EQUINE VETERINARY EDUCATION / AE / MARCH 2016
145
Original Article
The effect of intravenous fresh frozen plasma administration on fibrinogen and albumin concentrations in sick neonatal foals
A. R. Hollis, P. A. Wilkins*, B. Tennent-Brown, J. E. Palmer and R. C. Boston Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, USA. *Corresponding author email:
pawilkin@illinois.edu. Dr Hollis’ present address: Scott Dunn’s Equine Clinic, Straight Mile Farm, Wokingham, Berkshire RG40 5RW, UK. Dr Wilkins’ present address: Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, Illinois, USA. Dr Tennent-Brown’s present address: Faculty of Veterinary Science, University of Melbourne, 250 Princes Highway, Werribee, Victoria 3030, Australia.
Keywords: horse; transfusion medicine; inflammatory mediator; acute phase protein; neonate Summary
This study investigated the immediate (6 h or less) effects of fibrinogen and albumin contained in transfused equine origin fresh frozen plasma on those proteins when measured in sick neonatal foals. Fibrinogen and albumin concentrations were measured in the administered plasma and in 31 sick foals at admission to a referral neonatal intensive care unit. Additional samples were obtained from the foals at 2 and 6 h following transfusion. No changes in albumin concentration were recognised. The main determinant of fibrinogen
concentration following transfusion was the concentration of fibrinogen in the foal at admission. Importantly, intravenous transfusion of equine fresh frozen plasma did not result in
immediate (6 h or less) increases or decreases in the fibrinogen concentration in the recipient foals. Fibrinogen from the donor contained within transfused plasma will not directly affect fibrinogen concentrations measured at later times.
Fresh frozen plasma contains, amongst other clotting
factors and proteins, FIB from the donor animal. It is currently unknown whether the FIB contained in the administered FFP affects the recipient foal’s [FIB], potentially confounding the interpretation of changes in [FIB]. The specific aim of the study was to investigate the
immediate (within 6 h) effect of FFP transfusion on [FIB] and albumin concentration ([ALB]) in critically ill neonatal foals. We hypothesised that i.v. administration of equine FFP to critically ill equine neonates will cause changes in the recipient’s plasma [FIB] proportional to the [FIB] of the administered plasma. Albumin concentration was concurrently assessed because it is present in plasma at a larger concentration, has a longer half-life and should be less affected by acute changes in the inflammatory status of the foal.
Materials and methods Introduction
Transfusions of fresh frozen plasma (FFP) are frequently administered to healthy foals as treatment for failure of passive transfer or as prophylaxis for Rhodococcus equi infection and to critically ill neonatal foals as part of their therapy (Becht and Semrad 1985; LeBlanc 1987; White 1990; Madigan et al. 1991; Wilkins and Dewan-Mix 1994; Gigu
ere
et al. 2002, 2011). Little is known regarding the effect on the plasma concentrations of the other components of transfused FFP in healthy or critically ill foals. Fibrinogen (FIB) is a plasma protein component that is frequently monitored in critically ill foals as a measure of the acute inflammatory response and as an indicator of response to treatment. Fibrinogen concentration ([FIB]) normally increases from birth to age 4–7 days, when it reaches mature values (Barton et al. 1995). Increasing or increased [FIB] is found in cases with inflammation and infection while decreasing [FIB] is thought to occur with resolution of inflammation or infection. Fibrinogen concentration monitoring is used to determine efficacy of treatment of patients with inflammatory disease, in conjunction with other clinical parameters, and can play a key role in guiding case management.
Animals Consecutively admitted critically ill neonatal foals (age <2 weeks) of various breeds and either gender, admitted for evaluation and treatment and receiving commercially available equine origin FFP as a part of their treatment, were enrolled following informed owner consent. All procedures were approved by the Institutional Animal Care and Use Committee.
Study design This was an observational prospective clinical study.
Fresh frozen plasma Commercially available equine origin FFP was stored according to the instructions of the manufacturer (HiGamm- Equi)a. Frozen plasma was thawed slowly in warm water baths immediately prior to administration. Each lot of plasma was assayed for albumin and fibrinogen concentrations prior to administration, using citrated plasma sample(s) provided by the manufacturer. Plasma lots are prepared by collection of a single large volume from one horse that is thoroughly mixed. We had previously established that there was excellent correlation (R2 = 0.97; P<0.001) between [ALB] measured in citrated or heparinised plasma (data not shown) allowing us to use the provided citrated plasma samples to determine [ALB] and [FIB] in the administered plasma.
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