Under the microscope with ACAHF grant recipient - Dr Lisa Smart

19 Dec 2019

Lisa is a senior lecturer in Veterinary Emergency and Critical Care at Murdoch University. Her role combines clinical service, undergraduate and postgraduate teaching, along with research. She is also completing a PhD with the Centre for Clinical Research in Emergency Medicine at Harry Perkins Institute of Medical Research, combining human clinical research with comparative canine research.

Lisa has been nominated for several Excellence in Teaching Awards at Murdoch University and has also received many research grants, including the Jean Kahan Memorial Scholarship and the American College of Veterinary Emergency and Critical Care Research Grant in 2015.

“My area of research for the last 10 years has been focused on treatments used for hypovolaemic shock in dogs,” she says.

“We’ve been particularly interested in better understanding the potential adverse effects of synthetic colloid fluids and blood products on patients. For example, in terms of synthetic colloid fluids, our group has identified a range of adverse effects, including coagulation deficits, increasing kidney injury and interference with some routine clinicopathological tests, especially in relation to refractometry.

“One of our ACAHF-funded projects, conducted by Dr Elodie Yam, a resident at Murdoch University, has assessed the effects of both gelatine and hydroxyethyl starchbased colloids in vitro on refractometric measurements of protein levels.

“When we started this study, we realised that the test agreement between total protein measurement via the biuret technique and via the refractometric method had not been fully explored to the limits of either test.”

Lisa says this finding surprised the research team, given how heavily refractometric testing is used in veterinary practice for the analysis of blood, urine and other body fluid samples of patients.

“Our starting point was establishing that these two techniques had adequate agreement,” she explains.

“From that point, we could then assess the effects of synthetic colloid fluids on these tests. The study compared protein measurements of different dilutions of plasma with either saline, Voluven® or Gelofusine®.

Although the findings are yet to be published, Lisa says the research group has found evidence that both of these commonly-used intravenous fluids heavily interfered with refractometry.

“This information is really useful for vets to know as they may rely on refractometry to help with clinical decision-making, especially in interpreting trends in total protein assessment. For example, a patient with severe hypoproteinaemia may have an increasing trend in total protein that the clinician may attribute to clinical improvement rather than interference from synthetic colloid use.”

Lisa is looking forward to the next phase of this study, which will be to explore the effect in vivo – not only on total protein measurement but also on urine specific gravity.

“We feel this information is vital for any practitioner using synthetic colloid fluids, especially in regards to interpretation of urine concentration.

“We know that misdiagnosis of renal failure can have significant consequences for the patient, both in treatment choices and prognostication. We are on track to finishing the in vivo phase of this research within the next few months and we hope to present the results soon.”

One of Lisa’s other ACAHF-funded projects is being driven by Murdoch resident Dr Sarah Purcell and her supervisor Dr Melissa Claus (Lecturer in Veterinary Emergency and Critical Care). It concerns the effects of leucoreduction on inflammatory cytokines in stored blood products.

The research group have found that stored blood products may accumulate inflammatory cytokines due to ongoing activation of leucocytes.

“We measured cytokine levels in packed red blood cells over a storage period of 37 days and found a significant increase in interleukin-8, a pro-inflammatory cytokine,” Lisa explains.

“This is significant, given that delivering blood products to critically ill patients containing pro-inflammatory cytokines may be harmful.

“We then compared units of blood that had undergone leucoreduction. Leucoreduction is the technique of removing white blood cells (leucocytes) from the blood components that are needed for a blood transfusion. It involves passing the blood through a filter that removes the leucocytes before storing the blood.

“We found that leucoreduction led to an approximate 10-fold reduction in median interleukin-8 levels in these units.

“The next phase of our research is to assess the clinical impact of leucoreduction by performing a randomised controlled clinical trial, with research endpoints such as measuring the cytokine levels in transfusion recipients.

“In human medicine, leucoreduction has now become the accepted standard of care but we are yet to establish the clinical impact of using leucoreduced products in canine medicine.

“The benchtop research program funded by the ACAHF was the stepping-stone we needed to justify progressing our research to clinical trial phase and we are really delighted to be able to continue this work.”

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