Veterinary Clinical Medicine-I (General and Systemic)

TREATMENT OF BLEEDING DISORDERS

• Hemostatic disorders can be conveniently classified into vasculopathies, thrombocytopenias, thrombopathias, von Willebrand disease (vWD), and coagulopathies realizing that some disease processes cause combined hemostatic defects (e.g., disseminated intravascular coagulopathy [DIC]). A high suspicion of a hemostatic dysfunction based upon signalment, history, clinical signs, and laboratory tests, as well as definitive identification of the specific hemorrhage defect is important in order to institute promptly the most effective and safe treatment. Whereas the diagnostic approach to the bleeding patient was discussed in the previous presentation, this lecture will cover the treatment modalities for hemorrhage focusing on transfusion medicine.
  • Depending on the severity of the hemorrhage conservative prevention of further hemorrhage to intensive care and transfusion support may have to be instituted. There are several general therapeutic principles to consider:
  • Provide local hemostasis with wound pressure, ligations, and topical agents.
  • Rehydrate the patient in case of rapid blood and other fluid losses with electrolytes; avoid plasma expanders as they can induce a bleeding tendency.
  • Collect diagnostic blood samples prior to treatment as blood components and drugs can affect results.
  • Transfuse packed red blood cells as needed for the correction of severe anemia.
  • Administer other blood components to replenish deficient or consumed coagulation factors and rarely platelets.
  • Remove triggering agents such as toxins in a household and infectious agents with antimicrobial therapy.
  • Treat underlying disease whenever possible, including vitamin K supplementation, immunosuppression, and other specific therapy.
  • Monitor the patient's bleeding tendency and overall well-being, prevent reexposure to toxins, delay any harmful surgical interventions, and avoid exposure to drugs that impair hemostasis (e.g., aspirin, acepromazine).