Taking your pet to the vet can be stressful and if your companion is bleeding it is understandable that you will be very worried. The way your vet will address the bleeding will very much depend on the cause. This may not be immediately obvious so sometimes further investigations are required before treatment can begin. In all cases, however, the first priority is to reduce the ongoing bleeding as much as possible.
This article aims to explain what we, as vets, do when you hand over your much-loved pet and how we treat bleeding and clotting disorders.
Open Wounds: Stop the bleeding
Pressure bandages
Following a triage assessment, it is likely your vet will administer first aid to an actively bleeding wound by placing a pressure bandage. This could be a fresh, traumatic injury or wounds that are bleeding following a surgical procedure. Pressure bandages involve several layers of tightly wrapped bandaging material placed around the area that is bleeding. The aim is to reduce and slow down the bleeding as much as possible while the body’s natural clotting process takes place. It is advisable that firm pressure is applied to bleeding wounds for at least 20 minutes.
This can be tiring to do manually especially if your pet isn’t too keen on sitting still for that length of time. Placing a dressing will apply a more even and long-lasting pressure than manually pressing on an area and is likely to be better tolerated by your pet. It is important that these dressings are not left on for too long without veterinary supervision or assessment as they can restrict blood supply to the area involved and cause tissue damage. In some instances pressure alone is sufficient to stop the bleeding. If however further treatment is necessary, placement of a pressure bandage has reduced the amount of blood lost while this additional treatment is being carried out.
Adrenaline
Adrenaline solution soaked into gauze swabs may also be used to apply pressure onto a small area of mild bleeding. Adrenaline causes blood vessels to constrict reducing the amount of blood flow. This is only likely to help however when capillary bleeding is involved. Bleeding involving larger blood vessels will likely need further treatment and investigation. Vets in surgery, to stop the gums bleeding following dental extractions, sometimes use this method.
Cautery
This technique uses an electrical current to heat a metal probe which, when applied to tissue, will seal off tiny vessels (capillaries). It is most commonly used in cases where the blood vessels are too small to tie off individually. This will only ever be utilized during a surgical procedure when your pet is either heavily sedated or fully anaesthetized.
Surgery
Unless very small or superficial, most wounds will need surgery to place stitches or ligatures. During the process of preparing your pet for surgery and cleaning the wound the body will usually have got to work forming clots so often there is very minimal bleeding during the surgery itself. If there is still some bleeding, the pressure of the stitches as they hold the skin edges together is usually enough to aid the clotting process. However, if a larger blood vessel has been damaged this will need to be located and tied (ligated) using suture material.
Surgery may also be required if your pet has decided to start licking or chewing at a lump and created a wound. Or a tumour may have grown bigger and started to damage the normal tissue surrounding it. In the majority of cases this bleeding is unlikely to be severe initially. By using a buster collar to stop them traumatizing the wound further and antibiotics to address any infection, we can try and help the skin to heal. However in some cases, your vet may consider surgery to remove the lump itself. This can be tricky depending on the size and type of mass and its location. Each case will have to be assessed by your vet in person and an individual treatment plan created.
If your pet has already had surgery, there can sometimes be bleeding from the small blood vessels under the skin that has been stitched back together. Usually this is mild and no further intervention is required, but it is always worth speaking to your vet if you are concerned about how your pet’s surgical wound is looking at home. In rare cases repeat surgery may be needed to find the vessels that are still bleeding and the techniques described above such as pressure, adrenaline or cautery may be needed.
Internal bleeding
Internal bleeding, where the abdominal cavity fills with blood, is one of the more serious types of bleeding a vet might be required to treat. This can occur as a complication of neutering surgeries, following severe blunt trauma or due to a ruptured tumour. The reasons this can be so serious is due to the fast rate at which bleeding can occur from the large vessels within the abdomen and the large volume of blood that can be lost before it becomes obvious that surgical intervention might be required.
If internal bleeding is suspected then your vet will use an ultrasound machine to scan the abdomen. Any pockets of fluid found will be sampled using a needle to check for the presence of blood. The next step will often be surgery to locate where the blood is coming from. The blood will first be removed, usually using suction and/or absorbed by gauze swabs, so that the vet can find the source of the bleeding more easily. Any bleeding vessels identified will be tied using suture material. Bleeding tumours are most commonly associated with the spleen so sometimes removal of this entire organ (splenectomy) is necessary to stop the bleeding. Damaged liver tissue can bleed following a blunt trauma such as a road traffic accident. Sometimes the bleeding can be stopped using stitches or cautery, as described above, but occasionally the affected liver lobe may need to be removed.
Fluid therapy and blood transfusions
Sometimes, if a lot of blood has been lost in a short space of time, either internally or externally, this volume needs replacing so that the heart can continue to function and pump oxygen around the body. Initially this can be replaced with saline fluid given directly into the vein, and if the cause of the bleeding is resolved quickly this may be sufficient. The body will naturally regenerate the lost red blood cells in a couple of days. But if a large volume of blood has been lost, a blood transfusion may be required, as the body can’t replace this loss quickly enough.
For this we use donated blood to replace the blood your pet has lost while the cause of blood loss is identified and treated. A charity, Pet Blood Bank, collects blood safely from healthy dogs at donation days all over the country. This blood is then processed and stored appropriately so it is available for vets to order if they have a patient that needs it. Just like us, dogs and cats have several blood types, so your vet will need to check your pet’s blood type to ensure the donor blood is a match before starting the transfusion.
Clotting disorders
Any bleeding that doesn’t stop as expected following the treatments described above, can be due to a problem with the body’s ability to form a blood clot. Known as haemostasis, this process kicks in when the body detects damage to a blood vessel and relies on proteins in the blood called clotting factors, and cells called platelets, to plug the hole. However, inherited genetic disorders, auto-immune conditions, parasites or toxins can disturb this normal chain of events resulting in bleeding that doesn’t appear to stop.
Specific blood tests to measure these clotting factors are available and can help determine why your pets’ blood isn’t clotting as expected. A sample of blood will also be examined under a microscope so that platelet numbers can be measured.
TCP: Thrombocytopenia
If a very low number of platelets is counted this could be due to a condition called immune-mediated thrombocytopaenia. This occurs when your own immune system gets confused and attacks its own cells, destroying the platelets so there aren’t enough to form a clot when a blood vessel is damaged. Suppressing the immune system to prevent further platelet destruction is the priority in this condition. However, further investigations will need to be performed if this condition is suspected in a patient. Treatment is often long-term and can sometimes be lifelong.
Poisoning
Ingestion of rat poison can also prevent blood clots forming and is treated using vitamin K in either oral or injectable form.
Parasites
The parasite Angiostrongylus vasorum, otherwise known as lungworm, while more commonly causing a cough can also cause internal bleeding. A quick blood test can diagnose this and your vet can prescribe worming treatment focused on killing the parasite will be started immediately. Regular worming with a product prescribed by your vet is very important to prevent lungworm, especially if you live in a high-risk area or your dog is prone to eating slugs or snails.
Direct Treatment Options
Similarly to the blood transfusion procedure we discussed above, many animals with a clotting disorder can benefit from receiving a transfusion. However, they usually receive a product called fresh frozen plasma (FFP) rather than whole blood. This is the portion of the blood that contains highly concentrated clotting factors and is separated from the other blood cells by spinning at high speeds in a machine called a centrifuge. While the other treatments described above are being given for the specific disease process occurring, replacing the clotting factors will support haemostasis in the meantime and reduce the ongoing bleeding.
Hopefully this article has reassured you that your vet is well prepared and has a wide array of equipment and techniques at their disposal to treat bleeding in your pet. Knowing what we do behind the scenes will also hopefully set your mind at rest that they truly are in the best hands and make your wait for news that little bit less anxious.
We know it is much easier said than done, but if you notice your pet bleeding, try not to worry, and contact your vet straight away for further advice. Having some knowledge of basic pet first aid can also come in handy in these situations so check out this other useful article here…
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