Emergency and Critical Care Quiz

Anemia

• Anemia is a condition characterized by decreased oxygen-carrying capacity in the blood due to low levels of hemoglobin and red blood cells.
• It is not a diagnosis itself, but a laboratory abnormality requiring further investigation to identify the underlying cause.
• The three main mechanisms of anemia are blood loss, hemolysis, and ineffective erythropoiesis.

Main Causes of Anemia

• Blood loss:
  • Normal hemostasis: trauma, surgery, parasitosis, NSAIDs, steroids, neoplasms, etc.
  • Abnormal hemostasis: thrombocytopenia, thrombocytopathy (von Willebrand disease), coagulopathies (DIC, hepatopathy, rodenticide toxicity, etc.)
• Hemolysis:
  • Congenital, infectious, immune, chemical (zinc, copper, sulphonamides), hypophosphatemia-induced, mechanical (DIC), neoplastic (hemangiosarcoma, histiocytosis)
• Ineffective erythropoiesis:
  • Refractory anemias: chemicals, chronic renal failure, chronic illnesses (organ dysfunction, infection, cancer, idiopathic), etc.
  • Non-refractory anemias: aplastic anemia, pancytopenia, drug- or chemical-induced, infectious, immune, neoplastic, radiation-induced, congenital anemia, malabsorption or cobalamin deficiency, idiopathic anemia, etc.

Diagnosis of Anemia

• Clinical signs include pale mucosa, lethargy, weakness, anorexia.
• Hemorrhagic losses may present with signs of external, internal, or occult bleeding.
• Hyperacute hemorrhage may lead to circulatory collapse, while internal bleeding or gastrointestinal bleeding can be harder to interpret.
• Hemolytic anemia may be accompanied by icterus, hemoglobinemia, or pigmenturia.
• Signs of anemia due to ineffective erythropoiesis depend on the underlying pathology.
• Laboratory testing includes hematocrit, total protein, blood smear, platelet count, coagulation parameters, and examination of erythrocyte morphology.

Treatment of Anemia

• Treatment depends on the cause, severity, and progression of the anemia.
• Hyperacute bleeds require intensive fluid therapy to maintain perfusion before considering blood transfusion.
• Transfusion of fresh whole blood or blood products is indicated in many clinical situations.
• Transfusion volumes depend on the degree of anemia, clinical condition, and size of the animal.
• Slow transfusion initiation, monitoring for reactions, and appropriate rates based on the animal's status are essential.

Coagulopathies

• Coagulopathies are a clinical syndrome resulting from a deficiency in clotting factors of the secondary hemostasis system.
• Causes of coagulopathies:
  • Acquired:
    • Vitamin K deficiency or antagonism (rodenticide toxicity).
    • Hepatopathy.
    • Disseminated Intravascular Coagulation (DIC).
    • Anticoagulant administration (heparin, etc.).
  • Congenital:
    • Deficiencies in various clotting factors (Factor I, II, VII, VIII, IX, X, XI, XII) in specific dog breeds.

Diagnosis of Coagulopathies

• Diagnostic tests:
  • Activated clotting time (ACT): evaluates factors XII, XI, IX, VIII, X, V, II, and fibrinogen.
  • Prothrombin time (PT): sensitive test for the same factors.
  • Activated partial thromboplastin time (APTT): evaluates factors III, VIII, X, V, II, and fibrinogen.
  • Fibrin degradation products (FDPs) and D-dimer for evaluating fibrinolysis.
• Clinical signs:
  • Hematomas and bleeding into subcutaneous tissues, body cavities, muscles, and joints.

Treatment of Coagulopathies

• Treatment for rodenticide toxicity:
  • Administer vitamin K1 (phytonadione) at a dose of 2-5 mg/kg/day orally or subcutaneously for several weeks.
  • Follow-up check of clotting times (PT/APTT).
  • In cases of intense bleeding, severe anemia, or bleeding in vital organs, consider simultaneous administration of fresh frozen plasma (FFP) at a dose of 6-20 ml/kg every 8-24 hours.
• Treatment for severe liver disease:
  • Administer vitamin K1 and FFP while organ dysfunction persists.
• Treatment for Disseminated Intravascular Coagulation (DIC):
  • Critical to treat the primary cause.
  • Administration of fresh frozen plasma (FFP), heparin, packed red blood cells (pRBCs), or whole blood may improve the patient's condition.