Hemorrhage

Question 1

What is the prevalence of spontaneous anemia in cats compared to dogs? What could explain this difference

Answer 1

Anemia due to spontaneous hemorrhage is not as common in cats as it is in dogs

This may be because they tend to avoid ingestion of vitamin K antagonists and are less likely to get immune-mediated thrombocytopenia

In cats, a frequent cause of blood loss anemia is exuberent sampling

Question 2

What are the specific clinical clues for blood loss anemia

Answer 2

Hematemesis
Hematochezia
Melena
Hematuria (need to differentiate from hemoglobinuria and myoglobinuria)
Epistaxis
Hemothorax/hemoabdomen
Hemarthrosis (very uncommon in cats)
Hematomas
Petechiation/ecchymoses
Palatine ulceration

Question 3

What would be your major differentials for hemorrhage/blood loss

Answer 3

Trauma, surgery (external or internal blood loss)

Other causes of internal blood loss:
- GI ulceration
- bleeding tumors, especially gastric lymphoma
- bleeding palatine ulcer
- damage to internal organs (e.g., liver/spleen/kidney secondary to trauma)
- increased organ friability, leading to hemorrhage (e.g.? hepatic amyloidosis)

Acquired or congenital defects in primary hemostasis

Acquired or congenital defects in secondary hemostasis

Question 4

Give a defenition of “Menrath’s ulcer (=bleeding palatine ulcer)

Answer 4

Menrath’s ulcer refers to an unsual syndrome in which for some reason, cats with allergic skin disease develop life-threatening bleeding from an ulcer on the palate immediately adjacent to the upper canine tooth

Question 5

What is the supposed pathomechanism of Menrath’s ulcer

Answer 5

It is thought that over-grooming associated with pruritic skin disease somehow results in the papillae on the tongue abrading the hard palate until a branch of the palatine artery is eroded

When this occurs, significant hemorrhage results
- because the blood emanating from the bleeding ulcer is swallowed, the owner may not appreciate the cause of the bleeding until the cat is almost dead

Question 6

How would you manage a cat with a bleeding palatine ulcer

Answer 6

On-going hemorrhage is best controlled by placing a horizontal mattress or cruciate stitch (using deep bites) across the ulcer so that the ensuing pressure stops the hemorrhage