Development and implementation of a novel immune thrombocytopenia bleeding score for dogs

Kelly M Makielski; Marjory B Brooks; Chong Wang; Jonah N Cullen; Annette M O'Connor; Dana N LeVine

doi:10.1111/jvim.15089

Development and implementation of a novel immune thrombocytopenia bleeding score for dogs

J Vet Intern Med. 2018 May;32(3):1041-1050. doi: 10.1111/jvim.15089. Epub 2018 Apr 21.

Authors

Kelly M Makielski¹, Marjory B Brooks², Chong Wang^{3

4}, Jonah N Cullen³, Annette M O'Connor³, Dana N LeVine¹

Affiliations

¹ Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa.
² Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York.
³ Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa.
⁴ Department of Statistics, College of Veterinary Medicine, Iowa State University, Ames, Iowa.

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.

Keywords: bleeding scale; daily canine bleeding assessment tool; immune-mediated thrombocytopenic purpura; platelets.

MeSH terms

Animals
Dog Diseases / diagnosis*
Dogs
Female
Male
Platelet Count / veterinary
Purpura, Thrombocytopenic, Idiopathic / diagnosis
Purpura, Thrombocytopenic, Idiopathic / veterinary*
Reproducibility of Results
Severity of Illness Index