Clinical evaluation and management of hemoperitoneum in dogs

Abstract

Objective: Review the clinical presentation, assessment, resuscitation, and medical and surgical management of dogs with hemoperitoneum.Etiology: Hemoperitoneum is defined as free intra‐abdominal hemorrhage. Hemoperitoneum occurs from traumatic and nontraumatic causes. Common etiologies include atraumatic rupture of intra‐abdominal masses, coagulopathies, as well as blunt, and penetrating trauma to the abdomen.Diagnosis: Definitive diagnosis of hemoperitoneum entails demonstration of free intra‐abdominal blood via paracentesis or diagnostic peritoneal lavage. Imaging and other diagnostic tests including coagulation studies may help to determine underlying causes of hemoperitoneum or concurrent organ dysfunction.Therapy: Goals of therapy for patients with hemoperitoneum include maintenance and restoration of effective circulating volume, maintenance and restoration of oxygen‐carrying capacity, and arrest of hemorrhage. These goals can be achieved via fluid resuscitation, administration of blood products or hemoglobin‐based oxygen carriers, as well as application of abdominal counterpressure, and surgical intervention. Surgery usually is required for bleeding intra‐abdominal neoplasms. Emergency surgery is recommended for hemorrhaging patients with penetrating trauma, gastric dilatation and volvulus, bleeding cysts, liver lobe torsion, splenic torsion, and any other condition resulting in organ ischemia.Prognosis: Prognosis in patients with hemoperitoneum may depend on the underlying cause and concurrent injuries.

Transfusion practice in dogs and cats: an Internet‐based survey

“…No cats received allogenic blood and no transfusion reactions occurred, with all 15 cats being discharged and doing well >6 months later . An important benefit of autologous transfusion is sparing valuable blood resources while eliminating the risk of severe transfusion reactions, when it is safe and feasible . In a report of autologous transfusion following intra‐abdominal vessel damage and hemoperitoneum, blood removed from the abdominal cavity using cell‐salvage devices was effectively readministered to replace circulating volume with no detrimental effects related to RBC salvage .…”

Autologous blood transfusion in dogs with thoracic or abdominal hemorrhage: 25 cases (2007–2012)

“…However, investigations in people have failed to demonstrate worse outcome or increased metastatic rate associated with administration of ABT to patients undergoing oncological surgery, and no association has been found between the presence of circulating neoplastic cells and poorer prognosis . Nonetheless, the use of leukocyte depletion filters has been recommended when performing ABT in human cancer patients to reduce the number of malignant cells infused . Such filters were not used in these dogs.…”

“…When active hemorrhage is the source of ABT blood, the addition of anticoagulant may be warranted . It has been recommended in the veterinary literature to add either 0.05–0.07 mL of anticoagulant per milliliter of collected blood or 0.14 mL of anticoagulant per milliliter of collected blood . In this study, 12 dogs had the collected blood transferred into commercial blood bags containing 63 mL citrate phosphate dextrose adenine.…”

Perioperative red blood cell transfusion requirement for various surgical procedures in dogs: 207 cases (2004–2013)

“…[8][9][10][11][14][15][16][17] Values are number (%). 4,8 At the authors' hospital (University of Missouri Veterinary Teaching Hospital), partial gastrectomy is most commonly performed to remove gastric tissue damaged secondary to gastric dilation and volvulus. †Denominator is number of dogs that received a transfusion or number of dogs that did not, as applicable.…”

“…Kerl and Hohenhaus 5 developed a transfusion need scale on the basis of current hospital transfusion practices and available human literature in 1989; this scale assigned point values to criteria including anemia determined by PCV, history of rapid blood loss versus gradual decrease in RBC production, need for anesthesia, and clinical signs related to anemia, such as weakness, tachypnea, and tachycardia. [2][3][4][5][6] The transfusion criteria were compared with the medical records of those patients that had received RBC transfusions. 5 Conversely, the scale failed in dogs with acute blood loss that would not yet have changes in their PCV or anesthetized patients that would not acquire points for clinical signs such as tachypnea or weakness.…”