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what clinical signs are seen with ITP?
- primary hemostatic defect signs
- -petechia, echymoses
- -mm bleeds (hematuria, melena, epistaxis), hyphema
- mild anemia, fever
- acute/peracute onset
what is plt count to see spontaneous bleed? what about for petechiation?
- spontaneous bleed: <30,000 in dog (<5,000 cat)
- petechia: <50,000
If you suspect ITP, what diagnostics do you request?
- CBC- plt # often <20,000
- smear: ck for giant platelets
- check tick titers, vx, and drug history
- check for DIC
- imaging for neoplasia
what does 1 plt seen on oil immersion amount to?
what is Evan's syndrome?
ITP + IMHA
Although not usually performed, what would bone marrow aspirate show with ITP?
what are treatment goals for ITP?
- immunosuppression (stop plt destruction)
- reduce blood loss
- maintain tissue Oxygenation if severe bleeding
- adequate perfusion
What drug and dose should you use for ITP?
- dexamethasone 1-2mg/kg
- (more potent than prednisone)
what medication can be started while waiting on tick titer results?
what should you give if oxygen saturation is a problem?
whole blood to provide O2 carrying capacity + some plt
Can we give platelets?
- in short, there is no good way to transfer plt
- (options include vincristine, DMSO preserved banks, cryoprecipitate/plt rich plasma but all questionable efficacy)
How long should immunosuppresion be continued in ITP patient?
- 3-6 months until taper the dose
- some need life long therapy
what is prognosis of ITP patient?
- 70% respond to therapy
- poorer if evan's syndrome or severe bleed
Should vaccines continue to be given to ITP patient?
no more vaccines, could trigger immune reaction and recurrence of ITP
what is the most common INHERITED bleeding disorder in dogs?
von Willebrand's disease
what is the difference between type 1,2,3 vWD? which type do dobies usually get?
- 1: decr. concentration but NORMAL vWF - dobies
- 2:low/normal amt of ABNORMAL vWF
- 3:absence of vWF
one of the major adhesive proteins in the body, what does vWF circulate attached to? is vWF part of primary or secondary hemostasis?
- complexed to factor 8
- initiates PRIMARY hemostatic plug
what are clinical signs seen with vWD?
- NO spontaneous bleeds
- primary bleeding defects (ecchymoses, melena,etc)
- excessive bleeding w/surgery
how is vWD diagnosed (what is expected plt count, coag test results, BMBT, PFA)?
- normal plt count
- most coag tests normal (may see prolonged APTT)
- prolonged BMBT
- abnormal PFA
- specialized labs to quantify vWF
how is vWD treated?
- desmopressin acetate causes massive release of vWF from endothelial cells
- -only effective in type 1
blood products to incr. vWF in minutes
what are expected clinical signs after rodenticide/vit K antagonist deficiency?
- acute collapse
- coughing/thoracic pain
- pale mm
- *bleeding wont show for several days*
what does CBC show with rodenticide toxicity?
- regenerative anemia
- +/- mild thrombocytopenia (from consumption)
What are results of OSPT and ASPT tests with rodenticide toxicity?
- both prolonged; (factor 7 shortest half life)
- OSPT prolonged BEFORE clinical signs of bleeding (before ASPT prolonged)
what is PIVKA?
- proteins induced by vitamin K antagonism/absence
- -elevated with rat poisoning but takes days to get results
how is rodenticide poisoning treated?
- emesis +/- charcoal if recent ingestion
- transfusions if significant anemia
- supportive care + coagulation factors (FFP, whole)
- vitamin K = *phytonadione*
how is vitamin K administered in the hospital? how is it given once pt is stable/eating? for how long?
- SQ with small needle into many sites
- oral when stable - long term (4-6wks)
how do you know when its ok to stop vit K (what diagnostic test do you run)?
check OSPT 1-2 days after stopping vit K