WSAVA Nov 2021 Proceedings - Flipbook - Page 41
intervals. Crystalloid fluid therapy is utilised to aid in maintenance of
blood pressure. Due to physical and physiological respiratory changes associated with pregnancy, assisted ventilation may be required to maintain
normocapnia. Hypotension should be addressed immediately as it can
have serious consequences for the neonate and mother. Fluid boluses,
decreasing inhalant and decreasing anaesthetic depth(if possible) are
appropriate. If pharmacologic intervention is required, ephedrine may be
of benefit. Ephedrine produces an increase in venous tone. As ephedrine
causes minimal arterial vasoconstriction uterine perfusion is maintained.
Nor-adrenaline, dopamine or dobutamine are also reasonable choices
depending on underlying causes of hypotension. Care should be taken to
maintain temperature as hypothermia may increase coagulation time, risk
of infection and delay recovery from anaesthesia.
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HOW CAN LABORATORY ASSIST FOR DIAGNOSIS,
PROGNOSIS AND MONITORING ONCOLOGIC
PATIENTS?
S. Comazzi
Lodi/Italy
Qualifications:
Stefano Comazzi
Neonatal Resuscitation
DVM PhD diplECVCP
Neonates delivered by caesarean often show signs of reduced cardiorespiratory function. Foetal hypoxia may be due to premature placental
separation, impaired maternal ventilation, drug induced foetal depression,
or position induced maternal hypotension. Ensuring oxygen supply is
available for resuscitation as well as prewarmed areas to receive the neonates is essential. Resuscitation of neonates should focus on oxygenation
and maintaining temperature. Membranes should be removed quickly, and
fluid cleared from upper airways. Low pressure suctioning, bulb syringes
or cotton tips may be useful for clearing mucous and fluids from the upper
respiratory tract. Vigorous body rubbing should be used to dry neonates
and to stimulate spontaneous respiration. Swinging neonates is not
recommended due to risk of cerebral contusion and removal of pulmonary
surfactant. Flow-by oxygen should be supplied. If newborns are unresponsive and make no attempt to spontaneously breathe, they can be intubated
and ventilated. A tight-fitting mask may also be used for positive pressure
ventilation. Naloxone can be administered to antagonise opioid induced
respiratory depression(most often administered sublingually). Acupuncture stimulation of GV 26 has also been found to be effective. A slow
heart rate is most commonly due to myocardial depression from hypoxaemia, therefore oxygen is extremely important as treatment. If bradycardia
is unresolved, transthoracic compressions or adrenaline may be indicated.
Anticholinergic drugs are not recommended as drug induced tachycardia
may worsen myocardial hypoxaemia. Doxapram increases myocardial
and cerebral oxygen demand so may be detrimental in the presence of
hypoxaemia. Neonates should always be examined for congenital abnormalities. Once stable the newborn should be kept warm with a supply of
O2 and returned to the dam and encouraged to suckle as soon as possible
following delivery.
stefano.comazzi@unimi.it
Veterinary clinical pathology is the veterinary discipline Veterinary discipline focused on laboratory medicine including the laboratory support to
all the medical procedures for diagnosis and monitoring treatment and
follow-up. The European College of Veterinary Clinical Pathology (ECVCP)
and the equivalent subspeciality of the American College of Veterinary
Pathology (ACVP-ClinPath) identify four disciplines as part of the training
of veterinary clinical pathology. These include general clinical pathology,
hematology, clinical biochemistry/urinalysis, and cytology. The laboratory
support in the diagnosis and treatment of dogs and cats with tumors has
become essential to modern veterinary oncology, similar to what happens
in humans.
Recovery
Post-operative monitoring should include SpO2, heart rate, respiratory
rate, and temperature. Supplemental O2 should be provided if required.
Pain management must follow through the postoperative period. Left
untreated, pain can cause negative changes in patient metabolism,
behaviour, and immune system. Failure to adequately address pain may
result in decreasing milk production, interfere with suckling and bonding
between dam and offspring. Opioids may be administered but they will
be excreted in milk and may have effects on neonates. The practice of
a single dose of NSAID’s is also considered appropriate. This is usually
administered post operatively and limited to one dose due to potential
secretion in milk and effects on immature neonatal renal development.
The goal should be to discharge these patients as soon as they are stable.
References available on request.
Hematology may help the diagnosis of specific neoplastic diseases,
directly (such as in hematopoietic tumors) or indirectly (such as in
paraneoplastic diseases). In addition, it plays an important role to frame
health status, predict response to therapies, and monitor therapies and
recurrences.
Non-regenerative, normocytic normochromic anemia, is the most frequent
erythrocytic abnormality in animals with cancer. Anemia may be due to
chronic disease (mostly), iron deficiency (due to malabsorption or chronic
blood loss), myelophtisis (mainly in leukemias), neoplastic cachexia, or
occasionally to myelosuppression due to chemotherapy.
Regenerative anemia may rarely occur as a consequence of paraneoplastic hemolytic anemia (mainly in histiocytic disorders or lymphoma), microangiopathic anemia (in hemangiosarcoma), or rarely acute post-hemorrhagic anemia.
In contrast, erythrocytosis is generally very rare and suggest a primary hematopoietic disorder (Polycythemia Vera) or secondary polycythemia due
to renal tumors, lymphoma, hepatic tumors, pulmonary tumors, and others
Each of these processes shows peculiar hematologic features that may
drive the clinicians to a better framing of the clinical case.
Leukogram may show several different abnormalities; among these, neutrophilia with lefts shift may encounter quite frequently due to inflammation, necrosis, or rarely paraneoplastic neutrophilia (reported in pulmonary
carcinoma, lymphoma, transitional carcinoma, others)
Neutrophilia without lefts shift may also occur related to hyperadrenocorticism, steroids therapy (also during chemotherapy), or severe stress
related to the disease.
Neutropenia is quite rare at admission and often related to myelophtysis,
bone marrow suppression Immuno-mediated neutropenia. In contrast,
neutropenia is an important feature during chemotherapy. It is the first
sign of myelosuppression and for this reason, it is carefully evaluated to
prevent adverse effects.
Nadir is variable for different drugs (5 to 10 dd) followed by a rebound
after 2-3 days; a Complete Blood Cell (CBC) count at day 7 is generally
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