Approach to the bleeding patient

Question 1

What are two differentials for multifocal bleeding?

Answer 1

trauma and coagulopathy/primary hemostatic disorder (can also cause lameness/MSK pain)

Question 2

If you have a patient come in with multifocal bleeding, lameness, and prolonged PT/PTT times what are your differentials?

Answer 2

Coagulopathy/primary hemostatic disorder likely due to rodenticide, liver dysfunction, DIC or hemophiliac

Question 3

What treatments should be given to a patient with a
Coagulopathy/primary hemostatic disorder

Answer 3

Vitamin K, supplemental O2, Plasma for the coagulation factors, pain medication/sedation.

Question 4

What blood products are available and what do they contain?

Answer 4

Canine Whole blood- literally whole blood, contains everything that should be given to anemic patients who also have coagulopathies

Canine-packed red blood cells- only RBCs, no clotting factors. give to Normovolemic, anemic patients

Canine fresh-frozen plasma: has clotting facts but no RBCs. Give to all coagulopathies

Stored frozen plasma- not frozen rapidly, given for anticoagulant rodenticides (vit K dependent factors) and hypoproteinemia

Question 5

When should each of the blood products be used after collection?

Answer 5

Canine Whole blood- Fresh is given in 8 hours but can be stored for 3-4 weeks.
Canine-packed red blood cells- 21 day shelf life
Canine fresh-frozen plasma: 1 yr
Stored frozen plasma: 5 years

Question 6

Patients with suspected anticoagulant rodenticide ingestion should have what treatment?

Answer 6

FFP to stabilize along with Vitamin K PO for 30 days

Question 7

T/F it is okay to give a combo of FFP and packed RBC if no whole blood is available

Answer 7

True- but whole blood is preferable.

Question 8

What platelet level does spontaneous hemorrhage become a possibility?

Answer 8

30-50 cells/uL

Question 9

What are the differentials for thrombocytopenia

Answer 9

Destruction- infectious, immune, neoplasia, drugs
Decreased production- drugs, immune, infectious, myelodysplastic disorders
Consumptive- DIC, vasculitis, envenomation, thrombosis
Sequestration- splenomegaly, vasculitisis

Question 10

What is the common antigen that causes an immune reaction?

Answer 10

DEA 1

Question 11

Why do we not give platlets to dogs with thrombocytopenia?

Answer 11

They do not last long in the body and no study has shown that giving platelets increases the chance of going home.

Question 12

What are some treatments for IMTP

Answer 12

Corticosteriods +/- secondary and tertiary immunosuppressants. Vincristine (chemo drug to stimulation bone marrow release of blood products),