Extracorporeal therapy is a procedure that removes blood from the body, circulates it through a filter system and then returns that blood back to the body. In veterinary medicine this encompasses Hemodialysis (HD), Hemoperfusion (HP) and Therapeutic Plasma Exchange (TPE).
This revolutionary treatment is available at our Tinton Falls location and is performed a board certified veterinary criticalist.
What is hemodialysis?
Hemodialysis is an extracorporeal therapy that removes solute and fluid waste produced during normal metabolism from the blood. A dialysis machine uses a pump to pass blood through a circuit containing a semi-permeable membrane in order to remove solute and water from the blood. The blood that has been purified is then returned to the pet. It is very important to understand that although HD helps to restore normal metabolic balance allowing the pet to feel better it is not “fixing” the kidneys.
What diseases can be treated with hemodialysis?
Most commonly in veterinary medicine HD is used to treat acute renal injury (AKI), occasionally end stage renal patients may be treated as well. No matter the cause of the acute injury HD may be beneficial, prognosis will depend on each individual pet and is part of the discussion at the time of an initial consult. In some cases, like ureteral obstruction, HD can be used to stabilize the pet prior to other necessary procedures. Lastly, HD can also be used in certain intoxications to prevent life threatening organ dysfunction from developing or in some cases quicken the recovery time if signs have already developed. In these cases timing of treatment is of great importance and early treatment is key.
what is hemoperfusion?
Hemoperfusion is basically HD with the addition of a charcoal adsorbent. Certain toxins that cannot be removed with traditional HD alone can be bound by the charcoal and removed from circulating blood. The use of HP can prevent damage or treat clinical signs associated with an intoxication in cases when HD alone would be ineffective.
What is therapeutic plasma exchange?
Therapeutic Plasma Exchange uses a different type of semi-permeable membrane to remove the pet’s own plasma proteins from the blood. The pet’s own red and white blood cells are returned while donor plasma is used to replace what was removed. Antibodies are a large protein removed in this way. When a pet is suffering from an immune mediated disease removal of these antibodies can help gain control over the disease much quicker than with medication alone. This can prevent further decline and the need for more intensive care, lead to the pet feeling better quicker, as well as lessen the time in hospital. TPE can also be used to remove highly plasma bound substances in certain intoxications with the same goal of preventing or treating clinical signs.
What happens to my pet?
At the time of initial consult common complications, risks, prognosis and what to expect will be discussed. In general, once a pet arrives they will undergo a physical exam, any catheters will be checked and medical records reviewed if not already done so. Initial vitals will be gathered and stabilization therapy may or may not be started. Once the initial consult is over the pet will either be sedated or anesthetized to have a jugular catheter placed, this is necessary for any extracorporeal therapy.
The number and duration of each session will depend on the situation, however, expect a therapy session to last anywhere from 4-8 hours including set up time and getting the pet back in their kennel afterwards. They lay down in a well-padded bed, connected to multiple monitoring devices and are not sedated during this time unless absolutely necessary. Most pets just hang out with us and enjoy the one on one attention, and cannot be visited during a session. Aggressive animals are unfortunately disqualified from extracorporeal therapy due to the amount of interaction needed and safety to them and the staff.
WHAT IS A BOARD CERTIFIED VETERINARY CRITICALIST?
Board certified veterinary criticalists focus on current techniques for diagnosing and treating life-threatening conditions in an emergency and for the critical time while pets are recovering. In addition to undergraduate training and four years of veterinary school, board certified criticalists complete an internship and residency, an additional three to five years of training. This is followed by a rigorous examination from the American College of Emergency & Critical Care. Passing this examination grants the status of Diplomate of the American College of Emergency & Critical Care (DACVECC).
Board certified criticalists work together with primary care veterinarians, emergency doctors, and other specialists. They diagnose, stabilize, and manage pets experiencing a medical crisis.