IMPROVING PATIENT CARE WITH EQUINE SERUM AMYLOID A TESTING SIDDRA HINES, DVM, PHD, DACVIM (continued)
Patients should be tested during the initial exam and retested in 24-48 hours in case SAA increases further. Follow up testing should be performed 3-4 days after treatment is initiated (or 1-2 days after peak [SAA] has been identified). Inflammation/infection will begin to resolve with effective treatment, with associated decline in SAA. If SAA remains high, additional evaluation or alternative treatments should be considered. Follow-up assessments every 2-3 days can identify concerns with ongoing treatment success if SAA stops declining or starts to increase. At a minimum, it is advisable to test SAA prior to discontinuing therapy and/or hospital discharge to ensure the horse has returned to normal. Tracking SAA is also useful for early identification of post-operative complications and for management of other medical conditions to improve patient care and outcome. Although surgery itself will cause some elevation, it should follow an expected pattern with uneventful recovery, peaking at 2-4 days post-op and then gradually declining. If post-operative values remain high, or spike up during later recovery, complications are likely and should be explored. SAA can be re- SAA is a valuable tool for biosecurity and evaluation of horses at high risk for infections to identify subclinical disease early and allow rapid intervention. Any elevation of SAA should be considered abnormal and trigger further investigation. SAA can increase even in the absence of fever, and unlike fever, will not be resolved by NSAID therapy. Disease outbreaks may be prevented with SAA screening prior to comingling at events or when introducing new horses to a resident population, along with existing measures. During an active infectious disease outbreak, SAA can help monitor at- risk or exposed horses to identify affected individuals early for proper containment, treatment, and additional diagnostics. SAA can also be used to monitor populations at increased risk due to age, stress, exposure, population density, or other factors. This includes young horses in intense training, hospital populations, or horses undergoing long-distance travel. Testing prior to transport can identify subtle abnormalities with potential to develop into bigger issues, and shipping-related infections can be identified quickly after transport. 5 SAA BIOLOGY EXPLAINS MOST SURPRISING RESULTS SAA results must be interpreted in light of other clinical data, and with an understanding of SAA biology. Little increase is seen in localized, chronic, or allergic issues, which can be confusing when faced with a horse that is clearly sick. However, these negative or low positive results are quite useful as they indicate a low likelihood of systemic inflammation due to bacterial or viral infection. Importantly, although SAA increases rapidly, a horse may show peracute signs with severe illness before SAA is measurable. In such cases, treatment must be based other clinical evidence, and SAA can be rechecked in 12-24 hours. (continued) evaluated every 1-3 days depending on budget, level of concern, and patient proximity. 4 SAA IMPROVES BIOSECURITY AND MONITORING OF HIGH-RISK HORSES
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