Chapter 89
Acquired Coagulopathies
Marjory B. Brooks,
Armelle De Laforcade,
Marjory B. Brooks
Search for more papers by this authorArmelle De Laforcade
Search for more papers by this authorMarjory B. Brooks,
Armelle De Laforcade,
Marjory B. Brooks
Search for more papers by this authorArmelle De Laforcade
Search for more papers by this authorBook Editor(s):Marjory B. Brooks DVM, DACVIM,
Kendal E. Harr DVM, MS, DACVP,
Davis M. Seelig DVM, PhD, DACVP,
K. Jane Wardrop DVM, MS, DACVP,
Douglas J. Weiss DVM, PhD, DACVP,
Marjory B. Brooks DVM, DACVIM
Director, Comparative Coagulation Section
Animal Health Diagnostic Center, Cornell University, Ithaca, New York, USA
Search for more papers by this authorKendal E. Harr DVM, MS, DACVP
URIKA, LLC, Mukilteo, Washington, USA
Search for more papers by this authorDavis M. Seelig DVM, PhD, DACVP
Associate Professor, Clinical Pathology
Department of Veterinary Clinical Sciences, University of Minnesota, College of Veterinary Medicine, St. Paul, Minnesota, USA
Search for more papers by this authorK. Jane Wardrop DVM, MS, DACVP
Professor and Director, Clinical Pathology Laboratory
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
Search for more papers by this authorDouglas J. Weiss DVM, PhD, DACVP
Emeritus Professor
College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
Search for more papers by this authorFirst published: 04 March 2022
Summary
Thrombocytopenia and acquired coagulopathies are the most common hemostatic defects encountered in clinical practice. An index of suspicion and consistent use of screening tests early in the diagnostic workup are key to recognition and effective management of acquired coagulopathies. Acquired coagulopathies discussed in this chapter include disease processes that delay or prevent fibrin clot formation or increase the rate of fibrinolysis. The initial evaluation of animals with signs of hemorrhage should aim to differentiate blood loss caused by vessel injury or vascular disease from a systemic failure of normal hemostasis (i.e., bleeding diathesis). Some animals with acquired coagulopathies do not manifest overt hemorrhage at initial presentation. Detection of factor deficiency in these cases requires an index of suspicion and consistent inclusion of coagulation screening tests early in the diagnostic workup.
REFERENCES
- Brooks MB , Gu W , Ray K . Complete deletion of factor IX gene and inhibition of factor IX activity in a labrador retriever with hemophilia B . J Am Vet Med Assoc 1997 ; 211 : 1418 – 1421 .
- Caldwell SH , Hoffman M , Lisman T , et al. Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management . Hepatology 2006 ; 44 : 1039 – 1046 .
- Center SA , Warner K , Corbett J , et al. Proteins invoked by vitamin K absence and clotting times in clinically ill cats . J Vet Intern Med 2000 ; 14 : 292 – 297 .
- CRASH-2 trial collaborators . Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomized, placebo-controlled trial . Lancet 2010 ; 376 ( 9734 ): 23 – 32 .
- Diniz MS , Teixeira-Neto FJ , Goncalves DS , et al. Effects of 6% tetrastarch or lactated Ringer's solution on blood coagulation in hemorrhaged dogs . J Vet Intern Med 2018 ; 32 ( 6 ): 1927 – 1933 .
- Diquelou D , Barbaste C , Gabaig AM , et al. Pharmacokinetics and pharmacodynamics of a therapeutic dose of unfractionated heparin (200 U/kg) administered subcutaneously or intravenously to healthy dogs . Vet Clin Pathol 2005 ; 34 : 237 – 242 .
- Edwards DF , Russell RG . Probable vitamin K-deficient bleeding in two cats with malabsorption syndrome secondary to lymphocytic-plasmacytic enteritis . J Vet Intern Med 1987 ; 1 : 97 – 101 .
- Fletcher D , Rozanski E , Brainard B , et al. Assessment of the relationships among coagulopathy, hyperfibrinolysis, plasma lactate, and protein C in dogs with spontaneous hemoperitoneum . J Vet Emerg Crit Care 2016 ; 26 ( 1 ): 41 – 51 .
- Fry W , Lester C , Etedali NM , et al. Thromboelastography in dogs with chronic hepatopathies . J Vet Intern Med 2017 ; 31 ( 2 ): 419 – 426 .
- Galli M . Clinical utility of laboratory tests used to identify antiphospholipid antibodies and to diagnose the antiphospholipid syndrome . Semin Thromb Hemostasis 2008 ; 34 : 329 – 334 .
- Ganter MT , Hofer CK . Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices . Anesth Analg 2008 ; 106 : 1366 – 1375 .
- Greipp PR , Kyle RA , Bowie EJW . Factor X deficiency in amyloidosis: a critical review . Am J Hematol 1981 ; 11 : 443 – 450 .
- Hess J , Brohi K , Dutton R , et al. The coagulopathy of trauma: a review of mechanisms . J Trauma 2008 ; 65 : 748 – 754 .
- Holme PA , Brosstad F , Tjonnfjord GE . Acquired haemophilia: management of bleeds and immune therapy to eradicate autoantibodies . Haemophilia 2005 ; 11 : 510 – 515 .
- Jutkowitz LA , Rozanski EA , Moreau JA , et al. Massive transfusion in dogs: 15 cases (1997–2001) . J Am Vet Med Assoc 2002 ; 220 : 1664 – 1669 .
- Kelley D , Lester C , Shaw s , et al . Thromboelastographic evaluation of dogs with acute liver disease . J Vet Intern Med 2015 ; 29 ( 4 ): 1053 – 1062 .
- Kumar D , Greer FR , Super DM , et al. Vitamin K status of premature infants: implications for current recommendations . Pediatrics 2001 ; 108 : 1117 – 1122 .
- Lawson JH . The clinical use and immunological impact of thrombin in surgery . Semin Thromb Haemostasis 2006 ; 32 ( S1 ): 98 – 110 .
- Leisewitz AL , Blaylock RS , Kettner F , et al. The diagnosis and management of snakebite in dogs – a southern African perspective . J S Afr Vet Assoc 2004 ; 75 : 7 – 13 .
- Lisciandro SC , Hohenhaus A , Brooks M . Coagulation abnormalities in 22 cats with naturally occurring liver disease . J Vet Intern Med 1998 ; 12 : 71 – 75 .
- Marlar RA , Husain S . The enigmas of the lupus anticoagulant: mechanisms, diagnosis, and management . Curr Rheumatol Rep 2008 ; 10 : 74 – 80 .
- McConnico RS , Copedge K , Bischoff KL . Brodifacoum toxicosis in two horses . J Am Vet Med Assoc 1997 ; 211 : 882 – 886 .
- Mischke RH , Schuttert C , Grebe SI . Anticoagulant effects of repeated subcutaneous injections of high doses of unfractionated heparin in healthy dogs . Am J Vet Res 2001 ; 62 : 1887 – 1891 .
- Morris BR , deLaforcade A , Lee J . Effects of in vitro hemodiluation with crystalloids, colloids, and plasma on canine whole blood coagulation as determined by kaolin-activated thromboelastography . J Vet Emerg Crit Care 2016 ; 26 ( 1 ): 58 – 63 .
- Mount ME , Kim BU , Kass Ph . Use of a test for proteins induced by vitamin K absence or antagonism in diagnosis of anticoagulant poisoning in dogs: 325 cases (1987–1997) . J Am Vet Med Assoc 2003 ; 222 ( 2 ): 194 – 198 .
- O'Kelley BM , Whelan MF , Brooks MB . Factor VIII inhibitors complicating treatment of postoperative bleeding in a dog with hemophilia A . J Vet Emerg Crit Care 2009 ; 19 : 381 – 385 .
- Prasad S , Lillicrap D , Labelle A , et al. Efficacy and safety of a new-class hemostatic drug candidate, AV513 in dogs with hemophilia A . Blood 2008 ; 15 : 672 – 679 .
- Reding MT . Immunological aspects of inhibitor development . Haemophilia 2006 ; 12 ( Suppl 6 ): 30 – 36 .
- Reipert BM , van den Heilden PM , Schwarz HP , et al. Mechanisms of action of immune tolerance induction against factor VIII in patients with congenital haemophilia A and factor VIII inhibitors . Br J Haematol 2006 ; 136 : 12 – 25 .
- Reiss RF . Hemostatic defects in massive transfusion: rapid diagnosis and management . Am J Crit Care 2000 ; 9 : 158 – 167 .
- Rodeghiero F , Castaman G , Tosetto A , et al. The discriminant power of bleeding history for the diagnosis of type 1 von Willebrand disease . J Thromb Haemostasis 2005 ; 3 : 2619 – 2626 .
- Stone MS , Johnstone IB , Brooks M , et al. Lupus-type anticoagulant in a dog with hemolysis and thrombosis . J Vet Intern Med 1994 ; 8 : 57 – 61 .
- Toulza O , Center SA , Brooks MB et al. Evaluation of protein C activity for detection of hepatobiliary disease and portosystemic shunting in dogs . J Am Vet Med Assoc 2005 ; 229 : 1761 – 1771 .
- Tripodi A , Manucci PM . Abnormalities of hemostasis in chronic liver disease: reappraisal of their significance and need for clinical and laboratory research . J Hepatol 2007 ; 46 : 727 – 733 .
- Tseng LW , Hughes D , Giger U . Evaluation of a point-of-care coagulation analyzer for measurement of prothrombin time, activated partial thromboplastin time, and activated clotting time in dogs . Am J Vet Res 2001 ; 62 : 1455 – 1460 .
- Warkentin TE , Crowther MA . Reversing anticoagulants both old and new . Can J Anaesthesiol 2002 ; 49 : S11 – S25 .
- Wiinberg B , Jensen AL , Rozanski E , et al. Tissue factor activated thromboelastography correlates to clinical signs of bleeding in dogs . Vet J 2009 ; 179 : 121 – 129 .
- Winfield LS , Brooks MB . Hemorrhage and blood loss-induced anemia associated with an acquired coagulation factor VIII inhibitor in a Thoroughbred mare . J Am Vet Med Assoc 2014 ; 244 : 719 – 723
- Zorio E , Gilabert-Estelles J , Espana F , et al. Fibrinolysis: the key to new pathogenetic mechanisms . Curr Med Chem 2008 ; 15 : 923 – 929 .
ON-LINE RESOURCES
- Comparative Coagulation Laboratory . Animal coagulation, anticoagulant, and fibrinolysis assays . https://www.vet.cornell.edu/animal-health-diagnostic-center/laboratories/comparative-coagulation
- Massachusetts General Hospital . Overview of assays to aid in diagnosis of coagulopathies . http://www2.massgeneral.org/pathology/coagbook/handbook.htm
