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Y3 MOD clinical pathology > Approach to the bleeding patient > Flashcards

Approach to the bleeding patient Flashcards

1
Q

In ml/Kg what is the total blood volume of:

  • dogs
  • cats
A

80/90ml/Kg

60-70ml/Kg

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2
Q

When there is blood loss which 3 life threatening situations need to be considered?

A
  • Hypovolaemic shock
  • Severe anaemia
  • Brain or pulmonary haemorrhage
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3
Q

In a patient, what samples would you want to collect?

A
  • Blood smear
  • Full blood count (EDTA)
  • Coagulation profile (Citrate)
  • Biochemistry (heparinised plasma)
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4
Q

What are the steps when approaching a bleeding pateint?

A
  • Attempt to quantify blood loss
  • Identify life threatening situations
  • Establish venous access and take samples
  • Control haemorrhage
  • Fluid replacement
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5
Q

What fluids should be given if a patient is hypovolaemic?

A

Crystalloids

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6
Q

“Shock rates”: recommend a bolus of fluids of?

A

1/4 of the animals normal blood volume

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7
Q

What are the 5 stages of haemostasis?

A
  • Vessel injury
  • Vascular contraction
  • Primary haemostasis
  • Secondary haemostasis
  • Tertiary haemostasis
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8
Q

Describe primary haemostasis

A

Formation of the primary plug:
- Von Willebrand factor attached to the walls of vessels interacts with platelets and allows them to bind to each other and the vessel wall

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9
Q

What does secondary haemostasis involve?

A

Coagulation cascade resulting in the generation of thrombin

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10
Q

Compare when primary vs primary and secondary haemostasis is needed

A
  • Small defect: platelet only (primary haemostasis)

- Large defect: requires platelets and stabilisation of the clot by cross-linked fibrin (secondary haemostasis)

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11
Q

What does tertiary haemostasis involve?

A

Fibrinolysis - plasmin

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12
Q

What are the clinical signs of secondary haemostasis defects?

A
  • Deficiency in clotting factors
  • Present more acutely with life-threatening blood loss
  • subcutaneous or cavity bleeding e.g. haemothorax
  • haematoma formation
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13
Q

Which vessel must you not sample from if a bleeding disorder is suspected and why?

A

Jugular vein

- it will be very hard to stop the bleeding and a pressure bandage cant be used on the neck

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14
Q

Which in house labs tests are used to differentiate 1 vs 2 coagulopathy

A

Primary coagulopathy (test of platelet function or number)

  • Manual platelet count
  • Buccal Mucosal Bleeding Time
  • Von Willebrand factor

Test of Coagulation

  • Prothrombin Time (PT)
  • Activated Partial Thromboplastin Time (APTT)
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15
Q

In which situation should you use a buccal mucosal bleeding time test?

A

Should only be performed in a situation of a normal platelet count & normal clotting (PT/APTT) times – assessing platelet function

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16
Q

Give examples of disorders of primary haemostasis

A
  • Thrombocytopenia
  • Inherited thrombocytopenia
  • Immune mediated thrombocytopenia
  • Platelet dysfunction
  • Von Willebrand disease
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17
Q

What is thrombocytopenia?

A

a condition in which you have a low blood platelet count

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18
Q

What are the causes of a thrombocytopenia?

A
  • Lack of platelet production
  • Increased platelet consumption
  • Increased platelet destruction
  • Splenic torsion
19
Q

What can cause a lack of production of platelets?

A
  • Bone marrow disorder

- Drug toxicosis

20
Q

What can cause an increase in platelet consumption?

A
  • Disseminated Intravascular Coagulation

- Acute severe haemorrhage

21
Q

What causes a primary immune mediated thrombocytopenia?

A

IgG binding to platelets, resulting in their destruction

22
Q

What causes a secondary immune mediated thrombocytopenia?

A

Secondary to drugs, infectious disease or neoplasia

- 5-7d of exposure of drug required to produce sensitisation and onset of thrombocytopenia

23
Q

How would you treat an Immune Mediated Thrombocytopaenia?

A

If 1° treat with glucocorticoids, eg Prednisolone or Dexamethasone.

If 2° treat underlying disease of discontinue drug

24
Q

What is the name given to decreased platelet function?

A

Thrombocytopathia

25
Q

Which test is used to assess platelet function?

A

Buccal mucosal bleeding time

26
Q

Describe Von Willebrand disease

A

Deficiency of von Willebrand factor

27
Q

How is von Willebrand factor normally synthesised, stored and used?

A

By endothelial cells

  • vital for platelet adherence
  • Binds to factor VIII and prolongs its half life
28
Q

Which situation should prompt evaluation of von Willebrand factor?

A

Mucosal surface bleeding or excessive bleeding following surgery or trauma in a dog with a normal platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT)

29
Q

Disorders of secondary haemostasis are inherited or quired disorders of …?

A

Clotting factors

30
Q

Give examples of acquired secondary disorders of haemostasis

A
  • vitamin K deficiency
  • liver disease
  • DIC
31
Q

Vitamin K deficiency is most commonly caused by?

A

Ingestion of vitamin K antagonist rodenticides

32
Q

Vitamin K is involved in the production/activation of which clotting factors?

A

II
VII
IX
X

33
Q

What are the clinical signs of a vitamin K deficiency?

A
  • observed 2-5 days after ingestion
  • epistaxis, melaena (black stool), haemoptysis, haematoma, ecchymoses, haematuria, gingival bleeding, haemoabdomen, haemothorax
34
Q

Which breeds are pre-disposed to von Willebrand disease?

A

Doberman pinschers

35
Q

What is haemophilia A?

What is haemophilia B?

A

Deficiency of factor VIII

Deficiency of factor IX

36
Q

Disseminated Intravascular Coagulation (DIC) is related to which part of haemostasis?

A

Tertiary haemostasis - problems with the breakdown of the clot

37
Q

How does DIC first present?

A

As a thromboembolic disease so there are clots everywhere

38
Q

How does DIC progress leading to organ failure?

A

Bleeding begins as clotting factors are exhausted

  • widespread activation of coagulation and thrombosis
  • microthrombi in organs
  • ischaemia and necrosis
39
Q

What are some of the underlying causes of DIC?

A
  • infectious disease
  • immune mediated disease
  • neoplasia
  • trauma
  • heat stroke
  • cardiac disease
40
Q

What lab abnormalities are seen with acute DIC?

A
  • prolonged clotting times
  • thrombocytopenia (low platelet blood count)
  • decreased fibrinogen
41
Q

When are fibrin degradation products formed?

A

During degradation of both fibrin (fibrinolysis) and fibrinogen (fibrinogenolysis)

42
Q

When are fibrin degradation elevated?

A
  • DIC

- Thrombotic disease

43
Q

What are D-dimers specific for?

A

Breakdown of cross linked fibrin

Y3 MOD clinical pathology (10 decks)

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