Clotting Deficiency (Liver Related) in Dogs

Liver disease often means there will be a deficiency in clotting proteins as a result. For example, neoplasia (abnormal growth of tissues and cells), and inflammation of the liver will cause a reduction in the breaking down of blood clots, and a deficiency in the production of coagulation proteins. Clotting factors are thirteen in number, with all but five of them being produced in the liver. This explains why liver disease can so easily cause a disorder in the clotting process.

A clotting disorder can be related to the functioning of the liver. A hepatic disease can greatly affect the ability of the blood to coagulate, specifically because the liver plays such an important role in the process of hemostasis (stopping of bleeding in an affected area of the body).

Episodes of bleeding which occur all of a sudden are often seen in veterinary clinics. Coagulation, or clotting of the blood, should occur under normal instances. Hemostatic derangement due to a liver-related problem must be addressed to ensure the wellbeing of your pet’s health. Symptoms that can be related to a clotting deficiency are listed here.

• Jaundice
• Fluid retention
• Vomiting
• Diarrhea
• Thirst
• Frequent urination
• Black or red stool
• Excessive bleeding after trauma or surgery

Many issues with proper clotting function can arise due to liver disease. Causes for this condition can be attributed to the following.

• Decreased Vitamin K which can cause an interference in the coagulation process
• Decreased albumin production (the inhibition of the production can be due to elevated ammonia because of liver disease)
• Lack of clotting factors because of the damaged liver
• Fluid accumulation in the peritoneal cavity
• Prolonged prothrombin and partial thromboplastin (clotting) time due to abnormal clotting function
• Thrombocytopenia (deficiency of platelets) due to dead liver cells
• Fibrinolysis (prevention of clot formation) due to liver damage
• Neoplasia (abnormal tissue growth)
• Liver enzyme dysfunction
• Inflammation

In simple terms, the majority of proteins and factors essential for clotting are produced in the liver. If the liver is diseased, the clotting process is disturbed.

When you bring your furry family member to the clinic for an evaluation, you will be asked many questions about the recent health of your pet (whether he has had an illness recently, and whether it is possible that he has been exposed to toxins). Also important to relay to the veterinarian are your dog’s urinary and bowel habits, his exercise routine, and the typical diet that he partakes in daily. A physical examination will be next, including heart rate, blood pressure, and palpation of the abdomen. It is possible that your veterinarian may find that the abdomen is swollen or tender.

The diagnosis of a clotting deficiency will be determined by laboratory testing procedures, such as listed below.

• Complete blood count
• Biochemistry profile
• TT - thrombin time (to check the fibrinogen function)
• PIVKA - to check the levels of Vitamin K
• ACT - activated clotting time
• PTT - activated partial thromboplastin time
• PT - prothrombin time (to verify the levels of this clotting factor)

The evaluation of the white and red blood cells is important also, to look for anemia which is common with coagulating deficiencies. As in every case, your veterinarian will be looking for an underlying cause for the clotting disorder. Further diagnostic tools could include liver function tests such as bile pigment concentration and plasma ammonia concentration. Imaging diagnostics like radiographs and ultrasound can give input into the condition of the liver, and an outlook on why the clotting deficiency is occurring.

The course of treatment will vary according to the cause of the deficiency. Because the problem is liver related, supportive care is most likely what will be in store. Dogs typically display symptoms of liver-related clotting deficiency only as the liver is becoming progressively more diseased. There are often multiple factor deficiencies contributing to the problem which are concurrent to the liver disease.

If there is a treatable underlying condition other than a serious progressive liver disease, medical intervention may completely resolve the problem. However, documentation shows that most often, the condition of the liver has deteriorated by the time the clotting deficiency has been discovered. 

Your dog may need hospitalization if his health is suffering at the time of the veterinarian visit; in this case, he will receive intravenous support to stabilize him. Protocol could include the following.

• IV fluids to correct electrolyte levels and aid in hydration
• Diuretics to correct balance fluids
• Corticosteroids for inflammation if required will be given and carefully monitored
• Medications for nausea
• Antibiotics for infection
• Vitamin K if levels are dangerously low

Even if the liver disease that is causing the clotting deficiency has no cure or is too advanced for repair, your dog can still live a pleasant life for the time that he has left. Your veterinarian will prescribe medication as needed and advise you on the diet and supplementation that will provide  your pet with a good quality of life. With your love and careful attention, your dog will have just what he needs to be healthy and happy.