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Anemia, Blood Loss 57

Possible Complications • Young dogs may be more likely to Technician Tips
• Secondary infections/sepsis due to neutro- recover or respond to immunosuppressive • Individuals handling a severely neutropenic
VetBooks.ir • Adverse drug effects (p. 60) • Most cats die or are euthanized within 1 mask, gown, hair and shoe covers) to prevent Diseases and Disorders
penia and/or immunosuppressive therapy
patient should wear protective gear (gloves,
therapy.
month of diagnosis, but some cats can survive
• Transfusion reactions (p. 989)
transmission of infectious agents to the
patient.
Recommended Monitoring for years despite pancytopenia. • Severely thrombocytopenic patients are prone
• Repeat CBC at least weekly (depending on PEARLS & CONSIDERATIONS to bleeding, and minimal, gentle handling
severity of signs) until full recovery. can reduce the risk of hemorrhage.
• On recovery, CBCs should be monitored Comments • Monitor patients closely during transfusion
monthly for an additional 3 months. Early recognition of aplastic anemia may for early recognition of adverse reactions.
improve the chance of marrow recovery.
PROGNOSIS & OUTCOME SUGGESTED READING
Prevention Weiss DJ: Aplastic anemia. In Weiss DJ, et al, editors:
• Depends on underlying cause • CBCs should be monitored regularly in Schalm’s Veterinary hematology, ed 6, Ames, IA,
○ Acute: good to guarded; often reversible animals receiving medications associated with 2010, Blackwell, pp 256-260.
within 2-3 weeks after resolution of the development of aplastic anemia. AUTHOR: John M. Thomason, DVM, MS, DACVIM
marrow insult • For cats, minimize the risk of exposure to EDITOR: Jonathan E. Fogle, DVM, PhD, DACVIM
○ Chronic and idiopathic: guarded to poor; FeLV and FIV (pp. 325 and 329).
less responsive to therapy with long
recovery times (months)

Anemia, Blood Loss Client Education
Sheet

BASIC INFORMATION • Hemoabdomen hematocrit with evidence of red cell regenera-
• Petechiae, ecchymoses: suggestive of underly- tion (reticulocytosis, anisocytosis, polychroma-
Definition ing bleeding disorder sia) in the absence of hemolysis. The cause may
A decrease in total red blood cell (RBC) mass be apparent from history and physical exam
secondary to loss of RBCs from the vascular Etiology and Pathophysiology alone or may require additional testing.
space • Acute blood loss
○ Trauma Differential Diagnosis
Synonym ○ Surgery • Differentiate from hemolytic anemia (pp.
Hemorrhagic anemia ○ Bleeding neoplasm (especially hemangio- 59 and 60).
sarcoma) • Blood loss anemia is typically character-
Epidemiology ○ GI ulcer ized by decreased plasma total protein
SPECIES, AGE, SEX ○ Bleeding disorder (thrombocytopenia, (TP) without autoagglutination, sphe-
Varies depending on underlying cause anticoagulant rodenticide toxicosis, rocytosis, hyperbilirubinemia/-uria, or
hemophilia) hemoglobinemia/-uria.
RISK FACTORS • Chronic blood loss/iron-deficiency anemia
Neoplasia, gastrointestinal (GI) ulcers, throm- ○ GI bleeding most common: neoplasia, Initial Database
bocytopenia, coagulopathy, heavy parasite load hookworms, GI ulcers • Packed cell volume (PCV)/TP: with acute
(e.g., fleas, hookworms) ○ Less common: heavy flea infestation, blood loss, there is initially little change in
urinary tract hemorrhage PCV because of concurrent loss of plasma
Clinical Presentation ○ Iatrogenic (overuse of blood donors or with RBCs. Over hours, redistribution of fluid
HISTORY, CHIEF COMPLAINT frequent phlebotomy) occurs, resulting in lowered PCV and TP.
• Weakness, lethargy, collapse, anorexia, ○ Iron-deficiency anemia from chronic • CBC/blood smear (p. 1327):
exercise intolerance external bleeding: ○ Normocytic, normochromic RBCs initially
• Trauma ■ Iron depletion leads to decreased ○ Reticulocytosis 3-5 days after acute
• Abdominal distention, melena, epistaxis, synthesis of hemoglobin and delayed loss; hypochromic macrocytosis and
hematuria RBC maturation. RBCs are less deform- polychromasia
• Pica may be noted with chronic anemia. able, with accelerated lysis. ○ Microcytosis, increased red cell distribu-
Young animals at increased risk, due tion width and hypochromasia suggest
■
PHYSICAL EXAM FINDINGS to decreased iron storage chronic blood loss/iron-deficiency anemia
Varies with severity and duration: ○ The platelet count is usually normal, but
• Pallor DIAGNOSIS it can be mildly decreased due to con-
• Weakness, exercise intolerance; collapse or sumption or increased with chronic
syncope Diagnostic Overview bleeding. Severe thrombocytopenia may
• Tachycardia, tachypnea, bounding pulses The diagnosis of hemorrhagic anemia is sus- be the cause of blood loss.
• Heart murmur: systolic, left-sided, and pected in patients with pale mucous membranes, ○ Schistocytes are possible with hemangio-
generally soft (<III/VI) weakness, and tachycardia/tachypnea, often sarcoma or other splenic mass.
• Melena on rectal exam with a history of surgery, trauma, or melena • Serum biochemistry panel: panhypoprotein-
• Hemorrhage from surgery, trauma, or or with an abdominal fluid wave. Confirmation emia may be present if there has been external
underlying cause requires a CBC demonstrating a decreased blood loss.

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