Small Animal Emergency and Critical Care Medicine: Self-Assessment Color Review, Second Edition, Q&A 02
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Student tip: This case is effective in showing the application of theory to real life. |
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| Question | Answer | Article | |
| How do HES colloids affect coagulation? | They can cause a dilutional effect and affect von Willebrand’s factor, factor VIII, and platelet function, as well as reduce fibrin polymerization. There is no clinical evidence of bleeding reported in animals receiving 6% hetastarch in saline (Hespan®) or 6% tetrastarch (Voluven®) at doses <20 ml/kg/day. Tetrastarch has no bleeding at doses <50 ml/kg/day.
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| What are the pros and cons of using an HES colloid in the following cases:
• A 6-year-old intact male Labrador Retriever presents with severe anemia and compensatory shock 24 hours after ingesting an anticoagulant rodenticide. PCV equals 0.15 l/l (15%); TS equals 45 g/l (4.5 g/dl). • An 11-year-old cat presents with vomiting and abdominal pain after eating bacon grease. The cat is in early decompensatory shock with a diagnosis of pancreatitis. PCV equals 0.5 l/l (50%); TS equals 54 g/l (5.4 g/dl). • A 14-year-old mixed-breed dog presents for surgical removal of a mass in a single liver lobe. The perfusion is adequate prior to induction. PCV equals 0.38 l/l (38%); TS equals 79 g/l (7.9 g/dl). |
HES can be used for initial volume replacement, but plasma and pRBCs whole blood transfusions will be required to supplement coagulation proteins and restore clotting times, and provide RBCs.
• Pancreatitis is an SIRS disease characterized by vasodilation, increased capillary permeability, and hypercoagulable state. A differential charge between administered HES molecules and the capillary pore may occur, blocking the passage of HES molecules into the interstitium. HES may also downregulate and decrease expression of endothelial surface adhesion molecules, reported to decrease cytokine release, inflammation, endothelial injury, and leukocyte migration into the interstitium. HES has been shown to reverse changes in microvascular permeability caused by oxygen free radicals during reperfusion injury. • HES products can be safely used in the surgical patient, remembering that blood flow and circulatory pressures may be enhanced, facilitating tissue oxygenation, compared with when crystalloids are used alone. Adequate hemostasis is always required, and blood products may be given to supplement coagulation proteins. |
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