Von Willebrand’s Disease

This is Roxxi.    She looks a little woozy because she got spayed today (a complete ovario-hysterectomy, i.e. the removal of the entire puppy works).  People tend to think of this surgery as routine because it is performed so commonly.  Of course, it’s never routine for the dog — for her it’s a once-in-a-lifetime major surgery.  Most of the time it is routine for the doctor.  I’ve done lots of them, most dogs are put together in pretty much the same arrangment internally, I know what I’ll do first, what I’ll do second, etc.  It’s not like an exploratory surgery where you’re "making it up as you go".

Roxxi is a little different, though.  She has a bleeding/clotting disorder called Von Willebrand’s Disease.  She doesn’t make enough of a particular blood-clotting protein.  We discovered this when she had her ears cropped at ten weeks of age.  Interestingly, there was no excessive bleeding during her surgery (performed in the morning), nor was she oozing any during the day.  When I came back at 10:00PM to give her pain medicine, everything looked fine.  The next morning, we arrived to find that, while she wasn’t bleeding at the moment, she had bled a significant amount during the night. ["significant amount" = AAAGH!!! There’s huge puddle of blood under the grate in her cage!]  Fortunately, the rest of her recovery was uneventful.

We took blood to test for clotting disorders and found that she had Von Willebrand’s Disease.  The Doberman Pinscher is one of the breeds that is known to have this in their genes.  The disease is inherited, but it has incomplete penetrance, meaning that many individuals are carriers, but are not themselves affected with the bleeding problem. 

Another neat thing is that these dogs are not "free bleeders" under everyday circumstances.  It’s mostly only when they get some seriously traumatic event like being hit by a car, or surgery, that they have problems.  So when they need their clotting ability the most, that’s when they have it the least.  Bad timing.

If you read the VWD article in VeterinaryPartner.com, you’ll get a lot more technical information, if you’re interested.  One thing they mention is performing a "bleeding time" test pre-surgically.  Aside from the fact that it would add another $20 test to every surgery, I guess I’ve just been fortunate to see very little of this disease over the years (this is number two since 1978).  I’ve gotten complacent about checking for it ahead of time.

Normal test results for the VWD factor range from 70 to 180 at our lab.  Anything less than 60 is considered a potential bleeder.  Roxxi tested out at a big 7.  Since this is hereditary, she obviously should not be bred.  Ah, but what about doing surgery?  Won’t she bleed to death?  Yeah, she might…UNLESS she gets a transfusion of clotting factors (cryoprecipitate) before the operation.

It turns out that you can buy this from Midwest Animal Blood Services all ready to rock and roll.  They ship it to you frozen on dry ice and you just thaw and serve (through an IV over about an hour, that is).  There’s really only one hitch: it costs about $240.00 (including the overnight shipping).  That was enough to cause Roxxi’s folks to "think about it for a while".

Unfortunately, while they were thinking about it, Roxxi attained puberty, slipped out and got bred.  Whoops!  Now we’re looking at a potential hemorrhage during the birthing process, or during an abortion, just as we might fear during surgery.   So, they decided to take care of business, and Roxxi is doing just fine (though a bit groggy with pain meds tonight).