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EQUINE VETERINARY EDUCATION / AE / MARCH 2016
Fresh frozen plasma administration Fresh frozen plasma was administered at the discretion of the attending veterinarian as part of the treatment plan for each foal. No effort was made to standardise timing of FFP administration following patient admission or rates and composition of i.v. administered isotonic crystalloid fluids. FFP transfusion was performed using a i.v. administration set and a continuous i.v. fluid infusion pump (Alaris Gemini IV)b. After an initial observation period, the administration rate would then be increased if no reaction had occurred. Transfusion duration was not recorded.
Sample acquisition Admission blood samples were obtained during i.v. catheter placement at the time of admission (Arrow Central Venous Catheter)c. The whole blood sample was distributed as routine aliquots into multiple glass blood tubes with a variety of anticoagulants, including a 3.2% citrate tube used for this study. Additional whole blood samples were obtained at 2 and 6 h following completion of the FFP transfusion by direct venipuncture or by aspiration through the i.v. catheter after withdrawal of an appropriate presample and placed in 3.2% citrated tubes.
Fibrinogen and albumin concentration determination Fibrinogen (nephelometry technique; ACL 7000)d and albumin (bromcreosol green dye reflectance photometry dry chemistry slide technique; Vitros 350 Chemistry System)e concentrations were routinely measured by the hospital clinical pathology laboratory.
Statistical analyses Kruskal–Wallis and regression analyses were used to assess differences between groups, sample periods and associations. Statistical significance was defined as P≤0.05. [FIB] to [ALB] ratios, change (D) in [FIB] and [ALB] between sample times, and percent D in [FIB] and [ALB] between sample times were calculated in the administered plasma and at each sampling time for the enrolled foals. Analyses were performed using commercially available software (Minitab 16)f.
Results
Data were not normally distributed and are summarised using median and 25–75 percentile interquartile ranges with numbers of foals provided as n. Transfusion reactions were not observed in any foal.
Fibrinogen Fourteen lots of plasma were used. Median [FIB]Plasma was 2.45 g/l (range 1.52–3.78 g/l). Admission [FIB]Foal was determined in 31 foals. Not all data at later sample points were available for all foals. Neither D[FIB]Foal nor percent D[FIB] over any time period
were significant (Fig 1, Tables 1 and 2). Linear regression demonstrated that [FIB] of the foal at Admission was the primary determinant of [FIB] 2 and 6 h after FFP transfusion (R2 = 82.6%, P<0.001; R2 = 86.7%, P<0.001, respectively; Fig 2). [FIB]Foal at 2 h was impacted by [FIB]Plasma to a small degree (R2 = 14.8%, P = 0.043).
a) 600 500 400 300 200 Admission b)
3.25 3.00 2.75 2.50 2.25 2.00 1.75 1.50
Admission 2 h 6 h
Fig 1: Line plots showing individual foal values for (a) fibrinogen (g/l) and (b) albumin (g/l) concentrations in sick foals treated with equine origin fresh frozen plasma at admission and at 2 and
6 h following plasma transfusion. Two foals with extremely high fibrinogen concentrations have been removed from the plot in (a) to allow improved ease of viewing detail. There were no differences between sample times for either fibrinogen or albumin concentration.
TABLE 1: Summary data for fibrinogen concentration (g/l) and albumin concentrations (g/l) from 31 foals receiving fresh frozen plasma transfusion
Admission
Fibrinogen 2.95 (2.28–455) (n = 31)
Albumin 22.9 (19.7–24.8) (n = 25)
2 hours
3.28 (2.81–4.31) (n = 30)
23.7 (2.02–26.2) (n = 26)
6 hours
3.23 (2.53–414) (n = 27)
23.4 (20.7–26.5) (n = 30)
Foals were sampled at the time of admission to the hospital and at 2 and 6 h following completion of plasma transfusion. Results are presented as median (25–75th interquartile range) (n = number sampled). Differences were tested using Kruskal– Wallis with no significant differences detected for either protein between any sample timepoints. Statistical significance was set at P≤0.05.
Albumin Median [ALB]Plasma was 24.3 g/l (range 19.6–27.0). D[ALB]Foal was not significant over any time period (Fig 1, Tables 1 and 2). Similar to [FIB], Admission [ALB] was a significant (P = 0.019) determinant of 2 h [ALB] (Fig 2). Different from [FIB], [ALB]Foal at 2 h was not impacted by [ALB]Plasma (R2 = 0.4%, P = 0.769). No differences were identified between the FFP calculated
2 h 6 h
© 2015 EVJ Ltd
g/I (15.0–32.5)
g/I (2–16)
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