Microsoft word - ff treament of bleeding disorders.doc

HEMOPET/HEMOLIFE
11330 Markon Drive, Garden Grove, California 92841 TREATMENT OF BLEEDING DISORDERS
VON WILLEBRAND’S DISEASE (VWD)
For short-term control of bleeding or prophylaxis for dogs at risk to bleed from vWD (vonWillebrands disease): 1. For elective procedures, assess bleeding potential first with a toenail or mucosal bleeding time. Normal 2. Use L-thyroxine therapy at 0.1 mg per 10 pounds body weight twice daily for 7-10 days. Start 48 hours
prior to elective surgery where applicable. Continue thyroid replacement if patient is still bleeding orhas thyroid disease.
Thyroid supplementation promotes hemostasis by improving platelet function, stimulating thrombopoiesis in bone marrow and other sites, and enhancing protein synthesis of vonWillebrand factor (vWF) and other coagulation factors.
3. Transfuse Fresh-Frozen Plasma with High vWF at 3-5 mL per pound of body weight once or twice
daily. For elective procedures (e.g. surgery on Doberman pinchers with vWD), transfuse first and then
perform surgery within 4 hours to maximize the bleeding time correcting effect of transfused vWF.
4. For patients with PCV at or below 15%, transfuse Packed Red Blood Cells in saline at 3-5 mL per
pound given once or twice daily. The packed cells can also be given sequentially or mixed with Fresh-
Frozen Plasma with High vWF and transfused as reconstituted whole blood (see Product Inserts for
detailed options).
5. Avoid drugs or biologics that impair hemostasis and/or induce thrombocytopenia. These include:
RODENTICIDE TOXICOSIS (Vitamin K Deficiency)
1. Identify toxicant and manage case to induce vomition as indicated.
2. Use vitamin K1 by subcutaneous, intramuscular, or oral routes at 1 mg per pound body weight once or
twice daily for 7-10 days; taper dosage gradually each week over the next 30 days depending on the
potency and half-life of the rodenticide involved. (When in doubt, assume that toxin is one of the long-
acting more potent compounds). Do not give vitamin K by intravenous route as anaphylaxis can occur.
Several hours are required to correct the coagulopathy once vitamin K is incorporated into synthesis of
prothrombin complex coagulation factors.
3. Transfuse Fresh-Frozen Plasma at 3-5 mL per pound of body weight once or twice daily.
4. For patients with PCV at or below 15%, transfuse Packed Red Blood Cells along with Fresh-Frozen
Plasma, each to be given at 3-5 mL per pound once or twice daily, either sequentially, or after
premixing to reconstitute as whole blood (see Product Inserts for additional details).
THROMBOCYTOPENIA
1. Identify underlying cause (e.g. immune-mediated, infectious, neoplasia, drug-induced, etc.) and treat
2. Use L-thyroxine therapy at 0.1 mg per 10 pounds body weight twice daily for 7-10 days. Start 48 hours
prior to elective surgery where applicable. Continue thyroid replacement if patient is still bleeding orhas thyroid disease.
Thyroid supplementation promotes hemostasis by improving platelet function, stimulating thrombopoiesis in bone marrow and other sites, and enhancing protein synthesis of vonWillebrand factor and other coagulation factors.
3. For patients with PCV at or below 15%, transfuse Packed Red Blood Cells in saline at 3-5 mL per
pound (or equivalent volumes of fresh whole blood) given once or twice daily. There are insufficientnumbers of platelets in freshly collected whole blood to achieve hemostasis in severe thrombocytopeniaor thrombopathia (platelet dysfunction). However, the plasma component and platelets present canprovide some thrombopoietic and hemostatic benefit to sustain the patient until the underlying problemand requisite therapy have been managed.
4. For control or prophylaxis in special situations of severe, chronic thrombocytopenia (e.g. oncology patients on chemotherapy) or acute life-threatening bleeding from thrombocytopenia, fresh Platelet-
Rich Plasma (PRP) can be provided.
This treatment is not recommended routinely for immune
thrombocytopenia as platelets are rapidly destroyed. Repeated use of PRP is not advised as immune
sensitization (alloimmunization) to platelets and white blood cells is likely to develop.
alloimmunization, PRP should be processed after collection through a special filter set that removesmost of the white blood cells. Only filtered PRP should be used for sustaining the platelet needs ofchemotherapy or other patients with severe platelet disorders.
5. Avoid drugs or biologics that impair hemostasis and/or induce thrombocytopenia. These include:
OTHER BLEEDING DISORDERS
1. Follow general directions for treatment or prophylaxis of von Willebrand’s disease. Continue therapy as long as needed to control bleeding. See Product Insert for more details or call Hemopet for further caseconsultation.
2. For disseminated intravascular coagulation (DIC), identify underlying cause and remove or
ameliorate. Give Fresh-Frozen Plasma and/or Packed Red Blood Cells as needed to sustain PCV at
or around 15%. Use plasma only when fibrinogen level is below 75 mg/dL or patient is experiencing
life-threatening bleeding. Use antiplatelet drugs (e.g. asprin) and/or heparin as indicated at standard
therapeutic dosages. Call Hemopet for further consultation on case management.
Copyright 1991, HEMOPET. All Rights Reserved.

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