Splenic Hemorrhage in Dogs
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.
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.
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 A small sample of fluid is withdrawn from the abdominal cavity and the fluid submitted for microscopic analysis. The bloody fluid withdrawn should not clot, since blood in the peritoneal space rapidly loses it's ability to form a clot.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.
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.