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Emergency Service: Extracorporeal Services

The extracorporeal service at NC State Veterinary Hospital offers an omnicomprensive array of therapies including hemodialysis, hemoperfusion, plasmapheresis, and bone marrow transplantation.

Besides the well-established role of hemodialysis in the treatment of severe kidney injury, we offer this treatment, along with hemoperfusion, for the rapid removal of a multitude of toxins and drug overdoses. Over the past 2 years our hemodialysis program has grown exponentially and currently receives a consistent inflow of referrals spanning on a radius of 500 miles.

Therapeutic plasmapheresis is effective and often life-saving for the treatment of acute forms of immune-mediated diseases, as IMHA, Myasthenia Gravis, and Pemphigus. Drug removal and hepatic encephalopathy also represent possible additional indications for its use.

Peripheral blood mononuclear cell collections are also performed, which are used for canine bone marrow transplantation for the treatment of a variety of canine hematologic malignancies, including lymphomas and leukemias. We have performed >80 bone marrow transplants to date. We can also perform leukoreductions prior to initiating chemotherapy to reduce the chances of tumor lysis syndrome.

Over the past year our extracorporeal team has performed more than 80 treatments with exceptional therapeutic results and client satisfaction. Our team is always enthusiastic and available for a free consultation about our extracorporeal services and to discuss the suitability of a patient for any of these cutting-edge treatments.

What is Hemodialysis?

The kidneys are in charge of a multitude of vital functions for the body along with eliminating metabolites, excess fluids, toxins and drugs.

Acute Kidney Injury (AKI), often known as kidney failure, is a life threatening condition associated with a sudden decline in kidney function. Cats and dogs can be equally affected by this condition and common causes of AKI include bacterial infections, toxins, urinary tract obstruction, immune-mediated diseases.

Once a pet is diagnosed with kidney failure, it is then critical to identify as rapidly as possible the initiating cause in order to provide the most appropriate treatment. Often though there is no time to wait for all tests results given that at the time of diagnosis of AKI, the patient is already systemically affected, requiring intensive medical care. Unfortunately medical management of AKI in pets as well as in humans is only effective in treating about half of the patients. When medical management fails to improve the patient’s clinical condition and the severity of the kidney injury, hemodialysis may represent the only chance for these patients.

Hemodialysis takes on the kidney function of removing metabolites, toxins and excess fluid form the body, while the kidneys are recovering from the damage they sustained. In pets, we use the same machines and devices used in people, adapting the treatment protocols to the needs of the patient. We routinely treat cats and dogs of all sizes, from a 1 kg teacup yorkie, to a 80 kg Great Dane. Horses and other large animal species can also be candidate for hemodialysis treatment should it be required.

Hemodialysis is performed by connecting the patient to the dialysis machine via a specially designed central venous catheter. Each hemodialysis sessions lasts approximately 4 to 6 hours and multiple sessions are performed intermittently during the course of treatment of acute kidney injury. During the session the patient rests comfortably on a soft padded bed. In some cases mild sedation is needed for the more excitable pets. The average hospitalization time for patients treated with hemodialysis is usually between 2 to 3 weeks with hemodialysis sessions performed every other day until the kidneys recover sufficient function to not require any further support.

Hemodialysis and related therapies (ie hemoperfusion) are also extremely effective in removing toxins, poisons and drugs from the body following accidental exposure or overdose. The hemodialysis and hemoperfusion filters are capable of removing a number of different drugs at speed far higher than the body or any other therapeutic intervention. The sooner the patient is treated the higher is the chance to prevent the deleterious effect of the toxin or drug overdose. Often one single session is all is necessary to remove most of the ingested/administered drug.

What is a Bone Marrow Transplant?

Bone marrow is found within your bones and bone marrow stem cells are the source of all the blood cells needed for life. We can cause these stem cells to leave the bone marrow (with a medication called Neupogen) and travel out into the peripheral blood, where we can collect them using a sophisticated apheresis machine. The apheresis machine painlessly takes blood out of the patient, removes the needed stem cells, and puts all the other blood cells back into the dog.

During apheresis, the dogs are anesthetized so they don’t move around for ~4-5 hours. Once cells are collected, the dogs undergo total body irradiation in an attempt to kill all the remaining cancer cells in the body. This treatment also kills all the bone marrow in the body, which is why we need to replace it with the peripheral blood stem cells we previously harvested. Once these cells are put back into the dogs with an IV catheter, the transplant is complete.

After the transplant, the dogs are hospitalized and monitored for ~2 weeks until their bone marrow is recovered and blood cell counts return to normal.. During this time, the dogs are provided with gastrointestinal medications for supportive care and antibiotics to fight infections until their bone marrow takes over. When their white blood cell count is very low, they spend 2-4 days in an isolation ward to protect them from infections from other dogs in the hospital.

Overall, patients tolerate this therapy well, although this is an aggressive therapeutic option with risks from anesthesia, radiation side effects, and infection. Cure has been obtained in 33% of B cell lymphomas and 19% of T cell lymphomas, although the dogs should be in a clinical remission before the transplant is performed. Further information is available from our Bone Marrow Transplant Unit under the direction of Dr. Steven Suter.

GETTING STARTED

Once you have determined the best therapeutic option for your pet, you may work with our oncology team to develop an appointment plan.

Learn more

Appointments, Referrals and Resources

Appointment Guidelines
No appointment is needed, but calling ahead is encouraged.

What to Expect
Due to the unpredictability and severity of patient problems long waiting times are sometimes experienced. Upon admission all patients are assessed immediately and triaged according to severity of problem. Patients with the most serious problems are seen first and patients with less serious problems will be attended to as soon as possible (similar to emergency rooms in human hospitals). Senior veterinary students play an important role in our care team and thus clients should expect to speak to a veterinary student as part of the intake and treatment process. All students are in close communication with our care team’s veterinarians and communicate clinician recommendations to you. As soon as the veterinarian working with your pet is available, they will talk with you regarding additional testing needed, prognosis and treatment options, and the anticipated costs associated with care. Our care team consults with on-call specialists when appropriate.

Emergency Service Fees: 

  • Emergency exam fee is $155.00.
  • Initial stabilization services for pets range between $400-$600. Additional diagnostic tests, specialty consults, therapeutics and other fees may also apply.

Download our full client expectations document here.

All pets presenting to the emergency hospital will be “triaged” by our technical staff. This means that patients are assigned a medical priority based on vital signs and a brief history. Similar to a human ER, this ensures that the most critically ill patients are given priority. A technician will greet you in the lobby and obtain your pet’s vital signs. If your pet’s vital signs are abnormal, or your pet is clearly unstable, the technician will escort your companion immediately to the back to be examined by a doctor. A student will then obtain vital historical information while your companion is stabilized. You may be asked to sign a permission form for “emergency treatment” at this time. As soon as medically possible, the attending clinician will consult with you and present a diagnostic and therapeutic plan.

If your companion is stable at the time of admission, you will be escorted to an examination room, where a veterinary student will obtain pertinent historical information and perform a physical examination. This information will then be presented to the attending clinician. Shortly afterward, the attending clinician will perform a through physical examination on your companion, consult with you, and present a diagnostic and therapeutic plan.

If your companion’s problems are complex in nature, specialists may be consulted and transfer to a specialty service may be recommended. In the event that your pet is hospitalized for a complex problem, his or her care will be transferred to one of these specialty services in the morning. Alternatively, care of your pet may be transferred back to your family veterinarian in the morning. In this instance, you must pick up your pet by 8am and proceed directly to your veterinarian.

It may be recommended that your pet be hospitalized. In this instance, we have several levels of care that are tailored to the needs of your pet. Technicians staff all hospital wards 24 hours a day, 365 days per year. Our intensive care unit is also staffed with dedicated technicians and doctors 24 hours a day. Visiting is encouraged and hours are established for all areas of the hospital. At the time of admission, please ask the attending clinician or student to provide you with this information.
If you provide the front desk with the name of your veterinarian, a full report will be faxed the following morning. Your veterinarian can also call at any time for consultation or with questions concerning your pet’s care. If your pet remains in the hospital and is transferred to a specialty service, the clinician in charge will contact your veterinarian by phone the following day.