Atypical Bleeding Cases Continued�

Getting back to my interesting anaemic case load. I was still mentally trying to get my head around ‘Myff‘ and what I could have done better in her management, then I admitted another seriously anaemic patient.

The owner brought in ‘Cass’, her 12-year-old female desexed labrador cross that had crashed overnight.

The owner said ‘Cass’ had been going down hill slowly over the past few weeks but had suddenly collapsed last night.

The poor old sausage could not even muster the energy to get up and I immediately noticed she had a severely distended abdomen. I admitted her to hospital straight away for full workup and proceeded with a blood test and abdominal x-ray�and ultrasound. She was confirmed to be severely anaemic and requiring a blood transfusion. I could also palpate an enlarged liver and possibly splenic tumour. Her abdominal ultrasound� made us very suspicious that�both her liver and�spleen were affected.�I explained to the owner that her dog most likely had a ruptured splenic tumour with possible liver involvement and requires a blood transfusion immediately and surgical removal of the spleen.

Unfortunately, I had to give her a very guarded prognosis because the liver was suspected to be involved. Her dog was in a very critical state and�not a good surgical�candidate.�The owner opted for us to give her the blood�transfusion and see if she pulls through the night and discuss potential surgery the next day. The tough cookie survived the night but to my utter dismay she continued to bleed.�She was requiring an emergency surgery the next morning which the owner could not afford.

It was a very�emotionally charged situation�for everyone involved.

The owner could not let go of her beloved pooch and was devastated about not having the money to go ahead. My vet team�felt tortured�about�watching the patient suffer in silence and not being able to jump into surgery or put her out of her misery.�The owner could not make up her mind and wanted to make her final�decision when she saw her dog.��She looked at her poor old dog and was�so broken�to make that�difficult decision. She kept telling me�she would have done the surgery if she had the�money. I tried to soothe the owner�and explain that we in fact do not recommend surgery in�Cass’s state especially because her liver was most likely involved.

It was not worth putting her through that huge surgery when we already knew that her days were counted. �I felt so much better when I put my patient to rest and knew she was finally at peace.

The same day I admitted ‘Cass’, I examined ‘Jake’, a 12-year-old male desexed Maltese cross,�that presented to me for continuous shaking and lethargy. The owner had been concerned about his waxing and waning symptoms over the past few weeks. He had one episode of collapse on his back legs 2 weeks ago but bounced back from it. My examination showed that he was guarding his abdomen but I suspected it was due to referred back pain. I got a second opinion and still we could not pin point his major area of concern. I gave him a shot of pain relief, collected bloods & sent it off to�the pathologist�and booked him in for abdominal/back x-rays the next morning.

The next day arrived and his abdominal radiographs revealed a large splenic mass and his blood results showed he had a mild anaemia and increased white cell count (indicating secondary infection).

I called his parents immediately and informed them of our findings and recommended an exploratory surgery to remove his splenic tumour. I warned�his owners about liver involvement and explained we would be unable to resect any affected liver tissue. We came to an agreement that if the liver was confirmed to be involved, we would not wake ‘Jake’ up from the anaesthetic.

My colleague Phil did the surgery and found the spleen had ruptured in its central area. Check out some gruesome pictures below of Jake’s ruptured spleen.

Phil identifying the spleen and pulling it out for better exposure.

Phil clamping all the vessels before removing the spleen to�prevent any further bleeding.

The whitish surface on the middle bit of the spleen is where the tumour originated.

This is the ruptured splenic tissue at the site of the tumour.

Fortunately the liver was not involved.

I must admit I was relieved that the owners had given me the okay to work ‘Jake’ up. If they had declined the blood test and xrays and simply asked for conservative medical therapy, ‘Jake’ would have most likely presented to us a week later on the brink of death. Instead they followed through with my recommendations and saved their dog’s life!

It is important to note that splenic tumours in older dogs�are common. They can either be benign (localised and don’t spread)�or metastatic (ones that spread). Some dogs can�start to appear fatter around the tummy�as the spleen�gets bigger but that is�not always the case.�The tumour in a spleen keeps growing until it ruptures leading to a major bleed.�It can�also lead to�necrotic (dead)�splenic tissue and the dog will present with an infection. Both small and large breed dogs can be affected.

However, large breed dogs are more commonly affected namely German Shepherds, Labradors�and Great Danes.

If you get your geriatric dog checked out by your local veterinarian regularly say every 6-12 months, they may be able to detect splenic enlargement in�its early stages. At that stage, you can do something about it.�Otherwise,�splenic tumours�can be�missed and your dogs can end up like ‘Cass’.

I also happened to examine another very complicated anaemic case that same week.� Now do you believe I’m jinxed?

Related articles

Jinxed with atypical bleeding cases (rayyathevet.com)

Filed under: Hardships, Medicine Cases Tagged: anaemia, benign, Blood transfusion, crashed, desexed, distended abdomen, Dogs, emergency surgery, enlarged liver, German Shepherds, going down hill slowly, Great Danes, Gribble, gribble’s pathology, guarded prognosis, haemangiosarcoma, labrador, Labradors, metastatic, necrotic, removal of the spleen, ruptured splenic tumour, spleen, splenic tumours, suddenly collapsed, surgical removal of spleen, ultrasound, veterinary treatment, waxing and waning, xrays Source: http://rayyathevet.com/2011/09/26/atypical-bleeding-cases-continued/

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Rayya The Vet

I was born overseas and grew up in Lebanon. About 9 years ago, I left my family and friends behind to pursue my dream of becoming a veterinarian in Australia.

I have now been out in practice for the past 5 years. I absolutely love being involved with all types of animals and consider it my "calling". Whilst my job can be quite an emotional rollercoaster ride, I cannot fathom doing anything else for as long as I am living. I simply feel blessed every day that I am practicing what I truly love.

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