ISSN 2398-2950      

Hemostatic disorders: acquired

ffelis
Contributor(s):

Severine Tasker

Synonym(s): Bleeding disorders


Introduction

  • Signs: associated with hemorrhage - usually adult onset.
  • Treatment: symptomatic often requiring blood product administration, while addressing underlying cause.
  • Prognosis: depends on underlying cause.

Pathogenesis

Etiology

  • Platelet deficiency (thrombocytopenia Thrombocytopenia):
  • Platelet dysfunction:
    • Hepatic, renal, neoplastic, infectious diseases (eg FIP), DIC, dysproteinemias (eg myeloma) and drugs (eg aspirin, other NSAIDs).
  • Liver disease important cause of acquired coagulopathies in cats since liver synthesizes clotting factors. Especially seen with cholestatic disease (malaborption of fat soluble vitamin K due to biliary stasis). Multiple abnormal coagulation times can occur although clinical signs of spontaneous bleeding are rare.
  • Vitamin K deficiency coagulopathy due to rodenticide toxicity Anticoagulant rodenticide poisoning but less common in cats than dogs.
  • Vitamin K-responsive coagulopathies seen due to fat malabsorption with inflammatory bowel disease Inflammatory bowel disease: overview or exocrine pancreatic insufficiency Exocrine pancreatic insufficiency.
  • FIV infection has been associated with prolongation of the APTT Hematology: activated partial thromboplastin time although the cause has not been identified.
  • DIC due to systemic activation of hemostasis with neoplasia (especially lymphoma), pancreatitis Pancreatitis, sepsis Shock: septic, infectious diseases (eg toxoplasmosis Toxoplasmosis, FIP), liver and cardiac disease. DIC cases present with hemorrhagic and/or thrombosis.

Pathophysiology

  • May be defect in:
    • Primary hemostasis  Primary hemostasis - involves platelet adhesion via vWF to the subendothelial collagen resulting in the formation of a platelet plug, as well as reflux vasoconstriction of the blood vessel.
    • Secondary hemostasis  Secondary hemostasis 01  Secondary hemostasis 02 - involves formation of fibrin by coagulation factors to stabilize the primary hemostatic platelet plug. Coagulation cascade is classically divided into intrinsic and extrinsic pathways with a final common pathway.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Bianco D, Armstrong P J & Washabau R J (2008) Presumed primary immune-mediated thrombocytopenia in four cats. J Feline Med Surg 10 (5), 495-500 PubMed.
  • Brazzell J L & Borjesson D L (2007) Evaluation of plasma antithrombin activity and D-dimer concentration in populations of healthy cats, clinically ill cats, and cats with cardiomyopathy. Vet Clin Pathol 36 (1), 79-84 PubMed.
  • Estrin M A, Wehausen C E, Jessen C R et al (2006) Disseminated intravascular coagulation in cats. JVIM 20 (6), 1334-1339 PubMed.
  • Kohn B, Linden T & Leibold W (2006) Platelet-bound antibodies detected by a flow cytometric assay in cats with thrombocytopenia. J Feline Med Surg (4), 254-260 PubMed.
  • Smith W, Day T & Mackin A (2005) Diagnosing Bleeding Disorders. Compen Contin Educ Pract Vet 27 (11), 828-843 VetMedResource.
  • Kohn B, Weingart C & Giger U (2003) Haemorrhage in seven cats with suspected anticoagulant rodenticide intoxication. J Feline Med Surg (5), 295-304 PubMed.
  • Center S A, Warner K, Corbett J et al (2000) Proteins invoked by vitamin K absence and clotting times in clinically ill cats. JVIM 14 (3), 292-297 PubMed.
  • Randolph J F, DeMarco J, Center S A et al (2000) Prothrombin, activated partial thromboplastin, and proteins induced by vitamin K absence or antagonists clotting times in 20 hyperthyroid cats before and after methimazole treatment. JVIM 14 (1), 56-59 PubMed.
  • Tasker S, Mackin A J & Day M J (1999) Primary immune-mediated thrombocytopenia in a cat. JSAP 40 (3), 127-131 PubMed.
  • Tasker S, Cripps P J & Mackin A J (1999) Estimation of platelet counts on feline blood smears. Vet Clin Pathol 28 (2), 42-45 VetMedResource.
  • Lisciandro S C, Hohenhaus A & Brooks M (1998) Coagulation abnormalities in 22 cats with naturally occurring liver disease. JVIM 12 (2), 71-75 PubMed.
  • Hart S W & Nolte I (1994) Hemostatic disorders in feline immunodeficiency virus-seropositive cats. JVIM (5), 355-362 PubMed.

Other sources of information

  • Stokol T (2005) Disorders of haemostasis. In: E Villiers & Blackwood L (eds) BSAVA Manual of Canine and Feline Clinical Pathology .2nd edn, BSAVA, Gloucester. pp 83-98.

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