Bleeding, Severe
Bleeding, severe (severe hemorrhageA hemorrhage is severe Bleeding caused by the rupture of blood vessels. It can be internal or external and often requires medical intervention.)
Severe Bleeding is an acuteAcute refers to a condition that occurs suddenly and is usually of short duration. In a medical context, it describes symptoms or illnesses that can quickly become serious and require immediate attention., relevant Blood loss to the outside or inside that can lead to circulatory failure. Signs include pale mucous membranes, weakness, rapid pulse, and cold extremities. It is always a life-threatening emergency.
Severe Bleeding in pets is an acuteAcute refers to a condition that occurs suddenly and is usually of short duration. In a medical context, it describes symptoms or illnesses that can quickly become serious and require immediate attention. emergency that requires immediate action. Severe Bleeding is defined as significant Blood loss resulting from injury to blood vessels, which, if left untreated, can lead to life-threatening conditions. Depending on the type of vessel affected, we distinguish between three main types of Bleeding: Arterial Bleeding is characterized by bright red, pulsating blood and is particularly dangerous because arterial blood is under high pressure. Venous Bleeding is characterized by dark red, steadily flowing blood. Capillary Bleeding is more superficial and less dramatic, with blood seeping from small vessels in the skin.
In pets, Blood loss of more than 15–20% of total blood volumeBlood volume is the total amount of blood circulating in an organism’s circulatory system. Changes in blood volume can indicate various health conditions, including dehydration or cardiovascular disease. can lead to hypovolemic shock. Especially small dog breeds and cats have a lower blood volumeBlood volume is the total amount of blood circulating in an organism’s circulatory system. Changes in blood volume can indicate various health conditions, including dehydration or cardiovascular disease. and can therefore develop critical conditions more quickly. The total blood volumeBlood volume is the total amount of blood circulating in an organism’s circulatory system. Changes in blood volume can indicate various health conditions, including dehydration or cardiovascular disease. of an animal is about 80–90 ml per kilogram of body weight, which means that a 5 kg cat only has about 400–450 ml of blood. A loss of only 80 ml can therefore already be critical.
Causes
Severe Bleeding in pets can be triggered by various causes. Traumatic injuries are the most common cause, including traffic accidents, falls from heights, bite Wounds from other animals, or cut Wounds from sharp objects. In cats, high-rise falls and territorial fights are common triggers, while in dogs, traffic accidents and injuries from playing or foreign bodies predominate.
In addition to external traumas, internal Bleeding can also occur, such as from splenic ruptures, liver traumas, or tumorA tumor is an abnormal growth of tissue that can be benign or malignant. Tumors can develop in any part of the body and affect various functions. Bleeding. These are particularly insidious because they are not immediately visible externally. Blood coagulationBlood coagulation is a process that helps stop Bleeding when a blood vessel is damaged. Platelets and certain proteins in the plasma form a blood clot that seals the wound. disorders are another important group of causes. These include congenitalCongenital means "present from birth" and refers to characteristics or conditions that are already present at birth. This can include genetic disorders, developmental anomalies, or infections transmitted by the mother. diseases such as von Willebrand’s disease in certain dog breeds (especially Dobermans) or acquired disorders due to poisoning (e.g., rat poison/coumarin derivatives), liver diseases, or medications such as non-steroidalNon-steroidal refers to medications or substances that are not steroids and often have anti-inflammatory, analgesic, or antipyretic effects. They are used in dogs and cats to treat Pain and Inflammatory conditions. anti-inflammatory drugsAnti-inflammatory drugs are medications that reduce inflammation. They can be divided into nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids and are used in dogs and cats to reduce Inflammatory conditions and Pain..
IatrogenicIatrogenic refers to conditions or diseases that arise as a direct result of medical treatments or interventions. Examples of iatrogenic problems in dogs and cats can include medication side effects or post-operative complications. causes, such as complications after surgical procedures or blood draws, can also lead to severe Bleeding, especially in animals with pre-existing Blood coagulationBlood coagulation is a process that helps stop Bleeding when a blood vessel is damaged. Platelets and certain proteins in the plasma form a blood clot that seals the wound. disorders.
Symptoms
Bleeding, severe in dogs and cats
Typical Symptoms:
- Visible Blood loss (spurting, pulsating, or widespread)
- Rapid soaking of bandage/fur
- Restlessness, Panting, Shivering
Alarm signs:
- Bleeding does not stop within a few minutes despite pressure
- Signs of shock: pale mucous membranes, weak pulse, collapse
- Large Wound, amputationAn amputation is the surgical removal of a body part, usually a limb or part of a limb. In veterinary medicine, amputation is performed to relieve Pain or prevent the spread of diseases, such as cancer., deep stab Wound
- Blood from body openings in large quantities (mouth, nose, anusThe anus is the opening at the end of the digestive tract through which stool is eliminated from the body. In dogs and cats, the health of the anus can be an important indicator of various conditions such as parasite infestation and gland problems., urine)
Escalation/course:
- Increasing weakness in 10–30 minutes → life-threatening Blood loss
- Bleeding is heavy again after a short pause → renewed vessel opening/Blood coagulationCoagulation is the process of blood coagulation, in which liquid blood is transformed into a solid clot. This process is crucial for stopping Bleeding and promoting wound healing. disorder (coagulopathies)
- Hypothermia, apathyApathy refers to a state of indifference and reduced interest or lack of emotional involvement in activities or events that would normally arouse interest. → late shock
The symptoms of severe Bleeding vary depending on the location, extent, and speed of Blood loss. In the case of external Bleeding, the Blood loss is obviously visible. Arterial Bleeding is recognized by the bright red, pulsating blood escaping, while venous Bleeding is characterized by dark red, steadily flowing blood. In contrast, in internal Bleeding, the signs are more subtle and can easily be overlooked.
Systemic symptoms of major Blood loss include pale to white mucous membranes, prolonged capillary refill time (over 2 seconds), tachycardiaTachycardia refers to an unusually fast heartbeat with a resting heart rate of over 100 beats per minute. It can indicate physical exertion, stress, illness, or heart problems. (increased heart rate), tachypneaTachypnea or tachypoe refers to an increased respiratory rate that is above the normal range for the respective living being. It may be a sign of shortness of breath or other respiratory diseases. (rapid breathing), weakness, lethargy, and in advanced cases, impaired consciousness to collapse. With Bleeding into the abdominalThe term "abdominal" refers to anything that concerns the belly or the abdomen. It is an adjectival expression used to describe the location, symptoms, or conditions that occur in the abdominal area. cavity, the abdomenThe abdomen, also known as the abdominal cavity, is the part of the body located between the rib cage and the pelvis. It houses several important organs, including the stomach, liver, kidneys, intestines, and spleen. may appear distended and be painful on palpationPalpation is an examination method in which the condition of body tissues is assessed by feeling them with the hands. It is used to identify swelling, pain, or other abnormalities.. Thoracic Bleeding can lead to shortness of breath and cyanoticCyanotic refers to the presence of cyanosis, a bluish discoloration of the skin or mucous membranes, indicating a lack of oxygen in the blood. (bluish) mucous membranes.
Especially in cats
In cats, the signs of shock can be very subtle, as these animals often hide symptoms of stressStress refers to the state of an organism reacting to external stimuli or demands. In veterinary medicine, stress can have physical or psychological effects on animals, impacting their health and well-being. and pain. A calm, withdrawn cat with pale mucous membranes should therefore always be a cause for concern.
First Aid
- Remove any foreign objects that may have penetrated.
- However, do not examine the Wound and do not attempt to clean a heavily Bleeding Wound yourself.
- Just focus on stopping the Bleeding.
- Apply a bandage or a clean cloth to the Wound and apply steady pressure to the Wound until the Wound stops Bleeding. This can take up to 15 minutes for arterial Bleeding.
- If necessary, apply a thick bandage that maintains steady pressure.
- For head injuries, be careful not to put pressure on the eyes.
- Also, do not apply pressure if you still suspect a foreign body in the tissue.
- Take your animal to a quiet place, wrap it in a blanket, and place it on the floor if possible so that it cannot fall from anywhere if it is Restlessness.
- If blood soaks through your bandage, do not remove it, but place more bandage material over it.
- If the heavily Bleeding Wound is on a leg, you can also try to reduce the overall blood supply by ligationA ligation is a medical procedure in which a band or thread is used to tie off or close a blood vessel or other channel in the body. This is often done to stop Bleeding or interrupt the blood supply to an area. (tourniquet). However, also for no longer than 20 min.
When should you see a vet sooner?
Red always means an emergency. See a vet immediately. Pressure bandage/compression.
Diagnosis
The diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. of severe Bleeding begins with a thorough clinical examination. In the case of external Bleeding, the diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. is obvious, but the extent of the injury and Blood loss must be assessed. In the case of internal Bleeding, imaging procedures are essential. UltrasoundUltrasound refers to sound waves that are above the hearing threshold of the human ear. In medicine, ultrasound is used for diagnostic imaging procedures to visualize internal organs, tissues, and blood flow. (sonography / ultrasoundSonography / ultrasound, also called ultrasound examination, is an imaging technique that uses sound waves to create images of the inside of the body. It is used for diagnostic purposes in veterinary medicine, including the examination of soft tissue structures.) is particularly valuable because it is non-invasive and can quickly detect free fluid in body cavities. In the case of abdominalThe term "abdominal" refers to anything that concerns the belly or the abdomen. It is an adjectival expression used to describe the location, symptoms, or conditions that occur in the abdominal area. Bleeding, an abdominocentesis can be performed to confirm that the free fluid is blood.
X-rays can provide clues to organ injuries, foreign bodies, or fractures that may be associated with Bleeding. In specialized facilities, computed tomography (CT) or magnetic resonance imaging (MRI)Magnetic resonance imaging is an imaging technique that uses strong magnetic fields and radio waves to create detailed images of the inside of the body. It is used in veterinary medicine to diagnose diseases of the brain, spine, and other organs. can provide more detailed information about the source of Bleeding.
Laboratory tests are necessary to quantify the extent of Blood loss and identify Blood coagulationBlood coagulation is a process that helps stop Bleeding when a blood vessel is damaged. Platelets and certain proteins in the plasma form a blood clot that seals the wound. disorders. A complete blood count provides information about the hematocritThe hematocrit value indicates the proportion of red blood cells in the total blood volume. It is an important indicator of the state of blood formation and can provide information on anemia, dehydration, or other diseases., the erythrocyte count, and the hemoglobinhemoglobin is an iron-containing protein in red blood cells responsible for transporting oxygen from the lungs to the body tissues and carbon dioxide back to the lungs. value. These values may initially be normal in acuteAcute refers to a condition that occurs suddenly and is usually of short duration. In a medical context, it describes symptoms or illnesses that can quickly become serious and require immediate attention. Bleeding because the body has not yet reacted with fluid shifts. Blood coagulationBlood coagulation is a process that helps stop Bleeding when a blood vessel is damaged. Platelets and certain proteins in the plasma form a blood clot that seals the wound. tests such as prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet count help to identify Blood coagulationBlood coagulation is a process that helps stop Bleeding when a blood vessel is damaged. Platelets and certain proteins in the plasma form a blood clot that seals the wound. disorders.
Further veterinary measures
A severe, usually arterial bleeding, is an immediate emergency. Take your pet to a vet as quickly as possible.
Larger arterial bleedings carry the risk of significant blood loss and are difficult for a layperson to stop. There is a risk of hypovolemic shock or exsanguination.
The therapyTherapy refers to the treatment of diseases or disorders with the aim of alleviating symptoms, promoting healing, or improving quality of life. Therapies can be medicinal, surgical, or through other medical interventions. for severe Bleeding follows the principle of “hemostasisHemostasis is the process that leads to hemostasis and stops Bleeding. It involves the formation of a blood clot by platelets and blood coagulation by coagulation factors. and circulatory stabilization.” For external Bleeding, direct compression is the most important initialInitial means beginning or at the start. In medicine, it can refer to the first symptoms of a disease or the first phase of a treatment process. measure. A pressure bandage should be applied; for arterial Bleeding, a tourniquet (ligation) proximalProximal describes a position closer to the torso or the point of origin of a body part. The term is used to describe the location of structures in relation to the body as a whole or to a specific organ. to the source of Bleeding may be necessary for a maximum of 20 minutes. In the case of penetrating injuries, foreign bodies must not be removed, as they may be tamponading vessels.
Circulatory stabilization is achieved through intravenous fluid therapy, preferably with crystalloid solutions such as Ringer’s lactate or isotonic saline. In cases of severe Blood loss, colloids or blood transfusions may be necessary. Ideally, blood typing should be performed before a transfusion, especially in cats, who can develop severe transfusion reactions.
Definitive surgical care includes identification and ligationA ligation is a medical procedure in which a band or thread is used to tie off or close a blood vessel or other channel in the body. This is often done to stop Bleeding or interrupt the blood supply to an area. of Bleeding vessels, removal of damaged tissue, and Wound closure. In cases of internal Bleeding, an exploratory laparotomyAn exploratory laparotomy is a surgical procedure in which the abdominal cavity is opened to examine internal organs and make a diagnosis. This procedure is used in dogs and cats when imaging techniques do not allow a clear diagnosis. or thoracotomy may be necessary. In some cases, interventionalInterventional describes medical procedures that are invasive to make diagnoses or treat diseases. Interventional techniques in veterinary medicine include surgeries, catheter procedures, and image-guided therapies. procedures such as embolization of Bleeding vessels via angiographyangiography is an imaging technique that uses a contrast agent to visualize blood vessels. It is used in veterinary medicine to diagnose blood vessel diseases in dogs and cats. may be an alternative to open surgery.
In Blood coagulationBlood coagulation is a process that helps stop Bleeding when a blood vessel is damaged. Platelets and certain proteins in the plasma form a blood clot that seals the wound. disorders, treating the underlying cause is crucial. For poisoning with anticoagulantsAnticoagulants are medications that slow down or inhibit blood coagulation. They are used to prevent the formation of blood clots and are used in dogs and cats with certain heart conditions or coagulation disorders. such as warfarin, vitaminVitamins are organic compounds that are necessary in small amounts for the normal growth, development, and physiological function of the body. Vitamins must mostly be obtained through food, as the body cannot produce them or not in sufficient quantities. K1 is administered, supplemented by plasmaPlasma is the liquid part of blood in which blood cells are suspended. It contains water, salts, proteins, and other substances and serves as a transport medium for nutrients, hormones, and waste products. or whole bloodWhole blood refers to blood in its natural composition, as it exists immediately after being drawn from the body, including all blood cells and plasma. transfusions in severe cases.
Prognosis and aftercare
The prognosis for severe Bleeding depends largely on the cause, the extent of Blood loss, the time to treatment, and the presence of other injuries or underlying diseases. Early treated external Bleeding generally has a good prognosisThe prognosis is the prediction of the likely course and outcome of a disease based on the general state of health, the nature of the disease, and the response to treatment. It can provide information on how a disease is expected to develop., while massive internal Bleeding or Bleeding due to severe Blood coagulationBlood coagulation is a process that helps stop Bleeding when a blood vessel is damaged. Platelets and certain proteins in the plasma form a blood clot that seals the wound. disorders may be associated with higher mortalityMortality is the death rate within a population over a specific period. It is often used to assess the severity of diseases or the effectiveness of health measures..
Aftercare includes regular monitoring of vital signs, hematocritThe hematocrit value indicates the proportion of red blood cells in the total blood volume. It is an important indicator of the state of blood formation and can provide information on anemia, dehydration, or other diseases., and wound healingWound healing is the natural process of repairing tissue damage, occurring in phases including inflammation, tissue regeneration, and wound contraction, to restore tissue integrity.. Significant Blood loss can leave behind anemia, which requires supportiveSupportive refers to supportive treatments that aim to alleviate symptoms and improve quality of life without directly treating the underlying cause of the disease. therapyTherapy refers to the treatment of diseases or disorders with the aim of alleviating symptoms, promoting healing, or improving quality of life. Therapies can be medicinal, surgical, or through other medical interventions. with iron supplements. The regeneration of red blood cells usually takes 3–4 weeks. During this time, the animal should be spared and only engage in light physical activity.
In surgically treated Wounds, watch for signs of infectionAn infection is the colonization and multiplication of pathogens such as bacteria, viruses, fungi, or parasites in an organism, which often, but not always, leads to a disease. or renewed Bleeding. DrainageDrainage refers to the removal of fluid from body cavities, Wounds, or inflamed areas, often using a tube or other device. It is used to prevent infection and promote healing. systems must be checked regularly and removed at the right time. Depending on the underlying disease, further specific measures may be required for aftercare. These include long-term anticoagulantAn anticoagulant is a medication that inhibits blood coagulation, thus preventing the formation of blood clots. It is used for the treatment and prevention of thrombosis and embolism. therapy for thrombosisThrombosis is the formation of a blood clot in a blood vessel that can obstruct or block blood flow. Thromboses can occur in veins (venous thrombosis) or arteries (arterial thrombosis). or chemotherapyChemotherapy refers to the treatment of diseases, especially cancer, with chemical substances or drugs. It aims to kill cancer cells or prevent their growth, but can also affect healthy cells. for tumorA tumor is an abnormal growth of tissue that can be benign or malignant. Tumors can develop in any part of the body and affect various functions. Bleeding.
Summary
Severe Bleeding in pets is a medical emergency that requires immediate action. They can be triggered by various causes such as traumas, Blood coagulationBlood coagulation is a process that helps stop Bleeding when a blood vessel is damaged. Platelets and certain proteins in the plasma form a blood clot that seals the wound. disorders, or tumorA tumor is an abnormal growth of tissue that can be benign or malignant. Tumors can develop in any part of the body and affect various functions. diseases. Recognition is based on clinical symptoms such as visible Blood loss, pale mucous membranes, and circulatory instability. In the case of internal Bleeding, imaging procedures and laboratory tests are crucial for the diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients..
The therapyTherapy refers to the treatment of diseases or disorders with the aim of alleviating symptoms, promoting healing, or improving quality of life. Therapies can be medicinal, surgical, or through other medical interventions. follows the principle of rapid hemostasisHemostasis is the process that leads to hemostasis and stops Bleeding. It involves the formation of a blood clot by platelets and blood coagulation by coagulation factors. and circulatory stabilization, followed by definitive surgical care. The prognosisThe prognosis is the prediction of the likely course and outcome of a disease based on the general state of health, the nature of the disease, and the response to treatment. It can provide information on how a disease is expected to develop. depends on the extent of Blood loss, the underlying cause, and the speed of treatment. Careful aftercare is essential to avoid complications and ensure complete recovery.
Pet owners should know basic first aid measures for Bleeding and act quickly in an emergency. A well-equipped first aid kit for pets should be available in every household and checked regularly for completeness.
Outlook on current research
Research in the field of hemostasisHemostasis is the process that leads to hemostasis and stops Bleeding. It involves the formation of a blood clot by platelets and blood coagulation by coagulation factors. and Bleeding management in pets is constantly evolving. New hemostatic materials such as zeolite-based powders or chitosan dressings show promising results in rapid hemostasisHemostasis is the process that leads to hemostasis and stops Bleeding. It involves the formation of a blood clot by platelets and blood coagulation by coagulation factors. and are increasingly used in veterinary medicine. These materials promote Blood coagulation through various mechanisms such as dehydrationDehydration occurs when the body loses more fluid than it takes in. This can lead to a number of problems, including headaches, Dizziness, and in extreme cases, renal failure or Cardiovascular collapse. or direct activation of the coagulationCoagulation is the process of blood coagulation, in which liquid blood is transformed into a solid clot. This process is crucial for stopping Bleeding and promoting wound healing. cascade.
In the field of transfusion medicine, blood substitutes and artificial oxygen carriers are being researched, which could potentially reduce the need for blood transfusions. These products would have the advantage of longer shelf life and universal applicability without blood type compatibilityBlood type compatibility refers to the matching of blood types between donor and recipient during a blood transfusion to avoid rejection reactions or complications. This is especially important in dogs and cats, as they also have different blood types..
Minimally invasiveInvasive describes medical procedures or pathogens that enter the body or penetrate tissue. In medicine, invasive procedures can range from minimally invasive techniques to open surgery. surgery and interventionalInterventional describes medical procedures that are invasive to make diagnoses or treat diseases. Interventional techniques in veterinary medicine include surgeries, catheter procedures, and image-guided therapies. radiologyRadiology is a medical specialty that uses X-rays, ultrasound, magnetic resonance imaging (MRI), and other techniques to image the inside of the body. In veterinary medicine, it is used for the diagnosis of diseases and injuries. are also gaining importance in veterinary medicine. Techniques such as endovascular embolization enable targeted occlusion of Bleeding vessels without open operation, which can be particularly beneficial in internal Bleeding.
In the field of Blood coagulationBlood coagulation is a process that helps stop Bleeding when a blood vessel is damaged. Platelets and certain proteins in the plasma form a blood clot that seals the wound. disorders, new diagnostic tests are being developed that provide faster and more accurate results. Point-of-care devices for measuring coagulation parameters enable timely diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. and therapy adjustment directly in the practice.
Frequently asked questions (FAQs)
- How do I know if my pet has internal Bleeding?
Watch for symptoms such as pale mucous membranes, weakness, rapid breathing, accelerated heartbeat, distended abdomenThe abdomen, also known as the abdominal cavity, is the part of the body located between the rib cage and the pelvis. It houses several important organs, including the stomach, liver, kidneys, intestines, and spleen., or collapse. If you suspect internal Bleeding, you should seek veterinary attention immediately. - Can I help my animal myself if it has severe Bleeding?
Yes, by applying direct pressure to the Wound with a clean cloth or bandage. Raise the affected limb and transport the animal calmly to the veterinarian. Do not remove foreign objects from Wounds. - How long does it take for my animal to recover from severe Blood loss?
Recovery can take 3–4 weeks depending on the severity. The formation of new red blood cells takes time. The animal should be spared during this phase. - Do cats and dogs need different treatments for Bleeding?
The basic principles are the same, but cats have specific blood types and can develop severe transfusion reactions. They are also more sensitive to certain medications. - Which dog breeds are particularly susceptible to Blood coagulationBlood coagulation is a process that helps stop Bleeding when a blood vessel is damaged. Platelets and certain proteins in the plasma form a blood clot that seals the wound. disorders?
Dobermans, German Shepherds, Poodles, and Scotch Terriers have an increased risk of von Willebrand’s disease. Hemophilia is more common in German Shepherds and Boxers. - How can I prevent Bleeding in my pet?
Keep your animal on a leash in busy areas, secure your garden, avoid sharp objects in the household, and ensure regular veterinary check-ups. - What should a first aid kit for pets contain?
Sterile compresses, elastic bandages, tape, scissors, tweezers, disposable gloves, disinfectant, and ideally hemostatic bandages or powder. - Can my animal Exsanguination from a small cut?
This is unlikely in healthy animals. However, in animals with Blood coagulationBlood coagulation is a process that helps stop Bleeding when a blood vessel is damaged. Platelets and certain proteins in the plasma form a blood clot that seals the wound. disorders or if arteries are injured, even minor Wounds can lead to dangerous Bleeding.
Literature
- Löwe, G. and Löwe, O., 2021. Emergencies in dogs and cats – A veterinary Guide. Kreuztal: Kynos-Verlag.
- Holowaychuk MK, Hanel RM. Canine and feline emergency and critical care. 2nd ed. Hoboken: Wiley-Blackwell; 2021.
- Plunkett SJ. Emergency procedures for the small animal veterinarian. 3rd ed. London: Elsevier; 2019.
- Giger U. Transfusion medicine and blood banking in small animals. Veterinary Clinics of North America: Small Animal Practice. 2021;51(1):1-19.
- Kelmer E, Segev G, Papashvilli V, et al. Effects of intravenous administration of tranexamic acid on hematological, hemostatic, and thromboelastographic analytes in healthy adult dogs. Journal of Veterinary Emergency and Critical Care. 2020;30(1):60-66.
- Lynch AM, Respess M, Boll AE, et al. Hospital-acquired coagulopathy in critically ill dogs and cats: a retrospective study. Journal of Veterinary Emergency and Critical Care. 2019;29(6):653-660