Development and implementation of a novel immune thrombocytopenia bleeding score for dogs. (21st April 2018)

• Record Type: Journal Article
• Authors: Makielski, Kelly M.; Brooks, Marjory B.; Wang, Chong; Cullen, Jonah N.; O'Connor, Annette M.; LeVine, Dana N.
• Is Part Of: Journal of veterinary internal medicine. Volume 32:Number 3(2018)
• Page Start: 1041
• Page End: 1050
• Publication Date: 2018-04-21
• Subjects: bleeding scale -- daily canine bleeding assessment tool -- immune‐mediated thrombocytopenic purpura -- platelets; Veterinary medicine -- Periodicals; 636.0896
• DOI: 10.1111/jvim.15089
• Languages: English
• ISSNs: 0891-6640

Abstract

Abstract : Background: A method of quantifying clinical bleeding in dogs with immune thrombocytopenia (ITP) is needed because ITP patients have variable bleeding tendencies that inconsistently correlate with platelet count. A scoring system will facilitate patient comparisons and allow stratification based on bleeding severity in clinical trials. Hypothesis/Objectives: To develop and evaluate a bleeding assessment tool for dogs, and a training course for improving its consistent implementation. Animals: Client‐owned dogs (n = 61) with platelet counts <50, 000/μL; 34 classified as primary ITP, 17 as secondary ITP, and 10 as non‐ITP. Methods: A novel bleeding assessment tool, DOGiBAT, comprising bleeding grades from 0 (none) to 2 (severe) at 9 anatomic sites, was developed. Clinicians and technicians completed a training course and quiz before scoring thrombocytopenic patients. The training course was assessed by randomizing student volunteers to take the quiz with or without prior training. A logistic regression model assessed the association between training and quiz performance. The correlation of DOGiBAT score with platelet count and outcome measures was assessed in the thrombocytopenic dogs. Results: Clinicians and technicians consistently applied the DOGiBAT, correctly scoring all quiz cases. The odds of trained students answering correctly were higher than those of untrained students ( P < .0001). In clinical cases, DOGiBAT score and platelet count were inversely correlated ( r s = −0.527, P < .0001), and DOGiBAT directly correlated with transfusion requirements ( r s = 0.512, P < .0001) and hospitalization duration ( r s = 0.35, P = .006). Conclusions and Clinical Importance: The DOGiBAT and assessment quiz are simple tools to standardize evaluation of bleeding severity. With further validation, the DOGiBAT may provide a clinically relevant metric to characterize ITP severity and monitor response in treatment trials.