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  Discussion on Research Summary: DIC and Foal Septicemia
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DrO

Posted on Tuesday, Oct 21, 2008 - 10:28 am:

Treating septic foals continues to be a challenge and this research reveals one probable reason. Many of the foals that die have evidence of Disseminated Intravascular Coagulopathy (DIC). This is a complicated condition but basically represents a state of the blood becoming coagulated within the vessels. Paradoxically by the time DIC is diagnosed usually the blood has increased clotting times because of the consumption of the blood clotting factors and hemorrhaging can become widespread. DIC leads to organ failure do to the interference with perfusion of the tissues. Treatment in horses is controversial and unlike other species heparin is not clearly of benefit. When instituted specific therapy requires a hospital environment where the coagulation parameters can be carefully monitored as they change with therapy. Prevention is paramount with early recognition and treatment of the primary disease process. The use of low dose flunixin three times daily early in the illness may be beneficial at it interferes with parts of the mechanism that lead to DIC, for more see the article on Foal Septicemia.
DrO

J Vet Intern Med. 2008 Sep 9;
Fibrin Deposits and Organ Failure in Newborn Foals with Severe Septicemia.

Cotovio M, Montreal L, Armengou L, Prada J, Almeida JM, Seguro D.

Departamento de Ciencias Veterinarias, Universidade de Tras-os-Montes e Alto Douro, Vila Real, Portugal.

Background: Septicemia in human neonates frequently is complicated by activation of the coagulation system, disseminated intravascular coagulation (DIC) and multiple organ failure synDrOme, which may contribute to high mortality. In adult horses with DIC, the lung has been the organ most frequently affected by fibrin deposits. In addition, in vivo studies suggest that homeostatic mechanisms may be immature in foals <1-day old. Hypothesis: Newborn foals with severe septicemia have fibrin deposits in their tissues independently of their age, and these fibrin deposits are associated with organ failure. Animals: Thirty-two septic and 4 nonseptic newborn foals euthanized for poor prognosis. Methods: Tissue samples (kidney, lung, and liver) collected on postmortem examination were stained with phosphotungstic acid hematoxylin (PTAH) and immunohistochemistry (IHC) for blind histologic examination. A fibrin score (grades 0-4) was established for each tissue sample and for each foal. Medical records were reviewed for assessing clinical evidence of organ failure during hospitalization. Results: Fibrin deposits were found in most septic foals (28/32 when using IHC and 21/32 when using PTAH), independently of the age of the foal. The lung was the most affected tissue (97% of the septic foals). Additionally, organ failure was diagnosed in 18/32 septic foals (8 with respiratory failure, 14 with renal failure), although a statistical association with severe fibrin deposition was not identified. Conclusions and Clinical Importance: Nonsurviving septic foals have fibrin deposits in their tissues, a finding consistent with capillary microthrombosis and DIC.
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