Čeprav je nega instrumentov zamudna, je natančnost pri delu in primeren kontaktni čas razkužil ter čistil nujen za preprečevanje prenosa okužb in za zago-tavljanje dolge življenjske dobe instrumentov.

Literatura

1. Willard MD. Endoscopy. In: Steiner J, ed. Small animal gastroenterology. Hannover: Schlütersche Verlagsgesellschaft, 2008: 72-89.

2. Cox S. Care and maintenance of endoscopy equipment. In: Veterinary Continuing Education Convention Individual Proceedings Papers. San Diego: CVC 2009: 2 str.

http://veterinarycalendar.dvm360.com/care-and-maintenance-endoscopy-equipment-proceedings (22.feb.2017)

3. Washabau RJ, Day MJ, Willard MD, et al. Endoscopic, biopsy, and histopathologic guidelines for the evaluation of gastrointestinal inflammation in companion animals. J Vet Intern Med 2010; 24 (1): 10-26.

4. Goutal-Landry CM, Mansell J, Ryan KA, and Gaschen FP. Effect of endoscopic forceps on quality of duodenal mucosal biopsy in healthy dogs. J Vet Intern Med 2013; 27: 456-461.

5. Ruiz GC, Reyes-Gomez E, Hall EJ, Freiche V. Comparison of 3 handling techniques for endoscopically obtained gastric and duodenal biopsy specimens: a prospective study in dogs and cats. J Vet Intern Med 2016; 30: 1014-1021.

6. Willard MD, Mansell J, Fosgate GT, et al. Effect of sample quality on the sensitivity of endoscopic biopsy for detecting gastric and duodenal lesions in dogs and cats. J Vet Intern Med 2008; 22: 1084-1089.

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USTNA HIGIENA: KAJ NAJ PRIPOROČIM SKRBNIKU PSA ALI MAČKA?

Ana Nemec

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VETERINARSKA AMBULANTA SKOZI PASJE IN MAČJE OČI

Petra Mohar

Povzetek

Obisk veterinarja je za pse in mačke stresen, kar se kaže tudi v obliki nekooperativnosti pri rokovanju ali celo izražanju agresivnih reakcij. Posledično sta pregled in odkrivanje vzrokov zdravstvenih težav otežena oziroma včasih celo nemogoča brez sedacije. Razumevanje učinka stresnih situacij na organizem, prepoznavanje vzrokov (stresorjev) in posledic (vedenjskih reakcij) nam lahko pomaga znižati nivo stresa. Čeprav ima vsaka žival svojo zgodovino, izkušnje, karakter in se z okoljem sooča na popolnoma samosvoj način, so sprememba okolja, hrup in poseganje v osebni prostor univerzalni stresorji. Z ma-nipulacijo okoljskih dejavnikov (npr. hrup, svetloba) in na-dzorom lastnega pristopa do živali lahko stres zmanjšamo tako, da ostaja pod pragom reaktivnosti živali, s katero rokujemo. Če se tega zavedamo že pri prvem obisku stranke oziroma pacienta, lahko z nekaj truda zgradimo odnos, ki bo temeljil na zaupanju. Žival se bo na ta način lažje soočala s poseganjem vanjo, delo pa bo za veteri-narje in osebje veterinarske klinike varnejše in predvsem prijetnejše.

Pomen dobrega počutja pacientov

Živali so v naši družbi vedno bolj cenjene kot življenski sopotniki, čeprav so ljudje skozi zgodovino v njih zelo ver-jetno videli predvsem njihovo uporabno vrednost. Dan-danes se na žival gleda kot na člana družine, kar pomeni, da so skrbniki v svoje živali mnogokrat pripravljeni vložiti veliko truda, časa in denarja. Posledično imajo živali daljšo življensko dobo, saj je velik poudarek na njihovi kvalitetni prehrani, opremi in ugodnem zdravstvenem stanju. Na tem mestu imajo veliko vlogo veterinarji. Veterinarji in os-ebje veterinarske klinike imajo pogosto največ možnosti za dolgoročen stik s skrbnikom. Preventivni pregledi in obvezna cepljenja predvsem v začetnih fazah pridobitve živali dajejo veterinarjem možnost vpliva na odnos med

človekom in njegovim ljubljenčkom ter na izgradnjo odno-sa živali do obiska veterinarja. Oblikovanje pozitivnega odnosa do veterinarskih obiskov je pomembno tako zaradi dobrobiti živali kot tudi za prijetnejše in varnejše delovno okolje osebja veterinarske ambulante. Zadovoljevanje in razumevanje pacientovih potreb ter njegovega vedenja ne vpliva le na lažje rokovanje, ampak je tudi osnova za najboljšo in najsodobnejšo oskrbo živali. Vedenje oziroma počutje pacienta je namreč pomemben dejavnik pri pre-poznavanju zdravstvenih težav in njihovem zdravljenju.

Zaradi preobremenjenosti in zahtev strank po hitri obravnavi je pravilen pristop do živali in njihovo počutje pogosto zanemarjeno. Odnos postane pomemben šele, ko je treba rokovati s problematično, težavno, nekoopera-tivno, agresivno oziroma reaktivno živaljo. V takih primerih je zdravljenje zelo oteženo in včasih nevarno za osebje am-bulante. Posluževati se je treba vedno bolj restriktivnih in prisilnih metod, ki nekooperativnost živali le še povečujejo (1). Da bi se temu izognili, je treba vložiti nekaj več ener-gije, truda in časa v prvo srečanje z živaljo.

Reaktivnost in stres

Vse živali, ki pridejo v veterinarsko ambulanto, so po-tencialno reaktivne. Vzrok za reaktivnost je stres, ki so mu živali v taki situaciji podvržene. Stres je vsako stanje spre-menjene homeostaze v organizmu, ki je lahko fizičnega ali psihičnega oziroma čustvenega izvora. V takem stanju telo sproži fiziološke, imunske in vedenjske mehanizme, da se organizem lahko prilagodi novonastali situaciji (2). Prva reakcija organizma pod stresom je sproščanje adrenalina (3), ki telo pripravi na reakcijo bega ali boja. Ta odgovor organizma je nezaveden in se zgodi v trenutku. Žival nanj nima nikakršnega vpliva.

Adrenalin, nevrotransmiter iz skupine kateholaminov, povzroči številne spremembe v telesu, kot so: povišan srčni utrip in delovanje srčno-žilnega sistema, povečan sistolični krvni tlak in raven krvnega sladkorja, dilatacija sapnic in zenic, kot tudi višjo raven prostih maščobnih kislin v krvi. Hkrati adrenalin stimulira prenašalec ACTH (ardenokor-tikotropni hormon), ki med drugim stimulira izločanje kortizola. Kortizol, ki spada v skupino glukokortikoidov, uravnava številne pomembne telesne funkcije, kot so urav-navanje telesne temperature, cirkadiani ritem, uravnavanje krvnega pritiska in dihanja, nadzor metabolizma maščob in ravnovesja vode v telesu (3). Med stresom se njegova ra-

Petra Mohar Dogcom, Sonja Hoegen, Allmend 18, 74206 Bad Wimpfen, Deutschland, petra.mohar@gmail.com, info@dogcom.de

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ven v telesu povečuje, kar povzroči povišanje koncentracije glukoze, aminokislin in prostih maščobnih kislin v krvi. Na ta način se telesu zagotovi zadostna količina energije za soočanje s stresom. Hkrati kortizol vpliva na imunski sistem in s tem niža odpornost telesa.

Telo ne zmore obstoja v večnem stanju visoke priprav-ljenosti, zato mora vsaki stresni situaciji slediti obdobje okrevanja. Če je stres dolgo trajajoč ali se stresne situacije pojavljajo (pre)pogosto, se organizem izčrpa. Če nima možnosti okrevanja, lahko v takem organizmu pričakujemo pojav sistemskih bolezni, kot so obolenja sečil, srca in ožilja. Na udaru je prebavni sistem, kar se kaže v obliki razjed želodca in kronične diareje. Raziskave kažejo tudi, da so psi, ki so pogosto izpostavljeni visokim nivojem kor-tizola, podvženi kognitivni degradaciji (4), torej težavam s spominom, učenjem, koncentracijo in sprejemanjem vsak-danjih odločitev.

Vedenjska posledica stresa je povečana reaktivnost oziroma izražanje agresivnih reakcij. Skupaj s povečanim izločanjem adrenalina in kortizola se poveča tudi izločanje drugih hormonov, med katerimi je testosteron, ki ga pov-ezujejo s povečano pripravljenostjo na boj. To nikakor ne pomeni, da se vsaka žival v stresni situaciji odzove agresiv-no. Pomeni pa, da bo pes ali maček v taki situaciji odre-agiral močneje in hitreje kot običajno, saj težje prenaša situacije, ki mu v preteklosti niso povzročale težav (npr. bližina drugih psov ali ljudi).

Prepoznavanje stresorjev

Prihod v veterinarsko ambulanto je za vsako žival stres. Vendar se stresna situacija začne mnogo pred vstopom v čakalnico. Tudi, če razlog obiska ni poškodba ali bolezen, kar že samo po sebi predstavlja močen stresor za žival, pomeni priprava na obisk veterinarja spremembo rutine in vedenja skrbnika. Mačke so nenadoma zaprte v trans-porter, na katerega jih običajno niso primerno navadili. Psi prestajajo vožnjo z avtomobilom, na katero so ali niso navajeni. Oboji zaznavajo vznemirjenost, živčnost ali strah svojega skrbnika. Pripeljejo se na neznan kraj ali kraj, kjer imajo slabe izkušnje, obdajajo jih neznani ljudje in množica drugih psov in mačk, ki so ravno tako živčni, prestrašeni, bolni ali poškodovani. Psi in mačke zaznavajo svojo okolico in podrobnosti v njej predvsem z vonjem. Še preden vs-topijo v ambulanto, se iz nje širi vonj po zdravilih, razkužilih in vseh mogočih drugih vonjavah, ki jih ne poznajo in jim zato predstavljajo vir strahu. Mačke v transporterju nimajo nikakršne izbire, kako bodo v ta svet vstopile, psi pa so po-gosto prisiljeni in zvlečeni v čakalnico. Prehodi so pogosto ozki, kar pomeni, da ni nobene možnosti umika nevarnos-ti. Tla v ambulantah so običajno iz gladkega, drsečega ma-teriala, prostor osvetljujejo močne luči z nenaravno svet-lobo, po prostoru se razlega hrup, ki je posledica glasnih pogovorov ljudi, prestavljanja in pripravljanja opreme za potrebe veterinarskega pregleda ter povečane vokalizacije prestrašenih psov in mačk. Dodaten povzročitelj stresa je neželena in neprijetna bližina tujih ljudi in živali ter na kon-cu še (z vidika psa ali mačke) invaziven pregled veterinarja.

Učinek stresorjev se sešteva in vodi v reaktivnost psa ali mačke. Ne glede na specifično težavo, ki jo žival v taki situaciji ima, je rokovanje in poseganje v reaktivno žival oteženo in pogosto nevarno, saj je z vsakim novim dražljajem verjetnost agresivnega odziva večja. Zato nam je lahko prepoznavanje stresorjev in odpravljanje nekaterih dražljajev v veliko pomoč.

Odpravljanje stresnih dražljajev

Okoljski stresorji so pogosto spregledani, čeprav igrajo pomembno vlogo pri počutju psa ali mačke. Vsekakor vsi ukrep v vsaki ambulanti niso mogoči, nekateri pa zahteva-jo le malo prilagajanja in iznajdljivosti:

1. Stoli, mize in ostala oprema za stranke v čakalnici naj bodo odmaknjeni od vhoda. Prostora naj bo dovolj, da se pes lahko v loku izogne neželenim srečanjem.

2. Med stoli za stranke, ob katerih čakajo njihovi ljubljenčki, naj bo dovolj prostora. Če to ni možno, naj bodo na voljo premične bariere, za katero se pes ali mačka, ki se drugih živali in/ali ljudi izogiba, lahko skrije.

3. Če je čakalnica majhna in ni mogoče zagotoviti do-volj prostora za dobro počutje pacientov, je treba več pozornosti nameniti organizaciji naročanja.

4. Gladka podlaga je lahko za žival grozljiva izkušnja. V ta namen imamo lahko pripravljene gumijaste podloge, na katere lahko pes ali maček stopi. Enako velja za delovne mize in kletke v katere so nameščeni pacienti. Gumijasta podloga daje živali občutek sta-bilnosti in s tem zmanjšuje stres. Če je žival dlje časa hospitalizirana, je dobro razmisliti tudi o mehkejši podlagi za spanje.

5. V ambulanti pri pregledu naj bodo na razpolago stoli, da se stranke lahko usedejo, saj so tako mirnejše, kar vpliva tudi na umirjanje njihove živali.

6. Pri pregledu ali v hospitalu lahko delna zatemnitev pomaga pomiriti žival. Za pregled uporabimo usmer-jen vir svetlobe.

7. Na oknih v ambulanti naj bodo nameščene žaluzije, da je mogoče prostor vidno izolirati pred motečimi zunanjimi dejavniki.

8. Prostor pred obiskom naslednjega pacienta poleg čiščenja in razkuževanja prezračimo.

9. Vredno je vložiti tudi nekaj časa v razmislek, kako bi lahko zmanjšali hrup. V čakalnici obesimo pravila, ki naj se jih naše stranke držijo (npr. če je mogoče, pustite žival do pregleda v avtu, ne posegajte v osebni prostor tujih živali, izogibajte se glasnemu pogovarjanju, na pregled prihajajte točno itd.).

10. V čakalnico in ambulanto na različne konce names-timo posode z vodo . V hospital lahko po potrebi namestimo naprave, ki oddajajo ustrezne umetne feromone (5).

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Usmerjanje skrbnika in prvi obisk pacienta

Vlaganje časa, energije in truda v dobro počutje nove stranke in pacienta ob prvem obisku se močno obrestuje. Marsikateri novopečeni skrbnik ni seznanjen s potrebami in pravilnim pristopom do vzgoje svojega psa ali mačke. Zato se že ob prvem telefonskem pogovoru dogovorimo, da naj bo prvi obisk veterinarja namenjen le pogovoru in privajanju živali na nenavadno situacijo. Med prvim obiskom pustimo psu ali mački, da si ambulanto v miru ogleda in jo po želji prevoha. Medtem lastniku razložimo, kako potekajo pregledi in za kaj vse bo treba poskrbeti, da bo njegova žival zdrava in zadovoljna. Lahko mu priporočamo, kako naj mačko navaja na transportni boks ali psa na vožnjo z avtomobilom. Razložimo, zakaj je treba upoštevati pravila v čakalnici in ambulanti, zakaj se njihova žival obnaša drugače, kot se je obnašala doma, in da bomo psu ali mački dovolili, da se na okolje privadi. V nasprotju s splošnim prepričanjem pes ali mačka potrebuje le nekaj sekund, da oceni situacijo in s tem odpravi začetni strah ter odpor. Tako dosežemo znatno večjo kooperativnost živali pri pregledu ali posegu.

Zavedanje lastnega vpliva na vedenje živali

Raziskave kažejo, da je vedenje psa do neznanega človeka v veliki meri odvisno od vedenja le-tega (6). To pomeni, da obstajajo določeni signali, kot so drža, hitrost gibanja, očesni stik, ton glasu, ki psu (in tudi drugim živalim) sporočajo ali oseba predstavlja grožnjo ali ne.

Pri prvem stiku je pomembno predvsem, da se premi-kamo počasi, kar se da potiho, živali damo čas, da najprej spozna prostor in se umiri (ne bega po prostoru). Medtem se s tihim glasom in umirjeno pogovarjamo s skrbnikom, ki nam lahko že pove, česa njegova žival ne mara ali česa se boji. Če se le da, pri psih počakamo, da se nam približajo sami. Pri mačkah počakamo, da sprostijo očesni stik. Živali se približujemo od strani, v rahlem loku in se izogibamo neposrednemu strmenju. Miritveni signali nam povejo, ali smo uspešni.

Pri psu smo pozorni na otrdelost telesa, položaj in gibanje repa, ušes in obrazno mimiko. Napogostejši mir-itveni signal je obračanje glave ali celotnega telesa stran od motečega dražljaja. Pozorni smo še na belino v očeh (“pogled izpod čela”), oblizovanje, zehanje, nenadno ovohavanje po tleh, zaprt gobec, vokalizacijo (lajež ali renčanje) in seveda vihanje ustnic. Najbolj uspešni bomo, če bomo upoštevali začetne znake, se ustavili in pustili psu, da ponovno preuči situacijo.

Pri mačkah ravno tako opazujemo celotno telo – otrdelost, položaj in gibanje repa ter ušes in obrazno mimiko. Predvsem smo pozorni na neprekinjen pogled, položaj ušes (bolj so ob glavi, večjo stisko doživlja mačka), spuščanje glave proti podlagi, nagibanje telesa vstran (na-kazovanje obračanja na hrbet) in vokalizacijo. V mačko ne posegamo, dokler ne sprosti pogleda, oziroma dokler se ušesa tesno prilegajo h glavi. Če ji bomo dali čas, da se sprosti, bo veliko bolj kooperativna pri pregledu ali posegu.

Največjo kooperativnost živali bomo dosegli, če ji bomo predvsem na začetku dali dovolj časa, da preveri novo okolje in oceni situacijo. Raziskave kažejo, da prisila in na-silen pristop močno zmanjšata naše možnosti za uspeh. Opustitev nasilnih metod poveča možnost preprečevanja agresivnih reakcij na 80 % (7). Miritveni signali nam dajo vedeti, kdaj delamo v varnem območju in kdaj smo dosegli prag reaktivnosti. Če jih upoštevamo že ob prvem obisku in prvem stiku z živaljo, bomo zgradili odnos, ki bo temeljil na zaupanju tudi, ko naše rokovanje pomeni za žival nepri-jetno ali rahlo bolečo izkušnjo.

Literatura

1. Axelrod J., Reisine T.D. (1984) Stress Hormones: Their Interaction and Regulation. Science 224, 452-459.

2. Berteselli G.V. et al. Evaluation of Immunological, Stress and Behavioural Parameters in Dogs (Canis familiaris) with Anxiety-Related Disorders. In: Current Issues and Research in Veterinary Behavioral Medicine: Papers Presented at the 5th International Veterinary Behavior Meeting. Indiana: Purdue University Press, 2005: 18-22.

3. Beerda B. et al. (1997) Manifestations of chronic and acute stress in dogs. Applied Animal Behaviour Science 52, 307-3019.

4. Jones A.C, Josephs R.A. Are we Dog’s Best Friend? Predicting Canine Cortisol Response from Human Affiliative and Punitive Behaviors. In: Current Issues and Research in Veterinary Behavioral Medicine: Papers Presented at the 5th International Veterinary Behavior Meeting. Indiana: Purdue University Press, 2005: 194-97.

5. Bonnafous L. Interest in the Use of a New Galenic Form of the Feline Allomarking Pheromone (F4) Analog (Felifriend) during Medical Examination. In: Current Issues and Research in Veterinary Behavioral Medicine: Papers Presented at the 5th International Veterinary Behavior Meeting. Indiana: Purdue University Press, 2005: 119-22.

6. Vas J. et al. (2005) A friend or an enemy? Dogs’ reaction to an unfamiliar person showing behavioural cues of threat and friendliness at different times. Applied Animal Behaviour Science 94/1 , 99 – 115.

7. Alnot-Perronin M. Inappropriate Use of Pain as Punishment in Canine Aggression Toward Household Members. In: Current Issues and Research in Veterinary Behavioral Medicine: Papers Presented at the 5th International Veterinary Behavior Meeting. Indiana: Purdue University Press, 2005: 232-35.

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POGOSTA VPRAŠANJA IN DVOMI O KUŽNIH BOLEZNIH

Sara Suhadolc Scholten

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BRAHICEFALIČNI SINDROM PRI PSIH, ZGODNJE ZDRAVLJENJE JE NUJNO POTREBNO

Vladimira Erjavec

IZVLEČEK

Brahicefalične pasme psov imajo krajšo in širšo gla-vo, obrazni del je skoraj raven, kar pomeni, da nimajo dolgega gobca, ki je značilen za druge pasme. Živali z brahicefaličnim sindromom imajo velike težave z dihanjem in ohlajanjem, težave se stopnjujejo pri višjih zunanjih tem-peraturah in kadar so živali v stresu. Čeprav je brahicefalični sindrom pri psih že dolgo znan, postajajo v zadnjih letih značilni simptomi veliko resnejši in se pojavljajo že pri zelo mladih živalih. Zaradi prirojenih nepravilnosti v dihalnem sistemu veliko število psov brahicefaličnih pasem že zgodaj v življenju trpi zaradi oteženega dihanja.

Uvod

Brahicefalični sindom je posledica izbranega parjenja določenih brahicefaličnih vrst, da bi še bolj poudarili njihov značilni videz skrajšanega in ravnega obraza, predvsem gobčka. Zaradi mnenja, da so živali s potlačenim gobčkom ljubke, je selekcija dobila nerazumne razsežnosti. Pri krajšanju obraznega dela glave so se močno skrajšale določene kosti glave, vsa mehka tkiva pa so ostala ne-spremenjena in so se morala zgnesti na dolžino nekaj cen-timetrov. Stanje najlažje ponazorimo z odstiranjem zavese z okna, ko se zavesa nabere v debelo, nagubano gmoto. Enako se zgodi pri živalih z brahicefaličnim sindromom, pri katerih so nesorazmerja med kostmi in mehkimi tkivi nosu in žrela tako huda, da tvorijo mehka tkiva številne gube in deformacije, ki močno ovirajo pretok zraka pri dihanju.

Brahicefalični sindrom se pogosto pojavlja pri pasmah mops, francoski buldog, angleški in ameriški buldog, bos-tonski terier, pekinčan, shih tzu in nekaterih drugih pas-mah ter križancih teh pasem.

Anatomske ali funkcionalne nepravilnosti

Brahicefalični sindrom predstavlja zoženje zgornjega dela dihal, za katerega je značilna ena ali več nepravilnosti, kot so:

• zoženenosnice,

• zožennosnipreddvor(vestibulum),

• nosne školjke, ki so nepravilnih oblik in povečane(displastične in hiperplastične konhe),

• zaporanosnegadelažrela(obstrukcijanazofaringeal-nega meatusa),

• zaporahoan,tj.odprtin,prekkaterihseobepolovicinosne votline odpirata v žrelo. Do zaprtja pride zaradi spremenjene školjke, ki se obrne proti žrelu,

• predolgoinzelozadebeljenomehkonebo,

• sesedenogrlo(kolapslarinksa),

• izvihanjesluznicegrlavoblikilaringealnihvrečkin

• zožen (hipoplastičen) sapnik (predvsem pri angleškihbuldogih, mopsih).

Klinični znaki

Klinični znaki, ki se pojavljajo pri brahicefaličnem sin-dromu, so odvisni od tega, koliko anatomskih struktur je spremenjenih in v kakšni meri. Značilni klinični znaki so:

• glasnodihanje,

• sikajoči in piskajoči šumi pri dihanju zaradi zožitevzgornjih dihalnih poti (stridor),

• povečannaporobvdihu,

• hiterinoteženizdih,

• težaveprispanju,

• smrčanje,

• pogostodavljenje(spahovanje),

• težjepožiranje,

• širokastojaprednjihnog,

• nezmožnostfizičnihnaporov,

• modrikavostsluznic(cianoza)in

• izgubazavesti(kolaps).

Znaki se ob naporu in razburjenju stopnjujejo. Povečan napor ob vdihu lahko povzroči vnetje in oteklino (edem) sluznice grla in žrela, kar povzroči izvihanje laringealnih

Vladimira Erjavec Klinika za male živali, Veterinarska fakulteta, Gerbičeva 60, Ljubljana vladimira.erjavec@vf.uni-lj.si

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vrečk (grlne sluznice), to pa še dodatno zoži prehod zraka in otežuje dihanje.

Te živali se tudi težje ohlajajo, saj okoli nosnih školjk ni prostora za hladen zrak, ki bi krožil in s tem ohlajal or-ganizem. Zaradi naštetega brahicefalične pasme psov zelo slabo prenašajo telesni napor in višje zunanje temperature, živali se niso več sposobne ohlajati in začnejo še hitreje in plitveje dihati, zaradi česar v organizem ne dobijo do-volj kisika. Znajdejo se v začaranem krogu pregrevanja in pomanjkanja kisika, ki lahko hitro privede do kolapsa in smrti.

Zakaj so te pasme priljubljene?

Brahicefalične pasme psov so vedno bolj priljubljene, samo v Angliji se je število mopsov od leta 2002 do 2013 povečalo za več kot 7-krat (s 1105 na 8071 psov), število francoskih buldogov pa za 27-krat (z 247 na 6690 psov).

Velike okrogle, široko razmaknjene oči in okrogel raven obraz pri brahicefaličnih pasmah spominjajo na otroka, kar je ljudem instinktivno všeč in menijo, da so te pasme ljubke in prisrčne, kar je razlog za priljubljenost teh pasem.

Ali se lastniki živali zavedajo težav z dihanjem?

Večina ljudi, ki se odloči za te pasme, ni seznanjena z njihovimi zdravstvenimi težavami in zelo pogosto menijo, da je tako dihanje živali normalno. Na žalost tudi veliko poznavalcev teh pasem in vzrediteljev ter tudi veterinar-jev meni, da je to normalno dihanje. Tako dihanje je res značilno za brahicefalične pasme, nikakor pa ni normal-no. Ravno to zmotno prepričanje vpliva na nepravočasno zdravljenje predstavnikov teh pasem in na prenašanje teh lastnosti na nadaljnje generacije. Zato je potrebna načrtna vzreja psov teh pasem, da se v bodoče prepreči težave zaradi brahicefaličnega sindroma ter izboljša zdravje in do-bro počutje teh živali.

Zdravljenje

Pri blažjih oblikah brahicefaličnega sindroma lahko psu pomagamo tako, da ga v vročini ne sprehajamo in ga ne izpostavljamo situacijam, v katerih se močno razburi. Hujšanje pri prekomerno rejenih živalih lahko nekoliko omili klinične znake, vendar se moramo zavedati, da dol-gotrajno oteženo dihanje povzroča trajne degenerativne spremembe dihal, zato ima kirurški poseg pri starejših živalih le redko pričakovane rezultate.

Zdravljenje je predvsem kirurško. Najpogosteje se opravi krajšanje mehkega neba in razširitev nosnic. Pri pacientih z napredovalim stanjem bolezni se odstrani tudi laringealne vrečke, mandlje in nosne školjke. Odstranitev laringealnih vrečk ni rutinski poseg, saj lahko na tem mes-tu nastane brazgotina in posledično zoženje grla.

Naštete nepravilnosti so prisotne že ob rojstvu, znaki pa se pojavijo običajno kasneje in skrbniki živali navadno okoli 4. leta starosti živali poiščejo pomoč veterinarja.

Nekateri veterinarji svetujejo širjenje nosnic zelo zgodaj, ko so živali stare od 3 do 4 mesece, praviloma pa želimo te živali operirati pred 2. letom starosti. Tudi za krajšanje me-hkega neba se odločimo razmeroma zgodaj, to je pri sta-rosti 4 do 24 mesecev, saj tako preprečimo degeneracijo grlnih hrustancev in sesedanje grla, ki ju kirurško ne more-mo več popraviti. Ne glede na starost živali ob kirurškem posegu pride vedno do izboljšanja stanja.

Okrevanje po operaciji in možni zapleti

Načinov krajšanja mehkega neba je več, velikega pom-ena pa je, da mehko nebo skrajšamo ravno prav; če ga skrajšamo premalo, se bodo nadaljevale dihalne težave, če pa ga skrajšamo preveč, bo imel pes težave s požiranjem hrane. Ker pri prekomernem skrajšanju mehko nebo svoje funkcije ne opravlja v celoti, hrana zahaja v sapnik in nosni del žrela, kar lahko povzroči vnetje nosnih votlin (rinitis), sinuzitis in aspiracijsko pljučnico.

Po operaciji poskrbimo, da se žival mirno zbudi iz anestezije. Psa budno spremljamo, da takoj odkrijemo morebitne dihalne težave in nemudoma ukrepamo. Kljub kirurškemu posegu, s katerim razširimo zožene dihalne poti, lahko kmalu po odstranitvi tubusa iz sapnika zara-di krvavitve, otekline in krvnih strdkov pride do vnovične zapore dihalnih poti. Po operaciji se lahko pojavi kašljanje in davljenje. Vodo lahko ponudimo živali, ko je popolnoma zbujena iz anestezije, to pa je ponavadi po 6 do 12 urah, hrano pa ji ponudimo šele po 12 do 24 urah. Prezgodnje hranjenje namreč lahko povzroči poškodbo otečenih tkiv, kar oteklino še dodatno poveča, in lahko povzroči dušenje ali aspiracijo hrane. Priporočeno je enodnevno ali dvod-nevno hospitaliziranje živali, ponavadi pa gredo živali v domačo oskrbo isti zvečer, če seveda do tedaj ne pride do zapletov.

Zelo pomembno je, da se lastniki živali z brahicefaličnim sindromom zavedajo, da bo žival po operaciji lažje in tišje dihala, ne smejo pa pričakovati, da bo dihanje neslišno, kot je, denimo, pri nemškem ovčarju ali kateri drugi pasmi z normalno (mezocefalno) obliko glave.

Kaj morajo skrbniki vedeti, če imajo brahicefaličnega psa?

• Preden psa kupijo, naj se dobro poučijo o pasmi innjeni nagnjenosti k bolezenskim stanjem ter preverijo, kakšne dihalne težave imajo sorodniki psa.

• Psanajdovoljzgodajpripeljejonapregledkveterinar-ju (pri prvem pojavu glasnega in oteženega dihanja, ponavadi že pri 4 do 6 mesecih) in se po priporočilu odločijo za kirurški poseg.

• Izogibajo naj se okoliščinam, povezanim s povečanopotrebo po dihanju in hlajenju, to so stres, vročina in prevelika telesna aktivnost.

• Preprečujejonajnastanektoplotnegaudara:

izogibanje pregretju in dehidraciji;

živalim naj v vročih dneh zagotovijo senco oz. jih zadržujejo v ohlajenem prostoru.

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izogibanje transportu, potovanju v vročih delih dneva, oz. če že morajo na pot, naj bo avto klima-tiziran;

izogibanje telesni aktivnosti preko dneva, živali naj sprehajajo zelo zgodaj zjutraj in pozno zvečer, ko so zunanje temperature nižje;

zadostno pitje tekočin in

izogibanje okolju z visoko stopnjo vlažnosti.

LITERATURA

1. Bruchim Y, Klement E, Saragusty J, Finkeilstein E, Kass P. in Aroch I. Heat stroke in dogs: A retrospective study of 54 cases (1999-2004) and analysis of risk factors for death. J Vet Int Med 2006; 20: 38-46.

2. Flournoy SW, Wohl JS in Macintire DK. Heatstroke in dogs: pathophysiology and predisposing factors. Comp Cont Educ Pract Vet 2003; 25: 410-418.

3. Fossum TW. Small animal surgery, 4th ed. St. Louis: Mosby, 2013, 923-930.

4. ACVS. Brachycephalic syndrome. https://www.acvs.org/small-animal/brachycephalic-syndrome (25. 7. 2016).

5. Oechtering GU. Brachycephalic syndrome - new information on an old congenital disease. Veterinary Focus 2010; 20: 2-9.

6. Powell L. Canine Heatstroke. Clinician’s Brief 2008; 8: 13–16.

7. Tabor B. Heatstroke in dogs. Today`s veterinary practice 2014; 50-56.

8. Trappler M in Moore K. Canine brachycephalic airway syndrome: pathophysiology, diagnosis, and nonsurgical management. Compend Contin Educ Vet 2011; 33: E1–E4 .

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PODKOŽNI LIMFOM PRI MAČKI

Živa Černe1, Tamara Dolenšek2, Tanja Švara2 1 Veterinarska ambulanta Max, Dolenjska cesta 250, Škofljica; 2 Inštitut za patologijo, divjad, ribe in čebele, Veterinarska fakulteta, Gerbičeva 60, Ljubljana ziva.cerne@gmail.com

Podkožni limfom je redka oblika ekstranodalnega lim-foma pri mačkah. Tumor se tipično pojavlja kot neboleča čvrsta podkožna tvorba, ki se najpogosteje nahaja v stran-skem prsnem in trebušnem ter medplečnem področju. Histopatološke značilnosti so infiltrati limfoidnih celic v globokem dermisu in podkožju, ki infiltrativno vraščajo v okolno tkivo, obsežna področja nekroze in vnetje. O zdrav-ljenju in prognozi je znanega malo, priporoča se radikalna kirurška ekscizija v kombinaciji s kemoterapijo. Pogoste so lokalne ponovitve tumorja, pa tudi zasevki, predvsem v oddaljeno podkožje in bezgavke.

V prispevku opisujemo primer podkožnega limfoma domače dolgodlake mačke, stare 13 let, sterilizirane, s prekomerno telesno težo, ki je bila pripeljana v ambulanto zaradi multiplih, slabo omejenih vozličastih sprememb v koži in podkožju ledij in križa. S citološko preiskavo je bil postavljen sum limfoma, zato smo se odločili za incizijsko biopsijo sprememb. Hemogram in osnovna biokemična preiskava krvi pred anestezijo sta bila brez posebnosti. S histopatološko preiskavo je bil potrjen limfom podkožja z invazijo tumorskih celic v krvne žile. Kirurška resek-cija tumorja zaradi obsežnosti ni bila mogoča in lastniki so odklonili možnost napotitve z namenom zdravljenja s kemoterapijo oz. obsevanjem, zato smo se odločili za paliativno terapijo s kortikosteroidi. Po nekaj tednih je mačka nenadoma nehala jesti, ni zadrževala blata in urina, odpovedala je motorična funkcija zadnjih nog, začela je kazati bolečine, zato so se lastniki odločili za evtanazijo. Pri raztelesbi smo v podkožju hrbta, ledij, križa, zadnjice, stranske strani stegen in korena repa ugotovili slabo ome-jen, sivo bel, čvrstoelastičen tumor, velikosti 12,5 x 11,5 x 1,5 cm. Vse bezgavke in notranji organi so bili brez makroskopskih sprememb. S histopatološko preiskavo v notranjih organih nismo našli infiltratov limfoidnih celic.

Opisani primer kaže, da je pri mačkah med možne diferencialne diagnoze pri tumorjih podkožja potrebno vključiti tudi podkožni limfom.

UPORABA IN UČINKOVITOST ANTIPARAZITIKOV PRI PSIH

Kristina Dolinar Paulič, Diana Slaček, Luka Pozne, Matic Ramšak Biotehniška šola Maribor Vrbanska cesta 30, 2000 Maribor kristina.dolinar-paulic@guest.arnes.si

V raziskovalni nalogi smo preučevali pomen, uporabo in učinkovitost antiparazitikov pri psih. Zanimala sta nas predvsem antiparazitika Dehinel (febantel, pyrantel em-bonat, praziquantel) in Fypryst (fipronil). V raziskavo smo vključili 13 psov iz mariborskega azila ter tri lastniške pse.

Anketo o pomenu in uporabi antiparazitikov smo izvedli v veterinarskih klinikah v Mariboru in okolici. Učinkovitost antiparazitikov smo preverjali s kliničnim pregledom psov in koprološkimi preiskavami.

Ugotovili smo, da večina lastnikov psov, ki obiskuje veterinarske klinike, uporablja antiparazitike. Izbiro an-tiparazitika zaupajo veterinarju. Večinoma uporabljajo pre-parate spot-on, najbolj prodajano sredstvo pa je Frontline (fipronil, S-metopren). Vprašani veterinarji menijo, da so preparati spot-on najučinkovitejši. Fypryst je po njihovem mnenju enako učinkovit kot drugi preparati z enakim spektrom delovanja. To smo potrdili s kliničnim pregledom psov 10 dni in en mesec po aplikaciji ektoparazitika. Na psih nismo našli zunanjih parazitov. Po rezultatih ankete endoparazitike uporablja večina lastnikov psov. Večinoma uporabljajo endoparazitike v obliki tablet, največ pripravek Dehinel in Pratel. 43 % vprašanih lastnikov te preparate uporablja enkrat letno, 46 % pa vsake tri mesece. Večina lastnikov te pripravke uporablja preventivno.

Kljub informiranosti in vestnosti lastnikov pa smo ugo-tovili, da je 50 % psov kljub dehelmintizaciji še vedno in-vadirana s paraziti. Največjo težavo predstavljajo nematodi iz rodu Strongyloides. Okužba z njimi je ponavadi asimp-tomatska. Ti paraziti so zelo majhni, zato jih v blatu ne opazimo. Dokažemo jih lahko le s koprološkimi preiska-vami.Strongiloidoza ima tudi zoonotičen potencial.

HEPATOZOONOZA – NOVA KLOPNA BOLEZEN V SLOVENIJI

Petra Hodnik Veterinarska ambulanta Buba d.o.o., Rožna dolina 5, 1290 Grosuplje, petra.hodnik@gmail.com

Hepatozoonoza je klopna bolezen, ki smo jo julija lani po nam znanih in dostopnih podatkih prvič diagnostici-rali v Sloveniji. Povzročitelj je enocelični parazit Hepato-zoon canis (H. canis), ki se prenaša z rjavim klopom Rhi-picephalus sanguineus. Do okužbe pride, ko pes klopa poje. H. canis se s krvjo razširi po telesu - v jetra, ledvice, vranico, bezgavke, kjer povzroča vnetje, ter invadira lev-kocite. Klinični znaki so nespecifični, pojenjajo in se znova pojavijo, lahko pa bolezen sprva poteka asimptomatsko in izbruhne ob oslabljenem imunskem sistemu.

Psička Greta, stara 1 leto, je bila sprejeta zaradi nenad-nega bruhanja, driske, potrtosti,zmanjšanega apetita in povišane telesne temperature (40.5˚C). Laboratorijski izvid je pokazal povišane levkocite (23.6x109/L; 5.0-14.16x109/L) in alkalno fosfatazo (269U/L; 1-114U/L). Psičko smo hos-pitalizirali in začeli s terapijo: infuzija, metronidazol, rani-tidin in meloksikam. Naslednji dan se je stanje izboljšalo in odpustili smo jo v domačo oskrbo s terapijo (antibiotik, antacid in dieta).

Čez tri tedne je prišla nazaj s telesno temperaturo 41˚C, letargična in neješča. Krvna slika je pokazala še višjo levkocitozo (39.5x109/L). Opravljen je bil rentgen abdom-na (brez posebnosti). Po posvetu z lastnico smo se odločili

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za zdravljenje z doksiciklinom (10mg/kg/dan 28 dni). Na terapiji je bila asimptomatska. Štiri dni po prenehanju so se simptomi vrnili. Odločili smo se vzorec blata poslati na bakteriološko, mikološko in parazitološko preiskavo, ter kri usmerjeno na PCR za H. canis, v zunanji laboratorij (Idexx Laboratories, Lepizig, Nemčija). Prejeli smo pozitiven rezul-tat za H.canis, Giardio in Capillario sp.. Začeli smo s tera-pijo z imidocarb diproprionatom (6.6mg/kg s/c) in iverme-ktinom (0,3mg/kg s/c) in jo ponovili dvakrat v razmiku 14 dni. Kontrolni PCR je bil na prisotnost H. canis negativen. Po terapiji je bila psička asimptomatska. Prisotnost Giardie in Capillarie ocenjujemo kot sekundarna patogena in ne primarni vzrok simptomov. Z našim primerom želimo opo-zoriti na prisotnost H. canis v Sloveniji in izpostaviti tudi to kot možno diferencialno diagnozo.

PRIMER KOŽNE ASTENIJE (EHLERS-DANLOSOVEGA SINDROMA) PRI PSU

Miran Knez¹, Alja Kuštrin Knez¹, asist. Tamara Dolenšek², doc. dr. Tanja Švara², Francesca Abramo³ ¹ Ambulanta za male živali, Miran Knez, s.p., Loke 8, Trbovlje ² Inštitut za patologijo, divjad, ribe in čebele, Veterinarska fakulteta, Gerbičeva 60, Ljubljana ³ Department of Veterinary Science, University of Pisa, 56124 Pisa, Italy ambulanta.knez@gmail.com

Predstavljamo primer kožne astenije pri 18 mesecev starem psu moškega spola, mešancu s Sibirskim huskyi-jem. Pes je bil ves čas živahen, normalno ješč in v dobrega splošnega zdravja. S hematološko in biokemično preiskavo krvi ni bilo ugotovljenih odstopanj od normalnih vrednosti.

Prve težave z razpokano kožo in oteklinami na področju komolčnih ter skočnih sklepov so se začele po-javljati pri starosti štirih mesecev. Sledile so pogoste raz-trganine kože brez krvavitev, ki so nastale brez delovanja večje mehanične sile, večinoma na distalnih delih okončin. Večje rane smo kirurško obdelali, manjše so se zacelile sekundarno z brazgotinjenjem. Poleg tega smo ugotovili, da je koža na vratu in hrbtu prekomerno raztegljiva, zato smo postavili sum kožne astenije. Izmerili smo indeks raz-tegljivosti kože (ang. skin extensibility index, okr. SEI). SEI smo izračunali po formuli: razmerje med vertikalno višino kožne gube ÷ dolžina telesa × 100. Vrednosti SEI normal-nih psov so manj kot 14,5 %, v našem primeru je bil SEI 21,43 %. Kasneje smo ugotovili še povečano gibljivost karpalnih sklepov.

Histopatološka preiskava kože je v dermisu pokazala snope kolagenih vlaken različnih debelin, ki so imeli mul-tifokalno neurejen potek. Posamezni snopi kolagenih vlaken so bili izredno tanki. V epidermisu ni bilo vidnih posebnosti.

Na osnovi kliničnih znakov in histopatološke preiskave smo postavili diagnozo kožne astenije. Kožna astenija (sin. Ehlers-Danlosov sindrom) je redka dedna bolezen vezivne-ga tkiva, katere značilnosti so hiperelastičnost in krhkost kože s slabim celjenjem ran in brazgotinjenjem, krhkost krvnih žil ter prevelika razteznost sklepov. Edina podporna

terapija, opisana v literaturi, je aplikacija 500 mg vitamina C dnevno, ki jo je pes v času objave tudi prejemal.

KIRURŠKO ZDRAVLJENJE DEGENERATIVNE LUMBOSAKRALNE STENOZE (DLSS) Z DEKOMPRESIJO, DISTRAKCIJO IN STABILIZACIJO PRI PSIH

Milan Matko Toplica center za zdravljenje živali, Topolšica 15, 3326; matko.toplica@siol.net

DLSS je eden najpogostejših vzrokov za šepanja na zadnji nogi in L/S bolečino pri starejših psih srednjih in ve-likih pasem ter pri delovnih psih. Prvenstveno vlogo pri tem igra degeneracija medvretenčnega diska L7-S1.

Kirurško zdravljenje je indicirano, ko s konzervativnim zdravljenjem ne moremo umiriti bolečin, pri kronični dinamični kompresiji in, ko je prisoten motoričen in / ali senzoričen deficit.

V letu 2016 in do konca januarja 2017 smo kirurško zdravili 6 psov pri katerih smo diagnosticirali DLSS. Di-agnoze smo postavili po anamnezi, na osnovi odziva na medikamentozne terapije, po klinični sliki, z ortopedskim in nevrološkim pregledom ter z nativnimi in kontrastnimi (mielografija) rentgenskimi in računalniško tomografskimi (CT) preiskavami.

Z nativnimi in kontrastnimi CT preiskavami smo natančno ugotovili obseg degenerativnih sprememb in mesta zožitev hrbteničnega kanala in/ali medvretenčnih lin ter vrsto kompresije, kar je pri kirurškem zdravljenju omogočilo boljši, natančnejši pristop in uspešen izhod operacije. S kirurško tehniko L/S dekompresije, z dorzalno laminektomijo, distrakcije in stabilizacije L7-S1 smo elim-inirali zožitve in pritiske, pri L/S nestabilnosti pa preprečili napredovanje degeneracije in kolaps vretenc L7-S1. Za dorzalno laminektomijo smo uporabljali kovinske in dia-mantne frezice ter različne kostne ščipalke. Laminektomija je obsegala dolžino 1/3 do 2/3 sedmega ledvenega vreten-ca in dolžino 1/3 križnice (S1) ter v širino 1/3 vretenc. Po distrakciji s posebnim gelpijem z vzporednima konicama smo L7-S1 najprej stabilizirali preko sklepnih podaljškov s kiršnerjevimi iglami s trokar konico, s konico s pozitivnim navojem ali s kortikalnimi vijaki 2,7mm. Nato smo v telo vretenca L7 privili po dva kortikalna vijaka 3,5mm, tik za transferzalnima podaljškoma (kavdalno) in enako po dva vijaka v telo S2 in krila križnice. Odprtino po laminektomiji smo zaščitili z želatinskimi gobicami. Na glavice vijakov smo nanesli in jih povezali s polymethyl-methacrylatom (PMMA, DePuy CMW2 z gentamicinom). Pooperativno smo odredili strogo mirovanje 8 tednov in rentgensko kon-trolo po 3 tednih. Tehnika operacije je enostavna, zanes-ljiva in omogoča dobro in želeno rehabilitacijo.

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OKUŽBA Z MYCOPLASMO HAEMOFELIS PRI MAČKAH (Feline hemotropic mycoplasmosis)

Štefi P. Borko, Silvo Weingerl Veterinarska bolnica Lenart d.o.o., Gradiška cesta 6, Lenart dr.stefi.p@gmail.com

V letu 2016 (marec, september, november) smo se v Veterinarski bolnici v Lenartu srečali s tremi primeri okužbe z Mycoplasmo haemofelis pri mačkah, starih od 3 do 10 let.

Vsi pacienti so prišli s podobno anamnezo: neješčnost, apatija, letargija, slabotnost, hujšanje. Ob kliničnem pregledu so imeli vsi povišano telesno temperaturo (39.5°C-40.0°C), blede očesne veznice in dlesni, povečane mandibularne bezgavke, CRT>2 s, tahipneo, tahikar-dio, palpatorno neobčutljiv abdomen, pri enem pa je bil izražen tudi ikterus. Lastniki so v vseh treh primerih izključili možnost zastrupitve z rodenticidi.

Pri vseh so bile opravljene krvne preiskave, ki so poka-zale hemolitično anemijo, na osnovi krvnega razmaza pa smo postavili sum na okužbo z Mycoplasmo haemofelis. Kri je bila poslana v laboratorij Laboklin v Linz, kjer so s PCR preiskavo sum tudi potrdili. Hitri FeLV/FIV test (FAST TEST®Megacor) je bil pri prvih dveh mačkah negativen, pri tretjem mačku pa pozitiven (FeLV). Pri slednjem je bil opravljen še FIP test (FAST TEST®Megacor), ki pa je bil negativen.

V prvem primeru smo se, zaradi izredno nizkega he-matokrita in hemoglobina, odločili takoj za transfuzijo, pri ostalih pa smo začeli s tekočinsko terapijo, antibiotiki (kinoloni), kortikosteroidi (prednisolon) in podporno tera-pijo. En pacient se je lepo odzval na zdravljenje, druga dva pa sta bila zaradi slabega odziva na zdravljenje po nekaj dneh uspavana.

Rezultati so skladni z opisanimi, ki predvidevajo boljšo prognozo pri mačkah, ki so zdravljene pravočasno in/ali v zgodnji fazi bolezni. Pri mačkah, okuženih z virusom FeLV, pa se običajno pojavlja hujša oblika anemije, ki je pogosto smrtna.

KOLIZIJSKI TUMOR USTNE VOTLINE Z ZASEVKOM V MANDIBULARNO BEZGAVKO

Metka Šimundić1, Vice Zaninović1, Mitja Gombač2, Tamara Dolenšek2, Tanja Švara2 1 PRVA-K, Klinika za male živali, Gorkičeva 6, Ljubljana 2 Inštitut za patologijo, divjad, ribe in čebele, Veterinarska fakulteta, Gerbičeva 60, Ljubljana metka.simundic3@gmail.com

Kolizijski tumorji so redka patološka sprememba, pri kateri se na isti anatomski lokaciji pojavita dva izvorno različna tumorja.

V prispevku predstavljamo primer kolizijskega tumorja ustne votline, zgrajenega iz amelanotičnega melanoma in fibrosarkoma z zasevkom obeh komponent v mandibular-no bezgavko. Tumor smo diagnosticirali pri dvanajstletni zlati prinašalki, ki jo je lastnik pripeljal na pregled zaradi zatrdline na vratu. Med kliničnim pregledom smo v levem podušju ugotovili tvorbo, velikosti 6 x 3 x 3 cm, v sluznici ustne votline na levi bukalni strani pa eksofitno tvorbo, ve-likosti 2 x 1 x 1 cm. Z ultrazvočno preiskavo smo v podušju ugotovili tvorbo hipoehogene strukture. Ultrazvočna pre-iskava trebuha in rentgenska slikovna preiskava pljuč sta bili brez posebnosti, krvna slika pa je pokazala le blago levkocitozo z nevtrofilijo.

Tvorbi smo po predhodni tankoigelni aspiracijski bi-opsiji, s katero smo ugotovili skupine epiteloidnih celic, ki so izražale več kriterijev malignosti, kirurško odstranili in opravili histopatološko preiskavo. Ugotovili smo, da je tvorba v ustni votlini iz dveh komponent - tumorja, zg-rajenega iz vretenastih celic, in tumorja, zgrajenega iz epiteloidnih celic. Citoplazma obeh komponent tumorja je bila popolnoma nepigmentirana. V bioptu iz levega podušja smo ugotovili zasevek v bezgavki, ki je bil prav tako zgrajen iz dveh tumorskih komponent, ki sta bili po opisu enaki komponentama tumorja iz ustne votline. Z imunohistokemično preiskavo smo v tumorski komponenti iz epiteloidnih celic ugotovili izražanje antigena Melan A in S-100, komponenta, zgrajena iz vretenastih celic, pa je bila negativna na Melan A in S-100. Melan A je tumor-ski označevalec, visoko specifičen za melanom. Izražanje Melana A so ugotovili v 92,6 % amelanotičnih melanomov ustne votline, izražanje S-100 pa v 76 % tumorjev.

Na osnovi histopatološke in imunohistokemične pre-iskave smo tumor diagnosticirali kot kolizijski tumor ustne votline, zgrajen iz fibrosarkoma in amelanotičnega mela-noma, z zasevkom v mandibularno bezgavko.

Psička je čez štiri mesece začela šepati na prednjo levo okončino in nehala jesti. S kliničnim pregledom smo ugo-tovili recidiv na mestu odstranjene mandibularne bezgavke in čvrstoelastično, nepomično tvorbo v področju lopatice, zato so se lastniki odločili za evtanazijo.

Po naših podatkih je to prvi opisan primer kolizijskega tumorja v ustni votlini psa, sestavljenega iz melanoma in fibrosarkoma.

SEKUNDARNI (NUTRICIJSKI) HIPERPARATIREOIDIZEM PRI MAČKU

Primož Šušteršič1, Darja Pavlin2 1 PRIMAVET, Primož šušterič S.P., Ptujska cesta 38, 2327 Rače 2 Klinika za male živali, Veterinarska fakulteta, Gerbičeva 60, Ljubljana primoz.susteric@gmail.com

V ambulanto smo zaradi 10 dni trajajočega kihanja sprejeli kastriranega mačka, starega 8 mesecev in težkega 3,05 kg. Lastniki so navajali tudi občasen mišični tremor v zadnjih petih dneh.

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Ob kliničnem pregledu smo ugotovili normalno telesno temperaturo, rahlo povečane mandibularne bezgavke in pozitiven trahealni refleks. Laboratorijske preiskave krvi so pokazale relativno limfocitozo in hemokoncentracijo ter povišan ALP in K+ ter znižan Ca. Hitri test FIV/FeLv je bil negativen. V ambulanti smo naredili bris iz nosnic in citološko preiskavo vzorca, pri kateri smo našli veliko število nevtrofilnih granulocitov.

Terapirali smo ga z antibiotiki Convenia (Zoetis), Calfo-setom (Krka) ter Vitamini AD3E (Krka).

Na kontroli čez 3 dni so povedali, da je maček prenehal kihati, ampak da je videti prestrašen, občasno nepremično stoji in ima še vedno občasne mišične tremorje. Zaradi hipokalcemije smo se odločili za določanje koncentraci-je parathormona (PTH). Do izvidov smo mu predpisali nadomeščanje kalcija, kar so lastniki izvajali z dajanjem zdrobljene jajčne lupine, ker je maček odklanjal tablete kalcija. Na kontroli čez en teden je bil kalcij v referenčnih mejah. Pri pacientu je bila izmerjena zelo visoka kon-centracija PTH (> 1000 pg/ml, ref. < 40 pg/ml). Po pod-robni anamnezi smo izvedeli, da mačka hranijo izključno z mesom, brez kakršnihkoli komercialnih diet. Prav tako odklanjajo prehranska dopolnila. Upoštevajoč starost živali in anamnestični podatek o enostranski prehrani ter izjemno visoko koncentracijo PTH ob hipokalcemiji je najverjetnejša diagnoza sekundarni nutricijski hiperparat-ireoidizem. V angleški literaturi se za to bolezen pojavlja tudi izraz »all meat syndrome«. Nastane zaradi pomanj-kanja razpoložljivega kalcija v hrani in posledično znižane koncentracije kalcija v krvni plazmi.

Lastnikom živali smo priporočali terapijo s kalcijevim karbonatom (50mg/kg/24 ur) ter izbalansirano prehrano. Prognoza je v primeru, če ne pride do osteopenije, dobra.

PRIMARNI HIPOADRENOKORTICIZEM PRI MAČKI

Alenka Lavra Zajc, Maja Puc Veterina MH, Bernekerjeva 43, 1000 Ljubljana lavra.zajc@gmail.com

V ambulanto so pripeljali 3-letnega kastriranega mačka zaradi polidipsije in letargije. Med kliničnim pregledom je bila ugotovljena hipotermija, šibki femoralni pulzi, suhe sluznice, apatija in izguba telesne teže. Osnovna krvna slika je bila brez posebnosti. Biokemijska preiskava krvi je pokazala azotemijo, hiperkaliemijo, hiperfosfatemijo, hiperkalciemijo in hiponatriemijo. Analiza urina je bila brez posebnosti, razen znižane specifične teže (1,022). Bakteriološka preiskava urina je bila negativna. Ultrazvočni pregled trebušne votline je bil brez posebnosti, na rent-genogramu prsnega koša je bila ugotovljena mikrokardija. Po zdravljenju z intravensko infuzijo fiziološke raztopine (0,9% NaCl) se je klinično stanje močno izboljšalo. Ponovna biokemijska preiskava krvi je pokazala normalne ledvične parametre, normalne vrednosti kalija, klora in fosforja. Prisotna je bila le blaga hiponatriemija in hiperkalciemija. Opravljen je bil ACTH stimulacijski test. Vrednost kortizola

je 60 minut po intravenozni aplikaciji 0,125mg tetrakozak-trina ostala pod zaznavno mejo (<2,8 nmol/l), kar je potrdi-lo diagnozo hipoadrenokorticizma. Pričelo se je zdravljenje s prednizolonom (0,04 mg/kg/24ur) in fludrokortizonom (0,05 mg/12ur).

Po terapiji se je klinično stanje izboljšalo. Maček je začel pridobivati na teži, ni bil več letargičen, kožuh se je izboljšal, polidipsija ni bila več tako izrazita. Kljub temu so bile vrednosti natrija in klora še vedno nizke, zato se je doza fludrokortizona postopoma poviševala. Vrednosti smo kontrolirali približno na 3 tedne. Z dajanjem predni-zolona smo prenehali, saj so se pojavili znaki hiperadre-nokorticizma. Vrednosti elektrolitov so se normalizirale na dozi 0,15 mg/12ur. Doza fludrokortizona naj bi se pogosto morala poviševati v prvih 6-18 mesecih po začetku tera-pije, zaradi progresivnega uničenja skorje nadlevične žleze, sprememb v absorbciji ali metabolizmu zdravila.

Potrebni bodo redni pregledi, da ugotovimo ali je doza fludrokortizona še ustrezna. V kolikor bi postala previsoka, bomo fludrokortizon nadomestili z deoksikortikosteron pivalatom.

Hipoadrenokorticizem velja za izjemno redko bolezen pri mačkah, opisanih je le okrog 40 primerov. Ponavadi je vzrok idiopatska atrofija skorje nadledvične žleze, na-jverjetneje zaradi imunsko pogojenega procesa. Opisani so tudi primeri destrukcije žleze zaradi obojestranske infil-tracije žleze pri multicentričnem limfomu. Dejanska preva-lenca ni znana, saj verjetno mnogo primerov ni opisanih oz. se bolezen zlahka spregleda, saj so znaki nespecifični in jo lahko zamenjamo z drugimi boleznimi, predvsem s kronično ledvično boleznijo.

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CONTRAST ENHANCED ULTRASOUND FOR ASSESSMENT OF PERFUSION OF MURINE MELANOMA B16F10 TREATED WITH

IRRADIATION AND ELECTROTRANSFER OF PLASMID ENCODING shRNA AGAINST MCAM

Maja Brložnik

Perfusion is one of the key parameters for evaluation of the effectiveness of vascular-targeted therapies and one of the noninvasive methods for detection of tissue per-fusion on a capillary level is contrast-enhanced harmonic ultrasound (CEUS).

The aim of this study was to evaluate results of CEUS as possible prognostic and predictive factors of murine melanoma B16F10 treated with irradiation and gene elec-trotransfer.

The murine melanoma B16F10 tumors, growing on the back of C57Bl/6 mice, were treated by irradiation and electrotransfer of plasmid encoding shRNA against mela-noma cell adhesion molecule (MCAM). The treatment effect was evaluated by determination of tumor growth delay, tumor perfusion and proportion of complete re-sponses. Tumor volume was calculated from perpendic-ular diameters measured every second day with Vernier-calliper. Growth delay was determined as difference in time when tumors reach volume of 40 mm3. For perfusion assessment of the tumors before, during and after therapy contrast enhanced harmonic ultrasound with Sonovue® contrast agent was performed on days 0, 1, 2, 5, 7 and 10. Results of contrast studies were compared to results of tumor growth curves and proportion of complete re-sponses.

Perfusion of tumors in control groups and before treat-ment varied considerably between the tumors due to the presence of necrosis. This variability was even more pro-nounced with tumor growth. Nevertheless tumor perfu-sion correlated well with growth delay and complete re-sponses. The largest tumor growth delay was observed in mice treated with irradiation and gene electrotransfer of either control or therapeutic plasmid. However, propor-tion of tumor complete responses was significantly larger in mice treated with MCAM plasmid gene electrotransfer and irradiation compared to all other control groups. Per-fusion pattern could not differentiate these mice with mice treated only with gene electrotransfer of either MCAM or control plasmid.

Contrast-enhanced harmonic ultrasound of tumors proved to be a good method of perfusion assessment. Due to possible value as a prognostic and predictive fac-tor of the disease contrast-enhanced harmonic ultrasound of tumors might soon provide many interesting results regarding electrochemotherapy and gene electrotransfer in scientific research and clinical practice. The information gathered with contrast-enhanced ultrasound is easily avail-able during therapy and might therefore also support the decisions regarding the treatment of individual patients.

Maja Brložnik1, Simona Kranjc2, Maša Bošnjak2, Valter Mrak3, Nina Boc4, Monika Savarin2, Darja Pavlin1, Nataša Tozon1, Gregor Serša2, Maja Čemažar2 1 Small Animal Clinic, Veterinary faculty, Gerbičeva 60, Ljubljana 2 Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloška 2, Ljubljana 3 Angelini Pharma d.o.o., Koprska ulica 108, Ljubljana 4 Radiology Department, Institute of Oncology Ljubljana, Zaloška 2, Ljubljana majabrloznik@gmail.com

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SHORT-TERM EVALUATION OF BLEOMYCIN-BASED ELECTROCHEMOTHERAPY AS A SINGLE-MODALITY TREATMENT OF A COBBLESTONE COLORECTAL CARCINOMA IN A DOG

Alberto Bajo Vet Hospital H24 Firenze Via de’ Vanni 25 - 50142 Firenze (Italy) albertobajo81@gmail.com

Electrochemotherapy (ECT) is a local treatment for sol-id tumors that combines systemic or local administration of cytotoxic drugs with the application of electric pulses to the tumors. This technique enhances intracellular drug delivery and ultimately leads to cancer cells death.

The aim of this work is to evaluate the efficacy of ECT in the treatment of a canine colorectal carcinoma. Surgical excision is the current treatment of choice for this neopla-sia, with a postsurgical mean survival time of 12 months.

A 7-year-old, neutered male dog was referred because of hematochezia of 8 months duration. Colorectal carci-noma was diagnosed by means of histopathologic exami-nation of endoscopic biopsies of a colorectal cobblestone mass. Clinical staging, including abdominal ultrasound, cytology of medial iliac lymph nodes and a total body CT scan, revealed a stage 1 disease (T1N0M0). The dog under-went two ECT treatments 3 weeks apart. After prolapsing the mass through the anus, bleomycin was administered intravenously and electrical pulses were locally applied 8 minutes later. All ECT treatments were performed under general inhalational anaesthesia.

The treatment was well tolerated; the only indicative side effect reported was transient tenesmus of two weeks duration after the second ECT treatment.

Hematochezia immediately subsided after the first ECT treatment. It recurred 15 days later but completely resolved following the second treatment. At 6 months follow-up no recurrence of clinical signs was reported. Visual inspec-tion and a second CT scan failed to detect recurrence; the affected area was not resampled for histopathology.

Electrochemotherapy can be an effective, safe and well tolerated treatment of canine colorectal carcinoma, and could represent an alternative to surgery.

SAFETY AND EFFICACY OF INTRAOPERATIVE ELECTROCHEMOTHERAPY OF SOFT TISSUE SARCOMA IN 26 DOGS

Ron J Lowe1, Filippo Torrigiani2, Alessio Pierini2, George Lubas2 1 Ashleigh Veterinary Clinic, Knaresborough, North Yorkshire, UK 2 Veterinary Teaching Hospital, Department of Veterinary Sciences, University of Pisa, Via Livornese lato monte, Pisa, Italy pippotorrigiani@hotmail.it

Soft Tissue Sarcomas (STS) represent 15% of all skin and subcutaneous tumours in dogs. Local tumour control with wide margins surgery or a combination of surgery and radiation therapy is the standard of care in the man-agement of these tumours. Electrochemotherapy (ECT) is a local ablative technique for the treatment of locally in-vasive tumours.

The aim of this study was to evaluate the safety and efficacy of intraoperative ECT in the treatment of STS in dogs.

Twenty-six dogs with a diagnosis of STS were enrolled. All dogs were treated with cytoreductive surgery with very narrow or zero margins and intraoperative electrochemo-therapy coupled with systemic bleomycin. Local toxicity, tumour recurrence rate and disease free interval (DFI) were evaluated.

Most tumours were grade II (15/24), and most com-monly located to the limbs (19/26). Tumour size ranged from 2 to 15 cm (median 4.75 cm). Median follow-up period was 422.5 days (range 8-1297). Treatment toxic-ity was well tolerated in 62% of cases (16/26 had toxicity score ≤2 in a scale of 5 as maximum) and was not associ-ated with tumour grade, tumour size, pulse frequency and pulse voltage.

Nine dogs died during the study period, three had tu-mour recurrence, which was the reason for euthanasia in two cases. Of the other 17 dogs, three had tumour recur-rence and in one case the limb affected was amputated as rescue treatment. Overall, tumour recurrence rate was 23% (6/26). Recurrence rate was not associated with tu-mour grade, anatomical site, tumour size, pulse frequen-cy and pulse voltage. For all dogs, median DFI was not reached. For dogs with tumour recurrence, mean DFI was 240 days (range 26-1025).

Intraoperative electrochemotherapy coupled with sys-temic bleomycin has been well tolerated but its overall ef-ficacy needs further investigations.

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SUPERFICIAL SQUAMOUS CELL CARCINOMA SUCCESFULLY TREATED WITH BLEOMYCIN-BASED ELECTROCHEMOTHERAPY IN THREE CATS

Alberto Bajo Vet Hospital H24 Firenze Via de’ Vanni 25 - 50142 Firenze (Italy) albertobajo81@gmail.com

Electrochemotherapy (ECT) is a local treatment for sol-id tumors that combines systemic or local administration of cytotoxic drugs with the application of electric pulses to the tumors. This technique enhances intracellular drug de-livery and ultimately leads to cancer cells death. Although in recent years ECT has been investigated and documented as an effective treatment for feline superficial squamous cell carcinoma (SCC), surgical excision, radiation therapy, photodynamic therapy and strontium-90 plesiotherapy still represent the main therapeutic options available for the treatment of this neoplasia.

The aim of this study is to evaluate the efficacy and tolerability of ECT for the treatment of superficial feline squamous cell carcinoma (SCC).

Three cats diagnosed with superficial SCC by means of histopathologic examination of biopsies were included in this study. One cat with bilateral SCC on the head was in stage TisN0M0, the second cat with SCC localized on the nasal planum was in stage T1N0M0, and the third cat was in stage T2N0M0 with SCC localized on the pinnae. All cats were treated with intravenous bleomycin (15 mg/m2), then electrical pulses were locally applied 8 minutes later. The patients in stage TisN0M0 and T1N0M0 underwent a single ECT treatment while the one in stage T2N0M0 underwent two ECT treatments 3 weeks apart. All ECT treatments were performed under general inhalational anaesthesia.

The treatment was well tolerated; the only indicative side effect was transient anorexia after the ECT treatment of the nasal planum.

CR were obtained in all cats with a follow up of 3, 5 and 7 months.

Electrochemotherapy can be an effective, safe and well tolerated treatment for superficial feline SCC, and could represent an alternative to surgical excision, radiation therapy, photodynamic therapy and strontium-90 plesio-therapy.

CLINICAL OUTCOME IN A DOG AFFECTED BY SUBCUTANEOUS SOFT TISSUE SARCOMA (SSTS) TREATED WITH: SURGICAL THERAPY, INTRAVENOUS BLEOMYCIN INTRAOPERATORY-ELECTROCHEMOTHERAPY (IO-ECT) AND FLAP RECONSTRUCTION

Michela Campigli1, Elsa Pollaci1, Valentina Giacobbi2, Giovanna Bertolini1, Tomasso Furlanello2. 1 San Marco Veterinary Clinic, Padova 2 San Marco Veterinary Laboratory, Padova michelacampigli@virgilio.it

ECT combines the administration of trains of biphasic pulses with the local or systemic application of chemother-apy drugs. There is no information about the use of plastic surgery after IO-ECT and IV bleomicyn for treatment of canine sSTS.

The aim of the study was to evaluate the clinical out-come of sSTS treated at the time of surgery with intrave-nous bleomycin IO-ECT and skin flap reconstruction.

A dog with whole-body computed-tomography stag-ing and histological/immunohistochemical diagnosis of sSTS of the flank was treated with surgical tumor exci-sion, intravenous bleomycin IO-ECT and reconstruction with caudal superficial epigastric axial skin flap. Long-term follow-up was available.

The sSTS was a hemangiopericytoma with histological grade I, clinical stage I, with histological confirmation of complete tumor excision. The surgical wound was closed with a caudal superficial epigastric axial skin flap and an active drain was placed. Type and frequency of skin axial flap complications seen after intravenous bleomycin IO-ECT was similar to what currently reported in literature when this surgical reconstruction is not preceded by intra-venous bleomycin IO-ECT. The dog is currently in remission (mean: 455 days).

In our experience intravenous bleomycin IO-ECT fol-lowed by wound closure with axial flap seems effective and safe treatment for sSTS.

ZBORNIK REFERATOV XXX. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH ŽIVALI

Portorož, 31. marec – 1. april 2017

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XXX. SIMPOZIJ O AKTUALNIH BOLEZNIH MALIH ŽIVALI ZBORNIK REFERATOV

Portorož, 31. marec – 1. april 2017

90