Rebecca Pentecost DVM: PLAA 2011 Keynote Slides

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Dr. Rebecca Pentecost addresses Pennsylvania Llama and Alpaca Association\'s Annual Meeting at Toftrees Golf and Convention Center, State College, PA on March 24, 2011.

Dr. Rebecca Pentecost addresses Pennsylvania Llama and Alpaca Association\'s Annual Meeting at Toftrees Golf and Convention Center, State College, PA on March 24, 2011.

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  • Eggs produced by females Passed in manure Larva develop in fecal mass L1 hatches, feeds on bacteria, undergoes two molts L3 makes way out of feces onto forage Ingested Develops to L4, to immature adult After maturation, starts producing eggs Prepatent period is appx 3 weeks Occasional hypobiotic periods (RARE) Weather dependent (shown in Great Britain study, cold then warming to 10 C with moist environment needed to hatch.
  • Fecal egg count reduction test (FECRT) – eggs/gram at pretreatment levels versus those 10-14 days later. For practical purposes, a 90% reduction suggests successful treatment and <90% reduction may indicate resistant parasites, ineffective dose or route of administration. Egg count concerns – <200 epg are usually considered ok if BCS is also normal. If epg is rising, animals have poor bcs or other signs of ill thrift, it is possible treatment may be helpful. Epg significance is much lower when considering low or intermittently shedding parasites like trichuris, capillaria, nematodirus, or emac (even low numbers may warrant treatment).
  • Not ideal to blanket treat entire herd or to rotate dewormers regularly as this may lead to the development of resistant parasites. The ideal approach involves selectively treating animals based on fecal counts and clinical signs (20% of animals harbor 80% of the herd parasite burden). Targeted deworming allows one to leave a population of parasites that have not been exposed to specific drugs. Leaving these naïve parasites helps prevent selection for resistant parasites (refugia, as coined by parasitologists).
  • Large volume of blood lost by animal. 10 days of losing 200mL = 2L

Transcript

  • 1. Updates from Ohio State and Camelid Parasite Diagnosis, Control, and Prevention Rebecca Pentecost, DVM Hospital for Farm Animals Veterinary Clinical Sciences
  • 2. Objectives of Lecture –
    • Updates from Ohio State University College of Veterinary Medicine
    • Discuss one of the most important problems facing the Camelid producer
    • How to approach problem
      • The most logical and efficient means of addressing?
      • Most economical?
    • Questions and answers
  • 3. Update from Ohio State!
    • New Theriogenology section
      • Dr. Carlos Pinto
      • Dr. Marco DaSilva
  • 4. Update from Ohio State Alpaca embryo transfer program
    • Goals of the Program :
    • Advance knowledge of Alpaca reproductive physiology through basic and applied research
    • Promote development of assisted reproductive techniques for alpacas
    • Increase reproductive efficiency and accelerate genetic gain of the herd
  • 5.
    • Areas of Potential Research :
    • Protocols for Superovulation
    • Maternal Recognition of Pregnancy (ET time)
    • Embryo Cryopreservation
    • Endocrinology of Pregnancy
    Update from Ohio State Alpaca embryo transfer program
  • 6. Alpaca embryo – Inner cell mass
  • 7. Pharmacokinetics and bioavailability of florfenicol in Alpacas
  • 8. Introduction
    • Florfenicol has been studied extensively in cattle
    • Florfenicol commonly used empirically in camelids – pharmacologic data have never been established in this species
    • Goal: to determine the disposition and bioavailability of florfenicol after IV, SQ, and IM dosing
  • 9. Study design
    • 3 – way crossover design with a minimum of 2 weeks wash-out in between studies
    • IV dose, IM dose, SQ dose
    • 20 mg/kg florfenicol based upon current weights of each study subject
    • 8 Male alpacas
      • 1.5 to 7 years of age
  • 10. Study day preparation - IV
    • Accurate body weight
    • Place jugular catheter into each vein
    • Nuflor administered IV based upon weight in one jugular catheter
    • Samples drawn from contralateral catheter
    • Centrifuge to obtain serum
      • Stored in cryovials in duplicate
  • 11. Study day preparation – IM,SQ
    • Same as IV except one catheter placed for sampling
  • 12. Sample Analysis
    • Samples prepared for analysis using solid phase extraction (SPE)
    • Analyte quantitation by HPLC UV 224 nm
    • Samples reconstituted in mobile phase in brown glass vials after concentration and drying (50 μ L injections)
    • Complete standard curves were simultaneously extracted from blank alpaca serum on each day of analysis
    • Unknown sample concentrations were determined by linear regression analysis of known standard concentrations
  • 13. Method characteristics
    • Sample recovery >85% over range of concentrations tested
    • Between and within day accuracy was <10%
    • Between and within day precision was <10%
    • Limit of quantitation – 0.05 μ g/mL
  • 14. Pharmacokinetic analysis
    • Individual (IV) plasma concentration versus time data were modeled using compartmental analysis (1, 2, 3 compartments; Topfit 2.0).
    • Most appropriate model was selected base upon the Akaike Information Criterion (AIC) and correlation coefficient (r 2 )
      • 2 Compartmental model provided best fit to data
    • Data was described in tabular form as median and range
  • 15. Parameter Units Median Range A 1 (A) μg/mL 110 52 – 275 λ 1 ( α ) hr -1 4.48 2.57 – 14.8 A 2 (B) μg/mL 7.6 4.7 – 31 λ 2 ( β ) hr -1 0.367 0.099 – 1.04 k 31 hr -1 1.44 0.33 – 4.66 k 1e hr -1 1.32 0.54 – 2.0 k 13 hr -1 2.0 0.89 – 9.77 MRT hr 2.56 0.86 – 7.36 T ½ (elim) Hr 3.75 1.97 – 6.95 V ss L/kg 0.525 0.25 – 2.54 CL mL/min/kg 5.6 1.6 – 6.2 AUC μg*hr/mL 59.8 54 – 208 T max hr 0.00016 0.00011 – 0.014 C max μg/mL 109 52 - 275
  • 16. Serum concentration-time curve IV – Florfenicol (20 mg/kg)
  • 17. Concentration-time curves IM and SQ – Florfenicol (20 mg/kg)
  • 18. Conclusions
    • There were no adverse reactions to the administration of florfenicol intravenously
    • Bioavailability low (~11-40%)
    • Half-life of elimination is approximately 4 hr post dosing
    • Serum concentrations of florfenicol remain above 0.5 μ g/mL for at least 15 h post dosing for all 3 routes
    • Peak concentrations of florfenicol after IM dosing are higher and less variable than after SQ dosing.
    • Administration of florfenicol once daily should provide adequate serum concentrations for most susceptible bacteria
  • 19. Acknowledgements
    • Dr. Jeff Lakritz
    • Dr. Andy Niehaus
    • Dave Frederick
    • Columbus State Technical Students
    • Students and Technicians of The Ohio State VMC
  • 20. Mycoplasma haemolamae Transmission, virulence, and in vitro culture Morris Animal Foundation grant funded
  • 21. Introduction
    • A hemotropic parasite that attaches to the membrane surface of red blood cells
    • Originally described and classified as an Eperythrozoon -like organism
    • Reclassified to Mycoplasma along with M. suis and M. wenyonii (swine and cattle)
      • Based on similarity of the 16S ribosomal RNA gene
      • PCR testing is useful for parasite detection and isolation of DNA for sequencing
    • Colostral antibodies provide immunity for many diseases and parasites – also for M. haemolamae ?
  • 22. Acridine orange staining
    • AO stains nucleic acid. Mycoplasma has nucleic acid and stains bright yellow
  • 23. Clinical and Subclinical Disease
    • Majority of infected animals show no signs of disease
    • Signs of disease are often nonspecific
      • Lethargy
      • Decreased appetite
      • Fever
    • Variable degrees of anemia
    • Life threatening disease
      • Severe anemia
      • Marked hypoglycemia
  • 24. Transmission
    • Poorly understood
    • Suspected transplacental transmission
    • Potential transmission of pathogens via colostrum
    • Biting insect vectors
  • 25. Study Goals
    • To determine if in utero or colostral transmission was a significant route of infection by Mycoplasma haemolamae for neonatal crias.
    • To identify the presence of colostral antibodies, determine if they affect immune status, and evaluate the relationship between dam parasitemia and colostral antibody excretion.
    • Develop an in vitro culture for ongoing studies
  • 26. Study Design
    • Sample collection
      • 56 dam/cria pairs identified from a single alpaca farm
      • Samples obtained
        • Blood from dam at parturition (0 hr)
        • Blood from cria at parturition (0 hr)
        • Colostrum from dam at parturition (0 hr)
        • Blood from cria after colostrum ingestion (48-72 hr)
      • IgG levels checked at birth and post colostrum
  • 27. Sample Processing
    • DNA extraction
    • PCR amplification
    • Gel electrophoresis of PCR products
    • Positive and negative controls
  • 28. Colostral Antibodies
    • Several IFA slides prepared with parasitemic blood sample
    • Colostral samples were diluted 1:10 and 1:100 and incubated on the slides
    • A goat anti-llama antibody for flurochrome label incubated with slides
    • Antibodies are present if RBCs have areas of fluorescence under UV light microscopy
  • 29. Culture
    • Parasitemic animals identified and samples taken and cryopreserved for ongoing studies and culture maintenance
  • 30. Initial Results and Conclusions
    • Transplacental transmission is uncommon but does occur
    • Colostral transmission has not been demonstrated
    • Antibodies to M. haemolamae are present in colostrum and seem to provide immunity to the parasite
    • Further data analysis and publication pending
  • 31. Acknowledgements
    • Dr. Antoinette Marsh
    • Dr. Jeff Lakritz
    • Dr. Paivi Rajala-Schultz
    • Dr. Josh Daniels
    • Jackie Daleccio
  • 32. Stifle Arthroscopy in Camelids
  • 33. Study Goal and Design
    • Arthroscopy is commonly performed in human, canine, and equine patients
    • Minimally invasive approach
      • Decreased morbidity
      • Excellent joint surface visualization
    • Improvement in diagnosis and therapeutic intervention for stifle pathology
    • No previous reports in SAC
  • 34. Joint Model
    • PMMA injected into stifle joint
    • Soft tissues removed using concentrated NaOH and hypochlorite solution
    • Joint anatomy better defined
  • 35. Stife Arthroscopy
  • 36. Selected Cases
    • Llama with severe OA
      • Multiple osteochondral fragments
      • Possible cruciate rupture – unsure based on exam and radiograph findings
      • Very heavily conditioned
    • Alpaca with patellar fracture
      • Small basilar fragment
      • Minimal joint disease
      • Otherwise healthy
  • 37. Acknowledgements
    • Dr. Andy Niehaus
    • Dr. Elizabeth Santschi
    • Dave Frederick
  • 38. Pharmacokinetics of Midazolam in South American Camelids Anesthesia and Farm Animal Sections Collaborative Project Dr. Pam Fry, Dr. Turi Aarnes, Dr. John Hubbell, Dr. Jeff Lakritz
  • 39. Introduction
    • Midazolam classified as a benzodiazapene
    • Uses
      • Sedation
      • Anesthetic induction
    • Less cardiovascular and respiratory depression as compared to diazepam
    • No pharmacokinetic studies have been performed in camelids
  • 40. Study Design
    • 6 alpacas
      • 3 intact males and 3 intact females
    • Route of administration
      • IM and IV
      • Crossover study design
    • Drug levels measured using HPLC
  • 41. Results Pending
    • IV and IM show effect at the dosage administered
      • IV effect faster onset and more profound
      • Subjective findings indicate significant sedation
      • No major side effects have been noted
    • Drug bioavailability curves are pending
  • 42. Future Camelid Research at Ohio State
    • Dental disease in llamas and alpacas
      • Tooth root abscesses occur commonly in llamas and alpacas
      • Other ruminants seem less predisposed
      • Identification of feed, forage, or other husbandry practices that may predispose to dental disease
      • Current plan includes surveying owners in conjunction with retrospective case analysis from hospitalized patients
  • 43. Update from Ohio State!
    • International Camelid Health Conference for Veterinarians
      • March 2012 (2 nd or 3 rd week)
      • Camelid owners/breeders conference
      • Veterinary speakers from across the USA and world
  • 44. Buckeye Alpaca Show sponsors ICHC speakers
    • ICHC for DVM sponsorship by the Buckeye Alpaca Show and OABA?
      • Look to OABA and OSU CE website for more details coming soon
  • 45. ICHC for DVM meeting – tentative schedule
    • Modules of expertise in cohesive blocks
      • Individual presentation
      • Summary statements
      • Discussion/questions
    • Reproduction
    • Medical Diseases
    • Surgical Diseases
    • International presence
  • 46. ICI update –
    • Vets only forum
      • Duplicated by AOBA, NAAF(?)
    • Veterinary videos – Collaboration with ARI
    • Reference Library
      • Updated references
    • Endowment
      • Value ~ 700K
  • 47. Parasites and Camelids – Should We Be Worried? Becky Pentecost, DVM The Ohio State University Veterinary Medical Center Hospital for Farm Animals
  • 48. The top 10 reasons camelids develop GI disorders –
    • 1. Parasites
    • 2. Parasites
    • 3. Parasites
    • ………… ..
  • 49. Why discuss parasites?
    • What is your parasite management program?
    • How developed?
      • What is the goal of your parasite management program?
      • What is the cornerstone of your parasite management program?
    • What would you do if tomorrow, none of the deworming agents worked on any parasites?
  • 50. Parasitism in SAC
    • Camelids can survive pretty well on low quality feed
      • Increased digestion and fermentation of even coarse hay
      • Water conservation is impressive
    • Camelid parasites in North America
      • SAC have evolved without some of the parasites commonly encountered in NA
  • 51. Common Nematode Parasites GI Tract Location Parasites C3 Haemonchus contortus, Trichostrongylus, Ostertagia, Camelostrongylus, Teladorsagia, and Marshallagia Small Intestines Nematodirus, Cooperia, Trichostrongylus Large Intestines/Cecum Trichuris, Capillaria, and Oesophagostumum spp
  • 52. Life Cycle Review for Trichostrongyle-types Infective larvae are ingested during grazing Eggs hatch, larvae develop to L3 in soil and manure Eggs passed onto pasture in manure Adult nematodes in the digestive tract of camelids lay their eggs.
  • 53. Cestode Parasites
    • Moniezia most common cestode
    • Generally not a primary pathogen
    • Severe infections can cause generalized signs of unthriftiness
    • Treatment: Fenbendazole, albendazole, or praziquantel
  • 54. Protozoal Parasites
    • Coccidia – Eimeria spp.
    • Six species reported – 4 are common
      • E. punoensis, E. alpacae, E. lamae, E. macusaniensis
    • Direct fecal-oral transmission
    • Healthy adults rarely show signs of clinical disease
      • Juveniles more susceptible
      • Immunity develops after exposure
  • 55. Coccidia
    • Damage intestinal epithelial mucosal cells
    • Diarrhea may remain after clearing infection
    • Coccidiostats during times of high stress may help prevent outbreaks
      • Amprolium
      • Sulfadimethoxine
      • Ponazuril
      • Toltrazuril
  • 56. E. mac – A Big Deal?
    • First reported in the US in 1988
    • Slightly longer prepatent period than other Eimeria spp
    • Widespread geographic distribution
    • Can be subclinical carriers/shedders
    • Can cause serious disease/death
    • Evaluate for signs of infection
      • Protein levels of particular concern
      • Ponazuril generally accepted treatment
      • Toltrazuril becoming more popular
  • 57. Indications of GI Parasitism
    • Often nonspecific
      • Unthrifty appearance
      • Anorexia
      • Slow or stunted growth
      • Weight loss / Lower BCS
    • Diarrhea
    • Pale mucous membranes
    • Edema (submandibular or ventral)
  • 58. Fecal Exams
    • Preferred methodology
      • Concentrated sugar solution (1.27 SG)
      • Centrifugation
      • 30-60 minute flotation time
    • Qualitative vs. Quantitative Analysis
    • Fecal Egg Count Reduction Test (FECRT)
  • 59. Other Diagnostics?
    • PCV/TP
    • CBC
    • Blood transfusion may be required in severely anemic animals as a stabilization measure
  • 60. Anthelmintics
    • Accurate body weights
    • Deworming history
      • Timing
      • Fecal counts
      • Effectiveness of previous dewormers
    • Targeted treatment
    • Resistant parasites
    • Limited dewormers available – no new ones in sight…
  • 61. Available Dewormers Class Drug Dosage Route Avermectins Ivermectin 1.5 mL/100 lbs SQ Doramectin 2.0 mL/100 lbs SQ Cydectin Benzamidazoles Fenbendazole 9 mg/lb Oral Albendazole 5.5 mg/lb Oral Imidazothiazole derivative Levamisole 4 mg/lb Oral Depolarizing neuromuscular blocking agent Pyrantel pamoate 8 mg/lb Oral Antiprotazoal/ Coccidiostats Ponazuril 9 mg/lb Oral Toltrazuril Amprolium Sulfadimethoxine
  • 62. Deworming Conundrum
    • Meningeal worm
      • Deworming recommendations to prevent infection
        • Ivermectin
        • Doramectin
        • Treat monthly
    • What is the downside to this treatment pattern?
      • Resistant GI parasites
  • 63. Monthly deworming with Ivermectins – How effective against whipworms?
    • Ivermectins are of highly variable efficacy against Trichuris spp. in swine.
      • Riviere J, Papich M, Veterinary Pharmacology and Therapeutics 9 th Ed. 2009. pp. 1131
    • Ivermectin at higher doses for dogs and cats
      • Riviere J, Papich M, Veterinary Pharmacology and Therapeutics 9 th Ed. 2009. pp. 1131
    • Parasite fecundity – Low
    • Eggs high density; must use appropriate centrifugation techniques
    • Camelids highly susceptible to whipworm infestation
  • 64. Monthly deworming with Ivermectins – How effective against mites?
    • Reportedly highly effective against Sarcoptic mange, Psoroptic mange
    • Effective against sucking lice
    • Chorioptic mange?
      • Biology of this parasite?
      • May spend weeks off of host (environment)
      • Treatment with Doramectin or Ivermectin
        • G.L. D’Alterio, Vet. Parasit. 2005; 130 (3-4): 267-275
      • Fipronil application (topical, spray)
  • 65. FECR tests – Goats 2001 Terrill TH, et al., 2001; Vet. Parasitol. 97:261-268 Anthelmintic EPG (2 wk post) FECR % (95% CI) Control 3827 ABZ 1450 62 (35-78) Dora 917 76 (39-91) FBZ 3460 10 (0-42) IVM 844 78 (5-95) LEV 335 91 (81-96) Morantel 1990 48 (11-70) MOXI 0 100 (100) ABZ + IVM 445 88 (74-95)
  • 66. FECR tests – Goats 2003
    • ABZ resistance on 14/15 farms
    • IVM resistance on 17/18 farms
    • LEV resistance on 6/18 farms
    • MOXI resistance on 1/18 farms
    • Resistance to multiple drugs
      • 14/15 farms (ABZ, IVM)
      • 5/15 farms (ABZ, IVM, LEV)
    • FEC reduction (%)
      • ABZ 67, IVM 54, LEV 94, MOXI 97
    • H. contortus and Trichostrongylus most common isolated larvae
    Mortenson LL, et al., 2003; JAVMA 223:495-500
  • 67. FECR tests – Sheep and Goats
    • Haemonchus resistance
      • 45/46 farms – BZD
      • 25/46 farms – LEV
      • 35/46 farms – IVM
      • 11/46 farms – MOXI
    • Resistance to all 3 classes
      • 22/46 farms
    • Resistance to all 3 classes + MOXI
      • 8/46 farms
    • H. Contortus and Trichostronylus most common identified parasites
    Howell SB, et al., 2008; JAVMA 233:1913-1919
  • 68. Parasite resistance in SAC?
    • What is the incidence of resistant nematodes in SAC?
      • Gillespie RM et al., 2010; Vet. Parasit. 172:168-171
        • Resistance to IVM (Llama, Alpaca farms)
        • Resistance to FBZ (Llama farms)
        • Resistance to MOX (Llama farm)
        • No Resistance to LEV on any farm tested
  • 69. Parasite resistance and anemia
    • Seeing increased incidence of parasite problems
    • Many of these present with severe anemia
    • Haemonchosis?
  • 70. H. Contortus – C3, alpaca
  • 71. Blood loss ?
    • Blood volume in llamas 63 ± 4 mL/Kg, alpacas 72 ± 5 mL/Kg
      • Blood volume 9L (llama), 4.9L (alpaca)
    • Anemia hemorrhagic in nature
      • Adult worms suck blood for 12 min, 7 min continued bleeding after worm detachment
    • Sheep carrying 3-4k female worms lose up to 150-200 mL whole blood/day
    Moore DM, Vet. Hematology; 5 th Ed. Pp. 1184-90 Le Jambre LF, Int. J. Parasitol, 1995; 25:269-73 Rowe JB, et al., British J Nutrition 1988; 59:125-39
  • 72. Fecal ooccult blood –
  • 73. The Predicament – Death of your animals
    • Monthly deworming for meningeal worm
    • Selection for resistant nematodes
    • Overdosing dewormers
    • Anemia and death
  • 74. Building a parasite program
    • What things can you incorporate?
      • 1. Camelid behavior
      • 2. Pasture management
      • 3. Biological controls
  • 75. Peculiarities of camelids –
    • Dung piles
      • Most important aspect of camelid behavior relative to GI parasitism management
      • Overcrowding
  • 76. Map of property – Why?
  • 77. Integrated parasite management
    • Clean or safe pastures
      • Pastures not grazed for 6-12 mos
      • Pastures grazed by other species
      • Pastures where hay is removed
      • Pastures rotated with harvested crops
      • Tilled land put into pasture
      • Pastures rested for varying time period
        • 60 -120 day between grazing
        • Improved pasture outweighs parasite burdens
  • 78. Grazing strategy
    • 80% of worm burden in lower 2” of grass
      • Grazing taller grass will limit exposure
    • Browsing
    • Wait until dew or rain dries
      • Turn out later in day
    • Multi-species grazing
    • Alternative forages
      • Chicory
      • Sericea lespedeza
      • Birdsfoot trefoil
  • 79. Other Management Techniques
    • Feeding off the ground (bunks)
    • Eliminating standing water
    • Regular removal of dung piles and pen sanitation
    • Biosecurity - Quarantine incoming animals
  • 80.  
  • 81. Anemia in South American camelids –
    • Gastrointestinal parasitism
      • Primarily Haemonchus
    • Blood borne pathogens
      • Mycoplasma haemolamae
    • Toxic
      • Red Maple
    • Neoplasia
      • Lymphoma
  • 82. Review of recent anemia cases from OSU VMC
    • 46 Animals (35 Alpaca, 11 Llama)
    • 33 female, 13 male; 4.2 ± 3.5 yrs
    • 41 heavily parasitized, 2 obstetrical complications, 1 peritonitis, 1 tetrology of fallot.
  • 83. Iron deficiency anemia –
    • Microcytic, hypochromic, reduced MCHC, hypoferremia, reduced serum ferritin conc, decreased % transferrin saturation and normal to increased TIBC
    • Moderate anemia, PCV 18-22, RBC# normal, hemoglobin ½ normal, microcytic, low MCHC
      • Morin DE et al, Vet Pathol. 1992; 400-4
  • 84. Iron deficiency anemia
    • 2/3 of body iron is present in RBC
    • Bone marrow, spleen, liver
    • Serum iron drops first, followed later by BM decrease and change in RBC morphology (hypochromasia, microcytosis)
    • Vitamin B12 deficiency
      • Macrocytic anemia
    From: Smith BP, 2009; 4 th Ed., 2009
  • 85. Total plasma protein and red cell parameters – presentation Analyte Mean ± sd Range Median Reference TPP (Gm/dL) 5.2 ± 0.72 3.7 – 6.6 5.3 5.4 – 7.2 HCT (%) 9.9 ± 5.3 4 – 25 8 24 – 35 HgB (Gm/dL) 4.2 ± 2.3 1.6 – 11 3.6 9.1 – 16.2 RBC (x 10 12 /L) 4.2 ± 2.5 1.4 – 10.5 3 8.8 – 15.4 MCV (fL) 25 ± 6 12.7 - 44 24 21 - 30 MCH (pg) 10 ± 2 6.5 – 16 10 7.7 - 13 MCHC (g/dL) 42 ± 5.7 35.7 - 48 41 39 - 46 NRBC (ABS) 28 ± 47 0 - 257 15 0 – 0 NRBC (#/100 WBC) 4.8 ± 8.2 0 - 42 2 0 – 1
  • 86. RBC abnormalities - ?
  • 87. Polychromatic, hypochromatic, dacryocytes
  • 88. Serum Fe, TIBC, UIBC in anemic Alpacas Data from 13 anemic and 13 normal Alpacas *Indicates significant difference from normal using t-test (P<0.05); power with α = 0.05 are 0.915, 0.67 respectively Analyte Units Anemic (median) Range Normal (median) Range Serum Fe μ g/dL 43 ± 42 * (22) 2 – 121 95 ± 35 (96) 37 - 168 TIBC μ g/dL 261 ± 65 (266) 172 – 363 248 ± 44 (242) 186 – 339 UIBC μ g/dL 218 ± 71 * (209) 70 - 309 153 ± 51 (164) 61 – 230
  • 89. “ Otis May” – Presentation
    • Down, weak, pale
    • No milk in udder
    • Cria is hungry and trying to nurse
    • Ocular membranes
  • 90. Case Management
    • White mucous membranes
    • PCV – 7%
    • TP – 5.0 g/dL
    • CBC indicates regenerative response (NRBCs elevated)
    • Mild derangements on biochemical profile
    • Blood transfusion – 1-2 units whole blood
    • Iron and Vitamin B12 supplementation
    • Fecal examination, PCR for M. haemolamae , etc.
  • 91. Questions?