Anemia Due to Excessive Bleeding – Blood Disorders

By

Evan M. Braunstein

, MD, PhD, Johns Hopkins University School of Medicine

Reviewed/Revised Jul 2022 | Modified Sep 2022

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Anemia due to excessive bleeding results when loss of red blood cells exceeds production of new red blood cells.

• When blood loss is rapid, blood pressure falls, and people may be dizzy.

• When blood loss occurs gradually, people may be tired, short of breath, and pale.

• Stool, urine, and imaging tests may be needed to determine the source of bleeding.

• The cause of bleeding is corrected, and transfusions and iron supplements are given if needed.

The most common cause of anemia Overview of Anemia Anemia is a condition in which the number of red blood cells is low. Red blood cells contain hemoglobin, a protein that enables them to carry oxygen from the lungs and deliver it to all parts… read more is

• Excessive bleeding

When blood is lost, the body quickly pulls water from tissues outside the bloodstream in an attempt to keep the blood vessels filled. As a result, the blood is diluted, and the hematocrit (the percentage of red blood cells in the total amount of blood in the body, or blood volume) is reduced. Eventually, increased production of red blood cells by the bone marrow may correct the anemia. However, over time, bleeding reduces the amount of iron in the body, so that the bone marrow is not able to increase production of new red blood cells to replace those lost.

The symptoms may be severe initially, especially if anemia develops rapidly as a result of the sudden loss of blood due to an injury, surgery, childbirth, or a ruptured blood vessel. Losing large amounts of blood suddenly can create two problems:

• Blood pressure falls Low Blood Pressure Low blood pressure is blood pressure low enough to cause symptoms such as dizziness and fainting. Very low blood pressure can cause damage to organs, a process called shock. Various drugs and… read more because the amount of fluid left in the blood vessels is insufficient.

• The body’s oxygen supply is drastically reduced because the number of oxygen-carrying red blood cells has decreased so quickly.

Either problem may lead to a heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or a heart attack (myocardial infarction), depending on the location and amount… read more , stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction) and symptoms that… read more , or death.

Far more common than a sudden loss of blood is long-term (chronic) bleeding, which may occur from various parts of the body. Although large amounts of bleeding, such as that from nosebleeds and hemorrhoids, are obvious, small amounts of bleeding may not be noticed. For example, a small amount of blood may not be visible in the stool. This type of blood loss is described as occult (hidden). If a small amount of bleeding continues for a long time, a significant amount of blood may be lost. Such gradual bleeding may occur with common disorders, such as ulcers Peptic Ulcer Disease A peptic ulcer is a round or oval sore where the lining of the stomach or duodenum has been eaten away by stomach acid and digestive juices. Peptic ulcers can result from infection with Helicobacter… read more in the stomach or small intestine, polyps Polyps of the Colon and Rectum A polyp is a projecting growth of tissue from the wall of a hollow space, such as the intestines. Some polyps are caused by hereditary conditions. Bleeding from the rectum is the most common… read more in the large intestine, or cancers in the large intestine Colorectal Cancer Family history and some dietary factors (low fiber, high fat) increase a person’s risk of colorectal cancer. Typical symptoms include bleeding during a bowel movement, fatigue, and weakness… read more . Other sources of chronic bleeding include kidney tumors Kidney Cancer Most solid kidney tumors are cancerous, but purely fluid-filled tumors (cysts) generally are not. Almost all kidney cancer is renal cell carcinoma. Another kind of kidney cancer, Wilms tumor… read more or bladder tumors Bladder Cancer Most bladder cancers are of a type called transitional cell because they affect the same kinds of cells (transitional cells) that are usually the cancerous cells responsible for cancers of the… read more , which may cause blood to be lost in the urine, and heavy menstrual bleeding Abnormal Uterine Bleeding (AUB) Abnormal uterine bleeding in women of childbearing age is bleeding from the uterus that does not follow the normal pattern for menstrual cycles. That is, it occurs too frequently or irregularly… read more .

Symptoms are similar to those of other types of anemia and vary from mild to severe, depending on

When the blood loss is rapid—over several hours or less—loss of just one third of the blood volume can be fatal. Dizziness upon sitting or standing after a period of lying down (orthostatic hypotension) is common when blood loss is rapid. When the blood loss is slower—over several weeks or longer—loss of up to two thirds of the blood volume may cause only fatigue and weakness or no symptoms at all, if the person drinks enough fluids.

Other symptoms may occur as a result of the bleeding or the disorder that causes the bleeding. People may notice black, tarry stools if they have bleeding from the stomach or small intestine. Bleeding from the kidneys or bladder may cause red or brown urine. Women may notice long, heavy menstrual periods. Some disorders that cause chronic bleeding, such as stomach ulcers, cause abdominal discomfort. Other disorders, such as diverticulosis Diverticulosis of the Large Intestine Diverticulosis is the presence of one or more balloon-like sacs (diverticula), usually in the large intestine (colon). The cause of diverticulosis is unknown but may be related to diet, a sedentary. .. read more and intestinal cancers and polyps at an early stage, cause no symptoms.

Doctors do blood tests to detect anemia when people describe symptoms of anemia, have noticed bleeding, or both. Stool and urine are tested for blood in an effort to identify the source of bleeding.

Imaging tests or endoscopy may be needed to identify the source of bleeding.

For large or rapid blood loss, the source of bleeding must be found and the bleeding stopped. Transfusion of red blood cells Red blood cells People are sometimes given transfusions of whole blood during severe bleeding (for example after an injury or pregnancy complications), but usually they are given only the blood component they… read more may be needed.

With slow or small blood loss, the body may produce enough red blood cells to correct the anemia without the need for blood transfusions once the bleeding is stopped.

Because iron, which is required to produce red blood cells, is lost as a result of bleeding, most people who have anemia due to bleeding need to take iron supplements, usually tablets, for several months. Sometimes people are given iron intravenously.

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Hematocrit | University Hospitals

Does this test have other names?

HCT, packed cell volume, PCV

What is this test?

This test measures how much of your blood is made up of red blood cells.

Normal blood contains white blood
cells, red blood cells, platelets, and the fluid portion called plasma. The word
hematocrit means to separate blood. In this test,
your red blood cells are separated from the rest of your blood so they can be
measured.

Your hematocrit (HCT) shows whether you have a normal amount of red blood cells, too
many, or too few. To measure your HCT, your blood sample is spun at a high speed to
separate the red blood cells.

Why do I need this test?

You may need this test if it is
part of routine blood testing. You may also need your HCT checked before having surgery
or if your healthcare provider suspects you have a red blood cell disorder. Too many
red
blood cells is called polycythemia. Too few red blood cells is called anemia.

Polycythemia may cause:

• Heart attack

• Stroke

• Headache

• Blurred vision

• Itching

• Dizziness

Anemia can be caused by blood loss, your body making fewer red blood cells, or increased
destruction of red blood cells. Symptoms may include:

• Shortness of breath

• Fatigue

• Dizziness

• Headache

• Cold, pale skin

• Chest pain

What other tests might I have along with this test?

Your healthcare provider may also
order a complete blood count (CBC), which is a blood test that counts all the different
types of cells in your blood.

Your healthcare provider may also order a test that measures your hemoglobin to find
out how much oxygen your red blood cells are carrying.

What do my test results mean?

Test results may vary depending on your age, gender, health history, and other things.
Your test results may be different depending on the lab used. They may not mean you
have
a problem. Ask your healthcare provider what your test results mean for you.

Results are given as a percentage.
Normal HCT values are different for men, women, and children. Normal values are:

If your HCT is high, it may mean
your body is making too many red blood cells. Your HCT may also be high if your plasma
or blood volume is too low. This can happen when you are dehydrated or in shock.

If your HCT is low, it means you
may have:

How is this test done?

The test is done with a blood sample. A needle is used to draw blood from a vein in
your arm or hand. 

Does this test pose any risks?

Having a blood test with a needle carries some risks. These include bleeding, infection,
bruising, and feeling lightheaded. When the needle pricks your arm or hand, you may
feel a slight sting or pain. Afterward, the site may be sore. 

What might affect my test results?

Living at a high altitude may cause
your HCT to be higher than normal. Being pregnant or being older than age 60 can cause
your HCT to be lower than normal.

Certain medicines can also affect your results.

How do I get ready for this test?

You don’t need to prepare for this
test. Be sure your healthcare provider knows about all medicines, herbs, vitamins,
and
supplements you are taking. This includes medicines that don’t need a prescription
and
any illegal drugs you may use.

Anemia in cats – causes of anemia in cats, diagnosis and treatment in Moscow. Veterinary clinic “Zoostatus”

Symptoms of anemia

Diagnosis of anemia

Diseases causing anemia

Treatment of anemia

Prognosis for anemia in cats

Anemia in cats is a medical term for a reduced number of circulating erythrocytes (red blood cells), hemoglobin (Hb), or both. Anemia is not a disease, but rather a consequence of another process or condition.

Hemoglobin supplies oxygen to the cells and tissues of the body, and the anemic patient suffers from symptoms associated with lack of oxygen. RBCs are made in the bone marrow and released into the bloodstream, where they circulate for about two months. As we age, red blood cells are removed from the bloodstream and their components are recycled to form new red blood cells. The number of red blood cells may become low due to decreased production or increased loss of red blood cells.

The most easily observed general clinical symptom of anemia is the loss of the normal pink color of the gums; on examination, they may appear pale pink or white.

Pale gums and lethargy in a cat always indicate the need for blood tests.

Anemic cats have little stamina and energy, appear lethargic and tire easily.

Tests for anemia are often done as part of a complete blood count (CBC). Most revealing is the hematocrit (total percentage of erythrocytes precipitated) – to measure the hematocrit, a blood sample is processed in a centrifuge to separate the erythrocytes from the serum (the liquid part of the blood). After separation, the sample is measured to determine what percentage of the sample is composed of red blood cells. Twenty-five to forty-five percent of a healthy cat’s blood will be red blood cells. If the hematocrit is below 25%, the cat is anemic. Other tests to determine anemia include measuring the number of red blood cells and their hemoglobin content.

When a cat shows signs of anemia, it is important to know if the bone marrow is producing an increased number of new red blood cells in response to the lost red blood cells. Some new red blood cells will be released prematurely, and these young red blood cells (reticulocytes) may be stained for easier identification on a blood smear. The presence of an increased number of reticulocytes indicates that the anemia is regenerative, i.e. accompanied by a normal synthesis of young cells that replace lost red blood cells.

Careful examination of the blood smear is also important to look for parasites that could cause red blood cell destruction and other abnormal cells that could indicate changes in other formed elements.

A bone marrow biopsy or aspirate is performed if it is suspected that the bone marrow is not responding adequately (producing new red blood cells) to an anemic condition. A sample of the bone marrow is taken with a special needle (the test is performed under general anesthesia) and analyzed, providing valuable information about its condition and sometimes showing the cause of the anemia.

Blood chemistry and urinalysis are other important tests for cats with anemia. These tests evaluate organ function and electrolyte metabolism and provide important information about a cat’s overall health.

Examination of faeces for parasites is important to identify the presence of parasites in the intestines that could be causing chronic blood loss.

Finally, an anemic cat should be tested for feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) because these viruses are important and common causes of anemia.

A large number of diseases can cause a decrease in the number of red blood cells or hemoglobin.

Allocate:

1. diseases that cause blood loss,
2. diseases that cause hemolysis (erythrocyte breakdown and destruction),
3. diseases that reduce the production of red blood cells by suppressing their synthesis in the bone marrow.

Diseases that cause blood loss

The main causes of blood loss in cats include:

• Injury or damage to blood vessels or internal organs resulting in bleeding
• Heavy parasitic infestations by fleas, ticks and hookworms
• Tumors of the intestines, kidneys and bladder
• Diseases that prevent proper blood clotting, poisoning by anticoagulant substances

Diseases that cause hemolysis

The main causes of hemolysis in cats include:

• Autoimmune hemolytic anemia
• Feline leukemia virus (FeLV)
• Blood parasites such as Hemobartonella felis
• Chemicals or toxins
• Neoplasia (cancer)

Diseases causing bone marrow suppression

Main causes of bone marrow suppression in cats:

• Any severe or chronic disease (such as chronic kidney disease or liver disease)
• Very poor or severely unbalanced diet
• Autoimmune anemia
• Feline leukemia virus (FeLV)
• Feline immunodeficiency virus (FIV)
• Chemicals or toxins
• Neoplasia (cancer)

Iron deficiency anemia in cats

Iron deficiency anemia is a common disease in humans, especially women. However, it is rare in cats and may only develop secondary to severe chronic blood loss or occur in cats fed a highly unbalanced diet.

If your cat’s anemia is severe enough to be life-threatening, a blood transfusion is needed. Before a transfusion is performed, blood samples from the donor and recipient are taken for compatibility testing (cats have 3 blood groups). The main goal of a blood transfusion is to stabilize the cat while the underlying cause of the anemia is identified and targeted treatment for the anemia can be given if possible.

Further treatment begins as soon as the underlying disease causing the anemia is diagnosed. Treatment may include corticosteroids, anthelmintics, other medications, or surgery.

Most cats, if anemia is diagnosed early and are in relatively good health, have a good prognosis.

The prognosis for cats with anemia is based on the specific diagnosis and condition of the patient prior to treatment.

Cats that are anemic due to toxins, cancer or autoimmune disease, chronic viral infections (FeLV, FIV), or have suffered severe trauma have a less favorable prognosis.

(с) Veterinary center for the treatment and rehabilitation of animals “Zoostatus”.

Warsaw highway, 125 building 1. tel. 8 (499) 372-27-37

Clinical case: feline hemoplasmosis. | IVAN FILLMORE VETERINARY CLINIC



Clinical case: feline hemoplasmosis. | IVAN FILLMORE VETERINARY CLINIC

Home – Clinical case: feline hemoplasmosis.

British Shorthair cat, 2 years old, not neutered, weight 4.4 kg, not vaccinated, was admitted to the clinic with complaints of anorexia during the day. Vomiting, coughing, sneezing were not observed, the stool was decorated.
Examination result: T=39.7, turgor is reduced, exicosis is about 7%, mucous membranes are icteric, the abdominal cavity is soft, painless, palpation — without features; no discharge from the eyes, slight serous discharge from the nose.
Complete blood count, biochemical blood test, reticulocyte count were performed.

Laboratory test results:
Complete clinical blood count:

Note: anisocytosis +, polychromasia +, 8 nucleated erythrocytes / 100 leukocytes, shadow cells 10%, reactive lymphocytes 10%, toxicity +, inclusions were found on the erythrocyte membrane (single and in the form of chains of several inclusions)

Biochemical blood test:

Notes: hemolysis +, icterus ++

Reticulocytes:

According to the results of the tests, regenerative anemia was established, which, according to the etiology, was hemolytic, most likely of parasitic origin.

Based on the type of anemia and the presence of inclusions in erythrocytes, it was decided to send blood for testing for hemotropic mycoplasmas of cats by PCR.

Dynamics of the state after the prescribed treatment, including specific therapy with doxycycline and blood transfusion: mucous membranes are icteric, moist. The lymph nodes of the mandibular and popliteal are slightly enlarged. The appetite is there.

Blood tests after prescribed treatment.
CBC:

Blood chemistry:

Hemotropic mycoplasmas – are microorganisms that belong to the group of Gram-negative bacteria and parasitize on the erythrocyte membrane, causing their destruction, leading to hemolytic anemia, to which an autoimmune component can be connected.

Hemoplasma infection in cats can clinically progress from asymptomatic carriage to acute life-threatening anemia, depending on the susceptibility of the organism and the degree of pathogenicity of the pathogen. The susceptibility to infection increases with the age of the animal and in the presence of other chronic infections, especially feline leukemia virus. The risk of developing the disease increases with immunosuppression and splenectomy.

The incubation period after infection with M. haemofelis before the onset of clinical signs can be from 2 to 34 days. The acute phase of the disease usually lasts 3 to 4 weeks if left untreated and is characterized by severe anemia and bacteremia. At the same time, the hematocrit is sharply reduced, which often correlates with the appearance of microorganisms in blood smears. Acute infection with M. haemophelis can be fatal due to hemolytic anemia accompanied by massive bacteremia. At the peak of bacteremia, hematocrit may fall below 20%. The disease is manifested by lethargy, anorexia, fever. Hyperemia is undulating in nature with peaks during periods of the highest concentrations in the peripheral blood. Splenomegaly and jaundice are sometimes noted, which is caused mainly by extravascular hemolysis.
The blood picture associated with M. haemofelis is usually accompanied by anisocytosis and polychromasia with an increase in the absolute number of reticulocytes.
Most Candidatus M. haemominutum infections are chronic and not associated with anemia or other clinical symptoms. However, infection in cats with Candidatus M. haemominutum may initially be accompanied by a slight decrease in hematocrit, which usually returns to normal after 4–6 weeks.
After infection, the number of bacteria in the blood increases. It appears that Candidatus M. haemominutum may play a role in the pathology. Cases of acute hemolytic anemia in domestic cats have been described in which no obvious causative agent other than Candidatus M.