Disseminated intravascular coagulopathy (DIC) is an acquired disorder of hemostasis resulting in activation of the coagulation and fibrinolytic pathways. It is reported secondary to multiple disease processes and can be associated with increased mortality.2,3 Previous research at Lowry Park Zoo (LPZ) demonstrated that Florida manatees (Trichechus manatus latirostris) with cold stress syndrome (CSS) demonstrated thromboembolic disease.1 The object of this retrospective study was to establish the presence and clinical relevance of DIC in Florida manatees admitted to LPZ for rehabilitation from March 7th, 2010 to February 9th, 2015. A coagulation panel including prothrombin time (PT), partial thromboplastin time (PTT), platelet count, fibrinogen level, and D-dimer level was used to diagnose DIC. Prolonged PT, PTT, increased D-dimer and fibrinogen and reduced platelet count were considered consistent with DIC. There were 90 cases identified in the study period: 33 trauma, 31 CSS, 16 secondary to harmful algae bloom (HAB), and 10 other. Trauma and CSS cases had the highest incidence of DIC at 64% and 61%, respectively; DIC was not identified in HAB cases. In CSS cases, 98% resolved. Manatees that developed DIC during rehabilitation or where DIC progressed did not survive. D-dimer level was a valuable prognostic indicator with a poor prognosis at levels >1,500 ng/ml and 100% mortality at levels >3,200 ng/ml. Due to the clinical implications of DIC, identifying its presence and recognising its severity could improve clinical outcomes by enabling more intensive treatment protocols.
We gratefully acknowledge Florida Fish and Wildlife Conservation Commission for all the manatees successfully rescued. The authors would additionally like to thank Dr. Trevor Gerlach, Mrs. Virginia Edwards and her manatee rehabilitation team, as well as Lowry Park Zoo clinic staff Ms. Michelle Devlin and Ms. Heather Henry.
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2. Bick RL. Disseminated intravascular coagulation current concepts of etiology, pathophysiology, diagnosis, and treatment. Hematol Oncol Clin North Am. 2003;17:149–176.
3. Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med. 1999;341:586–592.