Splenic Hemorrhage in Dogs

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Splenic hemorrhage occurs when tumors of the spleen rupture, slowly bleed or invade into a blood vessel causing blood to enter the abdominal cavity. The spleen can also bleed when it is fractured or lacerated due to trauma. Splenic tumors can be either hematomas (an organized, local collection of blood) benign hemangiomas or malignant hemangiosarcomas. All forms have the potential to rupture and bleed. Depending on the degree of blood loss, and how rapidly the blood is lost, a splenic hemorrhage may be an emergency situation.

What to Watch For

  • Weakness
  • Collapse
  • Abdominal distension
  • Increased respiratory effort
  • Pale mucus membranes (the best place to check is the gums or inner lining of the lips)

    Other signs that might indicate a more chronic (longer term or gradual) blood loss include: anorexia, lethargy, intermittent weakness, and weight loss.

    Diagnosis

    A thorough history and physical exam is critical for prompt and accurate diagnosis. Tests may include:

  • Abdominal radiographs (X-rays)

  • Abdominocentesis, which is inserting a needle and syringe into the abdominal cavity to obtain a sample for diagnostic evaluation

  • Fluid analysis of the retrieved sample is required for definitive evaluation

  • Complete blood count

    Depending on the animal's condition and initial test results, additional tests that may be required include:

  • Biochemical profile
  • Coagulation panel
  • Abdominal ultrasound
  • Computed tomography (CT) or magnetic resonance imaging (MRI)

    Treatment

    The general approach to treatment varies on the clinical condition of the patient and the cause of the splenic hemorrhage. Treatment may include:

  • Intravenous fluid therapy
  • Blood transfusions
  • Belly wrap
  • Oxygen therapy
  • Analgesic therapy (pain medication)
  • Emergency exploratory surgery

    Home Care

    A splenic hemorrhage may be an emergency situation. Veterinary care should be given as soon as possible.

    Keep your pet calm and comfortable. Minimize stress and keep your pet warm. If a traumatic injury is suspected, be careful moving your pet, as fractures may be present.

    • Splenectomy (removal of the spleen)was performed in this patient. Notice the tumors (arrows) present on the splenic tissue.

    • Hemangiosarcomas are tumors that are aggressive and malignant and are commonly found on the spleen or liver.

    Splenic hemorrhage is a potentially life threatening situation. The abdominal cavity is a potential significant space that could contain a significant amount of blood. If a large amount of blood is lost into this space, the abdominal wall musculature is stretched and abdominal distension will be noted. Abdominal distension also may cause discomfort and pain, leading to increased agitation and stress. The rapid expansion of the abdomen may also cause pressure on the diaphragm, and thus, a decreased ability to breath comfortably.

    Rapid blood loss into the abdomen will also lead to a decrease in blood pressure and tissue perfusion. This may lead to shock. As continued blood is lost, the decrease in circulating red blood cells may lead to acute (sudden) anemia. Pale mucus membranes are commonly observed. If veterinary care is not immediately available, rapid blood loss may lead to death. A slower blood loss is more common and will allow for more time to seek veterinary care.

    Chronic (long standing) or intermittent blood loss generally occurs more slowly, and more subtle clinical signs might be present. If the blood loss is slow, the body can reabsorb the free blood. Thus, animals may only have a small amount of blood present in the abdominal cavity. These animals may not present as an emergency, but they still may have a serious underlying disease process. Making the diagnosis of a splenic hemorrhage is critical in establishing an underling cause.

    If the animal has normal clotting parameters, the bleeding into the abdomen will often stop on it's own. Blood clots form and stop the bleeding. Sometimes an animal will collapse due to the acute blood loss and then slowly recover due to clot formation and the body's own compensatory mechanisms. These animals appear pale and weak initially, but with time, they slowly become stronger and their mucus membranes again become pink. Owners may describe intermittent episodes of weakness followed by spontaneous recovery. Blood clots can, however, be dislodged especially with increased movement or manipulations. If blood clots are dislodged, the bleeding may start again.

    Causes

  • Trauma. The most common traumatic injury causing a splenic hemorrhage occurs when an animal is hit by a car. Severe splenic trauma may cause a rapid death if the bleeding is significant. Most of the time, bleeding occurs more slowly and there is time to seek emergency care. In addition to damage to the spleen, the liver may also be affected. The bleeding may be mild or severe, but most of the time it will stop without intervention. Other causes of trauma include gun and knife wounds that pierce the spleen.

  • Tumors. Tumors of the spleen may erode a blood vessel or simply rupture causing an acute bleed. The most common tumor is a hemangiosarcoma, which is a tumor of blood vessels. These tumors are aggressive and malignant and are commonly found on the spleen or liver. Golden retrievers and German shepherd dogs are two breeds at increased risk of getting this tumor. A hemangioma is the benign form, but it is not as commonly seen. Hemangiosarcoma is a common tumor in dogs, but it is rare in cats. In cats they usually involve the spleen, mesentery, liver or gastrointestinal tract.

  • Hematomas. Hematomas are formed by broken blood vessels that cause blood to accumulate in the spleen and are a common cause of splenic hemorrhage. They may be caused by previous trauma, or more commonly nodular regeneration, which is excessive production of splenic tissue. Hematomas may be quite large and are indistinguishable from hemangiosarcomas at surgery.

  • Diagnosis In-depth

    The order of diagnostic tests depends on the clinical condition of the pet. In an emergency situation, the pet would be stabilized prior to significant diagnostic procedures. A rapid but thorough veterinary evaluation is critical to prioritizing appropriate diagnostic procedures.

  • Abdominal radiographs are a good test to see if fluid is present in the abdominal cavity. Although they are a good initial diagnostic test, they cannot discern the type of fluid present. Abdominal radiographs also may identify mass lesions (tumors or hematomas). Unfortunately, a large volume of fluid in the abdomen will often make the radiographic visualization of masses more difficult.

  • Abdominocentesis. A small sample of fluid is withdrawn from the abdominal cavity and the fluid submitted for microscopic analysis. The bloody fluid withdrawn should not clot, since blood in the peritoneal space rapidly loses it's ability to form a clot. When a bloody fluid is obtained that does clot, it usually means that a blood vessel was inadvertently aspirated.

  • The fluid analysis will show mainly red blood cells with some white blood cells, in quantities similar to peripheral blood. The hematocrit (red blood cell count) should be similar to that of the peripheral blood.

  • Complete blood count. A CBC is an important test since it evaluates the red and white blood cell lines. When splenic hemorrhage is suspected, a hematocrit is used to evaluate the degree of blood loss (anemia). The CBC also provides information on whether the bleeding was acute or chronic. Red blood cell shape changes may suggest that hemangiosarcoma or other malignancy is present.

  • The biochemical profile is a useful test to evaluate if any other organ systems are affected. Animals with traumatic injuries, and sometimes cancer, will often have elevated liver enzymes. Kidney function is also evaluated.

  • An abdominal ultrasound is used to determine if there is a splenic tumor or hematoma present. Unlike radiographs, fluid in the abdomen does not inhibit the visualization of masses. An ultrasound-guided biopsy may be considered if a mass is found; however, many times the biopsy is non-diagnostic since some masses are mostly blood. Care must be taken when these masses are biopsied, as they do tend to bleed. Animals with splenic masses have the highest incidence of these potential problems.

  • CT or MRI. Rarely, a mass may be too small to be visualized on ultrasound. A CT or MRI available at specialty hospitals may identify these difficult to visualize masses.

    Treatment In-depth

    One or more diagnostic tests may be recommended by your veterinarian, but in the meantime, treatment of the symptoms might be needed, especially if the problem is severe. The following nonspecific (symptomatic) treatments may be applicable to some pets with splenic hemorrhage. These treatments may reduce severity of symptoms or provide relief for your pet. However, nonspecific therapy is not a substitute for treatment of the underlying disease responsible for your pet's condition.

  • If possible, immediate veterinary care should be sought. Splenic hemorrhage may be a life threatening condition requiring immediate intervention.

  • Intravenous fluids are frequently given if there is significant or rapid blood loss. Intravenous fluids maintain blood pressure and improve tissue perfusion. With trauma or bleeding splenic masses, animals are commonly in shock. Fluid therapy is critical in these patients, and animals often respond to treatment dramatically.

  • Blood transfusions may also be required if there is a significant amount of blood loss causing anemia.

  • A belly wrap is a pressure bandage placed around an animal's abdomen. It causes an increased intra-abdominal pressure that will sometimes slow or stop a splenic bleed.

  • Oxygen therapy may be needed in animals that have lost a large volume of blood. It is especially useful early in treatment, while initial fluids or blood products are being administered. Oxygen is administered via oxygen cage, mask or nasal oxygen canula.

  • Analgesic medication. Keeping the patient still and calm is very important. If an animal is painful, he will have increased stress and be more likely to re-injure himself. Bleeding that has previously stopped may start again. Treatment with narcotics or other pain medications helps keep animals more comfortable and potentially more stable.

  • Exploratory surgery. If there is a splenic mass, exploratory surgery may be the only way to obtain a diagnosis and treat the condition. If the splenic bleeding is continuing despite conservative treatment, an exploratory is recommended to stop the bleeding surgically and to discover the cause of the problem.

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