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HayKoeuü bíchuk ^HYBMET ÍMeni C.3. f^ицbкого
TOM 11 № 3(42) Hacmuna 2, 2009
Kamila Gliiíska-Suchocka, Krzysztof Kubiak, Marcin Jankowski, Jolanta Spuzak, Józef Nicpon, Vasyl Vlizlo*©
Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, University of Environmental and Life Sciences, pl. Grunwaldzki
47, 50-366 Wroclaw, Poland *Institute of the Animal Biology of UAAS, Lviv, Ukraine
BIOCHEMICAL ANALYSIS OF BLOOD AND PLEURAL FLUID OF THE DOGS WITH NEOPLASTIC HYDROTHORAX
Abstract
The aim of the study was an analysis of biochemical changes in the blood and fluid of the dogs with neoplastic hydrothorax. The study was conducted on 10 dogs with hydrothorax. The examinations were performed as follows: the history and clinical examination, thorax ultrasound and RTG examination, morphological and biochemical examination of selected blood parameters, thoracocentesis and fluid examination. Dogs were divided into 2 groups depending on the disease etiology: group 1- 5 dogs with the signs of hydrothorax connected with cardiac insufficiency (DCM), group 2- 5 dogs with the signs of hydrothorax connected with the neoplastic disease. The diagnosis of DCM was based on echocardiography examination. The criteria used for diagnosing tumors were standard cytological examinations. In the dogs with malignant hydrothorax the malignancies were of the following types: adenocarcinoma (4 dogs),carcinoma (1). The statistical analysis of the obtained results showed statistically significant differences between 2 examined groups.
The group 1 demonstrated the lower pleural fluid/serum total bilirubin ratio (p=0,0001) , pleural fluid/serum LDH ratio (p= 0,001) and pleural fluid/serum ALP ratio (p= 0,002) as compared with group 2. The group 2 demonstrated the higher pleural fluid/serum protein ratio (p=0,0009) and lower pleural fluid/serum glucose ratio (p=0,005) as compared with group 1. Key words: dog, hydrothorax, neoplasma
Introduction
Pleural fluid is an ultrafiltrate of plasma and there is usually less than 5- 10 ml of fluid in pleural cavity (3, 4, 5, 6, 7). The accumulation of clinically detectable quantities of pleural fluid is distinctly abnormal.
Pleural effusions may indicate the presence of pleural, pulmonary or extrapulmonary (heart, organs of abdominal cavity) disease (2). In some cases, the etiology of the effusion is obvious from the clinical picture (e.g. pleural effusions in congestive cardiac failure). In other cases, the cause and clinical significance is not apparent. In approximately 70-80% of cases, a definitive or presumptive
© Kamila Glinska-Suchocka, Krzysztof Kubiak, Marcin Jankowski, Jolanta Spuzak, Józef Nicpon, Vasyl Vlizlo, 2009
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identification of the cause can be determined through analysis of the pleural fluid obtained by thoracentesis (5).
Task, the aim of the article
The aim of the study was an biochemical analysis of blood and pleural fluid of the dogs with neoplastic hydrothorax.
Material and methods
The study was conducted on 10 dogs with hydrothorax (aged 1 ± 9 years, 4 females and 6 males). The examinations were performed as follows: the history and clinical examination, thorax ultrasound and RTG examination, morphological and biochemical examination of selected blood parameters (total protein concentration, glucose, total bilirubin, ALP, lactic dehydrogenase (LDH)), thoracocentesis and pleural fluid examination. The fluid collected from the pleural cavity was evaluated according to Light's criteria modified by the author (colour, translucency, special gravity, pH, total protein concentration, glucose, total bilirubin, ALP, lactic dehydrogenase, leukocyte count) (1, 6, 7, 8, 9), microbiological and cytological examination of the fluid). With these results, was calculated:
• Pleural fluid/serum protein ratio.
• Pleural fluid/serum glucose ratio.
• Pleural fluid/serum LDH ratio.
• Pleural fluid/serum ALP ratio.
• Pleural fluid/serum total bilirubin ratio.
Dogs were divided into 2 groups depending on the disease etiology: group 15 dogs with the signs of hydrothorax connected with cardiac insufficiency, group 2- 5 dogs with the signs of hydrothorax connected with the neoplastic disease. The diagnosis of DCM was based on echocardiography examination. The criteria used for diagnosing tumors were standard cytological examinations (11). The statistical analysis of the obtained results showed statistically significant differences between 2 examined groups.
Results of researches
The clinical history revealed lethargy, anorexia and dyspnoe in all the examined dogs. Two dog in group 2 presented vomiting. Thoracocentesis was performed in all the cases. It is a very useful tool for the diagnosis of pleural effusion. Diagnostic thoracentesis should be attempted whenever loculated pleural fluid is demonstrated with ultrasound (6). Thoracocentesis may be associated with a number of complications including pain, cough, haematoma, pneumothorax, haemothorax, syncope, liver laceration, re-expansion pulmonary oedema and pleural infection (7). Performance of the procedure by an experienced operator, especially under ultrasound guidance, considerably reduces the risk of complications. Traditionally, pleural effusions are classified as transudates and exudates (1, 3, 5, 6, 7, 9). A transudative pleural effusion derives from ultrafiltration of the pleural fluid across a membrane. Its accumulates due to an imbalance between hydrostatic and oncotic pressures. Common cause of transudate is congestive cardiac failure. Pleural
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Том 11 № 3(42) Частина 2, 2009
exudates imply involvement of the pleura by an inflammatory or malignant process causing increased capillary permeability.
In all cases in group 1 fluid from pleural cavity was transudate (clear yellow, it had low specific gravity and level of leukocyte, low concentration of protein, lower total bilirubine, LDH and ALP concentration).
In all cases in group 2 fluid from pleural cavity was exudate (bloody, it had high specific gravity and level of leukocyte, high concentration of protein, high total bilirubine, LDH and ALP concentration).
Separation of exudates from transudates is useful in determining the cause of a pleural effusion. Historically, specific gravity was used to separate these two entities, later a pleural fluid protein level. Actually many parameters are used to distinguish transudates form exudates. In our research we detect usefulness measure of biochemical parameters in distinguish hydrothorax caused by cardiac insufficient from neoplastic hydrothorax.
Our analysis showed that group 1 demonstrated the lower pleural fluid/serum total bilirubin ratio (p=0,0001) , pleural fluid/serum LDH ratio (p= 0,001) and pleural fluid/serum ALP ratio (p= 0,002) as compared with group 2. The group 2 demonstrated the higher pleural fluid/serum protein ratio (p=0,0009) and lower pleural fluid/serum glucose ratio (p=0,005) as compared with group 1. The bacteriological examination from the pleural fluid of dogs showed negative cultures in all the cases. In the dogs with malignant hydrothorax the cytological examination showed the malignancies were of the following types: adenocarcinoma (4 dogs), carcinoma (1 dog). Conclusion
Apart from differentiating between exudates and transudates, biochemical tests also serve as a guideline when assessing the etiology of the effusion. The measurement of glucose levels in pleural fluids has been used in the differential diagnosis of exudative disorders. Low pleural fluid glucose levels, and pleural fluid/serum glucose ratio usually indicate the presence of neoplastic disease. The low pleural fluid glucose level appears to result from a combination of increased glycolysis from pleural tissue, pleural fluid inflammatory cells and bacteria in conjunction with an impairment of glucose transport from blood to pleural fluid. High pleural fluid/serum LDH and ALP ratio in group 2 have been associated with malignancy effusion. Pleural fluid/serum total bilirubin ratio was helpful in distinguish transudate from exadute. In diagnosis of hydrothorax biochemical results should be interpreted with reference to clinical acumen and other laboratory tests, including cytology, microbiology and haematology.
References
1. Costa M, Quiroga T, Cruz E.: Measurement of pleural fluid cholesterol and lactate dehydrogenase. A simple and accurate set of indicators for separating exudates from transudates. Chest 1995, 108, 1260-1263.
2. Dzimira S.: Cytodiagnostyka pfynow z jam ciala. Magazyn Wet. 2004,3, 17-19.
3. Fry M.M., DeCock H.E., Greeley M.A., Vernau W.: Abdominal fluid from a dog. Vet. Clin. Pathol. 2003, 32, 77-80.
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4. Kooistra H.S.: Dogs with ascites. Tijdschr. Diergeneeskd. 1994, 15, 119-775.
5. Krus S., Skrzypek-Fakhoury E.: Patomorfologia kliniczna. PZWL, Warszawa, 1996, s.469-473
6. Light RW.: Clinical practice: pleural effusion. N. Engl. J. Med. 2002, 346, 1971 -1977.
7. Light RW. Pleural diseases. 4th edition. Philadelphia, Lippincott Williams and Wilkins, 2001.
8. Meisel S, Shamis A, Thaler M.: Pleural fluid to serum bilirubin concentration ratio for the separation of transudates from exudates. Chest 1990, 98, 141-144.
9. Peterman TA, Brothers SK.: Pleural effusions in congestive heart failure and in pericardial disease. N Engl J Med 1983, 309, 313.
10. Rosenthal R. C.: Veterinary oncology secrets. Hanley and Belfus Inc. Medical Publishers, Philadelphia, 2001
11. Woyke S.: Wybrane dziafy cytodiagnostyki. PZWL, Warszawa, 1973.
Summary
Apart from differentiating between exudates and transudates, biochemical tests also serve as a guideline when assessing the aetiology of the effusion. The measurement of glucose levels in pleural fluids has been used in the differential diagnosis of exudative disorders. Low pleural fluid glucose levels, and pleural fluid/serum glucose ratio usually indicate the presence of neoplastic disease. The low pleural fluid glucose level appears to result from a combination of increased glycolysis from pleural tissue, pleural fluid inflammatory cells and bacteria in conjunction with an impairment of glucose transport from blood to pleural fluid. High pleural fluid/serum LDH and ALP ratio in group 2 have been associated with malignancy effusion. Pleural fluid/serum total bilirubin ratio was helpful in distinguish transudate from exadute. In diagnosis of hydrothorax biochemical results should be interpreted with reference to clinical acumen and other laboratory tests, including cytology, microbiology and haematology.
Стаття надшшла до редакцИ 10.09.2009
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