Hemorrhage

Hemorrhage



Basic Information image



Definition


Loss of blood from the vascular space



Synonym(s)




• Extravascular blood loss


• Bleeding



Epidemiology



Species, Age, Sex


Horses of any age are susceptible to blood loss because of a number of causes; however, vessel rupture and urolithiasis are more common in older horses, and idiopathic hematuria is limited to males.



Genetics and Breed Predisposition


Genetic platelet disorders and coagulation factor dysfunction have been identified in horses, as well as a genetic predisposition to granulomatous gastrointestinal proliferation and urolithiasis.



Risk Factors




• Horses in race training are at risk for developing exercise-induced pulmonary hemorrhage.


• Horses taking nonsteroidal antiinflammatory drugs (NSAIDs; eg, phenylbutazone) are at risk for right dorsal colon ulceration and hemorrhage.



Contagion and Zoonosis




• Certain infectious and parasitic causes of hematuria may be transferred between horses


image Strongylus vulgaris

image Streptococcus equi


Clinical Presentation



Disease Forms/Subtypes


Hemorrhage can be classified by location (internal or external), duration (acute or chronic loss), vessel size (capillary and venuole or arteriole versus larger vessel), and cause (coagulation disorder versus traumatic vessel disruption)



History, Chief Complaint




• Chief complaints are variable and depend on the amount of blood lost and how acute the loss is.


image External signs of blood loss may be apparent (Figure 1).

image Significant blood loss may cause pallor, colic, sweating, and depression.

image Less significant blood loss or chronic loss of blood may be noted as lethargy and exercise intolerance.

image

FIGURE 1 Fatal guttural pouch mycosis. Complete exsanguination occurred within 10 minutes after rupture of the internal carotid.



Physical Exam Findings




• Hypothermia, cool extremities, sweating


• Tachypnea


• Tachycardia with extreme blood loss


• Pale mucous membranes


• Poor pulse quality


• Decreased gastrointestinal sounds, colic


• Petechia, ecchymosis



Etiology and Pathophysiology




• Traumatic vascular disruption occurs because of an injury that mechanically opens a vessel or vessels (caused by injury, disease, infection, or neoplasia) with a normal coagulation system that is unable or slow to repair the defect because of vessel size and blood pressure, repeated trauma, or systemic inflammation.


• Hemostatic bleeding disorders may occur by one of two pathways:


image Primary hemostatic defects involve either a genetic failure of the platelets to functionally occlude a vascular leak or thrombocytopenia, which reduces effective platelet numbers. Both result in capillary and small vessel hemorrhage (petechia, ecchymosis).

image Secondary hemostatic issues are related to coagulopathies caused by congenital defects, vitamin K deficiencies, hepatic disease, drug toxicity, envenomation, poisons, or consumption of coagulation factors (ie, disseminated intravascular coagulation). This results in overt hemorrhage into body cavities or externally.


Diagnosis image



Differential Diagnosis




• Degenerative disorders


• Vessel rupture

image Aorta

image Middle uterine artery

• Anomalies


• Idiopathic hematuria in geldings and stallions

• Coagulation abnormalities

image Genetic platelet function disorders

image Coagulation factor disorders (von Willibrand disease)
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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Hemorrhage

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