Haemorrhage

Hemorrhage refers to bleeding that can occur inside or outside the body. In dogs, a hemorrhage can be triggered by injuries, diseases, poisoning, or coagulation disorders. Depending on the severity, the spectrum ranges from minor bleeding to life-threatening situations requiring rapid veterinary assistance.

What is a haemorrhage?

A hemorrhage is the medical term for bleeding that can occur either inside the body (internal bleeding) or outside the body (external bleeding). It occurs when blood vessels are damaged and blood leaks into surrounding tissue, body cavities, or externally.

• External haemorrhage: Blood escapes from a wound or an injured area on the skin.
• Internal haemorrhage: Blood escapes from a damaged vessel into the body cavity, for example into the abdominal cavity, the lungs, or the brain.

Causes of haemorrhages in dogs

Hemorrhages in dogs have many possible causes; they can result from external injuries or internal health problems.

• Trauma or injuries: Accidents, fights with other animals, falls or car accidents can lead to severe external or internal bleeding if major blood vessels are injured.
• Poisoning: Certain toxins, such as rat poison, prevent blood clotting, which leads to serious internal bleeding. Such poisons often contain anticoagulants that block the production of clotting factors.
• Blood clotting disorders: Conditions such as von Willebrand disease or haemophilia disrupt normal blood clotting, increasing the risk of spontaneous or prolonged bleeding after injuries.
• Internal diseases: Conditions such as tumours or ulcers can damage blood vessels and lead to internal bleeding. Tumours in the spleen or gastrointestinal tract are often associated with bleeding.
• Blood vessel ruptures: In certain conditions, such as high blood pressure or heart disease, blood vessels can rupture due to excessive pressure, leading to internal haemorrhages, particularly in vital organs such as the brain (stroke) or lungs.
• Surgery or medical procedures: Bleeding can also occur as a complication after surgery, especially if there are pre-existing blood clotting problems or wound healing issues.

Symptoms of haemorrhage in dogs

The symptoms of a hemorrhage depend on the location and extent of the bleeding. Internal bleeding is often harder to detect than external bleeding, but both can be life-threatening.

External hemorrhages:

• Visible bleeding from wounds.
• Bleeding from body openings, such as the nose (nosebleed), mouth, ears, or anus.
• Bloody urine (haematuria) or blood in the stool (melena).

Internal hemorrhages:

• Weakness or lethargy: Dogs with severe internal bleeding often appear weak and tired, as they lose blood and thus oxygen.
• Pale mucous membranes: Pale gums or eye mucous membranes are a sign of anaemia due to blood loss.
• Breathing difficulties: Bleeding in the lungs or chest cavity can lead to respiratory distress.
• Bloated or hard abdomen: An enlarged abdomen may indicate internal bleeding in the abdominal cavity.
• Bruises or haematomas: Blood accumulations under the skin can become visible after trauma or with clotting disorders.
• Fainting spells or collapse: With severe blood loss, the dog may lose consciousness or collapse.

Symptoms of specific bleeding:

• Brain haemorrhage: Symptoms of bleeding in the brain can include seizures, behavioural changes or head tilting.
• Lung haemorrhage: Breathing difficulties, coughing up blood or rapid breathing may indicate bleeding in the lungs.

Diagnosing Haemorrhage in Dogs

A rapid diagnosis is important to identify the cause of the hemorrhage and initiate immediate treatment. The vet performs a combination of clinical examination, blood tests, and imaging studies.

Clinical examination:

• The vet thoroughly examines the dog to find external signs of bleeding or swelling and checks vital parameters such as heart rate and respiratory rate.

Blood tests:

• A complete blood count (CBC) is performed to check the number of red blood cells and the haemoglobin level. A low value may indicate anaemia due to blood loss.
• Clotting tests: Tests such as the prothrombin time test (PT) and the activated partial thromboplastin time (aPTT) help check clotting ability and detect disorders such as haemophilia or von Willebrand disease.

Imaging techniques:

• X-rays and ultrasound can be used to detect internal bleeding, e.g. in the abdomen or chest.
• In complex cases, a CT scan or an MRI may be required to identify bleeding in the brain or other hard-to-reach areas.

Treatment of Haemorrhages in Dogs

Treatment of a hemorrhage depends on the cause and severity of the bleeding. Common measures include:

1. First aid for external haemorrhage: Pressure bandages are used to stop external bleeding. In severe cases, surgical measures may be required to repair damaged blood vessels.
2. Fluid therapy: With significant blood loss, intravenous fluid therapy may be required to stabilise blood pressure and support the circulation.
3. Blood transfusions: Dogs that have lost significant amounts of blood may require a blood transfusion to replace the lost blood and clotting factors.
4. Medications to promote blood clotting: In dogs with clotting disorders or after rat poison poisoning, Vitamin K is often administered to promote blood clotting.
5. Surgical interventions: With severe internal bleeding, such as with spleen tumours, an emergency operation may be required to remove or repair the source of bleeding.

Prognosis

The prognosis for dogs with hemorrhages depends on the cause, extent, and speed of treatment. Minor bleeding can usually be treated successfully, whereas severe internal hemorrhages, particularly in cases of untreated tumours or serious coagulation disorders, can be life-threatening. Early diagnosis and veterinary intervention significantly increase the dog’s chances of survival.