A nine-year-old German shepherd is presented with unchecked bleeding from a cut on the gums above the right canine tooth. The owner relates that the dog has lost weight and had an episode of collapse three days ago, but he recovered.

On physical exam, the gums are pale with petechiae and ecchymotic hemorrhages. There is tachycardia and a palpable cranial abdominal mass.

A coagulation profile shows the following:

Thrombocytes= 82,533 per microliter..[N=200,000-900,000]
Buccal mucosal bleeding time (BMBT), increased
Activated partial thromboplastin time (aPTT), increased
Prothrombin time (PT), increased
Thrombin time (TT), increased
Fibrin degradation products (FDPs), increased

What disorder of coagulation best fits this pattern?

Sorry.  You chose A, but the correct answer is B. Disseminated intravascular coagulation

A lab pattern of low platelets, increased bleeding time and across the board increases in aPTT, PT, TT and FDP tests suggests disseminated intravascular coagulation (DIC). DIC is not a disease in its own right- it is a complex hemostatic defect characterized by enhanced coagulation and fibrinolysis, secondary to other diseases. Fibrinolysis and depletion of clotting factors leads to hemorrhage.

Many, many diseases, all of them bad, can precipitate DIC. This case presentation (pale, older German shepherd with Hx of collapse, bleeding and an abdominal mass) suggests hemangiosarcoma.

Remember your "H diseases" associated with DIC:
Heart failure
Hemolytic anemia
Hemorrhagic gastroenteritis
Hepatic disease, especially hepatic lipidosis in cats.
Gastric dilatation-volvulus (GDV), mammary gland carcinoma and pancreatitis can also lead to DIC.

Follow this link to see a table of the four most important coagulation disorder patterns.

Refs:Cote, Clinical Veterinary Advisor-Dogs and Cats, 4th ed. pp. 269-70, Blackwell's 5-Min. Vet Consult Canine-Feline, 4th ed. pp. 394-5, 582-3.

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