The use of therapeutic plasma exchange to reduce serum bilirubin in a dog with kernicterus

Tovar, Tricia; Deitschel, Sarah; Guenther, Christine

doi:10.1111/vec.12622

Cited by 14 publications

(15 citation statements)

References 29 publications

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“…The primary purpose of this technique is to remove harmful components from the patient's plasma. Plasmapheresis has been performed in veterinary medicine since in the 1980s and remains relevant today for a variety of conditions such as immunologic diseases, Ehrlichia canis infection, kernicterus, and multiple myeloma . Recently, 3 case reports have described the use of TPE for ibuprofen, meloxicam, and carprofen overdose.…”

Section: Introductionmentioning

confidence: 99%

Use of therapeutic plasma exchange to treat nonsteroidal anti‐inflammatory drug overdose in dogs

Rosenthal¹,

Labato

2019

Veterinary Internal Medicne

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Background Therapeutic plasma exchange (TPE) may be an effective technique for treatment of accidental nonsteroidal anti‐inflammatory drug (NSAID) overdose, but information regarding the use of this technique in veterinary medicine is currently limited. Objectives To evaluate the overall outcome for dogs with NSAID overdose treated with TPE and to determine if any presenting factors can predict or influence overall outcome. Secondary objectives included investigating TPE complications as well as the utility of other adjunctive treatments. Animals Eleven client‐owned dogs presented for NSAID overdose that received TPE. All patients also received additional supportive treatment including IV lipid infusion. Methods Retrospective review of medical records. Results Eleven cases were included in the study. Of these, the NSAID ingested was ibuprofen in 6 (54.5%), naproxen in 4 (36.4%), and deracoxib in 1 (9.1%). All dogs survived to discharge with 3 (27.3%) developing acute kidney injury during hospitalization. A larger initial dose of NSAID ingested was associated with a higher maximum serum creatinine concentration during hospitalization (P = .04) and larger change in serum creatinine concentration from baseline (P = .02). Six dogs (54.5%) developed complications associated with TPE. The use of other treatments did not affect the overall outcome. Conclusions and Clinical Importance We identified TPE as an effective treatment for NSAID overdose with good outcomes despite high doses of NSAID ingestion in dogs treated with a single TPE treatment. Complications were common but did not affect the final outcome. Therapeutic plasma exchange should be considered in patients presenting for high‐dose NSAID ingestion.

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Section: Introductionmentioning

confidence: 99%

Use of therapeutic plasma exchange to treat nonsteroidal anti‐inflammatory drug overdose in dogs

Rosenthal¹,

Labato

2019

Veterinary Internal Medicne

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“…The described pulmonary hemorrhages were most likely unrelated to the infusion of HAlb as they were already present before TPE in the affected dogs with leptospirosis. Twelve dogs died before the 14-day follow-up could be completed (median 2 days; IQR,[1][2][3][4]. In all other dogs, the monitoring could be completed as planned, either during their hospitalization (n = 6)…”

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confidence: 99%

Membrane‐based therapeutic plasma exchange in dogs: Prescription, anticoagulation, and metabolic response

Francey

Schweighauser

2019

Veterinary Internal Medicne

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Background Therapeutic plasma exchange (TPE) is used increasingly in small animals to remove circulating large molecular products such as antibodies, pathogenic proteins, and protein‐bound toxins. Specific, efficient, and safe protocols need to be developed. Hypothesis/Objectives To describe the technique of membrane‐based TPE, the resulting physiological and metabolic changes, and to define an adequate regional citrate anticoagulation protocol. Animals Thirty‐four dogs treated with TPE (2011‐2017). Methods Retrospective review of all TPE treatments performed at the Vetsuisse Faculty, University of Bern, identified through a search of the institutional database for extracorporeal treatments. Results Sixty‐four treatments were performed, resulting in 1.0 plasma volume exchange (range, 0.4‐1.1). Replacement fluids included fresh frozen plasma (12%‐100% volume), colloids (0%‐52%), human albumin (0%‐41%), and saline (0%‐70%). Anticoagulation was performed with regional citrate (n = 24), systemic heparinization (n = 2), or combined (n = 38). Main relevant laboratory changes included a 24.7% decrease in total proteins (interquartile range, 16.7‐31.4; P < .001), 53% in fibrinogen (−30 to 63; P = .009), 36% in bilirubin (13‐43, P = .02), 9.0% in urea (0.7‐15.7; P < .001), and 4.5% in creatinine (−6.6 to 10.6; P = .006). Citrate accumulation was evidenced in all dogs, more pronounced in those with renal but not with hepatic impairment. Maximal tolerable citrate rates were estimated as 5.5 and 9.0 μmol/kg/min for treatments in dogs with and without renal impairment, respectively. Complications were observed in 22 treatments (34%) and were fatal in 2 dogs. Conclusions and Clinical Importance Therapeutic plasma exchange causes metabolic and biochemical alterations. Understanding these effects makes possible to anticipate most complications and to improve safety of the procedure.

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“…TPE is a type of extracorporeal blood purification therapy, which historically functions to treat patients with immune‐mediated diseases in both the veterinary and human medical fields . Recently, both the veterinary and human fields have found success in treating drug overdoses with TPE, specifically ibuprofen, meloxicam, and carprofen .…”

Section: Introductionmentioning

confidence: 99%

“…9 TPE is a type of extracorporeal blood purification therapy, which historically functions to treat patients with immunemediated diseases in both the veterinary and human medical fields. [10][11][12] Recently, both the veterinary and human fields have found success in treating drug overdoses with TPE, specifically ibuprofen, meloxicam, and carprofen. [13][14][15][16] TPE is most efficient at removing highly protein-bound drugs (>80% protein binding), with a low volume of distribution (ie, <0.2 L/kg).…”

Section: Introductionmentioning

confidence: 99%

Treatment of a massive naproxen overdose with therapeutic plasma exchange in a dog

Kicera‐Temple

Londoño

Lanaux

et al. 2019

Clinical Case Reports

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The use of therapeutic plasma exchange to reduce serum bilirubin in a dog with kernicterus

Cited by 14 publications

References 29 publications

Use of therapeutic plasma exchange to treat nonsteroidal anti‐inflammatory drug overdose in dogs

Use of therapeutic plasma exchange to treat nonsteroidal anti‐inflammatory drug overdose in dogs

Membrane‐based therapeutic plasma exchange in dogs: Prescription, anticoagulation, and metabolic response

Treatment of a massive naproxen overdose with therapeutic plasma exchange in a dog

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