A Fresh Look at Anemia
One of our common Emergency Critical Care and Medicine Consultation questions is about management of patients with anemia.
When we see a patient with anemia, the first thought should be, is this anemia from decreased production, increased destruction or increased loss? What is the easiest single blood value to look at to help make this determination quickly? Total solids or total protein! In fact, PCV or HCT can't be accurately assessed without knowing what the TS or TP is!
PCV or HCT TS or TP Diagnosis
Low Low Increased loss
Low High Patient is more anemic than we think!
Normal Low Peracute blood loss!
Low Normal Decreased production OR Destruction
Remember that with peracute blood loss, such as in trauma (ie. HBC or BDLD, for example) or acute spontaneous hemoabdomen (ie. splenic mass, rodenticide etc), the PCV remains NORMAL while the TS drops. Splenic contraction and peripheral vasodilation from compensatory shock contribute to this response.
If only a PCV/HCT is assessed, one might assume that the patient does not have large volume blood loss initially and inappropriate choices in initial fluid resuscitation may be made (ie. high volume crystalloids). Only later would one identify progressive anemia as equilibration occurs and by then we have missed the opportunity to treat proactively.
Picture instead basing one’s initial assessment on the TS. If the PCV is normal but the TS is <5.5, this patient has significant blood loss until proven otherwise! Not only would that prompt smaller volume crystalloid resuscitation (5-10 ml/kg boluses for dogs, 3-5 ml/kg boluses for cats) but also would prompt additional diagnostics such as a FAST scan (Focused Abdominal Sonography for Trauma,Triage and Tracking) for confirmation. Fresh whole blood or packed red blood cells may be chosen as a resuscitation fluid in some cases.
Earlier diagnosis means more rapid hemodynamic stabilization and improved medical outcomes.
DVM STAT Criticalists are available to you 24/7 to consult on hemodynamic stabilization, management of anemia and coagulopathy and transfusion medicine.
We also have provided ongoing Blood Bank Development Consultations and support to hospitals and large referral centers to guide the development of their new self-sustaining blood bank programs.