Page 96 - Problem-Based Feline Medicine

88 PART 2 CAT WITH LOWER RESPIRATORY TRACT OR CARDIAC SIGNS

Clinical signs ● Send-out lab tests include prothrombin time (PT –
extrinsic system), partial tissue thromboplastin time
Hemorrhagic effusions generally result from either
(PTT – intrinsic system), and PIVKA test for rodenti-
trauma or coagulopathy. History and physical exam find-
cide toxicity. Factor analysis for deficiencies of factors
ings are vital in the separation of these causes.
II, VII and X may be requested.
Signs related to pleural effusion and anemia include ● Common coagulopathies include rodenticide expo-
dyspnea, orthopnea (positional dyspnea), tachypnea, sure and genetic bleeding diatheses.
minimal airflow with increased chest excursions and
muffled heart and lung sounds ventrally. Differential diagnosis

Weakness, hemic heart murmur, watery thready Differential diagnoses include any cause of pleural effu-
femoral pulse, pale mucous membranes all support sion with bleeding into the pleural fluid, such as bleed-
possible blood loss. ing neoplasms, some chylothoraces (the fluid is less
bloody and more “tomato soup-like”), as well as iatro-
Trauma may have signs of external trauma such as
genic bleeding from previous thoracocenteses.
skin abrasions, rib fractures, penetrating thoracic
wounds, etc., present.
Treatment
Coagulopathies may involve other bleeding sites such as
abdominal effusion (hemoabdomen), epistaxis, hyphema Thoracostomy tube placement is generally contraindi-
and hematoma formation. Common coagulopathies cated, especially in coagulopathies as it may trigger
include rodenticide toxicity, factor VIIIC deficiency further bleeding.
(hemophilia A), and factor XII deficiency (although this Gentle handling and supportive care are indicated in
rarely causes clinical bleeding). trauma patients, as well as tending to other injuries.
Diagnosis Whole blood transfusion may be lifesaving in severe
thrombocytopenia or coagulopathy. Depending on the
Thoracic radiography reveals signs of pleural effu- breed (i.e., Persians) and the geographic location, cats
sion, indistinguishable from other causes. Alveolar with type B blood may be common. Cross-matching must
densities may be also present, indicating intrapul- be performed to avoid catastrophic transfusion reactions.
monary hemorrhage.
Results of coagulation tests may help with therapeutic
Thoracocentesis decisions.
● Analysis of the fluid reveals obvious bloody fluid, ● Vitamin K1 may be used for rodenticide toxicity.
often with a packed cell volume (PCV) lower than ● Fresh frozen plasma transfusions may be used for
peripheral blood, except in cases of severe peracute coagulation factor deficiency, etc.
frank hemorrhage where the PCV is similar to
peripheral blood. The blood is generally defibri-
nated with no platelets observed cytologically, but, HYPOPROTEINEMIA
in acute bleeding situations, frank clotting blood
with platelets may be present. Classical signs
Coagulation testing. ● Muffled heart and lung sounds ventrally.
● Coagulation tests help rule in and categorize types ● Dyspnea characterized by excessive chest
of coagulation disorders. excursions with poor airflow.
● In-clinic tests include activated clotting time (ACT, ● Orthopnea (positional dyspnea).
generally normal considered to be less than 65 sec- ● Muscle wasting, weight loss, ascites, limb
onds in the cat) to test the intrinsic cascade, blood edema.
smear for platelet numbers (should be 11–25 per
high-power field), and buccal mucosal bleeding See main reference on pages 358 and 760 for details
time (BMBT, normal considered to be 1–3 minutes) (The Thin, Inappetant Cat and The Cat With Signs of
for platelet function (i.e., Von Willebrand’s disease). Chronic Small Bowel Diarrhea).