Bruising and Bleeding in Dogs
Dr. Bari Spielman
Complete medical history (including travel history, toxin exposure, environment) and thorough physical examination
There are many tests that may be recommended for the patient with bruising or bleeding. The following is a list of the most common tests that should be performed first.
A complete blood count (CBC) to evaluate for the presence of systemic infection or inflammation. This test may reveal anemia secondary to bleeding, and may show changes in other cell lines such as the white blood count that might be indicative of other or concurrent disorders.
A biochemical profile to evaluate kidney, liver, electrolytes (specifically, potassium and calcium), total protein, and blood sugar status. All of these parameters are important to establish in the bruising or bleeding patient, and to rule out the possibility of concurrent diseases.
A urinalysis to evaluate the kidneys, hydration status of the patient, and confirms or rules out the presence of blood.
Thoracic (chest) and abdominal radiographs (x-rays). Although they may be within normal limits, they may reveal evidence of lymphadenopathy (enlarged lymph nodes), and liver and/or splenic enlargement. In addition, it is important to rule out other diseases and causes of the patients' clinical signs as well.
Abdominal ultrasound. It is very helpful in evaluating all of the abdominal organs, including the liver, kidneys, lymph nodes and spleen. It is equally important to rule out other disorders or diseases that may be associated with bruising or bleeding. Abdominal ultrasound is a noninvasive test that often needs the expertise of a specialist and/or referral hospital.
Coagulation (clotting) studies (APTT, PT, platelet count) to better understand the underlying cause of bleeding, and/or to determine if there is concurrent DIC.
A bone marrow aspirate in the patient with thrombocytopenia or hyperglobulinemia (high globulin part of the protein fraction). This relatively noninvasive test allows us to sample the marrow (substance inside of the bone), which is responsible for producing red blood cells, white blood cells and platelets. With a local anesthetic, a small needle is introduced into the core of the bone, and a small amount of marrow is withdrawn and analyzed. There are characteristic changes consistent with ehrlichiosis that one may see. It is important to rule out other disorders, such as multiple myeloma or chronic lymphocytic leukemia that can initially be difficult to differentiate from ehrlichiosis. This test may be performed by your local veterinarian, although in some cases, may be best to have performed in a specialty hospital.
Your veterinarian may recommend additional tests to insure optimal medical care. These are selected on a case-by-case basis.
Endocrine testing to include an ACTH stimulation test and a thyroid profile to rule out hyperadrenocorticism (Cushing's disease) and hypothyroidism, respectively. They are blood tests that can usually be performed at your local veterinary hospital. Both Cushing's disease and hypothyroidism are endocrine disorders that are commonly seen in veterinary medicine, and can be associated with bleeding or bruising.
Protein electrophoresis. This blood test should be considered in animals with high protein levels (especially globulins) and may be helpful in diagnosing certain disorders such as multiple myeloma or ehrlichiosis.
Platelet function tests. These blood tests should be run on selected patients to rule out plate function disorders.
Von Willebrand's factor assay is a blood test that is necessary to confirm Von Willebrand's disease.
One or more of the diagnostic tests described above may be recommended by your veterinarian. 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 but not all pets with bruising and bleeding. These treatments may reduce severity of symptoms or provide relief for your pet. However, nonspecific therapy is not a substitute for definitive treatment of the underlying disease responsible for your pet's condition.
Generally speaking, treatment for the bleeding or bruising patient is done on an inpatient level until the underlying cause has been identified and/or addressed.
Minimize activity to reduce the risk of even minor trauma.
If an underlying cause has been identified, treat or remove it if possible.
Discontinue any medications that may cause bleeding or bruising.
Blood products may be necessary in patients who are profoundly weak and anemic secondary to excessive bleeding or bruising, and should be administered even before a definitive diagnosis has been established in some cases.