SAM final - blood

Pathology of Non regenerative anemia

• Primary Bone Marrow: intrinsic

  • Erythroid hypoplasia/aplasia

  • Myelophthisis

  • Myelofibrosis

  • Myelodysplasia

• Secondary Bone Marrow: extrinsic

  • Anemia of Inflammatory disease (AID)-chronic dz

  • Renal disease

  • Endocrine disease

  • Iron deficiency anemia  → regenerative early

Non-Regenerative Anemia

• Chronic

• MANY causes!

  – Pre-regenerative

  – Primary bone marrow (“intrinsic”)

  – Secondary bone marrow (“extrinsic”)

• Cats > Dogs

• Bone marrow sample may be needed!

Non-regeneration categories

1. pre-regen (acute) → takes 2-5d for making RBC

2. Primary bone marrow (intrinsic)

   • Erythroid hypoplasia/aplasia: Immune mediated destruction of RBC precursors (anemia only)

   • Myelophthisis

   • Myelofibrosis

   • Myelodysplasia

3. Secondary bone marrow (extrinsic)

   • Anemia of Inflammatory disease (AID)

     • Dogs never >30%

     • Cats <20% w/ severe renal dz

   • Renal disease ( EPO production)

   • Endocrine disease

   • Iron deficiency anemia (Often regenerative actually!) (anemia only)

Clinical Signs of Anemia

• GET full history!!

• May be normal depending on severity

• Lethargy, Exercise intolerance, Weakness, Collapse

• Pica (mainly cats)

• Icterus, Bleeding, Pale, Melena

• Tachycardia, Tachypnea, Bounding pulses, Heart murmur(physiologic)

Diagnostic Testing for Anemia Patients

• #1 test: CBC / chem & PCV/TS!

• Localizing: 

  • Anemia only → secondary bone marrow disease

    • Iron deficiency: Microcytic hypochromic regenerative anemia

  • Anemia + cytopenias → primary bone marrow disease

• Bone Marrow Aspirate #1 → Cellularity, Maturation,

  • Erythroid: myeloid ratio, Neoplasia, Infections

• Bone Marrow Biopsy → Structure, Fibrosis, Necrosis, FeLV testing

• CBC/ Chem → Coombs, RBC Ab, RBC indices, RBC morphology, Reticocytes, PCV/TP #1, smear + reticulocyte count, endocrine/renal panels

  • MCV- how big are the cells?

  • MCHC - how much hemoglobin in RBC?

• Imaging → Rads, US

• Infectious testing!! → FeLV/FIV, vector borne, fecal testing

Treating Anemia

• General support: Transfusions, Vit B12, Iron, Folic acid, Erythropoietin

• (2)Renal disease: Erythropoietin

• (2)Iron deficiency: Deworm, Gastroprotectants, Iron supp

• (1)PRCA: Immunosuppressive meds

• (1)Myelophthisis: Chemo, Antimicrobials

• (1)Myelofibrosis: Transfusions

Hemolytic Anemia

• Immune-mediated hemolytic anemia → PREMATURE RBC destruction, type 2 reaction

• CBC: Anemia of Inflammatory disease (AID), Hyperbilirubinemia

  • Hyperbilirubinemia does not differentiate extravascular vs. intravascular hemolysis

• Many hemolytic anemias are not immune-mediated…

  • Erythrocyte organisms: Babesia(dogs), Mycoplasma, Cytauxzoon felis

    • DT: Organism ID, Blood smear, Blood PCR, Serology

  • Toxins: Zinc, Onions/garlic, Acetaminophen

    • Oxidative injury → Heinz bodies → decreased RBC deformability → increased fragility → hemolysis

  • Microangiopathic/fragmentation anemia: DIC, Hemangiosarcoma, Vasculitis, Heartworm

    • Mechanical trauma to RBC → schistocytes, keratocytes

  • Increased erythrocyte fragility

  • Hemophagocytic syndrome

Intravascular Vs Extravascular hemolysis

• Extravascular hemolysis

  • IgG or IgM → Antibody bound to RBC → Premature RBC destruction

  • Spherocytosis, Hyperbilirubinemia, Bilirubinuria

•  Intravascular hemolysis

  • IgM → complement activation → MAC punches holes in RBC → Premature RBC destruction

  • Hyperbilirubinemia, Hemoglobinemia, Hemoglobinuria, Ghost cells

  • Worse prognosis

Canine IMHA

• Et: Neoplasia, Infectious diseases, Drugs, Vaccines

  •  Primary > secondary

• Sig: Cockers, Min Schnauzers, Poodles,  2-7 years

• Cs: Icterus, thromboembolism (leading cause of death), pigmenturia, anorexia, vomiting, diarrhea, hepatomegaly, splenomegaly, lymphadenopathy, fever

  • Port wine: hemoglobinuria

  • Darker/orange: bilirubinuria

• Dt: dx of exclusion! Spherocytosis, autoagglutination, rads, infectious testing, US, Anti-erythrocyte Ab (Coombs or flow cytometry)

  • #1: PCV/TS, saline agglutination, blood smear!, CBC/Chem → regen macroscopic, hypochromic anemia

• Tx: immunosuppression + thromboprophylaxis (acute)

  • Supportive Care, Thromboprophylaxis(#2), Glucocortoid(#1) + Azathioprine or Cyclosporine, IVIg (Blocks Fc receptors), Rivaroxaban, Clopidogrel (irreversible platelet inhibition), Euthanasia

• Chronic Tx: Gradual taper drugs → ALWAYS attempt full taper after PCV is NORMAL → ↓ 25% q4w

• Px: Guarded, at risk for other IM diseases

  • Negative indicators → Intravascular hemolysis, Hemoglobinemia, Hemoglobinuria, Ghost cells, Autoagglutination, Hyperbilirubinemia, Thrombocytopenia, ↑ ALP

Feline IMHA

• Et: Mycoplasma, FeLV, FIV, Cytauxzoon felis, Transfusion reaction, Neonatal isoerythrolysis

  • Secondary > Primary

• Dt: Autoagglutination

  • Spherocytes difficult to see in cats

  • Rule out secondary causes first

• Tx: immunosuppression + thromboprophylaxis

  • Primary: prednisolone, cyclosporine

  • Secondary: treat infection, prednisolone

Blood Loss Anemia

• Et:

  • Acute: Hemoabdomen, Severe thrombocytopenia 

  • Chronic: GI hemorrhage, Intestinal parasites, Ectoparasites → might have normal TP

• Cs: 

  • GI: melena, hematemesis, hematochezia, NSAID history

  • Urinary: hematuria, stranguria, pollakiuria

  • Epistaxis: nasal bleeding

  • Hemoabdomen: distention, weakness, decreased lung ventral sounds

  • Pulmonary / hemothorax: tachypnea, resp distress

• Dt: Rads, U/S, Fecal float, Chem/CBC BMBT, vWF testing, Factor deficiency testing, UA, PT/PTT, Low TP, High BUN, Thrombocytopenia, PCV, RBC indices, Retic count, RBC morphology 

  • Chronic might have normal TP 

• Tx: Blood transfusion, PPIs, sucralfate, barium, antiparasitics, plasma, vit K1

  • Transfusion + STOP the bleeding + treat underlying cause

Relative Erythrocytosis

• Et: dehydration

  • Sighthounds have naturally higher PCV

  • Acute hemorrhagic diarrhea syndrome (previously

    HGE)

• Dt: ↑ TP

  • Exception is acute hemorrhagic diarrhea syndrome

    • TP often low-normal or decreased

• Tx: Treat with IV fluids

Absolute Erythrocytosis

• Et: 

  • Primary: Polycythemia rubra vera, Bone marrow RBC proliferation, Low/undetectable EPO

  • Secondary: 

    • Appropriate → due to hypoxia → Pulmonary dz, Right-to-left shunts, High altitude

    • Inappropriate → no hypoxia → Renal mass, Neoplasia

• Cs: PU/PD, neuro signs, epistaxis, hyphema, retinal hemorrhage, Bright red mucous membranes 

  • may be normal

• Dt: PCV >70%, Rads, US, Arterial blood gas → Evaluate underlying cause

• Tx: Therapeutic phlebotomy, Hydroxyurea

  • Goal = reduce blood viscosity by lowering circulating RBCs

Nucleated RBCs

• Often “mis-counted” as WBC

• Et: Early marrow release

  • Strong regenerative anemia, heat stroke, neoplasia, extramedullary hematopoiesis, splenectomy, splenic dysfunction, lead toxicity

• Dt: nRBCs per 100 WBC or % of total nucleated cells

  • Often miscounted as WBCs → Must correct WBC count if nRBCs elevated

Clot formation

• Primary Hemostasis #1

  • Platelet plug formation at site of endothelial damage

    • Platelets + Adhesive proteins (vWF)

• Secondary Hemostasis  #2

  • Clotting factors assemble thrombus on platelet plug

    • Stabilize platelet plug

  • Intrinsic, extrinsic, and common cascaded 

  • Clotting factors produced in liver

Clinical Presentation of Coagulopathy

• Et: Medications, Toxins, Rodenticides, Previous surgery, Previous bleeding episodes, Recent vax, Inherited 

• Cs: Spontaneous bleeding, Prolonged bleeding, Hemothorax, Pulmonary hemorrhage, Neurologic, Anemia, Asymptomatic

  • Petechiae  <3 mm → Primary hemostasis → Platelets

    • do not blanch

  • Ecchymosis → >1 cm → Primary  + secondary hemostasis

    • do not blanch

  • Cavitary bleeding → coagulation factors → secondary hemostasis

• Dt: CBC, Platelet count, PCV/TP, BMBT, PT/PTT 

  • BMBT: vWF deficiency, thrombocytopathia → Not thrombocytopenia

  • PT: extrinsic + common pathway clotting disorders → first one to prolong (tests for factor 7)

  • aPTT: intrinsic + common pathway clotting disorders

    • ACT less sensitive

Special Considerations with Coagulopathy Patients

• Use peripheral vein + hold off 5min

• Do NOT blanch Petechia or ecchyosis

• Avoid cystocentesis

Pseudothrombocytopenia

• Et: Platelet clumping causes false decreased platlet count

• Sig: Cats > dogs

• Dt: Check smear manually

Macrothrombocytopenia

• Et: Mutation in beta1-tubulin

  • Platelets 50k–150k but functional

• Sig: Cavalier King Charles Spaniel

• Cs: No spontaneous bleeding

• Dt: Test at Auburn

Clinical Presentation of Thrombocytopenia

• Et: Increased Destruction, Increased Use, Increased Sequestration, Decreased Production

• Dt: Less than normal platelet count (175k-400k/µL)

  • Mild: 100k–175k

  • Moderate: 30k–100k

  • Severe: <30k → Spontaneous bleeding

• Tx: treat underlying cause

  • IM: immunosuppressives(pred/cyclosporine), Vincristine(acute), Splenectomy 

  • Neoplasia: chemotherapy

  • Infection:antibiotics

• Px: ITP has a better prognosis than IMHA

Increased Destruction Thrombocytopenia

• Et: Immune thrombocytopenia

  • Anti-platelet Ab + phagocytosis in spleen/liver + no complement fixation

  • Vector-borne diseases → Anaplasma platys

• Sig: Middle-aged, Females, Cocker spaniels

• Cs: Spontaneous bleeding

• Dt: severe <30k platlets 

  • Anti-platelet Ab → Flow cytometry

  • Anti-megakaryocyte Ab → Bone marrow sample

• Tx: Pred, Cyclosporine, Azathioprine, Doxycycline, Human IVIG, Vincristine

  • Immunosuppression + antibiotics + Supportive care

  • Vincristine → Stim megakaryocyte frag

• Px: Fair; neg prognostic factors → Melena, Increased BUN

  • ITP has a better prognosis than IMHA

Forms of Thrombocytopenia

• Increased Destruction → IM

  • Anti-platelet Ab + phagocytosis in spleen/liver + no complement fixation

  • Vector-borne diseases → Anaplasma platys

• Increased Use → Consumption

  • Normal response → Acute hemorrhage, GI bleed, Vit K antagonists, Thrombosis

  • DIC

  • Vasculitis → Pancreatitis, lepto, pneumonia, vector bone disease

• Increased Sequestration → Splenomegaly, vector bone disease

• Decreased Production(bone marrow) → Drugs, Infection, Neoplasia, IM

Vector-Borne Diseases and Thrombocytopenia

• Most common lab abnormality → thrombocytopenia

  • Bleeding can occur even if platelets >30k

• Mechanisms → Immune destruction, Consumption (vasculitis), Sequestration

Thrombocytopathia

• Et: Congenital, drugs, systemic disease → Uncommon

  • NSAIDs, clopidogrel, aspirin, synthetic colloids, uremia, liver disease, hyperglobulinemia, iatrogenic 

• Cs: spontaneous severe hemorrhage

• Dt: Genetic testing available (Auburn Lab), BMBT

vWF Disease

• Et: Most common inherited bleeding disorder in dogs tho still → Uncommon

  • Type I: decreased vWF (#1) -mild

  • Type II: decreased large vWF - mod

  • Type III: absence of vWF - severe

• Sig: Doberman

• Cs: resemble platelet disorder

• Dt: vWF assays, genetic testing, BMBT

• Tx: Desmopressin, Fresh plasma, Cryoprecipitate

Buccal Mucosal Bleeding Time (BMBT)

• Use: Evaluates primary hemostasis disorders 

  • Spontaneous/prolonged bleeding with normal platelets + PT/PTT

  • Suspected vWF deficiency or thrombocytopathia

  • Not thrombocytopenia

• Value: Measures time to platelet plug formation

  • Normal <3–4 minutes

Thrombocytosis

• Excess glucocorticoids

  • Endogenous → Cushing’s

  • Exogenous → steroids

• Inflammation

• Iron deficiency

Clotting Cascade for Secondary Hemostasis

• Vitamin K: activates 2, 7, 9, 10

• Intrinsic pathway PTT

  • Activation: by contact with non-endothelial surfaces

  • Factors: 12, 11, 9, 8 → “In” walmart: Nothing is $12…everything is $11.98”

• Extrinsic pathway PT

  • Activation: by contact with tissue factor

  • Factors: 7

• Common pathway

  • Ends: in fibrin production

  • Factors: 10, 5, 2, 1 → 10/2=5, 1 left

Inherited Secondary Hemostatic Disorders

• Signs of hemorrhage!

  - Anywhere!

  - Can be cavitary!!

• Hemophilia A - genetic

  • Et: X-linked factor 8 deficiency

    • More common than B

  • Dt: Prolonged PTT + ACT

• Hemophilia B - genetic

  • Et: X-linked factor 9 deficiency

  • Dt: Prolonged PTT + ACT

• Factor XII deficiency  - acquired

  • Sig: 20% of cats

  • Cs: No clinical bleeding

  • Dt: Very prolonged PTT

Rodenticide Toxicity

• Et: Warfarin, Diphacinone, Brodifacoum, Bromadiolone

  • Vit K epoxide inhibition → effects factors 2 +7 + 9 + 10 → affects all 3 pathways

  • Most common acquired secondary hemostasis disorder

• Cs: Cavitary bleeding, bleeding anywhere, hemothorax

  • Signs 4 days post ingestion

• Dt: Prolonged PT (1st effected), Prolonged PTT

• Tx: Induce vomiting Activated charcoal, Vit K1, Plasma

Liver Disease

• Et:

  • Dysfunction: ↓ clotting factor production, Abnormal platelet function, DIC

  • Cholestasis: ↓ Vitamin K absorption

• Cs: spontaneous hemorrhage

• Tx: Treat cause, Vit K1, Plasma

Clinical Pathology of Disseminated Intravascular Coagulation (DIC)

• Inappropriate activation of the coagulation system → coagulation & fibrinolysis imbalance

  • Excessive coagulation → Microthrombi formation → Consumption of platelets and clotting factors

    • Step 1: Hypercoagulable→ Thrombus, ischemia, necrosis, organ failure

    • Step 2: Hypocoagulable → hemorrhage

  • Mixed coagulation disorder of both primary and secondary hemostasis

    • Primary: Thrombocytopenia →  increased consumption

    • Secondary: Prolonged PT + PTT → consumption of clotting factors

Clinical Presentation of Disseminated Intravascular Coagulation (DIC)

• Et: Not a specific disease → secondary to inflam or other dz

  • Endothelial damage → Vasculitis, Hemangiosarcoma, Sepsis

  • Activation of tissue factor → Neoplasia, Hemolysis, Heat stroke, Pancreatitis

• Dt:  clinical suspicion + thrombocytopenia + prolonged PT/PTT + decreased antithrombin, increased D-dimers or FDPs

  • Consumption: Thrombocytopenia, Prolonged PT/PTT, Decreased antithrombin

  • Fibrinolysis testing: Fibrin-degradation products + D-dimers

  • Whole blood viscoelastic coagulometry: ONLY test for “hypercoagulable phase”

    • TEG, Sonoclot, VCM

• Tx: Treat underlying condition

  • IV fluids, plasma, whole blood, heparin

Virchow’s Triad

• Endothelial injury

  • Valve disease, Endothelial damage from endotoxins, Heartworm disease, Neoplasia, Vasculitis

• Changes in blood flow → Stasis or turbulence

  • heart disease, shock, hypotension

• Hypercoagulability of blood → Loss of natural anticoagulants

  • Antithrombin loss with GI or glomerular disease

Hyperfibrinolysis

• Sig: Greyhounds

• Cs: excessive post-procedure or post-trauma bleeding

• Tx: Antifibrinolytic agents → Epsilon aminocaproic acid or Tranexamic acid

  • Prevent activation of plasminogen to plasmin

Interpreting the Leukogram

• Step 1: Is the total WBC ↑, normal, or ↓?

• Step 2: Evaluate the differential (%)

  • Percentages used to calculate absolute numbers

  • Use absolute numbers, NOT percentages, for interpretation

Interpreting Neutrophil Values

• Neutrophilia 

  • Stress → Mature neutrophilia → No more than 2× upper RI

  • Inflam → Infection, Neoplasia, IM

• Neutropenia

  • Decreased production

  • Consumption → dumping

  • IM destruction

• Bands

  • Infection,systemic inflam, IMHA, Bone marrow rebound

• Toxic Change

  • Typically infection, severe non-infectious inflammatory disease

Interpreting Monocyte Values

• Monocytosis

  • Inflam, Infection, Neoplasia, IM, Non-infectious inflam

• Monocytopenia - who cares

  • Not clinically relevant

Interpreting Lymphocyte Values

• Lymphocytosis

  • Mild: Young, vax, stressed cats ONLY, addison’s

    • Dogs = lymphopenia (stress) 

      • <8,000

  • Mod: Ehrlichiosis 

    • < 10,000

  • High: Leukemia 

• Lymphopenia - who cares

  • Not clinically relevant

  • Stressed dogs

Interpreting Eosinophil Values

• Eosinophilia

  • Parasites

  • Allergy

• Eosinopenia - who cares

  • Not clinically relevant

  • Stress

Stress Leukogram

• "LEMON”

• idecreased Lymphopenia → Cats may have lymphocytosis or lymphopenia

• decreased Eosinopenia

• increased Monocytosis

• increased Mature neutrophilia →Should not exceed >2× normal

Lymph Node Anatomy

• Structure:

  • Cortex → B + T lymphocytes

  • Paracortical region → Small T lymphocytes, Macrophages

  • Medulla → Lymphocytes, Macrophages, Plasma cells

• Function: Filtration, Phagocytosis, Lymphocyte production, Ab production

• Location:

  • Superficial: Popliteal, Prescapular, Mandibular(palpable lymph nodes), Axillary, Inguinal

  • Thorax: Perihilar, Sternal (drains into abdomen)

  • Abdomen: Mesenteric, Sublumbar

Evaluating Lymph Nodes

• PE: Size, Texture, Mobility, Temperature, Pain, Localization

• Labs: CBC, Chem, UA

• DI: rads, US, CT

• FNA: Cell type/size, Infectious organisms, Culture

• Biopsy: Tissue core, Open (wedge), Removal

  • often not req

• Ancillary: Bone marrow, Infectious dz

Lymphadenopathy

• Et:

  • Localized: pathologic process in region drained → inflammation or neoplastic

    • Round cell neoplasia, Carcinoma, Sarcoma, Lymphoma, Bacti

  • Generalized: Systemic disease → Infection, IM, neoplasia

• Cs: Enlarged, tender, firm, Mobile or adherent, May be bi-lobed (neoplasia)

• Dt: FNA #1, biopsy (often not req)

  • Lymphoma → Lg lymphocytes 

  • Granulomatous → Macrophages + Neutrophils → Fungal, bacti

  • Reactive →Small lymphocytes + Plasma cellls → antigenic stimulation

Splenic Masses and Nodules

• Et:

  • Benign: Hematoma, Hemangioma, Myelolipoma

    • Most are benign 

  • Malignant: Hemangiosarcoma, Marginal cell lymphoma

    • Spontaneous bleeding = more likely malignant

• Dt: US

  • Cannot determine malignancy visually

Splenomegaly

• Et: Diffuse Splenic Enlargement 

  • EMH, lymphoid hyperplasia, lymphosarcoma, anemia, thrombocytopenia, infectious disease, drugs

    • Usually hematopoietic neoplasia

• Dt: Rads or US

Dog Blood Types

• Class: Dog Erythrocyte Ag 1, 3, 4, 5, 6, 7, 8

  • DEA 1 = clinically important

  • presence(+) or absence(-) of “dog erythrocyte

    antigens” (DEA) on the RBC membrane

• Immune: Dogs do not naturally have anti-DEA 1 Ab → Will form them after one exposure 

  • First transfusion → No rxn → Repeated transfusions → Hemolytic rxn

Dog Blood Donors

• At minimum, donor should be DEA 1 negative!

• Universal Donor

  • Negative for DEA 1, 3, 5, 7

  • Positive for DEA 4

• Characteristics

  • Friendly, healthy, young–middle aged.

  • >55 lb, able to give 450 mL safely.

  • No prior transfusions or litters.

  • Free of infectious disease.

  • Greyhounds ideal

    • large, cooperative, high PCV, easy venous access.

Cat Blood Types

• Must type all cats!!

• Types: 

  • Type A: Most common

    • Has weak anti-B Ab

  • Type B: Has strong anti-A antibodies 

    • Type A → Type B transfusion = fatal.

  • Type AB: Rare; no Ab; can receive A or B.

• Immune: 

  • No universal donor in cats  ALL cats must be typed before transfusion.

    • In-house testing cards

    • Mik Antigen → Anti-Mik Ab are likely in Mik-negative cats.

Cat Blood Donors Selection

• Friendly, healthy.

• >10 lb, ages 1–8 years.

• No previous transfusion.

• Free of infectious disease.

RBC Transfusion Administration

• Pre- Transfusion Testing

  • Dog: 

    • No previous transfusion → no mandatory testing

    • Previous transfusion >3–5 days → MUST cross-match.

  • Cats: Always blood type

• Dosing

  • Target: +10% PCV

  • pRBC: ~10 mL/kg

  • Whole blood dose: ~20 mL/kg

• Administration

  • Do not warm RBCs.

  • Always use a blood filter

  • Administer alone in IV line over 4h

• Monitoring

  • Minimum database → TPR, PCV/TP

  • Watch for reactions → vomiting, respiratory changes, facial edema, urticaria

Blood Products

• Fresh Whole Blood → no processing

  • Stored: <8 hours.

  • Contents: RBCs, WBCs, viable platelets, full plasma 

  • Indication: Any anemia

    • Refrigeration inactivates platelets!!

• Stored Whole Blood

  • Stored: 4°C for 30–35 days.

  • Contents: RBC, WBC, inactive platelets 

    • Lower labile factors (V, VIII, vWF)

    • Platelets inactive after refrigeration.

  • Indications: anemia, anemia + coagulopathy/hypoproteinemia.

    • Not indicated for severe thrombocytopenia or vWD

• Packed Red Blood Cells

  • Stored: refrigerated 35 days at 4°C

  • Contents: RBC, some WBC and inactive platelets 

    • Platelets inactive after refrigeration.

  • Indication: any anemia

Plasma Products

• Fresh Frozen Plasma (FFP)

  • Product: Frozen within 6-8 hours; shelf life 1 year.

  • Contains: albumin, vWF, ALL clotting factors, fibrinogen, antithrombin.

  • Dose: 10–20 mL/kg over 4 hrs.

• Frozen Plasma (FP)

  • Product: FFP frozen >8 hours; shelf life 5 years.

  • Contains: albumin, vWF, SOME clotting factors, fibrinogen, antithrombin.

    • Lacks Factor V, VIII, vWF.

  • Use: disorders not involving labile factor deficiencies

Plasma Transfusions

• Indications: Coagulopathy with active bleeding or needing invasive Sx

• Procedure: 

  • Thaw in warm water bath

  • Filter before administration

  • Monitor for reactions

    • Vomiting, diarrhea, fever, tachycardia, tachypnea, urticaria

Platelet Products

• Indications: life-threatening hemorrhage, invasive Sx 

  • Not indicated for thrombocytopenia alone without bleeding.

• Dose: 1 unit per 10 kg

Cryoprecipitate

• pre-surgical

• Production: Thaw FFP → centrifuge → collect precipitate.

• Contents: rich in vWF, Factor VIII, Factor V.

• Indications: vWF disease, Hemophilia A

• Dose: 1 unit per 10 kg