Page 1430 - Small Animal Internal Medicine, 6th Edition

1402 PART XIII Hematology

TABLE 87.5 secondary bleeding (blood in body cavities); diffuse intra-
operative bleeding is frequently the first sign detected by the
VetBooks.ir Primary Disorders Associated With Disseminated clinician. Clinical and clinicopathologic evidence of organ
dysfunction is also present. Most cats with DIC seen at our
Intravascular Coagulation*
DISEASE DOGS (%) CATS (%) clinic do not have evidence of spontaneous bleeding; clinical
signs in these cats are those associated with the primary
disease.
Neoplasia 18 29 In a recent retrospective study of 50 dogs with DIC con-
HAS 8 5 ducted in our clinic, only 26% had evidence of spontaneous
Carcinoma 4 10 bleeding, whereas only one of 21 cats with DIC had evidence
LSA 4 14 of spontaneous bleeding. Most patients were presented for
HA 2 0 evaluation of their primary problem and were not bleeding
Liver disease 14 33 spontaneously; DIC was diagnosed as part of the routine
Cholangiohepatitis 4 0 clinical evaluation.
Lipidosis 0 24 Diagnosis
PSS 4 0 Several hematologic findings help support a presumptive
Cirrhosis 2 0 clinical diagnosis of DIC. These include a regenerative
Unspecified 4 10 hemolytic anemia (although occasionally, because the patient
Pancreatitis 4 0 has a chronic disorder such as cancer, the anemia is nonre-
generative), hemoglobinemia (caused by intravascular
Immune-mediated diseases 10 0 hemolysis), RBC fragments or schistocytes, thrombocytope-
IHA 4 0 nia, neutrophilia with a left shift and toxic changes, and
IMT 2 0 rarely neutropenia. Most of these features are evident with
Evans syndrome 2 0 the evaluation of a spun hematocrit and blood smear.
IMN 2 0 Serum biochemical abnormalities in patients with DIC
Infectious diseases 10 19 include hyperbilirubinemia from hemolysis or hepatic
thrombosis, azotemia and hyperphosphatemia if severe renal
FIP 0 19 microembolization has occurred, increase in liver enzyme
Sepsis 8 0 activities caused by hypoxia or hepatic microembolization,
Babesiosis 2 2 decreased total carbon dioxide content caused by meta-
Rodenticide † 8 0 bolic acidosis, and panhypoproteinemia if the bleeding is
GDV 6 0 severe enough. Another manifestation of MOF is the devel-
HBC 4 0 opment of multifocal ventricular premature contractions
resulting in a tachyarrhythmia and easily visualized in an
Miscellaneous 18 19 electrocardiogram.
Urinalysis usually reveals hemoglobinuria and bilirubi-
FIP, feline infectious peritonitis; GDV, gastric dilation-volvulus; HA,
hemangioma; HBC, hit by car; HSA, hemangiosarcoma; IHA, nuria and occasionally proteinuria and cylindruria. Urine
immune-mediated hemolytic anemia; IMN, immune-mediated samples in dogs with acute DIC should not be obtained by
neutropenia; IMT, immune-mediated thrombocytopenia; LSA, cystocentesis because severe intravesical or intramural
lymphoma; PSS, portosystemic shunt. bleeding may result.
*In 50 dogs and 21 cats evaluated at The Ohio State University Hemostatic abnormalities in dogs with DIC include
Veterinary Teaching Hospital.
† The results of hemostasis profiles in dogs with rodenticide toxicity thrombocytopenia, prolongation of the OSPT or aPTT
mimic those seen in disseminated intravascular coagulation (DIC). (>25% of the concurrent control), normal or low fibrinogen
From Couto CG: Disseminated intravascular coagulation in dogs concentration, positive FDP or D-dimer test, and decreased
and cats, Vet Med 94:547, 1999. This table originally appeared AT concentration. Using a TEG, fibrinolysis can be enhanced
in the June 1999 issue of Veterinary Medicine. It is reprinted here in these animals. At our clinic, DIC is diagnosed if the patient
by permission of Thomson Veterinary Healthcare Communications,
8033 Flint, Lenexa, Kan 66214; (913) 492-4300; fax: (913) has four or more of the hemostatic abnormalities just
492-4157; www.vetmedpub.com. All rights reserved. described, particularly if schistocytes are present.
The hemostatic abnormalities in 50 dogs and 21 cats with
DIC evaluated in our clinic are listed in Table 87.6. In dogs
Acute DIC is extremely rare in cats. Regardless of the patho- thrombocytopenia, prolongation of the aPTT, anemia, and
genesis, dogs with acute DIC often are brought in because schistocytosis were common; in contrast with previous
of profuse spontaneous bleeding and constitutional signs descriptions of the syndrome in dogs, regenerative anemia,
attributable to anemia or parenchymal organ thrombosis prolongation of the OSPT, and hypofibrinogenemia were
(MOF). The clinical signs of bleeding indicate both primary not. In cats prolongation of the aPTT and/or OSPT,
bleeding (e.g., petechiae, ecchymoses, mucosal bleeding) and schistocytosis, and thrombocytopenia were common,