Liver Related Clotting Deficiencies in Cats

The coagulation proteins that are most often affected by liver disease are factors VII, IX, X and XI. These proteins are responsible for creating the fibrins that catch the clotted platelets to stop bleeding. Clotting issues may also arise if the liver becomes toxified by an external source (such as the ingestion of poison.) Toxins and or liver disease can also create a Vitamin K deficiency in the body. This vitamin is needed by the liver for proper protein production. Certain diseases prevent the liver from properly absorbing Vitamin K. A damaged liver can also lead to disseminated intravascular coagulation (DIC) in cats. This is a potentially fatal condition in which small blood clots form within the bloodstream, preventing proper clots from forming where needed. This can cause circulation within the cat to stop completely. 

Hemostasis is the natural clotting process within the body. The proteins in the blood that are responsible for completing hemostasis are created within the liver. When a liver is unhealthy for any reason, the production of these proteins in hindered or stopped completely, leading to potentially life-threatening situations. If a cat suffering from liver damage becomes bruised or cut in any way, the blood may not be able to clot properly to stop bleeding.

The first indication of a clotting problem may occur when bleeding is found but the source of the wound is unknown. This problem may also manifest itself as internal bleeding, which generally takes longer to identify. All signs to watch for include:

• Bruising
• Nosebleeds
• Hematuria (blood in the urine)
• Tarry stools (may appear black)
• Pale gums
• Dyspnea (difficulty breathing)
• Abdominal distention
• Lethargy
• Anorexia
• Jaundice
• Unconsciousness
• Seizures
• Paralysis

Any disease or injury that causes harm to the liver can result in clotting issues. Liver problems in cats can be exacerbated by diet or certain medications. Known causes are listed below.

• Liver disease
• Traumatic injury involving the liver
• Infection that has spread to the liver
• Liver cancer
• Consuming rodenticides or other poisons
• Viruses such as feline immunodeficiency virus (FIV) and feline infectious peritonitis (FIP)

Your veterinarian will need the cat's full medical history to help diagnose any underlying conditions. You also may be asked about any possible toxins available to the cat in your home. The veterinarian will perform a complete physical examination to feel for any organ enlargement or abdominal distention. The vet may then listen to both the heart and the lungs to check for abnormalities. Full blood work will be taken including a complete blood count to assess how much blood loss has occurred, and a biochemical profile to reveal any high liver enzyme activities.

A buccal mucosa bleeding time (BMBT) may be measured to see how long it takes the blood to clot. A sample of blood may also be sent to a lab to test the amount of soluble coagulation factors that are present. X-rays of the chest or abdomen may be needed to determine whether internal bleeding has occurred. These images can also be used to identify liver abnormalities and tumors. An activated partial thromboplastin time (aPTT) test may be performed to reveal any Vitamin K deficiencies. Clotting times that are longer than average by 30% or more indicate issues with Vitamin K factor responses. Urinalysis will identify any blood that is pouring out with the urine. An ultrasound guided liver biopsy may be done to collect samples of the liver for diagnostic testing. Viruses that affect the immune system such as FIV and FIP should be tested for. 

Blood loss and the inability for blood to clot may be treated before any underlying health issues. The appropriate course of treatment will depend on the liver condition that has been diagnosed. 

Vitamin K Injection 

Providing the body with this essential vitamin can help the liver to produce the proteins needed for the body to clot blood. This can aid both coagulation factor deficiencies and toxicity of the liver from ingested poisons. 

Blood Transfusions 

The transfusion of plasma or of fresh whole blood can help to elevate the amount of soluble coagulation factors in the body. Eventually, this may cause the body to properly clot any broken blood vessels. 

Other treatments will vary greatly depending on the liver problem at hand. Infections may be treated with a course of antibiotics, while cancers of the liver may need ongoing chemotherapy or extensive surgery.

The bleeding site should be monitored during recovery to ensure no more blood is lost. Elimination should become free of blood shortly after clotting takes place. Certain underlying liver conditions may need ongoing medications or drastic diet changes. Feed your cat a vet-approved, species specific diet geared towards the recovery of the liver. Administer all prescriptions as advised. Follow-up appointments may be needed to assess liver function.

It may be best to keep a cat with clotting deficiencies inside to decrease the chance of injuries that cause blood loss. This can also limit your cat's exposure to rodents who have ingested rodenticides. Go through your home and make sure any toxic substances are locked out of your cat's reach.