148


EQUINE VETERINARY EDUCATION / AE / MARCH 2016


a) 1600


1400 1200


1000 800


600 400 200


0 200 400 600 800 1000 1200 1400 1600 g/I (2–16)


b) 3.00 S 2.75 2.50 2.25 2.00 R-Sq


2 h [ALB] = 1.335 + 0.4507 Admisson [ALB] P = 0.019 0.286277


28.5% R-Sq(adj) 24.3% S


2 h [FIB] = 123.9 + 0.7467 Admisson [FIB] P < 0.001 108.184


R-Sq 82.6% R-Sq(adj) 82.0%


concentration were measured at unusually short intervals, with FIB kinetics and effects of i.v. fluid administration not being considered. Albumin concentrations have been reported as relatively


constant in foals for the first 3 months of life, increasing to mature concentrations by age one year (Rose et al. 1979; Rumbaugh and Adamson 1983). Albumin is a primary determinant of colloid osmotic pressure, with Thoroughbred foals having lower measured colloid osmotic pressure than mature horses (Landis and Pappenheimer 1963; Runk et al. 2000). We had anticipated that [ALB] would be a useful comparative protein to investigate the impact of FFP transfusion on [FIB], using the [FIB]:[ALB] ratio, but this did not prove to be the case, possibly due to the 5- to 10-fold larger [ALB] obscuring any potential but relatively smaller changes in [FIB] and its effect on colloid osmotic pressure, drawing water into the vascular space. This study could have been improved by controlling


timing of FFP transfusion relative to admission and by carefully recording times and volumes of additional crystalloid administration. More complete recording of admission and subsequent clinical pathology data, including blood gas analyses, might have allowed for more detailed query of the results and should be considered in any subsequent studies of this topic in sick foals. Using samples obtained immediately prior to FFP


1.50 1.75 2.00 2.25 g/I (20–30)


Fig 2: Linear regression analysis fitted line graph of relationship between admission and 2 h [FIB] (a) and [ALB] (b) demonstrating influence of [FIB] and [ALB] at admission on subsequent 2 h [FIB] and [ALB]. While [FIB] in the foal at admission has a large and statistically significant impact on [FIB] at 2 h (R2 = 82.6%; P<0.001); only a minor relationship is identified for [ALB] (R2 = 28.5%; P = 0.019).


increases post-FFP transfusion, particularly in foals with well- established disease. Differences in both directions, increased or decreased


[FIB] relative to admission, were of greater magnitude and more frequent between groups at 2 h than at 6 h post transfusion (Table 2). In fact, by inspection over all foals, there was small negative percentage of change in [FIB] from admission at 6 h, supporting the premise that any observed changes were due to either treatment or disease processes inherent in the foal, not due to FFP transfusion. This is also supported by the observation the [FIB] in the foal at admission was the major determinant of post transfusion [FIB] (Fig 2). The reasons for any observed differences are undefined, in part due to study limitations, but in some cases the differences were large enough potentially to impact case management, if fibrinogen


© 2015 EVJ Ltd 2.50 2.75 3.00


transfusion rather than blood samples obtained at admission would have limited the variability present in our results associated with treatment prior to institution of FFP transfusion and should be considered in future studies. However, we believe that this study does provide answers to questions related to the potential for acute (6 h or less) clinically important changes in [FIB] associated with FFP transfusion: minimal changes will be observed, generally of low magnitude and in unpredictable directions, and should not interfere with the use of [FIB] as a monitoring tool in sick equine neonates. Importantly, any observed changes in the time frame of this study could not be related to [FIB] of the transfused FFP and were more likely to be associated with underlying disease and administration of other i.v. fluids. In summary, i.v. transfusion of equine FFP did not result in


important acute changes in [FIB] in the recipient foals. Observed changes in [FIB] in the foals of this report were not of a magnitude that should interfere with monitoring of [FIB] as an indicator of response to treatment, particularly if performed at more appropriate intervals of approximately 48 h. This study did not investigate the impact of FFP transfusion on other indicators of inflammation or on inflammatory mediators in these foals, a potentially interesting and clinically relevant question.


Authors’ declaration of interests No conflicts of interest have been declared.


Ethical animal research


The study was approved by the Institutional Animal Care and Use Committee at New Bolton Center, Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine. Informed client consent was obtained for each foal enrolled in the study.


g/I (20–30)


g/I (2–16)


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