Presentation
On presentation , a patient can appear acutely unwell and , by this time , may already be severely thrombocytopenic as a result of platelet destruction . Presentation is varied due to the range in severity and clinical signs , but may include any of the following :
• Ecchymosis
• Petechiae
• Epistaxis
• Scleral haemorrhage
• Haematuria
• Mucosal bleeding
• Anaemia
• Hyphema
• Lethargy and weakness
• Anorexia
• Melaena
• Acute collapse
Figure 1 . Gum petechiae .
On examination , small pinpoint areas of bleeding called petechiae can be found on the skin and mucosal surfaces ( Figures 1 and 2 ). Larger areas of ecchymosis will accompany this and can often be found around the abdomen and groin areas . These clinical signs are the direct result of bleeding that has happened underneath the skin ( BluePearl Specialists , 2021 ). Bleeding can also occur from the gastrointestinal tract and the patient will begin to pass melaena . Gastrointestinal bleeds are a prognostic indicator and linked to a more guarded prognosis due to likeliness of internal haemorrhaging ( Gorman , 2021 ).
As haemostasis will be compromised in an IMTP patient , a presenting sign can be anaemia . Anaemia will result from an excessive amount of blood being lost , so added clinical signs to look out for would be :
Figure 2 . Abdomen petechiae .
• Pale mucous membranes
• Tachypnoea
• Tachycardia
Testing and diagnosis
On presentation , if the patient has not yet developed anaemia , it would still be important to monitor the patient ’ s packed cell volume ( PCV ) and total protein ( TP ) closely . This is because , during hospitalisation , deterioration can occur quickly as the patient will be at a higher risk of spontaneous bleeding . Heart rate , and respiratory rate and effort , should be regularly monitored to ensure the patient is cardiovascularly stable . A spike in these could indicate the patient is becoming anaemic and may require a packed red blood cell ( PRBC ) transfusion . Fresh whole blood may be considered in emergencies , which may help the patient form enough platelets to stop
Figure 3 . Blood smear identifying a platelet .
24 Veterinary Nursing Journal