Serum hepatitis associated with commercial plasma transfusion in horses.
Authors: Aleman Monica, Nieto Jorge E, Carr Elizabeth A, Carlson Gary P
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Serum Hepatitis Risk Associated with Commercial Plasma Transfusion Between 2005 and the present, awareness of serum hepatitis as a transfusion-related complication in horses has remained limited despite its severity; this case series documented four fatal instances in horses receiving 1.5–5 litres of commercial plasma, with one animal additionally receiving 8 litres of fresh blood. Clinical signs emerged 41–60 days post-transfusion and included acute, severe colic refractory to medical management, lethargy, and sudden death, with two horses developing secondary encephalopathy characterised by severe diffuse Alzheimer type II astrocytes on neuropathological examination. Serum hepatitis in affected horses manifested as acute hepatic central lobular necrosis, a pattern historically associated with equine-origin biological products rather than vaccination exposure in these particular cases. Whilst the prevalence of transfusion-associated serum hepatitis appears low, the uniformly fatal outcome in this series underscores the importance of recognising this complication as a genuine, if uncommon, risk factor—particularly relevant for practitioners managing critically ill horses requiring volume replacement or coagulopathy correction. Given the delayed presentation and non-specific early clinical signs, maintaining a transfusion history and considering hepatic function in horses presenting with prolonged post-transfusion colic or encephalopathy may facilitate earlier diagnosis, though prognosis remains grave once clinical signs are established.
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Practical Takeaways
- •Screen horses receiving commercial plasma transfusions for signs of hepatic disease (lethargy, severe colic) beginning 4-8 weeks post-transfusion, as delayed onset serum hepatitis may be fatal
- •Consider serum hepatitis in the differential diagnosis for refractory colic developing weeks after plasma administration, even if initial transfusion appeared successful
- •Document all plasma products used and maintain awareness that commercial plasma carries a small but real risk of transmissible serum hepatitis; discuss this risk with owners before transfusion
Key Findings
- •Four horses developed fatal serum hepatitis 41-60 days after receiving 1.5-5 L of commercial plasma transfusion
- •Clinical signs included acute severe colic unresponsive to medical therapy, lethargy, or sudden death
- •Two horses developed encephalopathy with histological confirmation of severe diffuse Alzheimer type II astrocytes in brain tissue
- •Serum hepatitis associated with commercial plasma is uncommon but potentially fatal, requiring consideration as a risk factor in transfused horses