For the last nine days Chief, a ten-year-old Arabian gelding, has been a patient in our clinic’s ICU. His adventure began on Monday evening December 6, 2010. His owners phoned in with an emergency: Chief had a puncture wound on his jaw that was bleeding heavily. Dr. O’Keefe immediately drove to their farm to assist. Although the wound was small (less than an inch) the facial artery and vein had been severed. Placing sutures to ligate the bleeding vessels didn’t stem the blood flow for very long. Blood continued to stream from the wound.
Chief was moved to our clinic so that we could tend to his wound more completely and do surgery if needed to close the blood vessels. Usually horses clot vessels (even large ones) long before losing as much blood as Chief had. Intravenous fluids were run as fast as possible and more work was done to close the vessels and stop the bleeding. The concern was that Chief had a second medical problem that was preventing his blood from clotting. Chief fainted and had seizures several times that evening. It quickly became impossible to do surgery due to Chief’s blood loss and unstable blood pressure. By the time he was stabilized and the bleeding contained, his packed cell volume (PCV) had dropped to 17 (normal is 32-50).
We expected Chief’s condition to stabilize once the bleeding was stopped, but over the next couple of days his PCV dropped from 17 to 12 and finally to 10 with his total protein levels reaching a critical 3.2 (normal is 5.4-7.6). Although there was no evidence of additional bleeding, he had lost so much blood the first evening that he was not able to produce new blood cells and proteins fast enough.
Thursday (the day his PCV dropped to 10), it was decided that a blood transfusion was needed. Chief’s owners had another Arabian gelding that was volunteered to be our blood donor. Over four hours that evening five liters of blood were transferred from Beau to Chief. The blood transfusion was successful. It helped Chief to maintain his blood pressure and will help stimulate production of new red blood cells. Chief went home today with a PCV of 14 and a total protein of 6.2. He will be monitored regularly until his red cell numbers return to normal.
For several days, Chief was monitored around the clock because the risk of his reopening the wound and bleeding were so high. In addition, because Chief’s case was so unusual, we consulted with our network of referral veterinarians: Dr. Lascola & Dr. Santos, Univ. of Illinois, and Dr. Phillip Johnson, Univ. of Missouri. Dr. Johnson shared another complicated bleeding case with us many years ago. The consulting veterinarians have been tracking his progress. There is no way to know why Chief lost so much blood. A shredded blood vessel that tore along its length or an autoimmune disease that affected clotting are both possible.