Bleeding Flashcards
Classifications of bleeding
Induced (sx or trauma)
Spontaneous (thrombocytopenia, rodenticides)
Life threatening (trauma, hemangiosarcoma)
Mild/ self-limiting (nose bleed)
Petechia
Small pinpoint bleedings underneath the skin (on mm)
Ecchymosis
Over a larger area, well-developed bruising
BMBT
Buccal mucosal bleeding time
Evaluate platelet function
vWT
Von Willabrands factor
How platelets attach to the collagen from a vessel injury
APTT and PT
Partial thromboplastin time and Prothrombin time
ID how a certain coagulation pathway is working
Intrinsic v extrinsic cascade
AT3
Antithrombin 3
Protein made in the liver, cofactor for heparin
Inhibits factors 9, 10 and thrombin (stopping excessive clot formation)
Primary Hemostasis
Forms an unstable platelet plug stopping capillary bleeding
Need vascular endothelium, platelets, vWF
Secondary Hemostasis
Larger vascular injury
Need clotting factors to form a stable fibrin clot
Fibronolysis
Breaking down the fibrin clots
Platelets
Made in BM by megakaryocytes
Life span: 5-7d
Norm: >200,000, spontaneous bleeding <30,000
Clotting factors
Produced in liver
Some vit. K dependent (2,7,9,10: inactive form)
Extrinsic, common and intrinsic
Primary hemostatic dz (hereditary)
Thrombocytopenia (↑ BT, ↓ plates)**
Von Willebrand’s (↑ BT)
Glanzmann’s (platelets aren’t working properly)
Secondary hemostatic dz (acquired)
Hemophilia A or B (↑ACT, aPTT)
Vitamin K deficiency (↑ACT, OSPT, aPTT, ↓plates, fibrinogen and FDP)
Overcompensating disorders (acquired)
DIC (↑BT, ACT, OSPT, aPTT, FDP, ↓plate, fibrinogen)
Thrombocytosis
Dx primary hemostasis
CBC for platelets and vWF
Bloodsmear (plate count:8-10)
BMBT
Dx for secondary hemostasis
Tests for coagulation
PT (extrinsic)
ACT, APTT
Test tubes
Purple top: tubes with EDTA- prevent clotting but binding Ca
Blue top: with Ca sitrate to stop clotting
Dog blood types
12 major groups named DEA (1.1 and 1.2 most common)
Cross match after transfusion
T/F: Dogs do not have natural Abs against their blood
TRUE
less chance of reactions with blood transfusion
Cats blood types
Types A*, B and AB (universal recipient)
Have naturally occurring Abs → life threatening complications (always need cross match)
Cat transfusion reactions
A → B= death
B → A= good
A or B → AB= really good
Crossmatching reasoning
Naturally occurring pathogenic AB present (cats)
No naturally occurring pathogenic AB, but previously sensitized to red cell Ag (dog)
Major cross match
Donor’s RBCs + recipient serum
Initial bleeding tx
Blood transfusion:
Whole blood
Packed RBCs (spinning and concentrating RBCs- low anemia)
Plasma (spin, on top)
Platelets
Transfusion rx
Acute v delayed
Immunologic v non (fever, vomiting, facial edema, fluid overload, dyspnea, hemolysis)
Hemophilia A
Factor 8 deficiency (↑ bleeding)
Most common inherited bleeding disorder in K9s
Sex linked trait (mostly males)
Most common breeds with Hemophilia A
German shepherds
Gold retrievers
Hemophilia B (Christmas dz)
Factor 9 deficiency (milder dz)
Primarily in males
CS for hemophilias
Weakness, dyspnea, recurrent hematomas, bleeding from loss of baby teeth
On PE seen with hemophilia
Bleeding from sx site/ trauma site
Epistaxis
Signs of bleeding into the body cavity
Pale mm
Dx hemophilias
HCT/ total proteins
Platelet count
APTT prolonged
Coagulant activity assays
Tx for hemophilias
Transfusions (fresh frozen plasma)
Pre-op transfusions
↓ strenuous activity
Avoid anticoagulants (NSAIDs, clopidogrel)
Von Willebrand’s Dz
Quantitative/ functional deficiency of vWF
Most common hereditary bleeding disorder in K9s, autosomal trait
Types 1**, 2 and 3
Dx Von Willebrand’s Dz
PE
PCV, TS and platelet count
Coagulation panel
BMBT
Measure vWF in plasma
Tx of Von Willebrand’s Dz
Control bleeding
Avoid unnecessary trauma/ surger
Avoid meds and correct underlying dz
Glanzmann’s thrombastenia
Platelets don’t aggregate normally and no clot
Defect/ mutation in glycoprotein 2b
Odd shaped, giant plates, genetic testing
Which breeds show Glanzmann’s?
Otterhounds, Great pyrenees
Vitamin K deficiency
Most common cause: rodenticide
Depletion of factors → coagulopathy
Lag period of 3-5d btwn exposure and CS
Dx for Vit. K deficiency
CBC, chemistry, coagulation panel (PT prolonged first, then APTT)
Tx of Vitamin K Deficiency
Bleeding: transfusions and Vit. K1
No bleeding: Monitor PT (vomit, activated charcoal)
Thrombocytopenia
↓ platelet production (no making enough- BM problem)
↑ platelet destruction (immune mediated), consumption (DIC) and sequestration (in spleen for a while)
Secondary thrombocytopenia
Secondary to another underlying problem
Tickborne dz, infectious causes, meds, neoplasia
Primary thrombocytopenia
Idiopathic
Immune mediated destruction of platelets
Triggering factors of thrombocytopenia
Drugs (rimadyl, estradiol, carprofen)
Vx
Stress
Infection
DD for thrombocytopenia
Tick borne dz
Neoplasia
FIV/FeLV
Tx for thrombocytopenia
Tx underlying dz (sx, doxycycline)
Transfusions
Immunosuppression (prednisone)
↓ activity
Thrombocytosis
↑ in # of platelets in circulation
Primary (myeloproliferatice dz)
Secondary
Secondary thrombocytosis
Reactive
Neoplasia, inflamm, trauma, steroid uses, cushings’
Dx and Tx of thrombocytosis
CBC, bloodsmear
Tx is to ↓ risk of thromboembolic dz
