Bleeding 48 hours after surgery in a Greyhound

Question

4-year-old retired racing Greyhound, neutered uneventfully. At 40 hours he develops extensive bruising of the scrotum and inguinal area and the wound is oozing blood.

Parameter	Result	Reference
Platelets	165,000/µL	150,000–500,000
PT	7.8 s	6.0–10.0
aPTT	13 s	10–16
Fibrinogen	135 mg/dL	150–400
D-dimers	Increased	Normal
Buccal mucosal bleeding time	2 min	< 4

What is the most appropriate treatment?

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A. Desmopressin for suspected von Willebrand disease

The buccal mucosal bleeding time is normal, and von Willebrand disease causes immediate bleeding at surgery, not two days later.

B. Fresh frozen plasma and heparin for disseminated intravascular coagulation

DIC would cause thrombocytopenia and prolonged PT and aPTT, and would arise in a patient with severe underlying disease, not a healthy Greyhound after castration.

C. Immediate re-operation for failure of the cord ligature

A failed ligature causes early, localised and often intra-abdominal bleeding. Extensive, diffuse bruising at 40 hours with low fibrinogen and high D-dimers points to hyperfibrinolysis.

D. Antifibrinolytic (epsilon-aminocaproic or tranexamic acid)

Correct. Greyhounds are prone to delayed postoperative bleeding (36–48 h) due to hyperfibrinolysis, with normal platelets and clotting times. Epsilon-aminocaproic acid reduces this bleeding and is also used prophylactically in the breed.

lightbulb Key takeaway

In Greyhounds and other sighthounds, delayed bleeding after surgery or trauma with normal coagulation tests suggests hyperfibrinolysis. Remember too that sighthounds physiologically have fewer platelets and a higher haematocrit than other breeds.

What is the most appropriate treatment?

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