Treatment of Acute Hemoabdomen in a Dog

Penelope, a 6-year-old, 44-lb, spayed pit bull terrier, presented 10 minutes after being struck by a vehicle traveling 35 miles per hour.

Physical Examination

Penelope had a heart rate of 200 bpm, respiratory rate of 32 breaths/min, and temperature of 99.8°F. She was obtunded and laterally recumbent. Mucous membranes were pale pink to white and moist with a prolonged capillary refill time (CRT) of 3 seconds. Femoral pulses were weak. She had normal heart and lung sounds. Penelope’s abdomen was tense and painful on palpation. No orthopedic or neurologic abnormalities were detected. A Doppler blood pressure of 80 mm Hg was recorded.

Laboratory Results

PCV was 40% (range, 35%–55%) and total protein (TP) was 3.2 g/dL (range, 5.2–7.8 g/dL). Irregularities in the biochemistry profile were present (See Table). Coagulation times (prothrombin and partial thromboplastin) were normal. The lactate level was 6.4 mmol/L (range, 1.2–­4.14 mmol/L).

Related Article: Placement of an Abdominal Wrap to Control Hemodynamics

Treatment

IV fluid resuscitation was initiated with several rapid infusions totaling 70 mL/kg of crystalloids (Plasmalyte-A), 20 mL/kg colloids (hydroxyethyl starch), and the only unit of stored whole blood (450 mL). Penelope was  administered 0.1 mg/kg of IV hydromorphone but remained tachycardic (180 bpm) and had weak pulses. An abdominal fluid wave was noted; abdominocentesis revealed a hemorrhagic effusion with a PCV of 34% and TP of 2.8 g/dL. A recheck revealed peripheral blood PCV of 20% and TP of 2.2 g/dL.

Table: Abnormal Biochemistry Profile Findings

CRT = capillary refill time, TP = total protein

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Benefits, Risks, & Techniques for Autologous Transfusions

Hemorrhage into the thoracic or abdominal cavities can be quickly collected and administered IV. Autologous blood has been demonstrated to be lifesaving, safe, and advantageous (See Suggested Reading below).

Benefits

• Simple to collect and administer

• Frequently sterile

• Contains functionally superior cells compared with banked blood

• Does not require warming

• Decreased risk for transfusion reactions from foreign protein

• Can be less expensive than banked blood

• Readily available

Risks

Potential complications attributable to autotransfusion include:

• Hypocoagulation

• Hemolysis

• Sepsis

• Dissemination of malignancy

• Embolism

Techniques

Blood can be suctioned out of the abdominal or thoracic cavity with centesis or direct suction (in a surgical case). Blood should be collected directly into a sterile suction canister, iv fluid bag (Figure 1), commercial blood bag, or syringe (in smaller patients). Passing the blood through a filter is recommended. Adding anticoagulant is often unnecessary unless hemorrhage is ongoing at collection. Monitoring PCv, Ts, electrolytes, and renal values is recommended.

FIGURE 1A

Autologous blood was collected in a sterile fashion and transferred into an empty sterile IV bag. It was administered IV through a filter, as shown here.

FIGURE 1B

Autologous blood was collected in a sterile fashion and transferred into an empty sterile IV bag. It was administered IV through a filter, as shown here.

CRT = capillary refill time, TP = total protein, TS = total solids

Treatment Options

Mild hemorrhage often responds to IV replacement with crystalloids and colloids. Rapid infusions (over 10–15 min) of 20 to 30 mL/kg of crystalloids and 5 mL/kg of colloids are necessary and may need to be repeated. Patients with coagulopathies or severe hemorrhage may require blood products. When blood banks are stressed or large volumes are required, autologous transfusion remains a viable option.

The risk:benefit ratio weighs heavily in favor of autotransfusion for the resuscitation of select patients, even despite neoplasia or gross contamination, when facing exsanguination and death.

Related Article: Current Thoughts on Coagulopathy Testing

Outcome

Penelope was taken to surgery where a large splenic laceration was identified as the source of ongoing hemorrhage; 900 mL of autologous blood was collected intraoperatively with a Poole suction tip into a sterile canister, transferred to a sterile IV bag, and administered IV. A splenectomy was performed, and the remainder of the exploratory laparotomy was unremarkable. Penelope recovered uneventfully from anesthesia and was discharged 48 hours later. Four weeks later, she was doing well and had returned to normal activity.