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58 Anemia, Blood Loss

• +/− Abdominocentesis (p. 1056) if fluid wave • Chronic blood loss • Fair with GI ulcers after underlying disease
(caution if bleeding disorder): hemoabdomen ○ Transfusion if severe (p. 1169) • Guarded to grave with neoplasia; short-term
treated
VetBooks.ir • +/− Coagulation panel and buccal mucosal involve GI protectants, dewormer, surgery response with surgery with or without
○ Treatment of underlying cause (may
secondary to trauma, splenic disease (e.g.,
hemangiosarcoma), bleeding disorder
additional chemotherapy, depending on
for intestinal tumor, etc.)
bleeding time (p. 1076) to rule out a
hemostatic defect Chronic Treatment tumor type and extent
• +/− Thoracic radiographs: neoplasia, pul- Chronic blood loss/iron-deficiency anemia: PEARLS & CONSIDERATIONS
monary hemorrhage, hemorrhagic pleural replace iron with iron dextran 10-20 mg/kg
effusion IM or ferrous sulfate 100-300 mg/DOG/day Comments
• +/− Abdominal radiographs, ultrasound, or 50-100 mg/CAT/day PO • In acute blood loss, PCV is not a good
endoscopy: neoplasia, GI ulceration indicator of patient status. Indicators of
• Fecal flotation/fecal occult blood Possible Complications perfusion (pulse quality, capillary refill time,
• Urinalysis to rule in/rule out hematuria and • Massive blood loss: hypoxemia, hypovolemic blood pressure, and blood lactate) are more
urinary tract blood loss shock, death important in acute situations.
• Transfusion reactions (p. 989) • Decision to transfuse a patient should be
Advanced or Confirmatory Testing ○ Dogs: determine blood type before based on clinical signs rather than PCV
Uncommonly required: transfusion to ensure blood type compat- alone. For example, a patient with massive,
• Iron-deficiency anemia ibility. If recipient is not typed, donor rapid blood loss may require transfusion
○ Low serum iron concentration, low serum should be negative for DEA-1.1. All dogs despite PCV = 25%, whereas slow blood
ferritin concentration, and low transferrin that have previously received a transfusion loss may elicit compensatory responses that
saturation (<20%) (p. 1355) should have a cross-match before limit clinical signs despite PCV = 15%.
○ Bone marrow: erythroid hyperplasia; transfusion. However, at a PCV < 12%, virtually all
Prussian blue stain: absence of iron par- ○ Cats: possess naturally occurring antibod- patients show clinical signs and require a
ticles in dogs ies against the blood type antigen they lack transfusion.
• Nuclear scintigraphy may confirm occult GI (alloantibodies). All cats must be typed or • If a patient has signs consistent with acute
blood loss. cross-matched before any transfusions. blood loss (low PCV/TP), without an
• Cystoscopy may be used to localize the source • Adverse drug reactions: iron dextran: injec- identifiable source, GI blood loss should be
of hematuria. tion site pain, anaphylactic reaction; ferrous suspected. There may be extensive GI blood
sulfate: vomiting, diarrhea, dark stools loss before melena, hematemesis, or hema-
TREATMENT tochezia is noted.
Recommended Monitoring • Do not treat iron-deficiency anemia without
Treatment Overview • Acute blood loss searching for an underlying cause of blood
The mainstays of treatment are to control active ○ Monitor PCV/TP q 12h initially; monitor loss.
hemorrhage if present, restore circulating blood heart rate, respiratory rate, blood pressure,
volume (with fluid resuscitation and/or blood mucous membrane color, and capillary Prevention
transfusion) if decreased, and correct the refill time. Concurrent use of corticosteroids and
underlying cause. ○ Polymerized bovine hemoglobin (Oxyglo- nonsteroidal antiinflammatory drugs (NSAIDs)
bin, if the product is available) increases is contraindicated (GI ulceration, blood loss).
Acute General Treatment oxygen-carrying capacity without increas-
• Acute blood loss ing PCV; need to monitor blood hemo- Technician Tips
○ IV fluids: crystalloids +/− colloids to globin concentration In addition to mucous membrane color, capil-
correct hypovolemia • Chronic blood loss lary refill time, and heart and respiratory rates,
○ If signs of hypoxemia (weakness, tachy- ○ Monitor CBC every 1-4 weeks if clinically a patient’s mentation and pulse strength are
cardia, tachypnea), consider transfusion: stable. important (and often overlooked) indicators
packed RBCs (6-10 mL/kg) are the best • Reticulocytosis may be the first sign of of the severity of anemia and are useful for
option if available, or use whole blood response. monitoring.
(10-20 mL/kg).
○ Autotransfusion if severe hemorrhage in PROGNOSIS & OUTCOME Client Education
a body cavity and no contamination with Stress importance of follow-up for chronic/
bacteria or neoplastic cells. Requires • Good with blood loss secondary to trauma iron-deficiency anemia.
aseptic collection and a blood filter. or surgery after hemorrhage is controlled
○ If a coagulopathy is present, correct and cardiovascular status is stabilized SUGGESTED READING
with vitamin K 1, 1-5 mg/kg SQ q 24h, • Excellent with parasites and appropriate Giger U: Anemia. In Silverstein D, et al., editors:
+/− fresh-frozen plasma (6-10 mL/ treatment Small animal critical care medicine, St. Louis, 2009,
kg), +/− cryoprecipitate (1 unit/10 kg • Fair with various bleeding disorders, depend- Saunders, 518-523.
IV) depending on severity and cause ing on severity of and ability to control blood AUTHOR: Alicia K. Henderson, DVM, DACVIM
(p. 1169). loss EDITOR: Jonathan E. Fogle, DVM, PhD, DACVIM

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