Page 199 - Basic Monitoring in Canine and Feline Emergency Patients

Suspect primary hemostatic disorder
VetBooks.ir bleeding?
Actively

No Yes

Anemic? Clinical
for anemia?
Administer
platelet product
Yes

Give red
Yes blood cells

No

Are invasive Look for
diagnostic tests underlying
needed? disease

Fig. 9.12. The general approach to the initial clinical management of suspected primary platelet disorders. The single
most important initial decision is whether or not the patient requires emergent treatment to stop active bleeding.
Otherwise, in all cases a diagnostic workup to look for underlying disease is required prior to definitive treatment.

further diagnose the underlying reason for the incidentally on bloodwork. Other stable cases are
hemostatic disorder. These cases should be prophy- those where the animal is known to have a histori-
lactically transfused with either fresh whole blood cal thrombocytopathic disease like vWd. It is
or platelet-rich plasma to provide functional plate- important to remember when interpreting blood-
lets prior to the procedure. The exact timing of the work that certain breeds of dogs (Cavalier King
transfusion is variable but transfusions are typi- Charles Spaniels, Greyhounds) have naturally lower
cally given anywhere from 1–4 hours before the platelet counts that are not pathologic. Stable
procedure (or the blood product can be given dur- thrombocytopenic/thrombocytopathic animals do
ing the procedure if necessary). If the animal has a not require emergent transfusion; efforts should
drug-induced thrombocytopathia, ideally the inva- instead be directed toward diagnosing their under-
sive procedure is delayed until the effects of the lying condition and treating it if indicated/possible.
drug have worn off and the platelets are functional Regardless of the categorization of the animal,
again. In inherited disorders such as vWd, the ani- once a primary hemostatic disorder is diagnosed,
mal can be given vWF in the blood/plasma prod- long term treatment involves addressing the under-
ucts listed above, or by transfusing fresh frozen lying disorder (if possible). Most of the inherited
plasma or cryoprecipitate. Drugs like desmopressin thrombocytopathias do not have specific treat-
can be given which induce release of vWF from the ment options aside from avoiding situations that
endothelial cells prior to the procedure. might induce hemorrhage, and being aware of the
condition when the animal does require proce-
dures that might induce hemorrhage, such as sur-
Stable primary hemostatic disorders
gery or dental extractions.
Stable cases are those animals which are thrombo- Typically, when animals have immune-mediated
cytopenic or have thrombocytopathia but are not destruction, platelet counts are extremely low
actively hemorrhaging. They may or may not have (<5,000–10,000/hpf; normal 200,000–500,000/hpf)
clinical signs such as petechia or ecchymoses. Often with many animals having no platelets present.
in these cases, low platelet counts are discovered When platelets are being consumed or lost during

Coagulation 191