Term
| What is the point of primary hemostasis? |
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Definition
| -formation of platelet plug at site of endothelial damage |
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Term
| What are the components of primary hemostasis? |
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Definition
-platelets
-adhesive proteins: Von Willebrand fator |
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Term
| Platelets must have correct ________ & ________ for primary hemostasis to be successful. |
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Definition
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Term
| What is the purpose of secondary hemostasis? |
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Definition
| -clotting factors assemble thr thrombus or clot on the platelet plug |
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Term
| What comprises secondary hemostasis? |
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Definition
| -intrinsic, extrinsic, and common coagulation pathways |
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Term
| What are the clinical signs associated with coagulopathy? |
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Definition
-spontaneous bleeding: oral/gingival, subcutaneous, hematuria, hypheema, epistaxis, GI bleeding, cavitary bleeding
-prolonged bleeding post-trauma/laceration
-resp signs: hemothorax, pulmonary hemorrhage
-signs associated with anemia
-associated with underlying disease: fever, lymphaneopathy, splenomegaly
-MAY BY ASYMPTOMATIC |
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Term
| What are the important question to ask during the history of a bleeding dog |
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Definition
-meds: humans too
-toxin exposure
-previous sugery? if it didn't happen at a 1y spay then it probably isn't congenital
-previous bleeding episodes
-recent vaccination |
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Term
| How do we check for hemorrhage on a physical exam? |
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Definition
-eval for subcutaneous hemorrhage
-rectal exam!!! |
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Term
| What is petechiae? What does it indicate? |
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Definition
-broken capillary vessels lead to pinpoint round spots on skin
-indicates primary hemostasis |
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Term
| What is ecchmosis? What does it indicate? |
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Definition
-subcutaneous extravasation of blood (>1cm)
-primary or secondary hemosatsis |
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Term
| How do we differentiate between petechiae and ecchymosis and just bleeding? |
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Definition
| -petechiae and ecchymosis do NOT blanch with pressure |
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Term
| What locations of bleeding are indicative of primary hemostatic defects? What about secondary hemostatic defects? |
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Definition
-primary: mucous membranes
-secondary: body cavities, delayed bleeding |
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Term
| What are the primary diagnostics for coagulopathies? |
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Definition
-CBC: platelet count, PCV/TP
-PT/PTT |
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Term
| What part of the coagulation cascade is messed up if petechiae is present? What about cavitary bleeding? |
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Definition
-petechia => platelets
-cavitary bleeding => coagulation factors |
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Term
| What other diagnostics do we run on dogs with suspected coagulopathies? |
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Definition
-chem panel: concurrent diseases, look for GI bleed (TP, BUN inc w/ normal creatinine)
-US
-imaging: concurrent disease or pulmonary hemorrhage
-specialized coagulation tesitng
-bone marrow: dec pdn of platelets |
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Term
| In what case would a decreased platelet count not be real? How do we double check this? |
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Definition
-Pseydothrombocytopenia (platelet clumping)
-dec automated platelet count
-double check by doing a manual blood spear (>10 platelets/HPF) |
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Term
| Does pseudothrombocytopenia occur more commonly in cats or dogs? |
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Definition
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Term
| What breed of dogs is predisposed to pseudothrombocytopenia? Any resulting clinical signs? Why? |
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Definition
-Cavalier King Charles Spaniel
-no clinical signs b/c all platelets are functional
-due to a mutation in beta-1-tubulin |
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Term
| At what platelet levels does spontaneous bleeding occur? |
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Definition
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Term
| How do we assess regeneration? |
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Definition
-platelet size on slide review
-mean platelet volume (MPV) |
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Term
| What are the 4 categories of thrombocytopenia? |
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Definition
-increased destruction
-increased use/consumption
-increaedsequestration
-decreased production |
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Term
| What are the three major occurrences of increased platelet use leading to thrombocytopenia? |
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Definition
-normal response: acute, severe hemorrhage, severe GI bleed, vit K antagonist rodenticide toxicity
-DIC
-Vasuclitis: more mild but can be due to pancreatitis, lepto, pneumonia, etc |
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Term
| What is the common presentation of increased sequestration leading to thrombocytpenia? Characterize the resulting thrombocytopenia. |
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Definition
-splenomegaly: 30-40% platelet pool stored in spleen
-mild to moderate but uncommon |
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Term
| What are the common causes of decreased platelet production leading to thrombocytopenia? Characterize the thrombocytopenia. |
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Definition
-bone marrow: drugs, infection, neoplasia, immune-mediated
-moderate to severe thrombocytopenia |
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Term
| In general, how do we treat the 4 ategories of thrombocytopneia? |
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Definition
-Immune-med thrombocytopenia (ITP): immunosuppressive agents, Vincristine/human IVIg
-consumption: treat underlying cause
-sequestration: treat underlying cause
-dec pdn: depends on the cause: immune-med = immunosuppressives, neoplasea = chemo, treat underlying infection if applicable |
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Term
| What is the cause of inc destruction of platelets leading to thrombocytopenia? Characterize the thrombocytopenia. |
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Definition
-immuno-mdiated thrombycytopenia: anti-platelet antibodies adhered to platelet membrane = phagocytosis of platelet by monocyte phagocytic system in spleen/liver
-typically very SEVERE |
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Term
| What are some common causes of immune-mediated thrombocytopenia? |
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Definition
-vector-borne diseases!
-Anaplasma platys |
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Term
| True or False: Due to the nature of monocytic phagocytosis, during immune-mediated thrombocytopenia, there is avid complement fixation. |
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Definition
| -FALSE, there is NO complement fixaiton |
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Term
| How do we test for the presence of anti-platelet antibodies in a suspected case of immune-mediated thrombocytopenia? |
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Definition
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Term
| How do we test for the presence of anti-megakaryocyte antibodies in a patient suspected of immune-mediated thrombocyopenia? |
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Definition
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Term
| Which classes of dogs are more likely to develop immune-mediated thrombocytopenia? |
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Definition
-middle aged
-F>M
-some breeds: Cocker |
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Term
| How do we treat immune-mediated thrombocytopenia? |
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Definition
-supportive care: blood transfusion, gastroprotectants, minimize bleeding/trauma
-immunosuppressive meds: prednisone +/- 2nd line agent, cyclosporine, azathioprine
-doxy too |
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Term
| What are the 2 primary agents of acute management of immune-mediated thrombocytopenia? What do they do? |
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Definition
-human intravenous immunoglobulin: hIVIg= blocks FC receptor on phagocytic macrophages
-Vincristine: stims megakarycyte fragmentation |
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Term
| Describe chronic management of immue-mediated thrombocytopenia> |
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Definition
-taper meds gradually when pIt ct NORMAL!!!
-platelet count usually responds faster than PCV: exception = bone marrow ITP |
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Term
| What is the gneral prognosis of immune-mediated thrombocytopenia? |
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Definition
| -fair to good: 10-30% moratlity, but depends on severity |
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Term
| What are the 2 primary negative prognostic factors of immune-mediated thrombocytopenia? |
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Definition
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