Assessment of Hematological Parameters and Uterine Hemodynamic Indices in Bitches with Pyometra

Abstract

Background: Pyometra is defined as chronic purulent inflammation of the uterus that causes changes in hematological and biochemical parameters. The disease is characterized with bacterial infection and pus accumulation in the uterus. Transabdominal B-mode ultrasonography provides easy and certain diagnosis of this disease. The hemodynamic changes in pyometra are evaluated by Doppler ultrasonography. The aim of the study is to determine the changes in hematological parameters and Doppler indices in bitches with pyometra, diestrus healthy bitches and evaluate the relationship between hematological parameters and hemodynamic indices within the both groups.Materials, Methods & Results: A total number of 27 bitches were enrolled in the study. The healthy diestrus bitches (group H; n = 7) aged 6.2 ± 1.14 years, weighted 14.57 ± 3.75 kg. The bitches with pyometra (group PYO; n = 20) aged 9.1 ± 0.62 years and weighted 17.65 ± 2.60 kg. Before all bitches had ovariohisterectomy, hematological analyses were performed. Transabdominal ultrasonography (USG) was performed with a 6.6 MHz convex transducer. The widest cross-sectional uterine diameter (UD), wall thickness of uterine horns (UWT) and presence of luminal content were evaluated. Diameter of the uterine artery (DUA) was measured on a mapped color image using the USG software program. The examination was carried out with pulsed-wave Doppler USG to characterize the waveform of the uterine artery (UA). Anechogenic areas in uterine lumen, increase in UD and UWT were observed in group PYO. All cases in group PYO had luminal content in both uterine horns ranging from 1.2 to 5.6 cm. The DUAs were measured in group H and in group PYO as 1.75 ± 0.03 mm, 1.94 ± 0.08 mm; respectively (P < 0.05). The PI and RI values of group PYO were lower than group H (P < 0.001). Hematological analysis results showed that RBC, HGB, HCT levels in group PYO were lower than group H (P < 0.001). However, WBC, NEU, LYM, MONO levels in group PYO were higher than group H. Hemodynamic indices were positively correlated with RBC, HGB, HCT, whereas they were inversely correlated with NEU, WBC, UD and UWT. Also, PI value was negatively correlated with MONO.Discussion: Cystic endometrial hyperplasia (CEH) is a predisposing factor for development of the pyometra in bitches. Besides, naturally occurring CEH and pyometra can arise independently from each other. The enlarged uterine body exhibits the development of intense exudative processes due to the higher proliferative stimulation in uterine infections. Uterine infections were associated with increase in uterine blood flow. Elevated uterine blood flow, vasodilatation and angiogenesis arise during inflammatory response. The inflammatory process leads to a diminution in hemodynamic indices of uterine arteries. Total blood count parameters are affected from the presence of pyometra. Elevated levels of leukocytes in bitches with pyometra are associated with worsening prognosis. Erythrocyte diapedesis into the lumen of the uterus, toxic depression of erythropoiesis in the bone marrow can cause anemia. In conclusion, hematological parameters were strongly correlated with hemodynamic indices in this study. Reduced RBC, HGB and HCT levels, decreased PI and RI values and elevated levels of UD, UWT, DUA were observed in group PYO. To our knowledge, this was the first study that observed the increase in DUA during pyometra in bitches.