Veterinary Clinical Medicine-I (General and Systemic)

PHYSICAL EXAMINATION 

• Careful clinical evaluation may differentiate between primary and secondary hemostatic defects. Surface bleeding is typically seen with primary hemostatic disorders. Petechia and ecchymosis are hallmark features of thrombocytopenias and thrombopathias. However, von Willebrand disease (vWD) is causing bleeding at sites of injury (trauma, dental disease, estrus, gastrointestinal) rather than petechia or ecchymosis. Coagulopathies may be associated with single or multiple sites of bleeding characterized by cavity bleeding such as hematoma, hemarthrosis, hemomediastinum, hemoperitoneum, and hemothorax, but gastrointestinal hemorrhage and bruising may also occur. Signs of other underlying diseases may be recognized.

Hemostatic Test

• Hemostatic tests are indicated:
  • whenever an animal is bleeding excessively
  • prior to surgery when an increased bleeding tendency is suspected
  • to monitor therapeutic interventions
  • for genetic screening in certain breeds or families with a known bleeding disorder.
• Hemostatic abnormalities should be assessed prior to instituting therapy whenever possible or at least appropriate blood samples should be collected pretreatment. Excellent venipuncture with discarding of the first few drops of blood (to avoid platelet activation and tissue factor) and extended compression over jugular, saphenous or femoral vein is required. The cuticle bleeding time crudely assesses overall hemostasis, but is not standardized and painful and is, therefore, not recommended. A minimal database includes a packed cell volume and total protein evaluation. Evaluation of a blood smear can provide a platelet estimate and identify platelet size and clumping as well as schistocytes. The results can provide some measure of the extent of blood loss and red blood cell transfusion requirement.