Hemorrhagic, Hemostatic, and Thromboelastometric Disorders in 35 Dogs with a Clinical Diagnosis of Leptospirosis: A Prospective Study

Abstract

BackgroundLeptospirosis in dogs is occasionally associated with a hemorrhagic syndrome, the pathophysiology of which is not fully understood.Hypothesis/ObjectivesTo characterize hematologic, hemostatic, and thromboelastometric abnormalities in dogs with leptospirosis and to study their association with hemorrhagic diatheses and outcomes.AnimalsThirty‐five client‐owned dogs.MethodsA prospective observational single cohort study was conducted. Results from the CBC, coagulation tests (prothrombin, activated partial thromboplastin and thrombin times, fibrinogen, fibrin(ogen) degradation products, and D‐dimer concentrations), rotational thromboelastometry (TEM), signalment, hemorrhagic diatheses, occurrence of disseminated intravascular coagulation (DIC) at admission, and survival to discharge were recorded.ResultsThe most common hematologic and hemostatic abnormalities were anemia (30/35), thrombocytopenia (21/35), and hyperfibrinogenemia (15/35). Eight dogs were diagnosed with DIC. A normal TEM profile was found in 14 dogs, a hypercoagulable profile in 14 dogs, and a hypocoagulable profile in 7 dogs. The 8 dogs with hemorrhagic diatheses at admission had significantly decreased platelet counts (P = .037) and increased D‐dimer concentrations (P = .015) compared with other dogs. Dogs with a hypocoagulable profile exhibited more hemorrhagic diatheses compared with the dogs that had normal and hypercoagulable profiles (P = .049). The mortality rate was lower in dogs with a hypercoagulable profile than in those with a hypocoagulable profile (21% vs 57%; P = .043). Disseminated intravascular coagulation was not a significant prognostic factor.Conclusions and Clinical ImportanceThromboelastometric parameters were altered in dogs with both hypercoagulable and hypocoagulable profiles. A hypocoagulable profile was significantly correlated with hemorrhagic diathesis and higher mortality rate.

Leptospirosis as an unusual culprit of acute pancreatitis and portal vein thrombosis in a New Yorker

“…However, leptospirosis is known to induce hypercoagulability in some cases (as seen in our patient), with measurable increases in prothrombotic indicators like fibrinogen, thrombin‐antithrombin III complex, and prothrombin fragments . Hemostatic dysregulation is corroborated in animal models, producing both hypercoagulable and hypocoagulable phenotypes—higher mortality was observed in the hypocoagulable subgroup …”

“…14,16 Hemostatic dysregulation is corroborated in animal models, producing both hypercoagulable and hypocoagulable phenotypes-higher mortality was observed in the hypocoagulable subgroup. 17 Rhabdomyolysis in this patient is also characteristic of leptospirosis. Leptospira antigens present in muscle sarcoplasm during active infection, creating an immunological target that produces myositis and elevated creatinine kinase.…”

Hypocoagulability and Platelet Dysfunction Are Exacerbated by Synthetic Colloids in a Canine Hemorrhagic Shock Model

“…Reduction in MCF is predictive of blood loss and transfusion requirements in human trauma and surgical patients ( 34 – 36 ). In dogs, EXTEM CT was longer and EXTEM MCF was lower in cases that had hemorrhage, compared to those that did not, with Angiostrongylus vasorum infection ( 37 ) and leptospirosis ( 38 ). Therefore, the effect of HES on coagulation may contribute to risk of hemorrhage in the dog.…”

Acute kidney injury management using intermittent low efficiency haemodiafiltration in a critical care unit: 39 dogs (2012–2015)

“…Dogs were diagnosed with leptospirosis if they fulfilled at least 1 of the following 3 criteria: single microscopic agglutination test titres > 1:800 for nonvaccine serovars or > 1:1600 for vaccine serovars; a fourfold rise in convalescent titres; and a positive urine or blood polymerase chain reaction assay as described previously [17]. Obstructive urolithiasis was diagnosed based on ultrasound findings.…”