Dogs with Nosebleeds

Q. My mom's 13-year-old [mixed breed] woke up and began bleeding profusely from her nose. We rushed her to the veterinarian, but all he did was stop the bleeding and tell us bleeding like that was normal for old dogs. Since then the dog has had four nosebleeds, each one directly after she wakes up. One day I was home alone and she had her fifth nosebleed. The neighbor took me to the veterinarian when I couldn't stop the bleeding. The veterinarian and my family were annoyed with me and said I am overreacting. I am 13, and I am the one who gets Dog Fancy. I am afraid for the dog. Are this many nosebleeds normal for an old dog in the span of two weeks? The dog is otherwise healthy.

A. You are absolutely correct to be concerned about your dog's nosebleeds. Bleeding from the nose (epistaxis) is not normal in dogs of any age and can signal serious illness. Epistaxis can occur from one or both nostrils and varies from mild and self-limiting to severe and life-threatening. Some cases start with sneezing and traces of blood in nasal discharges, while others have profuse bleeding as the first sign, which you have experienced.

Any process that disrupts the nasal lining or blood vessels can result in epistaxis. Some causes are obvious, while others are more subtle. Nasal foreign bodies such as plant debris (blades of grass, foxtails, burrs) can cause violent sneezing and irritation to the delicate nasal lining. Any other cause of violent sneezing can result in nosebleed. Severe nasal infections with bacterial and/or fungal organisms and chronic inflammatory conditions such as allergies can also cause bleedin g. Although rare, advanced dental disease can sometimes involve the nasal sinuses and cavity, leading to nosebleeds. Trauma to the head and nose frequently results in nasal hemorrhage. Cancers of the nasal cavity can be very invasive and erosive and often result in epistaxis.

Blood-clotting disorders, which can be caused by many diseases, commonly lead to nosebleeds. The inability to clot could make a dog bleed easily. In many cases, nosebleeds can be the first or only sign of such a problem. Common causes of clotting abnormalities include von Willebrand's disease, hemophilia and ingestion of certain rat poisons. Anticoagulant rat poisons cause bleeding lasting days to weeks after ingestion, but acute signs of toxicity are not usually seen when the poisons are ingested. Blood or bone marrow infections with certain organisms (Rocky Mountain Spotted Fever, Ehrlichia) can also cause bleeding. Ticks usually transmit these organisms.

There are many more potential causes of nosebleed in dogs. Further testing might be needed to determine the exact cause of your dog's problem. Physical examination, blood tests and clotting profiles, thyroid tests, nasal cultures, nasal X-rays and nasal scoping should be especially helpful. Examination of nasal debris under the microscope can provide valuable clues in some cases. I strongly encourage you to pursue a diagnosis so proper treatment can be administered before the bleeding becomes more severe or widespread.