vWD

Jdmomkb, being an intact male does not automatically translate to being dog-aggressive. Several of us here (including myself) have intact males who, as Jason said, have the foundation of being well-socialized around all dogs. Oscar goes on walks daily and trains around other intact (and neutered) males and females with no problems. Of course as Mom and pack leader, you have to be vigilant and in charge, since you cannot control other peoples' dogs who may be aggressive towards Reese. I vaguely recall a thread entitled "Reese Is A Wimp" which I will go back and re-read, but the point is that if Reese is a non-dominant, non-aggressive pup now, remaining intact at least until he is a little older and healthier is not going to corrupt him into becoming a snarling, fire-breathing, fighting monster when he sees another male, esp. at his young age. Personally, I would NOT put him through the trauma of surgery and risk his life by possibly bleeding out until you have his other health issues well under control. Bottom line, don't be afraid to hold off on the neutering for now. JMHO.

Also, surely Reese has happened upon other males somewhere. How has he reacted thus far?

jdmomkb said:

Reese was suppose to be neutered this past Monday but the Thursday before I called the vet to let them know what happened when he lost teeth. The first couple of teeth were lost early in the day. At around 10pm he went to sleep with his head on my lap. He drooled all over me and his gums were still seeping blood. When he lost his last tooth I pried open his mouth and it looked like a bottle of fake Halloween blood. You couldn't see anything but blood. I gave him water with ice in it and I had to dump and refill a couple of times before the bleeding stopped. The vet agreed we needed to run a vWD test before neuter. His results came in today and he's a 5. He is also anemic but the vet thinks that is a result of the blood loss. He was all for neutering but now is totally against it. He said if Reese's number had been higher he would go ahead. He could bring in a donor dog or order whole blood but with the number being so low he is afraid he wouldn't make it off the table. How will leaving him intact affect his behavior if we encounter a male during a walk? Anyone else dealing with vWD or have any advise?

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One of my dogs is vWD affected. He also had an undescended testicle, so his neuter was far more invasive than the usual neuter surgery. No clotting problems then, or at any other time in his life so far. That's the norm with MOST vWD affected dobermans, even those with extremely low ELISA factor scores.

While it's *extremely* rare for a vWD affected doberman to become clinically affected, it does happen. I'd be concerned about the prolonged bleeding attached to his tooth loss, that would worry me more than the ELISA result of 6 %. I've known more than one dog who had comparable (or lower) ELISA scores that never had any difficulties. But it's *not* normal for there to be extensive bleeding like that during teething.

What I would do is try to find a vet with some experience in dealing with vWD in dobermans if at all possible. Or consult with an internist about it. Some vWD affected dogs respond to being given DDAVP prior to surgery by improved clotting ability. I'd always do the BMBT clotting test before any surgery was done on this dog (or any vWD affected dog).

Fresh frozen plasma or cyroprecipitate can be given as necessary for short term clotting-even if you don't go ahead with a neuter, you need to find which vet clinics in your area store one of these products in case of an emergency situation, not all clinics do store blood products.

Thanks for the replies everyone. It really helps to get the opinion of experienced owners.

Jason - The blue pup isn't mine, but I wouldn't mind dognapping him. He's awfully cute. Reese is a black six month old.

I looked at the VetGen site and think I will do the DNA test. I am also looking for a vet that specializes in Dobes. I have always liked my vet but he basically suggested I treat Reese like he was made of glass. I asked his assistant about Cryoprecipitate and she didn't know what it was. They have worked with dogs with vWD but not enough for me to be comfortable. I did want Reese neuterd but not enough to take a chance with his life. When I find a vet and get some more test results I'll decide what to do.

This is my first male and he is a learning experience. I have tried to socialize and train him as much as possible. He always makes me proud when we are out. He has been great with adults, kids and other dogs. His biggest problem is that he's not the least bit humble. He knows he's a great dog and thinks everyone should pay attention to him.=) When we go to a dog show or training club I see mature intact males that tolerate each other but everything I read warns about male aggressiveness. They make it sound like males will try to rip each other apart at first sight. Reese the Wimp has started protecting me from scary things like the corn field and pine trees but I can't imagine him being what some articles turn male Dobes into.

The following is a good read:

INVESTIGATION OF COAGULOPATHIES IN DOGS

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Coagulopathies in dogs most commonly present as a bleeding tendency. This may be due to the failure of primary haemostasis (platelet aggregation and vascular contraction) or to the failure of secondary haemostasis (formation of a platelet/fibrin plug as a result of the coagulation cascade). The history, clinical examination, in-house screening tests and laboratory screening tests all have a place in accurately identifying the abnormality and in initiating therapy to correct the disorder.
HISTORY

The age of onset, breed, history of previous episodes, relation to surgical procedures or trauma, drug therapy, access to toxins and any familial history of haemorrhagic episodes should be recorded.

CLINICAL EXAMINATION

Coagulopathies due to platelet disorders (primary haemostasis) commonly present with multiple pettechiation or ecchymoses (skin, mucosal surface or gingiva), epistaxis, melaena, haematuria, retinal/intraocular haemorrhage, bleeding after venupuncture or prolonged bleeding from incisions. In contrast coagulation factor defects (secondary haemostasis) commonly present as single haematomata, deep cavity bleeds, haemarthrosis or delayed bleeding/rebleeding. Venupuncture is usually uncomplicated.

IN-HOUSE SCREENING TESTS

1. EXAMINATION OF A STAINED FRESH BLOOD SMEAR

A fresh, air dried blood smear can be rapidly stained (eg Diff Quick stain) and examined under oil immersion. Platelet numbers can be assessed approximately by counting the mean number of platelets per oil immersion field (ten fields over the length of the smear). >5 platelets/oil immersion field corresponds to >100 x 109/L and indicates adequate numbers of platelets. Between 2 and 5 platelets/oil immersion field indicates a thrombocytopenia whilst <2 platelets/oil immersion field indicates a marked thrombocytopenia with a likely bleeding tendency. Additional information which may be noted is the presence or absence of shift (large, immature) platelets. (Examination of RBC and WBC morphology will give an indication of the regenerative status of any anaemia and may indicate the presence of neoplastic cells).

2. THE BUCCAL MUCOSAL BLEEDING TIME TEST

This test utilises a bleeding time device to produce a standardised incision in the buccal mucosa. Sedation or anaesthesia may be required depending on the temperament of the patient. The time to cessation of bleeding is recorded and compared to reference values. It is essentially a screening test for defects in primary haemostasis and is consistently prolonged in cases of thrombocytopenia, severe azotaemia and von Willebrands disease (Jergens et al, 1987). The bleeding time is also prolonged by drug therapy, notably aspirin and phenylbutazone. Both the bleeding time device (Simplate II R) and a protocol for its use are available from the laboratory (LABfaX Test Protocol 5).

3. WHOLE BLOOD CLOTTING TIME AND CLOT RETRACTION

The whole blood clotting time measures the mean length of time taken for freshly drawn blood to clot. A simple protocol involves taking 1ml of blood into each of three glass tubes, inverting every 30 seconds and recording the mean time to clot formation. A normal mean value of 6.1 +/- 0.2 minutes is reported in the literature with the test performed at room temperature (Littlewood, 1992). This test requires adequate platelet numbers (platelet phospholipid) in order to initate clotting and is best interpreted along with a platelet count. A modification of this is the activated clotting time test utilising ciliceous earth vacutainer tubes to initiate clotting. Both the vacutainer tubes and a protocol are available from the laboratory (LABfaX Test Protocol 9).

Clot retraction is assessed by re-examining the tubes after one to two hours. Retraction to 50% of the original volume is considered normal.

Whole blood clotting time tests are prolonged due to failure of the intrinsic clotting pathway and also due to marked thrombocytopenia. The activated clotting time is prolonged when a single factor is depleted to <5% of its normal value. Inadequate clot retraction suggests poor platelet function or thrombocytopenia.

LABORATORY SCREENING TESTS

The Coagulation Screen offered by this laboratory incorporates a haemogram, a one stage prothrombin time (OSPT) test and an activated partial thromboplastin time (APTT) test. Where possible, samples should be taken before initiating therapy using a plastic syringe and tubes. Citrated blood samples should be immediately despatched to the laboratory or should be separated and the plasma refrigerated (< 48 hours) or frozen at -20°C. (The exception is the von Willebrand factor assay which uses citrated whole blood. von Willebrand factor protein is stable for up to 48 hours at 22°C but is adversely affeced by refrigeration).

1. HAEMOGRAM

Evaluation of the haemogram requires an EDTA blood sample and a fresh blood smear. It includes an RBC count, haemoglobin concentration, haematocrit, MCV, MCHC, WBC count and differential, platelet count and a cellular morphology report.

2. OSPT TEST

The OSPT test is performed on citrated plasma and is prolonged due to deficiencies in the extrinsic and common clotting pathways. A time > 3 seconds over the reference range is considered abnormal.

REFERENCE VALUES
Canine : 7 - 10 seconds
Feline : 7 - 10 seconds

3. APTT TEST
The APTT test is again performed on citrated plasma and is prolonged due to deficiencies in the intrinsic and common clotting pathways. APTT is prolonged due to severe deficiency of a single factor (<30% of its normal concentration).

REFERENCE VALUES
Canine : 12 - 15 seconds

Feline : 12 - 22 seconds

Sodium citrate tubes are available free of charge from the laboratory. These tubes have a limited shelf life and it is worth checking that they still contain the liquid anticoagulant and that samples are not clotted before dispatch to the laboratory. Tubes should always be filled to the mark (1.3ml) and at least two tubes should be sent for each Coagulation Screen.
FURTHER INVESTIGATIONS

Depending upon the results of the Coagulation Screen a number of specific tests may be recommended. These include Anti-Platelet Antibodies (suspected immune-mediated thrombocytopenia), Fibrinogen Degradation Products (suspected disseminated intravascular coagulation), von Willebrand Factor assay and Haemophilia A (Factor VIII) assay. Bone marrow aspiration may be indicated in cases of non-regenerative thrombocytopenia whilst liver function tests may be indicated in suspect hepatopathies.

Abnormalities detected by the OSPTand APTT assays can be further characterised by performing correction tests and specific factor assays. These are beyond the scope of this laboratory and are referred to the Animal Health Trust.

INVESTIGATION OF SELECTED ACQUIRED COAGULOPATHIES

1. IMMUNE MEDIATED THROMBOCYTOPENIA

Destruction of platelets by antibodies is the commonest cause of a marked thrombocytopenia. The condition may be idiopathic or may occur secondary to myeloproliferative disease, lymphoma and systemic lupus erythematosus. It has been associated with drug therapy and can be a sequel to viral infection or vaccination. Typically the bleeding time is increased and the clotting time normal or slightly increased. The time taken for clot retraction is also increased. The OSPT and APTT are both normal. Characteristically there is a profound thrombocytopenia (<50 x 109/L and often <20 x 109/L) (Bush, 1991). Few or no platelets may be present on a fresh smear. Where platelets are present there is often evidence of regeneration (immature or "shift" platetets). Diagnosis may be confirmed by demonstrating the presence of anti-platelet antibodies although often a presumptive diagnosis is made and immunosuppressive therapy initiated.

2. VITAMIN K ANTAGONISM BY COUMARIN DERIVATIVES

Vitamin K antagonism by coumarin rodenticides is one of the more common poisonings seen in dogs. Typically the bleeding time will be normal and the clotting time increased (normal in mild or early cases). Clot retraction will be normal. The OSPT is reliably increased before the APTT (the APTT may be normal in mild or early cases). The platelet count will be normal (Bush, 1991). Samples for the coagulation assays must be taken before vitamin K treatment is initiated. Some of the modern coumarin derivatives have long half-lives and treatment may be required for weeks. If the compound has not been identified it is useful to repeat the OSPT two to three days after cessation of vitamin K therapy to check that the compound is not still active.
Test Code Test Description Sample
COAG Coagulation Screen EDTA, Fresh Smear + Citrate 1:10 (>2ml)
APF Anti-platelet Antibodies EDTA (5ml)
FDP Fibrinogen Degradation Products 1:10 Citrate
VW von Willebrand Factor 1:10 Citrate


REFERENCES

BUSH,B.M. (1991). Interpretation of Laboratory Results for Small Animal Clinicians. Blackwell Scientific Publications. Oxford. p 196-219.

JERGENS,A.E.,TURRENTINE,M.A.,KRAUS,K.H AND JOHNSON,G.S. (1987). Buccal mucosa bleeding times of healthy dogs and of dogs in various pathologic states, including thrombocytopenia, uremia, and von Willebrands disease. Am J Vet Res. 48 (9) p 1337-1342.

LITTLEWOOD, J.D. (1992). Differential diagnosis of haemorrhagic disorders in dogs. In Practice 14 (4) p 172-180.

LABfaX Disease Investigation 5 : Version 1 : 01/03/96


Wish you all the best.

Naveen

There are too many other factors that can and do affect bleeding/clotting as you've seen here to write this off to vWD--you may have a clinically affected dog but you may not.

I think what you need to do is start interviewing vet surgeons/internests to see if you can find someone with more experience with surgeries for a dog with potential clotting problems.

I don't see any particular reason for keeping a dog intact if you aren't showing in conformation (where it is required) and even though I do keep intact males and do so without problems I think on average it's perhaps somewhat easier for most folks to live with a neutered male.

At least one of the potential problems of keeping intact dogs around is that there is always the scenario where some one with another intact male who has no clue about dealing with them them will allow their dog to be aggressive or to attack your dog. Unfortunate but true--it may take two dogs to fight but it only takes one aggressive dog to initiate a fight.

A neuter, particularly of a young dog is a very non-invasive proceedure--but it's possible to have quite a lot of leakage bleeding in the aftermath so you do need to find out what exactly is causing the bleeding--and what normal clotting time is for him. I'd certainly delay surgery until you find out, I'd gene test for vWD but I'd also be aware that you may have bleeding problems with everything all his life even if the bleeding isn't a direct result of his vWD status.