33. bleeding disorders ( coagulopathies, thrombocytopenia, thrombocytopathy) Flashcards
what to mention
list disorders of hemostasis ddx of hemostatic problems DIC coagulopathies rodeticide poisoning immune mediated thrombocytopenia von willebrand - thrombocytopathy
what are the disorders of hemostasis
coagulopathy - decreased clotting factor
thrombocytopenia: low platelet count
thrombocytopathy: decreased platelet function
vascular disorders: rare
DIC: coagulo + thrombocytopenia
ddx of hemostatic problems - list
history: rodenticide? first time?
coagulopathy def
thrombocytopathy/penia + vascular disorder def
diagnostic test: in exam room, laboratory test
what is coagulopathy
deep bleeding: hematoma, hemothorax, hemoperitoneum
clotting time increase
APTT, PTT increase
ACT increase
what is Thrombocytopenia, thrombocytopathy and vascular disorder
superficial bleeding: petechia, ecchymosis, epistaxis, melena, hematuria
bleeding time increase
clot retraction time increase or same
platelet count decrease or same
diagnostic tests in examination room
clotting time: 10-20 min in glass tube ACT: <120 sec bleeding time: <5 minutes clot retraction <2 hours blood smear: 10-15 PLT in oil immersion, PLT and RBC morphology
diagnostic test in lab
test tube with Na- citrate and EDTA
APTT: intrinsic and common pathway
PTT: extrinsic and common pathway factor VII
FDP or D-dimer, fibrinogen: DIC diagnosis
PLT count 200-800 g/l
rodenticide poisoning pathophysiology
dicoumarol poison
competetiv antagonist of factors: II, VII, IX, X
clinical signs of rodenticide poisoning
acute collapse, shock - bleed into chest
anemia
dyspnoe
hemothorax
diagnosis of rodenticide poisoning
history, access to poison
PTT
APPT, ACT, clotting time
treatment of rodenticide poisoning
treat shock: fluid, plasma expanders
fresh whole blood, fresh frozen plasma
vitamin K
(vomit induction if less than 2 hours since ingestion)
immune mediated thrombocytopenia pathogenesis and diagnosis
idiopathic immune mediated destruction of platelets
diagnosis by exclusion of other factors, specific tests not reliable
clinical signs of IM thrombocytopenia
siperficial bleeding
splenomegaly
platelet count decreased (below 25 g/l)
what should we rule out in case of immune mediated thrombocytopenia
drug induced thrombocytopenia: PBZ, estrogen, b-lactam
dog: tick born - babesia
cat: FeLV, FIV
DIC
treatment of immune mediated thrombocytopenia
stop bleeding
fresh whole blood, platelet rich plasma
immunosuppression: prednisolone
von willebrands disease - thrombocytopathy pathogenesis
common inherited of Doberman pincher, GSD
absence, low conc or abnormal function of vWFactor
sometimes together with low conc of factor VII
vWF is an important platelet adhesive protein
von willebrand clinical sign and diagnosis
spontaneous bleeding is rare, prolonged surgical bleeding increased bleeding time clot retraction time increases platelets are same ACT, APTT same or increased measurement of vWF by electrophoresis
von willebrand disease treatment
desmopressin (synthetic ADH) causes release of vWF from endothelial cells. (before surgery or during bleeding)
fresh whole blood, fresh frozen plasma
DIC what is it
disseminated intravascular coagulopathy
a consumptive coagulopathy
DIC pathogenesis
excessive systemic intravascular coagulation -> multi organ micro thrombosis
paradoxical bleeding caused by inactivation and consumption of platelets and coagulation factors
DIC triggers
endothelia damage platelet activation release of tissue coagulants these can be triggered by many things hemolysis, hypoxia, shock, infectious disease, pancreatitis
clinical signs of DIC
ofetn subclinical
microthrombi: signs of organ failure in kidney, liver and lung
superficial or deep bleeding
DIC diagnosis
FDP or D-dimer, fibrinogen decrease
increased ACT, APTT, PTT
thrombocytopenia, scistocytosis
treatment of DIC
treat primary cause
fresh blood, fresh frozen plasma
heparin
plasma expanders, crystalloids
