Blood Smear/PCV
Tests for Blood
Disorders
Examine feather edge for platelet clumped
Common with false low counts in cats
Platelet count in red cell area
>10 platelets per field under 100x oil immersion
Specific tests
Count 10 fields and get average per field
Hereditary conditions
<2-3 per field = thrombocytopaenia and spontaneous
ELISA for vWF Deficiency
bleeding
SNAP 4DX
Average x 15,000 = estimated count/microL
Anaplasmosis
PCV/TS
Erhrlichiosis
With blood loss both will usually decrease
Dirofilariasis
35-45% is normal
Activated clotting time (ACT)
Buccal mucosal bleeding time (BMBT) Tests intrinsic and common coagulation pathway
Tests platelet and vessel function Not done often as clotting analysers have become available
Done if suspect primary haemostatic defect despite normal platelets It can be obtained quickly
Normal Less precise than PTT
2-4 min in dogs Affected by
1-2.5 min in cats Ambient temp
Process Platelet count
Conscious animal Haemodilution
Lateral recumbency, minimal restraint Procedure
Upper lip folded back and held with a gauze bandage MAX-ACT tube - containing activator
Incision in non-vascular area Warm tube to 37*C in water bath
Filtre paper used to absorb the blood Fill tube with 0.5ml blood, tilt to mix and start timer
Time from incision to cessation of bleeding recorded Keep in water bath
Every 10 secs gently tilt to detect clot formation
Coagulation Tests ACT = time elapsed from blood collection to clot formation
Clotting tests Normal
Prothrombin time (PT) - Extrinsic and common pathway - Factor 7 55-85 (66) sec in cats
Activated partial thromboplastin time (aPTT) - Intrinsic and common 55-80 (71) secs in dogs
pathway - Factors 12, 11, 9, 8 If Prolonged ACT
Liver disease, Vitamin K antagonism, Haemophilia, DIC Anticoagulant - Rodenticide toxicity
Fibrinolysis Sever liver disease
FDP’s - DIC, blood clots, liver not clearing FDPs Disseminated Intravascular coagulation
D-dimer - DIC, recent blood clots within previous 5hrs, neoplasia Haemophilia A and B
, Coagulopathies
Differentials Factor 12 Deficiency in Cats
Primary Haemostatic Disorders (see on skin) vWF deficiency No bleeding
Vascular Endothelium disorder Glanzmann’s thrombasthaenia Dilution Coagulopathy
Thrombocytopaenia Angiostrongylus vasorum Excessive fluid therapy
Due to decreased production Secondary Haemostatic Disorders (Cavities) Snake Bite
Bone marrow disease Vitamin K deficiency Hypercoagulation
Ehrlichiosis Affects Factors 2, 7, 9, 10 Disruption of Virchow’s triad
Myelofibrosis / Drug Rxns Dietary deficiency / Rat poison / Vascular Stasis or damage
Due to increased consumption Cholestasis Increased coagulation factor or
Bleeding / DIC / Thrombosis Hepatic function disease decreased anticoagulation factors
Due to destruction Liver produces clotting factors Acquired
Immune mediated (ITP) Disseminated Intravascular Coagulation Inflammation
Due to splenic sequestration (DIC) Chronic Liver Disease
Torsion / Neoplasia / Sepsis Haemophilia A and B Steroid therapy
Thrombopathia Affects factors 8, 9 Aortic Thromboembolism in cats
NSAIDs / DIC / Liver failure / Uraemia Do a aPTT Loss of anti-thrombine
Remember to use a Citrate
Clinical Presentation
Specific tube (blue top) for samples
Unspecific
Lethargy Muffled heart sounds
Pale MM Signs of obvious bleeding
Excessive bleeding post
Management
Tachycardia / Tachypnoea Treat underlying conditions
Heart murmur venipuncture / in surgery / with
Replace as required - RBC / Platelets / Clotting Factors
Bounding pulses dental eruption
Fresh whole blood / Fresh Frozen Plasma / Platelet
Concentrate
Diagnostics POCUS - thorax and abdomen Vitamin K
Blood smear Radiographs or CT if available Initial s/c injection
PCV/TS ELISA for vWF disease Oral supplement for 6-8wks
BMBT SNAP 4Dx test Monitor with PT and aPTT
Haematology For Parasites Clopidogrel > Asprin for hypercoagulation
Serum Chemistry Prothrombin Time (PT) Tranexamic acid for hyperfibrinolysis
D-dimer and fibrinogen levels Activated patial thromboplastin time (aPTT) Immunosuppression Meds
Imaging Activated Clotting Time (ACT) Prednisolone > Azathioprine, Cyclosporine
, Differentials
Non-regenerative Anaemia
Regenerative Anaemia
Haemolysis - Destruction
Anaemia
Systemic / Bone Marrow Disease - Primary or Secondary IMHA
Production of Blood Infectious disease or Toxin
Inflammatory disease Hypophosphataemia
Endocrine disease Haemorrhage - Blood Loss
Infectious disease Acute or Chronic
Iron deficiency Trauma/Neoplasia
Renal Disease (erythropoietin) Coagulopathies
Drugs Parasites
Clinical Signs
General unspecific Haemorrhage Other
Pale MM Obvious bleeding / Trauma Jaundice
Tachycardia/Tachypnoea Epistaxis/wounds Pyrexia Differentiating Types of Anaemia
Heart murmur Haematochezia Abdominal distension Haemolysis specific signs
Water hammer pulse Petechiae Enlarged Spleen/Liver Icterus Auto-agglutination
Lethargy, exercise intolerance Ecchymoses Vomiting - toxicity Haemoglobinuria Splenomegaly
Weakness / collapse Intestinal parasites Lymphadenopathy Spherocytes Red cell changes
Anorexia Melaena (“coffee ground” vomit) Neoplasia Anaemia
Low PCV + normal CRT
Diagnosis Hypoperfusion
Blood tests PCV normal + Slow CRT
Other tests
Blood Smear Specific tests for anaemia Blood Smear Appearance
Urinalysis (for bilirubin or blood)
PCV and TP Coomb’s test MCV
Skin and faecal exam for parasites
Agglutination test Looks for antibodies on RBC Microcytic (small cells, low MCV)
SNAP test for FIV/FeLV
Haematology Bone marrow aspirate/biopsy Iron deficiency/Zn toxicity
Imaging - Radiograph/Ultrasound
Serum biochemistry Clotting profiles Hyperthyroidism
Endocrine disease screening
Renal or Hepatic Folate, Cobalamin and Iron profiles Macrocytic (large cells , high MCV)
Hereditary/Immune mediated
Folate deficiency
Treatment of IMHA Neoplasia
Immunosuppressive medications Blood transfusions Normocytic
Prednisolone > cyclosporine/azathioprine Splenectomy MCHC
In larger dogs start with a combination Human intravenous immunoglobin Hypochromic (too little Hb, pale cells)
Anti-thrombotic medications Therapeutic plasma exchange Iron deficiency
Clopidogrel > Aspirin Mortalitiy rate 50%, replase rate 6-13% Normochromic
Tests for Blood
Disorders
Examine feather edge for platelet clumped
Common with false low counts in cats
Platelet count in red cell area
>10 platelets per field under 100x oil immersion
Specific tests
Count 10 fields and get average per field
Hereditary conditions
<2-3 per field = thrombocytopaenia and spontaneous
ELISA for vWF Deficiency
bleeding
SNAP 4DX
Average x 15,000 = estimated count/microL
Anaplasmosis
PCV/TS
Erhrlichiosis
With blood loss both will usually decrease
Dirofilariasis
35-45% is normal
Activated clotting time (ACT)
Buccal mucosal bleeding time (BMBT) Tests intrinsic and common coagulation pathway
Tests platelet and vessel function Not done often as clotting analysers have become available
Done if suspect primary haemostatic defect despite normal platelets It can be obtained quickly
Normal Less precise than PTT
2-4 min in dogs Affected by
1-2.5 min in cats Ambient temp
Process Platelet count
Conscious animal Haemodilution
Lateral recumbency, minimal restraint Procedure
Upper lip folded back and held with a gauze bandage MAX-ACT tube - containing activator
Incision in non-vascular area Warm tube to 37*C in water bath
Filtre paper used to absorb the blood Fill tube with 0.5ml blood, tilt to mix and start timer
Time from incision to cessation of bleeding recorded Keep in water bath
Every 10 secs gently tilt to detect clot formation
Coagulation Tests ACT = time elapsed from blood collection to clot formation
Clotting tests Normal
Prothrombin time (PT) - Extrinsic and common pathway - Factor 7 55-85 (66) sec in cats
Activated partial thromboplastin time (aPTT) - Intrinsic and common 55-80 (71) secs in dogs
pathway - Factors 12, 11, 9, 8 If Prolonged ACT
Liver disease, Vitamin K antagonism, Haemophilia, DIC Anticoagulant - Rodenticide toxicity
Fibrinolysis Sever liver disease
FDP’s - DIC, blood clots, liver not clearing FDPs Disseminated Intravascular coagulation
D-dimer - DIC, recent blood clots within previous 5hrs, neoplasia Haemophilia A and B
, Coagulopathies
Differentials Factor 12 Deficiency in Cats
Primary Haemostatic Disorders (see on skin) vWF deficiency No bleeding
Vascular Endothelium disorder Glanzmann’s thrombasthaenia Dilution Coagulopathy
Thrombocytopaenia Angiostrongylus vasorum Excessive fluid therapy
Due to decreased production Secondary Haemostatic Disorders (Cavities) Snake Bite
Bone marrow disease Vitamin K deficiency Hypercoagulation
Ehrlichiosis Affects Factors 2, 7, 9, 10 Disruption of Virchow’s triad
Myelofibrosis / Drug Rxns Dietary deficiency / Rat poison / Vascular Stasis or damage
Due to increased consumption Cholestasis Increased coagulation factor or
Bleeding / DIC / Thrombosis Hepatic function disease decreased anticoagulation factors
Due to destruction Liver produces clotting factors Acquired
Immune mediated (ITP) Disseminated Intravascular Coagulation Inflammation
Due to splenic sequestration (DIC) Chronic Liver Disease
Torsion / Neoplasia / Sepsis Haemophilia A and B Steroid therapy
Thrombopathia Affects factors 8, 9 Aortic Thromboembolism in cats
NSAIDs / DIC / Liver failure / Uraemia Do a aPTT Loss of anti-thrombine
Remember to use a Citrate
Clinical Presentation
Specific tube (blue top) for samples
Unspecific
Lethargy Muffled heart sounds
Pale MM Signs of obvious bleeding
Excessive bleeding post
Management
Tachycardia / Tachypnoea Treat underlying conditions
Heart murmur venipuncture / in surgery / with
Replace as required - RBC / Platelets / Clotting Factors
Bounding pulses dental eruption
Fresh whole blood / Fresh Frozen Plasma / Platelet
Concentrate
Diagnostics POCUS - thorax and abdomen Vitamin K
Blood smear Radiographs or CT if available Initial s/c injection
PCV/TS ELISA for vWF disease Oral supplement for 6-8wks
BMBT SNAP 4Dx test Monitor with PT and aPTT
Haematology For Parasites Clopidogrel > Asprin for hypercoagulation
Serum Chemistry Prothrombin Time (PT) Tranexamic acid for hyperfibrinolysis
D-dimer and fibrinogen levels Activated patial thromboplastin time (aPTT) Immunosuppression Meds
Imaging Activated Clotting Time (ACT) Prednisolone > Azathioprine, Cyclosporine
, Differentials
Non-regenerative Anaemia
Regenerative Anaemia
Haemolysis - Destruction
Anaemia
Systemic / Bone Marrow Disease - Primary or Secondary IMHA
Production of Blood Infectious disease or Toxin
Inflammatory disease Hypophosphataemia
Endocrine disease Haemorrhage - Blood Loss
Infectious disease Acute or Chronic
Iron deficiency Trauma/Neoplasia
Renal Disease (erythropoietin) Coagulopathies
Drugs Parasites
Clinical Signs
General unspecific Haemorrhage Other
Pale MM Obvious bleeding / Trauma Jaundice
Tachycardia/Tachypnoea Epistaxis/wounds Pyrexia Differentiating Types of Anaemia
Heart murmur Haematochezia Abdominal distension Haemolysis specific signs
Water hammer pulse Petechiae Enlarged Spleen/Liver Icterus Auto-agglutination
Lethargy, exercise intolerance Ecchymoses Vomiting - toxicity Haemoglobinuria Splenomegaly
Weakness / collapse Intestinal parasites Lymphadenopathy Spherocytes Red cell changes
Anorexia Melaena (“coffee ground” vomit) Neoplasia Anaemia
Low PCV + normal CRT
Diagnosis Hypoperfusion
Blood tests PCV normal + Slow CRT
Other tests
Blood Smear Specific tests for anaemia Blood Smear Appearance
Urinalysis (for bilirubin or blood)
PCV and TP Coomb’s test MCV
Skin and faecal exam for parasites
Agglutination test Looks for antibodies on RBC Microcytic (small cells, low MCV)
SNAP test for FIV/FeLV
Haematology Bone marrow aspirate/biopsy Iron deficiency/Zn toxicity
Imaging - Radiograph/Ultrasound
Serum biochemistry Clotting profiles Hyperthyroidism
Endocrine disease screening
Renal or Hepatic Folate, Cobalamin and Iron profiles Macrocytic (large cells , high MCV)
Hereditary/Immune mediated
Folate deficiency
Treatment of IMHA Neoplasia
Immunosuppressive medications Blood transfusions Normocytic
Prednisolone > cyclosporine/azathioprine Splenectomy MCHC
In larger dogs start with a combination Human intravenous immunoglobin Hypochromic (too little Hb, pale cells)
Anti-thrombotic medications Therapeutic plasma exchange Iron deficiency
Clopidogrel > Aspirin Mortalitiy rate 50%, replase rate 6-13% Normochromic
