Life threatening haemorrhage is a worrying emergency for any species, but a large internal bleed can be a silent and fatal event in dogs that are rushed to the practice collapsed, seemingly without warning. A common site for medium to large breed dogs to bleed into is the abdomen, or belly, and this big space can quickly fill up with a critical amount of blood before owners are aware there is even a problem. This very scenario happened to poor Remy, the ten-year-old black Labrador, leaving her owner anxiously awaiting the outcome of an emergency surgery that was needed.

Enjoying her well deserved holiday in the New Forest, Remy had been running around the moorland, completely unaware of what was about to happen. She had spent a day or two drinking excessively which was a little unusual, and then this was followed by a few hours of her being very quiet, but this was put down to her being quite tired from her exertions. She perked up again towards the end of her holiday, but it was on the way back home that she really started to deteriorate.

Whilst stopping on the journey, Remy was laid flat out on her side and she wasn’t normally responding to her owner. She was cold to the touch and her owner really started to worry when Remy’s gums appeared quite pale compared to the usually healthy salmon pink colour. An emergency appointment was made at the practice as her owner anxiously rushed back home with her, and on arrival to the waiting room, Remy could barely walk in before flopping down on her side.

Normally such a bouncy, excitable dog, something was clearly wrong – her gums were indeed too pale and her temperature was reading worryingly low, confirming hypothermia. On top of this, Remy’s belly was slightly bloated, her heart rate was high and her breathing was laboured; she seemed exhausted.

A blood sample was immediately taken and analysed which confirmed that Remy was anaemic. An ultrasound scan of her abdomen revealed that a lot of blood was filling in the space between her organs. It seemed like this was originating from an irregular area – quite possibly a tumour. The most common reason for blood in the abdomen of a large breed dog like a Labrador is a bleeding tumour of the spleen – the largest organ in this region, containing a reservoir of red blood cells.

The news was broken to Remy’s owner that she needed to be rushed to theatre to have emergency surgery that evening, to locate the bleed and try to fix the problem. X-rays of her chest had shown there were no obvious underlying complications. Without hesitation, Remy’s owner consented and after a period of stabilisation with an intravenous drip, she was anaesthetised and prepared for the operation. During the operation, a huge amount of blood was immediately identified, but it came as a bit of a surprise that her spleen in fact appeared normal, as did her liver and kidneys. The two veterinary surgeons scrubbed into her operation that evening then had to investigate a little deeper to find the source of her life threatening bleed, whilst the veterinary nurse worked to keep her alive, monitoring her heart rate and blood pressure closely.

The haemorrhage that had occurred was suctioned out of her body using many syringes, and the excess blood was collected into a specialised bag with the aim of restoring it back into her circulation in a process known as an auto-transfusion. This was delivered into an intravenous line, simultaneously improving her now dangerously low blood pressure but also clearing a way for the surgeons to identify the underlying cause. Eventually, an irregular bleeding mass was identified hidden deep down in a corner of her abdominal cavity, and with great difficulty, the bleeding was stopped and the lesion was removed.

Remy’s parameters stabilised as her operation came to an end and she finished her transfusion overnight being monitored intensively by the night nurse on duty. Her unknown lump was sent to the laboratory for further investigation. The next morning, Remy was feeling better, eating and wagging her tail, and after a further night’s hospitalisation she was allowed home to recuperate further once her blood levels had shown her anaemia was slowly resolving.

After a few visits to the practice over the next week, her blood count gradually rose to within normal limits and by this time the result of her haemorrhaging mass had returned. It did reveal a tumour, and unfortunately a malignant cancer of the adrenal gland. The adrenal gland sits near to the kidney, and can sometimes become quickly enlarged and irregular to the point of being unrecognisable when cancerous. It releases steroid hormones, and when it is diseased it will often cause an increase in thirst just like Remy’s owner had noticed.

The result meant that Remy wasn’t cured, but she would have to be closely monitored for signs of tumour spread – known as ‘metastasis’. After a few weeks, she returned to the practice for a repeat ultrasound scan of her belly and X-rays of her chest. Fortunately, these were all clear and she is currently well and healthy, back to her bright self. Remy will now need regular surveillance over the rest of her life to try and quickly spot a return of the cancer, and when it is found, she will start a medication to help manage this. But for now, she is living her best life, whilst her owner cherishes every moment.