Bleeding

Question 1

Classifications of bleeding

Answer 1

Induced (sx or trauma)
Spontaneous (thrombocytopenia, rodenticides)
Life threatening (trauma, hemangiosarcoma)
Mild/ self-limiting (nose bleed)

Question 2

Petechia

Answer 2

Small pinpoint bleedings underneath the skin (on mm)

Question 3

Ecchymosis

Answer 3

Over a larger area, well-developed bruising

Question 3

BMBT

Answer 3

Buccal mucosal bleeding time
Evaluate platelet function

Question 4

vWT

Answer 4

Von Willabrands factor
How platelets attach to the collagen from a vessel injury

Question 5

APTT and PT

Answer 5

Partial thromboplastin time and Prothrombin time
ID how a certain coagulation pathway is working
Intrinsic v extrinsic cascade

Question 6

AT3

Answer 6

Antithrombin 3
Protein made in the liver, cofactor for heparin
Inhibits factors 9, 10 and thrombin (stopping excessive clot formation)

Question 7

Primary Hemostasis

Answer 7

Forms an unstable platelet plug stopping capillary bleeding
Need vascular endothelium, platelets, vWF

Question 8

Secondary Hemostasis

Answer 8

Larger vascular injury
Need clotting factors to form a stable fibrin clot

Question 9

Fibronolysis

Answer 9

Breaking down the fibrin clots

Question 10

Platelets

Answer 10

Made in BM by megakaryocytes
Life span: 5-7d
Norm: >200,000, spontaneous bleeding <30,000

Question 11

Clotting factors

Answer 11

Produced in liver
Some vit. K dependent (2,7,9,10: inactive form)
Extrinsic, common and intrinsic

Question 12

Primary hemostatic dz (hereditary)

Answer 12

Thrombocytopenia (↑ BT, ↓ plates)**
Von Willebrand’s (↑ BT)
Glanzmann’s (platelets aren’t working properly)

Question 13

Secondary hemostatic dz (acquired)

Answer 13

Hemophilia A or B (↑ACT, aPTT)
Vitamin K deficiency (↑ACT, OSPT, aPTT, ↓plates, fibrinogen and FDP)

Question 14

Overcompensating disorders (acquired)

Answer 14

DIC (↑BT, ACT, OSPT, aPTT, FDP, ↓plate, fibrinogen)
Thrombocytosis

Question 15

Dx primary hemostasis

Answer 15

CBC for platelets and vWF
Bloodsmear (plate count:8-10)
BMBT

Question 16

Dx for secondary hemostasis

Answer 16

Tests for coagulation
PT (extrinsic)
ACT, APTT

Question 17

Test tubes

Answer 17

Purple top: tubes with EDTA- prevent clotting but binding Ca
Blue top: with Ca sitrate to stop clotting

Question 18

Dog blood types

Answer 18

12 major groups named DEA (1.1 and 1.2 most common)
Cross match after transfusion

Question 19

T/F: Dogs do not have natural Abs against their blood

Answer 19

TRUE
less chance of reactions with blood transfusion

Question 20

Cats blood types

Answer 20

Types A*, B and AB (universal recipient)
Have naturally occurring Abs → life threatening complications (always need cross match)

Question 21

Cat transfusion reactions

Answer 21

A → B= death
B → A= good
A or B → AB= really good

Question 22

Crossmatching reasoning

Answer 22

Naturally occurring pathogenic AB present (cats)
No naturally occurring pathogenic AB, but previously sensitized to red cell Ag (dog)

Question 23

Major cross match

Answer 23

Donor’s RBCs + recipient serum

Question 24

Initial bleeding tx

Answer 24

Blood transfusion: Whole blood Packed RBCs (spinning and concentrating RBCs- low anemia) Plasma (spin, on top) Platelets

Question 25

Transfusion rx

Answer 25

Acute v delayed Immunologic v non (fever, vomiting, facial edema, fluid overload, dyspnea, hemolysis)

Question 26

Hemophilia A

Answer 26

Factor 8 deficiency (↑ bleeding) Most common inherited bleeding disorder in K9s Sex linked trait (mostly males)

Question 27

Most common breeds with Hemophilia A

Answer 27

German shepherds Gold retrievers

Question 28

Hemophilia B (Christmas dz)

Answer 28

Factor 9 deficiency (milder dz) Primarily in males

Question 29

CS for hemophilias

Answer 29

Weakness, dyspnea, recurrent hematomas, bleeding from loss of baby teeth

Question 30

On PE seen with hemophilia

Answer 30

Bleeding from sx site/ trauma site Epistaxis Signs of bleeding into the body cavity Pale mm

Question 31

Dx hemophilias

Answer 31

HCT/ total proteins Platelet count APTT prolonged Coagulant activity assays

Question 32

Tx for hemophilias

Answer 32

Transfusions (fresh frozen plasma) Pre-op transfusions ↓ strenuous activity Avoid anticoagulants (NSAIDs, clopidogrel)

Question 33

Von Willebrand's Dz

Answer 33

Quantitative/ functional deficiency of vWF Most common hereditary bleeding disorder in K9s, autosomal trait Types 1**, 2 and 3

Question 34

Dx Von Willebrand's Dz

Answer 34

PE PCV, TS and platelet count Coagulation panel BMBT Measure vWF in plasma

Question 35

Tx of Von Willebrand's Dz

Answer 35

Control bleeding Avoid unnecessary trauma/ surger Avoid meds and correct underlying dz

Question 36

Glanzmann's thrombastenia

Answer 36

Platelets don't aggregate normally and no clot Defect/ mutation in glycoprotein 2b Odd shaped, giant plates, genetic testing

Question 37

Which breeds show Glanzmann's?

Answer 37

Otterhounds, Great pyrenees

Question 38

Vitamin K deficiency

Answer 38

Most common cause: rodenticide Depletion of factors → coagulopathy Lag period of 3-5d btwn exposure and CS

Question 39

Dx for Vit. K deficiency

Answer 39

CBC, chemistry, coagulation panel (PT prolonged first, then APTT)

Question 40

Tx of Vitamin K Deficiency

Answer 40

Bleeding: transfusions and Vit. K1 No bleeding: Monitor PT (vomit, activated charcoal)

Question 41

Thrombocytopenia

Answer 41

↓ platelet production (no making enough- BM problem) ↑ platelet destruction (immune mediated), consumption (DIC) and sequestration (in spleen for a while)

Question 42

Secondary thrombocytopenia

Answer 42

Secondary to another underlying problem Tickborne dz, infectious causes, meds, neoplasia

Question 43

Primary thrombocytopenia

Answer 43

Idiopathic Immune mediated destruction of platelets

Question 44

Triggering factors of thrombocytopenia

Answer 44

Drugs (rimadyl, estradiol, carprofen) Vx Stress Infection

Question 45

DD for thrombocytopenia

Answer 45

Tick borne dz Neoplasia FIV/FeLV

Question 46

Tx for thrombocytopenia

Answer 46

Tx underlying dz (sx, doxycycline) Transfusions Immunosuppression (prednisone) ↓ activity

Question 47

Thrombocytosis

Answer 47

↑ in # of platelets in circulation Primary (myeloproliferatice dz) Secondary

Question 48

Secondary thrombocytosis

Answer 48

Reactive Neoplasia, inflamm, trauma, steroid uses, cushings'

Question 49

Dx and Tx of thrombocytosis

Answer 49

CBC, bloodsmear Tx is to ↓ risk of thromboembolic dz