Coagulopathy Diagnostic Algorithms Wendy Blount DVM EcchymosesPetechiae Algorithm

Coagulopathy Diagnostic Algorithms Wendy Blount, DVM

Ecchymoses/Petechiae Algorithm Platelet count Low (next slide) Both prolonged Normal or increased FDPs, AT 3, TT PT, PTT/ACT normal Vit. K deficiency One prolonged BMBT normal Observe Work up vasculitis or problem resolving prolonged v. WF assays Work up vasculitis platelet function v. WDz Vasculitis thrombopathia • PT: congenital def. 7 early anti. Vit. K • PTT: congen def 8 9 11 (12) severe v. WDz - 8 heparin toxicity Factor assays to Cornell v. WF assays Rodenticide tox screen or treat with Vit. K Check for MCT, anaphylaxis • All normal Liver Failure • TT prolonged • AT 3 low Factor 10 deficiency • All normal – blood to Cornell prothrombin deficiency • TT prolonged Snake Bite • FDP increased • TT prolonged • AT 3 normal Chronic Bleeding • FDPs increased

Ecchymoses/Petechiae Algorithm low platelet count normal 50 -150, 000/ul BMBT normal PT, PTT/ACT <50, 000/ul ACT < 10 sec prolonged bone marrow prolonged platelet clumps hyperlipidemia Cavalier mild vasculitis mild rickettsial Vasculitis rickettsial dz Some thrombocytopathias neoplasia rickettsial dz Aplasia Infection toxicity normal 1 o or 2 o IMT Severe platelet problem Both prolonged FDPs, D-dimers, TT Severe bleeding – platelet consumption • Advanced Vitamin K deficiency DIC • Increased FDPs, D-dimers, TT Snake Bite • Increased FDPs, TT

Ecchymoses/Petechiae Algorithm FDPs elevated Platelets, PTT, ACT, BMBT, D-dimers, TT, AT 3 normal Hypercoagulable state Remember…. . Some animals will have multiple coagulopathies simultaneously • DIC, paraneoplastic coagulopathy • Hypercoagulation • Severe bleeding • Vasculitis

Epistaxis Algorithm Onset history of nasal discharge serosanguinous to mucopurulent acute onset History of trauma? hemorrhagic no check out local processes Rads, scope, Bx, rhinotomy No abnormalities check blood pressure and go to petechiaeecchymoses algorithm No abnormalities yes supportive and symptomatic care, surgical repair