Bleeding (British Lady)

Question 1

What are the 3 problems related to bleeding?

Answer 1

Epistaxis
Melena
Red urine

Question 2

Epistaxis

Answer 2

Bleeding from the nasal cavity or the nares

Question 3

Melena

Answer 3

Passing digested blood
From diet (red meat), swallowing blood, GI bleeding

Question 4

Red urine

Answer 4

Hematuria (true blood in the urine)
Hemaglobinuria (Hb in the urine, not overt blood)
Myoglobinuria (dark red/ brown, broken down m. proteins)

Question 5

Local dz causing epistaxis

Answer 5

Neoplasia, fungal infection, FBs
Lymphocytic-plasmacytic rhinitis
Local vasculitis
Severe dental dz
Idiopathic

Question 6

Systemic dz causing epistaxis

Answer 6

Coagulopathy
Hypertension
Polycythemia
Hyperviscosity
Systemic vasculitis

Question 7

What causes primary and local melena?

Answer 7

Primary GI dz from neoplasia, parasites, FB and inflammatory

Question 8

Systemic dz causing melena (secondary)

Answer 8

Coagulopathy
Systemic vasculitis
Systemic dz causing ulceration: hypoadrenocorticism, mast cell tumor, liver dz, uremia and drugs

Question 9

What does dysuria and poillakiuris confirm?

Answer 9

Lower UT dz of the bladder, urethra, prostate

Question 10

Local causes of hematuria

Answer 10

Bacterial cystitis
Urinary calculi
Prostatitis
Idiopathic cystitis (cats)
Polyps
Bladder neoplasia (transitional cell carcinoma)
Neoplasia of the renal pelvis
Idiopathic renal hemorrhage
Vascular anomalies

Question 11

Bleeding disorderss

Answer 11

Abnormality of the vessel wall (trauma, vasculitis)
Reduced platelet numbers (thrombocytopenia)
Platelet dysfunction (lack of vWF)
Defect in the extrinsic or intrinsic coagulation cascade

Question 12

What does impaired coagulation lead to?

Answer 12

Bleeding

Question 13

What does ↓ hemostatic modulation and fibrinolysis lead to?

Answer 13

Thromboemboli

Question 13

CS of bleeding disorders

Answer 13

↓ platelet numbers or impaired platelet function (bleeding from mucosal surfaces)
Clotting factor deficiencies (deeper tissue and body cavity hemorrhages)

Question 14

Common causes of bleeding disorders

Answer 14

Immune-mediated thrombocytopenia
vWB dz
Drug-induced platelet dynsfunction
Rodenticide poisoning
Infectious thrombocytopenia
Angiostrongylus vasorum

Question 15

Platelet count (dx of bleeding disorders)

Answer 15

Absolute count (hematology machines)
8-15 plates per HPF (x100)
50 x 10^9 = 3-4 platelets per HPF

Question 16

Multiple platelet clumps in the feathered edge tells you what?

Answer 16

Number adequate for hemostatsis

Question 17

Thrombocytopenia

Answer 17

Inadequate production: BM disorders, drugs
Excessive consumption: DIC
Excessive destruction: immune mediated

Question 18

What causes thrombocytopenia

Answer 18

Erlichia, babesia, angiostrongylus, anaplasma

Question 19

Platelet function defects

Answer 19

vWB dz, Drugs (NSAIDs)
Systemic disorders (uremia, liver dz, pancreatitis, dysproteinemia)

Question 20

Buccal bleeding time (dx of bleeding disorders)

Answer 20

Crude screening test for platelet abnormalities
Standard cut made with spring-loaded lancet
<4 mins in dogs and <3mins in cats

Question 21

Platelet function dx

Answer 21

Crude measure: clot retraction
Clot should separate from the serum and contract to 50% of the OG vol by 4-6 hrs

Question 22

von Willebrand’s factor

Answer 22

Measure on citrated plasma, frozen in plastic tubes after immediate separation from RBCs

Question 23

Coagulation defects

Answer 23

Hereditary factor deficiency
Acquired multiple factor deficiencies (DIC and liver dz)
Vitamin K disorders (epoxide)

Question 24

Vitamin K disorders

Answer 24

Warfarin/rodenticide toxicity Malabsorption of vit. K Liver dz Devon rex coagulopathy

Question 25

Dx of coagulation factor disorders

Answer 25

Whole blood clotting time (WBCT) Activated clotting time (ACT) Activated partial thromboplastin time (APTT) Prothrombin time (PT) Thrombin time (TT)