Approach to the bleeding patient

Question 1

what are differentials for bleeding patients?

Answer 1

1. primary hemostatic disorders
2. hemorrhage from a mass
3. GI ulceration
4. parasites
5. trauma
6. iatrogenic / pharmacologic – surgery, NSAIDs
7. toxins – anticoagulant rodenticides, xylitol, sago palms

Question 2

what would be appropriate diagnostics for a patient presenting with dyspnea, hemorrhage, and wounds?

Answer 2

TFAST / AFAST
PT/PTT
Radiographs
CBC/Chem

Question 3

What treatments should be administered to a patient with a suspect anti-coagulant rodenticide toxicity?

Answer 3

1. vitamin K (SQ first, then oral)
2. oxygen
3. pain management
4. plasma (to replace clotting factors)

Question 4

T/F: whole blood products are for patients with platelet disorders because it will help them receive sustained platelet function

Answer 4

false – its appropriate for HYPOVOLEMIC patients with coagulopathies.

Question 5

what type of patients are good candidates for receiving packed red blood cells?

Answer 5

normovolemic, anemic patients.

Question 6

T/F: any patient with a coagulopathy would benefit from frozen plasma

Answer 6

true

Question 7

what are 3 differentials for a patient with petechiation?

Answer 7

1. thrombocytopenia
2. thrombocytopathia
3. endothelial dysfunction

Question 8

what diagnostics would you want to run on a patient with petechiation, lethargy, and hyporexia?

Answer 8

CBC/Chem
SNAP4dx
Ultrasound

Question 9

what are the 4 major etiologies for thrombocytopenia?

Answer 9

1. destruction (infectious dz, immune mediated dz, neoplasia, inflammatory disorder, drug-induced)
2. decreased production (myelodysplastic disorder, drug-induced, immune-mediated, infectious dz, hereditary)
3. consumption (DIC, vasculitis, envenomation, thrombosis)
4. sequestration (splenomegaly, vasculitis)

Question 10

what platelet count immediately makes you think there is a primary immune-mediated thrombocytopenia occuring?

Answer 10

severely low platelets (<20,000)

Question 11

what is the treatment for immune-mediated thrombocytopenian (IMTP)?

Answer 11

1. Immunosuppressants (steroids + secondary and tertiary drugs like azathioprine, cyclosporine, mycophenolate)
2. Whole blood (RBCs, proteins, & coagulation factors)
3. Sucralfate/omeprazole
4. vincristine (helps bone marrow release megakaryocytes sooner)

Question 12

T/f: primary immune-mediated thrombocytopenia is rare in cats

Answer 12

true

Question 13

what are your biggest differentials for hematochezia / hematemesis?

Answer 13

1. Acute hemorrhagix diarrhea syndrome / HGE
2. intestinal parasites
3. GI ulceration
4. endocrinopathy (coagulopathy, metabolic, pancreatitis, neoplasia)

Question 14

how do you diagnose AHDS/HGE?

Answer 14

rule out all other causes of hematochezia/hematemeis
(xrays, u/s, parasite screen, etc.)

Question 15

how do you treat patients with AHDS/HGE?

Answer 15

• IV fluids
• cerenia
• sucralfate and pantoprazole

METRONIDAZOLE does not work!!

Question 16

how long does it take for the diarrhea to resolve in cases of AHDS/HGE?

Answer 16

~ 1 week.