A concerned dog owner sent me the following question:
My dog’s nose has been bleeding from left nostril for the last two days. My vet tested blood, and it is low in platelets — 70-ish. He is treating her with vitamin C, vitamin K, iron, and antibiotics. My friend told me that she had this problem and was treated with cortisone for a long time until her platelets became stable, and she had no other problems for more than 20 years now. What suggestions can you make?
Let’s deal with the last sentence first. My suggestion is to get some more tests run. More on that below.
Nosebleeds are pretty common in dogs, and they can be quite intractable. Continuous nosebleeds in pets do not merely pose a risk to the owner’s home, car, and clothing. Nosebleeds can be life-threatening, and they often are caused by serious medical conditions.
Nosebleeds, I am sorry to say, also pose challenges for veterinarians. Of course, we’re not supposed to call a nosebleed a nosebleed. Like everything in medicine, there is a fancy term for a nosebleed: epistaxis. Some cases of epistaxis are nearly impossible to control. Diagnosing their cause can be difficult.
Let’s start with the dog in the question. Her owner has mentioned platelets, which are blood cells that help blood clot. A deficiency in platelets definitely can cause bleeding anywhere in the body. That means that low platelet counts can lead to nosebleeds, and in my experience this problem is a common cause of epistaxis. However, I do not believe that platelets have anything to do with this dog’s bleeding.
Platelet counts usually range from around 150,000 to 400,000 cells per microliter of blood. Bleeding problems usually start when they drop to around 20,000 cells per microliter. The dog in question has low platelets (70,000 cells per microliter), but they’re not low enough to be a likely cause of the problem. Vitamins and antibiotics don’t help raise platelet levels, though. Cortisone, on the other hand, usually does.
Other types of blood clotting problems also may lead to nosebleeds. Consumption of certain types of rodent baits may lead to blood-clotting problems and hence to nosebleeds. So might liver problems.
Dogs with epistaxis due to blood-clotting problems are at severe risk of bleeding elsewhere in the body, so nosebleeds may represent only a small part of their troubles.
Any person who has ever been sucker-punched knows that trauma can be a cause of nosebleeds. I often see nosebleeds in dogs who run into walls, are tackled by larger playmates, or are hit by cars. These dogs may have suffered additional internal injuries as well.
High blood pressure may cause blood vessels to burst in the nose, leading to nosebleeds. Again, epistaxis may be only part of the problem — blood vessels could be bursting in the brain (leading to stroke) or eyes as well.
Foreign bodies in the nose may lead to epistaxis. In California, dogs sniff up foxtails all the time. They come to my office sneezing and often bleeding from the affected nostril. During peak season, I may see several dogs with nasal foxtails each day. Fortunately, in most cases foxtails can be removed and dogs with them can be cured.
Dogs have large, strong teeth. Their roots penetrate deeply into the roof of the mouth, and they abut the nasal cavity. If a tooth root becomes infected, the structures between the root and the nose may be degraded. A nosebleed may result. Extraction of the tooth may be curative.
Unfortunately, there is some more bad news. Tumors or serious fungal infections of the nasal passages may cause epistaxis. These types of problems can be quite difficult to treat in many cases. Surgical removal of nasal tumors is extremely difficult, although some nasal tumors respond well to radiation therapy. Nasal fungal infections sometimes respond to orally or nasally administered antifungal medications. Sometimes they do not.
If your dog has a nosebleed, he needs a veterinary visit. Getting him to the vet is best done as a two-person job. One person drives, and the other person should try to staunch the bleeding. The best tactics for slowing a nosebleed include keeping the dog calm and gently holding a towel over the nose. Elevate the dog’s snout so that the tip of his nose points up. This allows gravity to help control the situation. A cool compress applied to the nose may help a bit as well. Be aware that these tactics should not be substituted for a vet exam. Rather, they should be used to help with the situation while on the way to the vet.
The vet will want to run tests. Basic bloodwork, blood-clotting tests, and blood pressure measurement will be indicated in most cases. If there is suspicion of a foxtail, your vet may recommend a nasal search.
Be aware, however, that diagnosis of tumors and fungal infections usually requires relatively advanced techniques such as endoscopy and CT scans.
I am sorry to say that nosebleeds can be serious matters. Please take them seriously.