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 AFS 1 and 2 (AFS <3) are “small‐volume bleeders” that reliably will not become significantly anemic from their intraabdominal bleed because, simply put, there is not enough intraabdominal hemorrhage to cause anemia (Figures 7.4 and 7.5). Of course, they must remain an AFS of 1 or 2 (AFS <3) on serial AFAST examinations.

 If an AFS 1 or 2 (AFS <3) dog or cat is or becomes anemic, then there are four major possibilities.The patient had preexisting anemia.The patient is bleeding somewhere else, emphasizing the importance of the Global FAST approach and a good physical examFigure 7.3. Modification of the AFAST‐applied AFS. The figure shows how size matters, using the AFAST CC view as an example. In (A) the small pocket, anechoic triangulation (circled) would be scored a ½ as a “soft” positive whereas in (B) the larger pocket would be scored a full 1 as a “strong” positive. This visual modification is used at all AFAST views and is an alternative to the measurement modification shown in Figure 7.2.Source: Reproduced with permission of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX.Figure 7.4. AFAST‐applied AFS and the small‐volume versus large‐volume bleeder principle. Cartoon of a dog in right lateral recumbency and the “small‐volume versus large‐volume” bleeder/effusion principle. In (A) and (B) the AFS is 1 and 2, respectively. Anemia is not expected in AFS 1 and 2 (modified AFS system <3) bleeding patients. In (C) and (D) the AFS is 3 and 4 (modified AFS system ≥3), respectively. These bleeding dogs will predictably be or become anemic from the intraabdominal volume of blood. The same principle holds true for cats. The AFS is validated only in lateral recumbency. CC, cysto‐colic view; DH, diaphragmatico‐hepatic view; HRU, hepato‐renal umbilical view; SR, spleno‐renal view.Source: Reproduced with permission of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX. Illustration by Hannah M. Cole, Adkins, TX.Figure 7.5. AFAST‐applied AFS system and the small volume versus large volume principle. Cartoon of a dog in left lateral recumbency and the “small‐volume versus large‐volume” bleeder/effusion principle. In (A) and (B) the AFS is 1 and 2, respectively. Anemia is not expected in AFS 1 and 2 (modified AFS system <3) bleeding patients. In (C) and (D) the AFS is 3 and 4 (modified AFS system ≥3), respectively. These bleeding dogs will predictably be or become anemic from the intraabdominal volume of blood. The same principle holds true for cats. The AFS is validated only in lateral recumbency. CC, cysto‐colic view; DH, diaphragmatico‐hepatic view; HRU, hepato‐renal umbilical view; SR, spleno‐renal view.Source: Reproduced with permission of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX. Illustration by Hannah M. Cole, Adkins, TX.Hemodilution has occurred from fluid therapy, which is much less common than a couple of decades ago because of more recently taught titrated fluid therapy.Lab error.