Every veterinarian should know about the sonographic finding of the gallbladder halo sign, its rule outs, and its use as supportive evidence for canine anaphylaxis.
A previously healthy, acutely collapsed preempted by vomiting, 17-month old intact female Yorkshire Terrier in Virginia, now having an abdominal fluid score of 4 with an impressive gallbladder halo sign and an initial ALT of 634. Hemoconcentration PCV > 55% another feature (bleeding masses would not be expected to be hemoconcentrated).
The attending veterinarians had no idea of canine AX and sonographic striation of the gallbladder wall, nor hemoabdomen as a complication. Fortunately, the internist reviewing the case, steered the attending in the right direction. The case was reviewed by my wife, Stephanie Lisciandro, DVM, DACVIM (SAIM), the working diagnosis changed from “open” to canine anaphylaxis with hemoabdomen.
Hemoabdomen was diagnosed via abdominocentesis and fluid analysis and cytology. Coagulation profile in-house out of range PT and aPTT. The dog had received no glucocorticoids since admission 24-hours earlier.
Treatment then included FFP for the coagulopathy and glucocorticoids (prednisone) and histamine 2 blockers (famotidine). You must treat with glucorticoids up front (or as soon as your realize this is an anaphylactic hemaabdomen) to stop the persistent oozing from the second episode of inflammation.
Once bleeding stops, expect the abdominal fluid score (AFS) to go to small volume (AFS 1) to negligent within 24-hours.
No other practice has recognized this complication more than we have, at least 100 cases, having recognized the complication back in 2009, published as an Lisciandro GR JVECC Abstract in 2016.
All veterinarians MUST be aware of its heparin-induced medially-treated hemoabdomen.
Read over our Proceedings. Watch the Webinar (yes it needs some tweaking but it gets to the point). And Use our Treatment Sheet to prevent rounds and rounds of FFP and even blood transfusions. Maropitant and pantoprazole do NOT treat anaphylaxis.
Watch the webinar:
Here is our recommended Treatment Sheet for Canine Anaphylaxis.
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