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Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)2022; 32(S1); 97-107; doi: 10.1111/vec.13127

Calculating and selecting fluid therapy and blood product replacements for horses with acute hemorrhage.

Abstract: Blood products, crystalloids, and colloid fluids are used in the medical treatment of severe hemorrhage in horses with a goal of providing sufficient blood flow and oxygen delivery to vital organs. The fluid treatments for hemorrhage will vary depending upon severity and duration and whether hemorrhage is controlled or uncontrolled. Methods: With acute and severe controlled hemorrhage, treatment is focused on rapidly increasing perfusion pressure and blood flow to vital organs. This can most easily be accomplished in field cases by the administration of hypertonic saline. If isotonic crystalloids are used for resuscitation, the volume administered should be at least as great as the estimated blood loss. Following crystalloid resuscitation, clinical signs, HCT, and laboratory evidence of tissue hypoxia may help determine the need for a whole blood transfusion. In uncontrolled hemorrhage, crystalloid resuscitation is often more conservative and is referred to as "permissive hypotension." The goal of "permissive hypotension" would be to provide enough perfusion pressure to vital organs such that function is maintained while keeping blood pressure below the normal range in the hope that clot formation will not be disrupted. Whole blood and fresh frozen plasma in addition to aminocaproic acid are indicated in most horses with severe uncontrolled hemorrhage. Conclusions: Blood transfusion is a life-saving treatment for severe hemorrhage in horses. No precise HCT serves as a transfusion trigger; however, an HCT < 15%, lack of appropriate clinical response, or significant improvement in plasma lactate following crystalloid resuscitation and loss of 25% or more of blood volume is suggestive of the need for whole blood transfusion. Mathematical formulas may be used to estimate the amount of blood required for transfusion following severe but controlled hemorrhage, but these are not very accurate and, in practice, transfusion volume should be approximately 40% of estimated blood loss. Conclusions: Modest hemorrhage, <15% of blood volume (25% of blood volume (> 20 mL/kg), often requires crystalloid or blood product replacement, while acute loss of greater than 30% (>24 mL/kg) of blood volume may result in hemorrhagic shock requiring resuscitation treatments Uncontrolled hemorrhage is a common occurrence in equine practice, and is most commonly associated with abdominal bleeding (eg, uterine artery rupture in mares). If the hemorrhage can be controlled such as by ligation of a bleeding vessel, then initial efforts to resuscitate the horse should focus on increasing perfusion pressure and blood flow to organs as quickly as possible with crystalloids or colloids while assessing need for whole blood transfusion. While fluid therapy is being administered every effort to physically control hemorrhage should be made using ligatures, application of compression, surgical methods, and local hemostatic agents like collagen-, gelatin-, and cellulose-based products, fibrin, yunnan baiyao (YB), and synthetic glues Although some synthetic colloids have been shown to be associated with acute kidney injury in people receiving resuscitation therapy, this undesirable effect in horses has not been reported.
© Veterinary Emergency and Critical Care Society 2022.
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Publication Date: 2022-01-20 PubMed ID: 35044062DOI: 10.1111/vec.13127Google Scholar: Lookup
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Summary

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This research paper discusses the methods and considerations for administering fluid therapy and blood product replacements in horses suffering from acute hemorrhage. The paper highlights the use of various substances such as blood products, crystalloids, and colloid fluids used in the treatment, underlining the need to maintain adequate blood flow and oxygen delivery to the horse’s vital organs.

Research Methodology

  • The study focuses on a variety of treatment methods for varying levels of hemorrhaging, taking into account whether the hemorrhage is controlled or uncontrolled. The factors considered in devising a treatment strategy include the severity and duration of the hemorrhage.
  • For controlled and severe acute hemorrhages, the approach is aimed at quickly boosting the perfusion pressure and blood flow to vital organs. This is commonly achieved, especially in field cases, through the administration of hypertonic saline.
  • Should isotonic crystalloids be used for resuscitation, the volume administered should match or exceed the estimated blood loss. Following this kind of therapy, factors such as clinical signs, Hematocrit (HCT), and laboratory evidence of tissue hypoxia can help ascertain the requirement for a whole blood transfusion.

The Concept of Permissive Hypotension

  • In uncontrolled hemorrhages, a more conservative resuscitation via crystalloids is utilized, known as “permissive hypotension”. This method aims to maintain enough perfusion pressure to the vital organs while keeping the blood pressure below regular levels. Doing so hopes to permit clot formation and not disrupt it.
  • The treatment of most horses with severe uncontrolled hemorrhage includes whole blood and fresh frozen plasma, along with aminocaproic acid.

Blood Transfusion Thresholds and Estimations

  • According to the research, while there isn’t a precise HCT value to trigger a transfusion, an HCT value less than 15%, a lack of clinical response, or significant improvement in plasma lactate following crystalloid resuscitation and a loss of 25% or more of blood volume suggest the need for a whole blood transfusion.
  • Formulas can be used to anticipate the amount of blood needed for transfusion following severe but controlled hemorrhage, but their accuracy is limited. In practice, the transfusion volume should be roughly 40% of the estimated blood loss.

Treatment Approach Based on the Severity of Hemorrhage

  • Hemorrhage that accounts for less than 15% of blood volume can generally be fully compensated by physiological mechanisms and usually does not require fluid or blood product therapy.
  • More severe hemorrhage amounting to more than 25% of blood volume often requires crystalloid or blood product replacement. Acute losses exceeding 30% of blood volume could lead to hemorrhagic shock, necessitating resuscitation treatments.

Physical Control Methods for Hemorrhage in Horses

  • Efforts to physically manage hemorrhage should coincide with the administration of fluid therapy. These efforts include the use of ligatures, application of compression, surgical methods, and local hemostatic products like collagen, gelatin, and cellulose-based items, fibrin, yunnan baiyao, and synthetic glues.

Note on Use of Synthetic Colloids

  • Despite reports in human medicine suggesting a link between the use of some synthetic colloids in resuscitation therapy and acute kidney injury, no such side-effects have been reported in horses as per the study.

Cite This Article

APA
Divers TJ, Radcliffe RM, Cook VL, Bookbinder LC, Hurcombe SDA. (2022). Calculating and selecting fluid therapy and blood product replacements for horses with acute hemorrhage. J Vet Emerg Crit Care (San Antonio), 32(S1), 97-107. https://doi.org/10.1111/vec.13127

Publication

Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)
ISSN: 1476-4431
NlmUniqueID: 101152804
Country: United States
Language: English
Volume: 32
Issue: S1
Pages: 97-107

Researcher Affiliations

Divers, Thomas J
  • Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.
Radcliffe, Rolfe M
  • Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.
Cook, Vanessa L
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA.
Bookbinder, Lauren C
  • Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.
Hurcombe, Samuel D A
  • Emergency Surgery and Medicine, Cornell Ruffian Equine Specialists, Elmont, New York, USA.

MeSH Terms

  • Animals
  • China
  • Colloids
  • Female
  • Fluid Therapy / veterinary
  • Hemorrhage / therapy
  • Hemorrhage / veterinary
  • Horse Diseases / therapy
  • Horses
  • Isotonic Solutions / therapeutic use
  • Plasma Substitutes / therapeutic use
  • Resuscitation / veterinary

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