Help! My horse lost half of her blood!

[Countryclips]

My Mare cut her back foot above the coronary band on Sunday and lost a ton of blood. By the time the vet arrived I had tried unsuccessfully to get it stopped. We had to knock her out to get it stitched then she got up too soon and banged around enough to break a stitch or 2 and it started gushing again. It was a nightmare then trying to get her to hold still to get a few more in. The lidocaine just did nothing. And the sedating drugs left her edgy and breathing like a race horse. It was just the 2 of us so near impossible to keep her still. The vet did not want to keep giving her drugs in her condition but we had to get it stopped. The nearest large vet hospital is over 4 hours away! We finally got help and twitched her, I helped hold the leg and we got it stopped. But she has lost so much I am wondering if there is anything I can give her to safely help her rebuild her strength. She is a good patient and stands quietly in her stall. She is eating and drinking well. All my horses are easy keepers so I have safe choice feed no molasses, oats ,flax, timothy hay, loose minerals. Should she be on a probiotic? The vet wants to keep the bandage on for a few days and she is leaving it alone. Any help would be appreciated.
Sandi

[JB]

Well, she didn't really lose half her blood - she'd be dead ;)

Leg wounds can bleed like stuck pigs and make it look like an incredible amount of blood.

Let her have her hay and her minerals. If you don't have a vit/min supplement or ration balancer, I would do that. Vit/min if she's an easy keeper, for sure.

She'll make more blood pretty quickly :)

[Bluey]

I think your vet would have given her fluids if she was too dehydrated to be safe.
Be sure she has lots of very clean water and ask your vet if you should give her any supplements.
He could give her some by injection, if that was a problem.

Always with such injuries, a pressure bandage will stop the rapid blood loss to a trickle.

Since your vet is the one that treated her, maybe you ought to ask him more questions, as they occur to you?

Looks like you did well acting quickly and getting her help.

[deltawave]

People can lose way more than half their blood and not die. I saw a 94 year old around Christmas who had bled down to a hemoglobin of 4. Her only complaint was she was hungry. :)

She has not only lost blood, but a good bit of her body's iron stores. See if the vet would like her to be on an iron supplement--it will help her replenish the lost red cells. Hands down that would be the most direct way of getting the body what it's lost, IMO.

[Ajierene]

I remember a mule getting a bad cut in his back leg. You could count his pulse by the blood gushing out - every hearbeat a big gush of blood. The interns were commenting how on a small dog, losing that much blood at a time would be serious, but this small mule, the vet was calmly talking to the owner and no one was rushing around - the blood he lost was a fraction of what he has in store.

I'm sure your horse is fine. Watching that blood gush out can be scary, but it doesn't sound like an emergency situation. If your horse really lost that much blood, she would likely be lethargic and kind of out of it.

[pj]

What about giving her some red cell for a while?

[Drive NJ]

The vet put Alex on Red Cell after he was injured in the fire to help increase his iron. With Vets Advice I'd try that.

[pintopiaffe]

I had a mare 'nick' a small vein down by her heel one winter. Every time she'd put weight on that foot, the geyser would shoot 12 feet or so. LOTS of blood. Paddock looked like a bad (overly dramatic) TV crime scene. Not stitchable and took several hours to clot. :dead:

She was pregnant at the time, so I started her on Sunshine Pellets/Calf Manna early. (Sunshine is the Blue Seal version of Calf Manna, almost identical ingredients) She was a little lethargic/depressed for a week or so, but picked back up nicely. I start with 2 cups and work up to 2lbs for the pregnant mares. I started her up pretty quick-2 cups the first day, 3 cups day 2, 4 cups day 3... etc.

The Sunshine/Calf Manna is very high in Vits A,B(s),D, & E, has good mineral levels, extra protein, & digestible energy...

Back in the day I'd have gotten Lixotinic or Red Cell, but I think the Sunshine/Calf Manna was plenty. Also had nice probiotics for the antibiotics she was on for a few days.

[Watermark Farm]

Here is some info for you. http://www.maineequineassociates.com/ArchivedArticles/BloodLoss.htm

I had a similar experience where my 8 year old mare sliced a little artery in her leg while galloping madly in pasture. The pasture and barn looked like a murder scene! Vet estimated she'd lost a good 20% of her blood volume. She recovered quickly with rest and a good diet.

Molasses is high in iron, and so is Teff grass hay, if you need ideas for some iron~

[4Martini]

When I lived in Dublin they would give us Guiness after donating blood to get our iron back up. Maybe a can or four of Guiness?

[deltawave]

No doubt the horse might enjoy the beer, but there's virtually no iron in Guinness. :lol: Maybe they did this in Dublin because it's probably a bit easier to get a buzz when you're slightly anemic and volume-depleted. ;)

[4Martini]

Not to argue with a doctor, but Deltawave maybe you should prescibe it:

http://www.telegraph.co.uk/news/uknews/1562788/Guinness-'may-be-good-for-you'-after-all.html

http://www.ivo.se/guinness/health.html

[deltawave]

I love it! :) If a dog needs 24 oz. to see a benefit, how much would a big, full-grown human need? :eek: This might be a happier town in general, come to think of it. ;) ;) ;)

[Foxtrot's]

Back in the '40's my Mom was told to drink Guiness to build her up after childbirth. She didn't argue the point!

[MelantheLLC]

Just a little emergency tip. Once I had a horse swing its hind leg over and hit the farrier's file tip--it apparently punctured a vein and the horse started to bleed all over the place, actually pumping blood. Soaked through five towels in a minute.

Vet on phone asked if I had any feminine pads on hand. Luckily I did. I slapped a couple of those over it, wrapped a towel around, and lo and behold, they absorbed and clotted enough blood to stop it flowing.

So I guess tampons are the order of the day now, but I always keep a box of pads around for bleeding emergencies!

[RiverBendPol]

Hey, that's funny, those guys http://www.maineequineassociates.com.../BloodLoss.htm are my vets!
I have a friend who was on a trail ride. Her mare stepped on the end of a stick. The stick flipped up and jabbed into her femoral artery. (that's the big ropey artery up inside a horse's thigh). The horse bled out (dead) in 7 minutes. Moral: if the bleed is actually pumping in rhythm with the beats of the heart, get a pressure bandage on it pronto. The pumping means you have an arterial bleed which will not stop on its own. In the case of a femoral artery, chances are you won't be able to stop it. Icare D’Auzay died at Badminton in 2007 from a femoral artery laceration.

[Murphy's Mom]

My mare cut an artery in her foot (split the hoof open) and there was a geyser shooting over six feet in the air. I was there when it happened and immediately stripped my turtleneck off and put on a pressure bandage before calling the vet. Gave the neighbors quite a show that day. :D Rebandaged before leaving for the hour drive to the vet on extremely icy roads.

Got there only to find the bandage had slipped and the inside of my trailer was covered in blood. I'm normally pretty calm in emergencies but this freaked me out and I started screaming for the vet. He came out and repeated over and over "she's not going die, she's not going to die, horses can lose a lot of blood". Luckily he had a surgery planned that day (a Sunday) so he had personnel already coming in. He bumped that horse and had my mare on the table within a half hour of our arrival. Since I had calmed down and was back to my normal, practical self he let me watch. Took over an hour to get the bleeding stopped and about two hours total for the surgery. She recovered just fine with some stall rest and her normal feed. No beer though. :lol:

ETA: He put a cast on her foot to keep her from ripping the sutures out. Don't know if that would work for your mare or not. My mare cut through the coronary band on the outside and through the bulbs of the foot, basically ripped a quarter of her hoof off. A friend had a horse with a similar injury. Her horse kept ripping the sutures out and her vet ended up putting a cast on a week later.

[George Myers]

A 500kg horse has about 40 litres of blood - that's a lot.

As stated above, if the blood is pumping and blood bright red, an artery has been breached and that's a whole lot more serious than a venous bleed which will be slower and the blood is darker. With an arterial bleed the most critical thing is to keep the horse's heart rate down as a stressed horse's heart rate can go up to over 200 beats a minute which, with a major artery bleed, means it will bleed out very quickly.

I've been lucky - never had to deal with a really serious laceration - thank goodness and touch wood.

[pines4equines]

I was hesitant to open this thread because I thought it was like a 1950s scary movie like The Blob or The Tingler or something....

My Horse Lost Half her Blood to Aliens from Mars!

Good luck with your horse.

[HFSH]

She has not only lost blood, but a good bit of her body's iron stores. See if the vet would like her to be on an iron supplement--it will help her replenish the lost red cells. Hands down that would be the most direct way of getting the body what it's lost, IMO.


NOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

No iron supplements!!!!! Ever! (no wire hangers... :lol: )

Horses have NO WAY of removing iron from their systems and many horses as they get older are iron-overloaded which causes a myriad of other problems (and can be a nightmare for an IR or PPID horse!)

Please do not ever, EVER supplement iron in a horse.

[4Martini]

I love it! :) If a dog needs 24 oz. to see a benefit, how much would a big, full-grown human need? :eek: This might be a happier town in general, come to think of it. ;) ;) ;)

According to my calculations (my dog weighs 1/2 what I do) the traditional 99 bottles of beer on the wall would cover me for a month (16oz bottles that is.) :lol:

Granted the same 99 bottles of beer would only last my horse 1.3 days based on weight :lol:

[S A McKee]

NOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

No iron supplements!!!!! Ever! (no wire hangers... :lol: )

Horses have NO WAY of removing iron from their systems and many horses as they get older are iron-overloaded which causes a myriad of other problems (and can be a nightmare for an IR or PPID horse!)

Please do not ever, EVER supplement iron in a horse.

I've had three different vets prescribe Finish Line, Red Cell and Red Glo for horses that were recovering from surgery or were anemic. All of those products contain supplemental iron among other things.

All horses involved were under 15 and were not IR.

[Thomas_1]

NOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

No iron supplements!!!!! Ever! (no wire hangers... :lol: )

Horses have NO WAY of removing iron from their systems

Please do not ever, EVER supplement iron in a horse. Where on earth did you get that silly idea from?

If a horse has had massive blood loss then there is likely going to be a reduced red blood cell count. As this is the oxyginating factor, it might help the horse to give them a boost.

Now I'm presuming that a blood transfusion wasn't needed or otherwise the vet would have arranged for that but for certain it won't harm the horse to provide haematinics, like iron and B12, available from a variety of sources today

Such as these:

http://www.ranvet.com.au/iron_plus.htm

http://www.allivet.com/RED-ALERT-p/aas141.htm

http://www.nutrecare.co.uk/prod6.asp?prod_id=1268&id=140&sub_cat=468&grpid=1268&msg=&offset=

or

Vital B mix
http://www.annascountrystore.co.uk/www.annascountrystore.co.uk/info.php?p=10&cat=95246

Even just loads of Water with molasses in

http://www.farmway.co.uk/equine-2/equine-feed-store-21/equine-supplements-27/natural-animal-molasses-supplement-197.htm

[Countryclips]

Thanks everyone. I did order some Red Cell and will get it tomorrow. The vet said that is a great idea. He drew some blood before he sedated her and ran it the next day and said her hemoglobin and plateletes were very low. He was amazed she was eating and doing so well. He is coming out on Thursday to remove the bandage and we are really hoping it doesn't start bleeding again. He did figure she may have lost up to 30% of her blood volume. I did have baby diapers and sanitary pads in my barn, so that is the first thing I grabbed . It was very cold so the vet wrap wouldn't stick to itself. Actually used duck tape and twine. I am going to make a better first aid kit for future emergencies. I advise everyone to think about that for your barns.

[deltawave]

orses have NO WAY of removing iron from their systems

One very good way to remove iron from the "system" is to bleed profusely. :rolleyes: Jeez, see the forest for the trees here. The horse has had a huge blood loss. With that blood went an enormous amount of iron. Putting it back is not going to hurt.

[Bluey]

Horse's spleen are a little tricky, storing at rest some 50% of red blood cells, that it can dump in the system when exerting, as in warming up and in a race.
I wonder if a horse that bleeds out so fast, if they will still have more red blood cells in reserve, those with enough iron, to replenish more easily that we would expect, once we get the blood volume up?

[deltawave]

I think the horse's spleen is simply a marvel of nature. Unlike our pitiful ones, good for nothing except to act as a giant lymph node. ;) (KIDDING, I know it's important like every other piece God gave us, but not NEARLY as cool or functional as a horse's)

My semi-educated guess would be that under the stress of a brisk and serious bleed, the same physiological messages would get sent out, along the lines of "time to flee", and the spleen would start pumping away, dumping its reserves just like if the animal were actually exerting itself. But don't quote me--maybe it's more blood pressure and cardiac-output-dependent than adrenalin or hypoxia mediated. Where's a vet student? :lol:

Each red cell contains its own little packet of iron, and when the cell is lost, the iron is lost forever. There is a little bit of extra stored here and there, and old red cells have their iron recycled, but a serious bleed = serious depletion of iron. The cells that are left can't share--new ones have to be manufactured, with whatever iron is left hanging around.

[stryder]

Each red cell contains its own little packet of iron, and when the cell is lost, the iron is lost forever. There is a little bit of extra stored here and there, and old red cells have their iron recycled, but a serious bleed = serious depletion of iron. The cells that are left can't share--new ones have to be manufactured, with whatever iron is left hanging around.

Nice explanation.
thanks.

[Pancakes]

I think the horse's spleen is simply a marvel of nature. Unlike our pitiful ones, good for nothing except to act as a giant lymph node. ;) (KIDDING, I know it's important like every other piece God gave us, but not NEARLY as cool or functional as a horse's)

My semi-educated guess would be that under the stress of a brisk and serious bleed, the same physiological messages would get sent out, along the lines of "time to flee", and the spleen would start pumping away, dumping its reserves just like if the animal were actually exerting itself. But don't quote me--maybe it's more blood pressure and cardiac-output-dependent than adrenalin or hypoxia mediated. Where's a vet student? :lol:

Each red cell contains its own little packet of iron, and when the cell is lost, the iron is lost forever. There is a little bit of extra stored here and there, and old red cells have their iron recycled, but a serious bleed = serious depletion of iron. The cells that are left can't share--new ones have to be manufactured, with whatever iron is left hanging around.


You called? :) Vet student chiming in --

You are correct in that the spleen is a magnificent organ that, in horses and dogs, can dump a set amount of reserves into the body in a time of need. That time of need does depend on a lot of things, and it's not necessarily as simple as hypoxia. Certainly, when horses are racing and they need an oxygen-carrying boost and have an increased cardiac output, they have contracture of the spleen. Also, adrenaliine can cause splenic contraction -- naturally more "excited breeds", such as Arabs and TBs, can have higher PCVs (packed cell volume) from transient bouts of excitement.

A horse's circulating blood volume is about 8% of its body weight, and they can lose only 33% of that volume to have a chance of survival.

In sudden blood loss, like from what the OP's horse experienced, the spleen does contract and help contribute what it can to the circulating blood volume, but unfortunately that's not enough sometimes. It's sometimes not evident how bad the loss was because the extra boost from the spleen can cover it up for a short while. So, the OP's horse may have seemed OK early on but can easily become anemic later -- something I'm sure the vet took into account when giving fluids to replace blood volume. However, in the case of immediate loss of blood volume, the goal is to replace the volume, not necessarily the blood cells itself. You'll die from hypovolemia before you die from anemia.

Replacing the RBCs is another problem and recommended in certain cases. Blood transfusions aren't quite easy in horses and there should be appropriate cross-matching done beforehand and blood typing, if possible. If not, a gelding or maiden mare makes the best donor to avoid adverse reactions. There are synthetic products to hep restore oxygen-carrying capacity, but they are quite expensive.

It takes a while for RBCs to form and mature properly. By the time the OP's horse will start to produce more RBCs, there will have been enough naturally-occurring iron turnover in the body from recycling of old RBCs. There will also continue to be absorption from the diet. It's not a permanent loss. The limiting factor in her case, an acute/sudden bleed, is not lack of iron but lack of circulating volume and RBCs.
While it won't necessarily hurt to give Red Cell in regulated amounts (use as directed by your veterinarian), it won't necessarily improve the situation. It's not that the RBCs in the body already are lacking iron, or that the body won't have enough to make more -- it's that there was a big loss all of a sudden. The chronic bleed situations is where you worry about having not enough iron, and the situation where an iron supplement like Red Cell would be needed.

Hopefully this novella on the pathophysiology of blood loss in the equine was helpful, haha. I hope I touched on the main points/questions people had; if not, feel free to ask for clarification or more questions!

[Bluey]

I still have somewhere our old, battery run hematocrit counter we used at the race track.
I wonder if they still use those?:yes:

[Kareen]

They do, at least here in ol' Europe. I know of few low-budget items that have greater value in instant diagnostics. Ok having a refractometer is a great thing too but these little hematocrit centrifuges are really really helpful in equine practise especially when you are out and the next clinic is far :)

[Countryclips]

Wow that was a great read. My mare is bright and relaxed in her stall. I have added some alfalfa to her diet and loose minerals, I have a little SweetPro Equipride. But I am almost out of it. No one mentioned if I should be giving her probiotics or not? She is on about 5 days of antibiotics. My vet says to keep an eye on the bandage, and I worry that with some swelling it can get too tight. But that seems to be the least of his worries. She is keeping it rested most of the time, but does put weight on it and walks about. I will let you know what it looks like tomorrow when he removes it to take a look!:eek:

[deltawave]

I'm not a big believer in probiotics in general, but they almost certainly can't hurt. :)

[HFSH]

Before you say I'm being "silly" please consider the following written by Dr. Kellon, VMD, a LEADING equine nutritionist. I'd trust someone with her knowledge far more than anyone who just assumes anything.



Iron is also typically ignored with regard to mineral balances, although it is known that high iron intakes inhibit at least zinc absorption. Many minerals have been found to potentially interfere with iron absorption in other species, including calcium, phosphorus, zinc, copper and manganese. Despite this, diet related iron deficiency has never been described in the horse except in foals (more on this under the iron discussion). Instead, because iron is so abundant in the equine diet, iron overload and iron interference with the absorption of the other trace minerals is much more likely. Iron is also unique in that the horse does not have a pathway for easily excreting it. Once inside the body, iron is there to stay except for tiny amounts lost in sweat and sloughed cells.



Iron is quite possibly the most oversupplemented mineral in equine diets. In fact, it's difficult to find a diet that is deficient in iron to begin with, even without all the supplemental sources. It only takes an
iron concentration in the overall diet of 40 ppm iron to meet estimated requirements (which have never actually been established to even be that high). More is never better, and this is particularly true for iron
since the horse has no way to actively excrete it. As little as 350 mg of supplemental iron can kill a foal. If iron deficiency is suspected, it should be confirmed by testing serum iron, total iron binding capacity and ferritin levels.


Excess iron has many effects, including predisposition to infection: secondary zinc and possibly copper deficiency, predisposition to arthritis and increased risk of tendon/ligament problems, liver disease and altered glucose metabolism – including insulin resistance and overt diabetes. In a self-perpetuating cycle, IR and diabetes also increase iron absorption.



The treatment for iron overload in people is blood-letting, periodic blood draws to remove the iron in the serum and contained in the red blood cells. In humans, it is known that regularly giving blood reduces the risk of developing IR, and lowering the iron burden improves already established IR. Iron build up can also be stopped, and levels of ferritin gradu ally lowered, by instituting a tightly mineral balanced diet.


Anemia is an abnormally low number of circulating red blood cells. “Anemia of chronic disease” is an anemia that is part of the overall reduction in metabolism that occurs when there is a chronic illness. These anemias tend to be relatively mild, with red cell counts hovering just below the low normal range.

It is very important to realize that anemia in these horses does NOT necessarily mean they have anutritional deficiency. Iron supplements should never be given

In fact, Dr. Kellon presented at the Equine Congress a lecture on this very subject, Iron overload, and how it relates to PPID or IR horses.

[HFSH]

I main point is before you just throw iron at your horse, confirm the horse is truly iron deficient first, by a simple blood test!

[JB]

I main point is before you just throw iron at your horse, confirm the horse is truly iron deficient first, by a simple blood test!

I think that is probably a much better way of stating it :)

Yes, most horses get PLENTY of iron in their normal diet, so supplementation, especially on purpose, should be done carefully.

But even the act of testing and showing the horse is "anemic" needs to be carefully looked at. Too many vets draw blood from a horse who has just been standing around. Bad idea since, as already stated here, a good bit of cells, and therefore iron, is stored in the spleen until it's needed. So, get the horse 15-20 minutes of exercise before pulling blood.

But even if he tests "low iron" then, I would not jump to adding iron. I would be looking at causes of poor iron absorption, since iron is so readily available in just even the hay or grass. Lack of sufficient copper is a big one - too little copper = too little iron uptake.

[deltawave]

The horse has HAD a major blood-letting. No, I don't think iron supplementation is required for horses in general, but this particular horse has lost a lot of its iron stores, very quickly. Replacing that is not going to hurt.

"Never" is a word that should be used in medicine, well . . . rarely. ;)

I think the thrust of the iron fears are based on the disease hemochromatosis, which is a genetic abnormality of iron metabolism, where the body just hoards the stuff. This is rare enough in humans, not sure about horses, but in general the body handles moderate amounts of iron (and every other mineral) just fine. :yes:

Needless supplementation? No. Giving a bit of a supplement when there has been a serious blood loss? I would.

[Pancakes]

The vet would be able to tell with a simple CBC if the horse is anemic (lacking RBCs) and if there is an iron deficiency through simple parameters measuring RBCs (MCH, MCHC, MCV).

Only horses with CHRONIC blood loss are at risk of iron deficiency.

I think the OP's horse would do fine if this is a one-time event and she chose to not give it Red Cell.
Save your money on the supplement and use it for the vet bill if your horse doesn't improve for some reason. The risk of anemia from iron deficiency is not as great as other possible complications, and I think the money might be more wisely spent on pain meds, antibiotics, dressings, etc. Besides, it's not like the horse is running around or doing anything that would require her to have a fully normal PCV and prime oxygen carrying-capacity.

[Thomas_1]

Before you say I'm being "silly" please consider the following written by Dr. Kellon, VMD, a LEADING equine nutritionist. I'd trust someone with her knowledge far more than anyone who just assumes anything.

In fact, Dr. Kellon presented at the Equine Congress a lecture on this very subject, Iron overload, and how it relates to PPID or IR horses. I think you failed to read or understand the use of the words "excess", "high", "supplemental" etc etc throughout the article. Likewise you seem to have glossed over the fact that the writer actually said that the "cure" for too much iron was blood letting!

What bit didn't you get about "This horse had a massive bleed."

[FindersKeepers]

Certainly tossing iron at an otherwise healthy horse will do nothing good. But it would do the same in any creature, really. There can be too much of a good thing.

But in the case of an animal with massive blood loss, that is anemic and iron deficient, replacing some of that can help the animal recover faster and prevent other serious problems.

So in this case, if the OP were to supplement for a week, and then have another CBC pulled, showing the horses values had normalized, obviously, she wouldn't continue to supplment, and clearly her efforts helped her horse. This isn't a post asking if someone should start giving their horse iron...it's asking what to do following a massive loss of blood to help the horse recover.

OP, I would add some probiotics. I always go that route when they are on antibiotics. It's just like a person eating yogurt when they are on antibiotics, it just helps keep things balanced. Nothing tragic will happen if you don't, but it might help her over all condition.

[deltawave]

It takes longer than a week for the body to crank up red cell production.

Following the hematocrit is one way to track things, but if there's any question of all about the horse's overall "iron status" then iron studies are very revealing. Different sort of test than a CBC, and does not depend on what the spleen is doing at that particular moment. ;)

[Countryclips]

I removed a very smelly bandage late yesterday. The vet advised me to leave it on 4 days in hopes it would not bleed when removed. Which it did not. but it was so wet and smelly from being wrapped with duck tape over the cotton and no way to breathe I wish I would have removed it sooner. We had a significant snowfall during the day and my vet chose to just let me send him pictures via Email and had I had problems he would have come out. It looked good, stitches all holding. I rewraped it after a flush with nolvassan . Today it was weeping a bit so left the wrap off. She is quite stocked up from being confined so let her walk about in the barn. It is below zero tonight and without the bandage I feel it will dry up sooner. But what do you guys advise? It will be 6 days tomorrow. She is very calm in her stall and does lie down each night but I have noticed it has always been on the opposite side of the injured foot.

[deltawave]

Is she getting anything for pain? Might help for a few days. I'd put some standing bandages on if she's stocked up, might help a little with the swelling and that alone might make her more comfortable. Swollen legs HURT. You don't have to put anything occlusive or heavy on the wound, just something for the stocking up.

If your vet thinks the wound is healing well, a little gentle handwalking might help, as long as it doesn't stretch or upset the healing tissues.

[columbus]

It is hard to estimate blood loss by sight. It is nearly always exaggerated and that includes by experienced doctors in ORs. Even a gallon of blood is not much for a horse and it can look like an immense amoung of blood squirting out an artery. The drama of the injury, the blood, waiting for the vet, the frustration of trying to get the bloodletting stopped in less than ideal circumstances makes it seem like a lot more blood than it usually is. Also remember that this is whole blood volume not red cell volume so half of what you are loosing is plasma.

I agree it is the volume that is the issue not the red cells lost and even that he would recover from quickly as he is a healthy horse with a normal appetite.

I would bet that no great splenic loss likely even occured as most of us work pretty hard to keep the horse calm in this situation to not activate the flight response(or the fight response). A nice slow natural red cell recovery is probably sufficient. It is in his best interest to feel a bit punk if his hemoglobin IS significantly low. He has a lot of healing before the wound site is ready for rough housing. A nice natural sedative of anemia isn't going to hurt and will probably help.

At this point by FAR the greatest risk is infection and this is a very tough area to treat especially considering that winter makes treatment much more difficult. Blood loss is a red herring here.

For the bleeding she had initially we usually make a mistake of removing our pressure bandages to SEE if it has stopped and the problem is we interupt the clotting cascade when we do this and a clot has to reform. If you put a compression bandage on and it has bled through I think yu need to place the next layer OVER the previous bandage without removing the first. I think our time might be better spent sharing what materials might have worked in winter cold...I have tried to get Duct Tape to stick at -20 and it won't stick so if it worked consider it a miracle. Has anyone had luck bandaging in this area to prevent excessive scarring...that is another trick. PatO

[HFSH]

I think you failed to read or understand the use of the words "excess", "high", "supplemental" etc etc throughout the article. Likewise you seem to have glossed over the fact that the writer actually said that the "cure" for too much iron was blood letting!

What bit didn't you get about "This horse had a massive bleed."

Completely ridiculous. Until you have a horse that suffers from iron overload (and all the health problems that come with it), you will probably not understand the reality and foolishness of supplementing for iron without hard evidence that the horse actually needs iron.

Most horses become iron overloaded at some point. Very rarely are horses on a properly balanced diet for their lifetime. Unbalanced diets can lead to iron overload. High vitamin C, high manganese increases iron toxicity. High iron can inhibit absorption of zinc and copper.

This horse may have benefited long-term from this blood loss. That was my point in the quote, which you failed to recognize, and instead got snarky about. Studies show that iron overload has proven to lead to a predisposition to infection, deficiency in zinc and possibly copper, athritis, liver disease, tendon issues, ligament issues, insulin resistance and sometimes diabetes.

I don't know what you know about equine nutrition (I gather not much or you would not be suggesting she supplement iron without testing), but I do know what I have studied, and continue to study. The classes I have taken are attended by vets and farriers, as well as breeders such as myself, and other horse owners. And I know that it is incrediby dangerous for people to make assumptions that the horse needs iron.
Iron supplementation for equines is foolish 99.99% of the time. NRC suggested iron requirements is only 40ppm. The upper 'safe' limit has been set at 500ppm. Most hay tests in the hundreds... more than sufficient.

In this senario, a blood check would be a worthwhile investment.

[Thomas_1]

Completely ridiculous. Until you have a horse that suffers from iron overload (and all the health problems that come with it), you will probably not understand the reality and foolishness of supplementing for iron without hard evidence that the horse actually needs iron. Wrong! I absolutely understand what over supplementation does. Indeed if you read my postings over time and re that matter you would come to appreciate that telling me not to supplement minerals or vitamins could be detrimental is like teaching your grandma how to suck eggs!

Most horses become iron overloaded at some point. Very rarely are horses on a properly balanced diet for their lifetime. Yeh right! And where's the evidence on that?

Unbalanced diets can lead to iron overload. High vitamin C, high manganese increases iron toxicity. High iron can inhibit absorption of zinc and copper. No sh** Sherlock!

This horse may have benefited long-term from this blood loss. :eek: Are you really being serious!??

That was my point in the quote, which you failed to recognize, and instead got snarky about. Studies show that iron overload has proven to lead to a predisposition to infection, deficiency in zinc and possibly copper, athritis, liver disease, tendon issues, ligament issues, insulin resistance and sometimes diabetes. You seem to have it in your head that the majority of horses are suffering detrimental and catastrophic health problems because of too much iron.

There's no evidence at all that that's the case.


I don't know what you know about equine nutrition (I gather not much Wrong! Know your audience!!! (or even just take a peek at my profile)

Iron supplementation for equines is foolish 99.99% of the time. NRC suggested iron requirements is only 40ppm. The upper 'safe' limit has been set at 500ppm. Most hay tests in the hundreds... more than sufficient. The requirement is 40 mg/kg for maintenance and a little more (50 mg/kg) for such as growth. However there's an interdependency with copper which is essential for iron absorption. When a horse has had massive blood loss then it's not "foolish" to suggest that it might be helpful to supplement iron.

In this senario, a blood check would be a worthwhile investment. The OP has told you that she's had a blood check and that hemoglobin and plateletes were very low and that haemostat would be a good suggestion.

[rcloisonne]

I think HFSH has drunk Eleanor Kellon's koolaid down to the last drop! The good Dr. blames DLSD on "iron overload" as well. What's next? Seems we're back to bloodletting as the cure for everything. :rolleyes:

[deltawave]

I think there is too much extrapolating going on between the well-described disease state of hemochromatosis (which is genetic and NOT acquired) and plain old "getting too much iron in the diet". The two are VASTLY DIFFERENT, and although it may be a reasonable thing to ponder, I'm not sure they are interchangeable. One is a disease where the body absolutely does not handle iron in the normal way. It's not caused by excess iron, it's genetic. The symptoms, indeed, are joint problems, liver problems, diabetes, heart failure--no question this is a very real entity.

Absolutely I think that excessive iron (and every other nutrient) is something to be avoided. Absolutely I think there may be a link between these things. But the major complications are seen in MAJOR iron overload, and IMO it's a bit of a long leap from one (dietary iron excess) to the other (a genetic disease of iron metabolism).

That said, if there's any doubt, a simple iron study (not a CBC) will answer the question nicely. If there is indeed excess, well, maybe the vet school could use a blood donor. :)

Another thing that makes this all confusing is that some of the iron studies (such as ferritin) are also used as inflammatory markers. Cause, or effect? We like to delude ourselves by thinking we know the answer to this one, but we don't. :no: "Inflammation" is a word that makes everyone's head spin, of course, but we understand it relatively poorly. How much is too much? When is it OK? When is it not? Whoever figures out this whole messy business will get the Nobel prize, hands down.

[Countryclips]

Well even though I find it very interesting reading all about the overloading of iron--that is not my concern at this point with my mare. I most worry about infection from the wet weepy wound, I left it unbandaged last night and it was not dirty this morning but the ooze was a bit thicker and has me concerned. She took the last of the 5 days of antibiotics yesterday and that is all my vet felt necessary. I sponged it gently with weak nolvassan and left it bare again. I plan to wrap it when I take her out later cause I no she will want to roll in the fresh snow. I will not have her out for long and will keep her away from the other horses so she does not get too excited. It did not feel hot. My vet does not want me to give her pain meds at this time just to keep her from feeling too good and wanting to romp around.
Thanks for all of your answers.
Sandi

[Stacie]

Today it was weeping a bit so left the wrap off.

Infection is much more immediate concern and leaving the bandage off will allow the wound to get dirty. Unless the vet recommends leaving the bandage off, I would keep it covered. Change it a lot if you are worried about the drainage.

[BornToRide]

I think HFSH has drunk Eleanor Kellon's koolaid down to the last drop! The good Dr. blames DLSD on "iron overload" as well. What's next? Seems we're back to bloodletting as the cure for everything. :rolleyes: And you must be drinking someone else's Kool-Aid?! Fact is that Dr. Kellon's research and information has helped thousands of horses and continues to do so. Are you jealous of her in some way?? :confused:

[Thomas_1]

And you must be drinking someone else's Kool-Aid?! Fact is that Dr. Kellon's research and information has helped thousands of horses and continues to do so. Are you jealous of her in some way?? :confused:
Who rattled your cage?

If you learnt to read for comprehension and context then you would come to appreciate that folks are saying that Dr Kellon's writing has been misunderstood, misused and misquoted out of context.

Seems that is something you don't have the monopoly on!

[Bluey]

Infection is much more immediate concern and leaving the bandage off will allow the wound to get dirty. Unless the vet recommends leaving the bandage off, I would keep it covered. Change it a lot if you are worried about the drainage.

Covering that site of the injury with some kind of bandage, although not as good for the healing as leaving it out to air, is also done to keep the tissues from swelling and pulling the stitches apart, which right now is also important.
That is very possible in that location and you don't want that.

You have to look at all the factors and manage as you see what is happening and what else may happen, as it looks you are already doing.:yes:

I have seen such kinds of injuries with stitches in the lower leg end up with some bow tendon, when it wanted to swell and the bandage didn't let it, as much as without bandaging, swell, rip stitches out and end up having to bandage anyway, for longer and then forming and leaving much scar tissue there, which in such a spot is not good.

When treating such, it is a balancing act with what you do or don't do, to keep adapting the treatment as the situation changes.

I hope all goes well and she heals fine.:)

[Countryclips]

It is still below zero here in Northern Mn this morning. I put a bandage back on and left it alone. But I see I will have to put something around the hole foot to give it any support. The cut is just above the coronary band and runs along the side midway towards the front of the hoof. It is actually not stressed too much when she walks. It is still icy here in spots so when I tried to walk her around yesterday there was some slipping going on. I mostly just tried to get her to stand out in the sun and look around. She did roll in the fluffy snow. I had a shipping boot on to give added protection. Is there anything I should be putting on the cut to help it heal? I still smell crud from the ooze. I am just not happy unless I am putting medicated ointments on boo boos.

[Thomas_1]

If it were me, then I'd be inclined if at all possible to be only just lightly covering it with a sterile dry gause dressing wound covering to keep out any mud and muck and then I'd be wanting to change the dressing at least a couple of times a day and each time I did it I'd be blasting the wound clean with a sterile saline solution. I wouldn't want to use ointment though as that's more inclined to hold in pus and infection and create the sort of dank environment loved by bacteria.

Wrapping up these sorts of wounds can be a bit of a nightmare if the horse is plodding around in the damp wet mud. If the dressing gets wet and warm then it's going to be a breeding ground for bugs.

So again I'd have him curtailed so he was just walking about on hard standing so he was getting limited movement only and not where it's all wet and yucky.

[HFSH]

Wrong! Know your audience!!! (or even just take a peek at my profile)


What does being a carriage driver have anything to do with equine nutrition? :confused: Are you a VDM? PhD? I don't find this in your profile? What are you implying, that driving horses means you know everything about equine nutrition? I don't see you doing research in the equine nutrition field.

I'm happy that the OP had a bloodwork drawn to determine if the horse needed iron. The problem is many people will read the first page of this thread and assume that if their horse gets a cut and has some bloodloss, they automatically need to supplement iron. Despite what has been said by many people here, supplementing iron is generally NOT neccessary nor warranted. It is generally readily available in the horses diet (hay, grain, pasture). I don't know why this is so hard to understand? I am not the person who brought up hemochromatosis. This is not what I was referring to.

And now Thomas, you're going on my ignore list. I suggest you put me on yours, so we can just agree to disagree and move on. ;)

[Pancakes]

I'm happy that the OP had a bloodwork drawn to determine if the horse needed iron. The problem is many people will read the first page of this thread and assume that if their horse gets a cut and has some bloodloss, they automatically need to supplement iron. Despite what has been said by many people here, supplementing iron is generally NOT neccessary nor warranted. It is generally readily available in the horses diet (hay, grain, pasture). I don't know why this is so hard to understand? I am not the person who brought up hemochromatosis. This is not what I was referring to.
)

I agree -- in the case of CHRONIC blood loss, iron supplementation is warranted. If there was acute blood loss so great it required a transfusion, adequate iron would be available in the packed RBCs or even a hemoglobin transfusion (oxyglobin, etc.). Regardless, the OP is FINE not supplementing iron; personally, I think it's a waste of money given that the horse is standing around and healing and not out there exercising a lot. Better spend the money/energy into wound care.

[rcloisonne]

And you must be drinking someone else's Kool-Aid?! Fact is that Dr. Kellon's research and information has helped thousands of horses and continues to do so. Are you jealous of her in some way?? :confused:
Sorry, but I'm a confirmed non-koolaid drinker. I prefer data, not wild speculation masquerading as fact, thank you very much.

[deltawave]

Did the horse get a transfusion? I wasn't aware of that. Indeed transfused red cells pack a very large amount of iron along with them. :yes: Since the body tends to chew them up first and fastest, the iron is readily re-utilized to make new cells.

[Pancakes]

Did the horse get a transfusion? I wasn't aware of that. Indeed transfused red cells pack a very large amount of iron along with them. :yes: Since the body tends to chew them up first and fastest, the iron is readily re-utilized to make new cells.

I don't recall the owner ever saying she did -- IV fluids were probably enough to resuscitate volume lost. If the PCV wasn't low enough to indicate a transfusion was necessary, then the horse should be fine.
I don't know how to make it more clear that iron supplementation is NOT INDICATED in acute blood loss not severe enough to require a transfusion. It's not like all the iron in the body is carried in the RBCs...there is enough elsewhere to support the creation of new ones!

In fact, supplementing iron without having veterinary instruction to do so (i.e. make sure the blood parameters do indeed show it is needed) can result in imbalance of absorption of other minerals such as copper and zinc.

[columbus]

I was just reading on some web page somewhere that those swim diapers for babies fit over a horse foot nicely...in this case it might go high enough up the ankle to cover the wound. Then vet wrap it into place...it is warmer now in Minnesota...after tonight...there was suggestions maybe on the TCCT Yahoo Group about what sticks in the cold. I know there is another option besides duct tape but it is to be in the 30s this week so now we get slop and frozen slop. Maybe a sock without a foot...be very glad it is not on the coronary band.

I would suggest you medicate while it is a wet wound and I use the human Tribiotic of some kind from the drug store. You can put a no stick pad on the wound and find something to cover. There is a light leg wrap that is gauze like but easier to work with and non-binding. Ask the vet...it may be a leg wrap down to the coronary band or he might very much NOT want that kind of bandage. remember don't comit to a high care bandage if you can't keep an eye on it. I am surprised your vet hasn't made any suggestions though they do wave good bye very nicely as they drive off. There is an advantage to the pressure of a leg wrap if that is needed to keep swelling from spliting the wound open. I use wet topicals or sprays until the wound healing starts contracting the edges together. At that point I switch to drying sprays that are to limit proud flesh. Many people than go to anti scarring medications to finish the healing. The goal is to keep the healing wound, then scab, then scar from continuously cracking due to the movement of the area of the wound. Good Luck. PatO

[foggybok]

You called? :) Vet student chiming in --




It takes a while for RBCs to form and mature properly. By the time the OP's horse will start to produce more RBCs, there will have been enough naturally-occurring iron turnover in the body from recycling of old RBCs. There will also continue to be absorption from the diet. It's not a permanent loss. The limiting factor in her case, an acute/sudden bleed, is not lack of iron but lack of circulating volume and RBCs.
While it won't necessarily hurt to give Red Cell in regulated amounts (use as directed by your veterinarian), it won't necessarily improve the situation. It's not that the RBCs in the body already are lacking iron, or that the body won't have enough to make more -- it's that there was a big loss all of a sudden. The chronic bleed situations is where you worry about having not enough iron, and the situation where an iron supplement like Red Cell would be needed.

!

Not quite, the recycled red cells will not provide enough iron for the accelerated erythropoiesis required after massive blood loss. Most iron in the body is stored in red cells and generally recycled as you say. With a huge bleed like this, the horse will lose a large portion of the body store of iron. In this case hepcidin levels will go down, which increases ferroportin expression in the enterocytes and macrophages, so more stored iron is taken out of the RE system and absorbed with the diet, but still will be not quite enough to meet the demand. It will take a while to catch up. Judicious iron supplementation in this case would be a good idea.

[foggybok]

Before you say I'm being "silly" please consider the following written by Dr. Kellon, VMD, a LEADING equine nutritionist. I'd trust someone with her knowledge far more than anyone who just assumes anything.




In fact, Dr. Kellon presented at the Equine Congress a lecture on this very subject, Iron overload, and how it relates to PPID or IR horses.




She's talking about a different problem, Anemia of Chronic Disease is indeed associated with increased iron stores and supplementation does nothing. But THIS horse had a significant bleed and has lost significant iron. It's likely he could benefit from supplementation for a while. Oh and by the way, I study this for a living:)

[foggybok]

The horse has HAD a major blood-letting. No, I don't think iron supplementation is required for horses in general, but this particular horse has lost a lot of its iron stores, very quickly. Replacing that is not going to hurt.

"Never" is a word that should be used in medicine, well . . . rarely. ;)

I think the thrust of the iron fears are based on the disease hemochromatosis, which is a genetic abnormality of iron metabolism, where the body just hoards the stuff. This is rare enough in humans, not sure about horses, but in general the body handles moderate amounts of iron (and every other mineral) just fine. :yes:

Needless supplementation? No. Giving a bit of a supplement when there has been a serious blood loss? I would.


oddly enough I just read somewhere where someone thought they had a HJV mutation in horses similar to the one in humans...so possible

But, as you have already said, this is a different case as this horse lost a LOT of blood........

[foggybok]

The horse has HAD a major blood-letting. No, I don't think iron supplementation is required for horses in general, but this particular horse has lost a lot of its iron stores, very quickly. Replacing that is not going to hurt.

"Never" is a word that should be used in medicine, well . . . rarely. ;)

I think the thrust of the iron fears are based on the disease hemochromatosis, which is a genetic abnormality of iron metabolism, where the body just hoards the stuff. This is rare enough in humans, not sure about horses, but in general the body handles moderate amounts of iron (and every other mineral) just fine. :yes:

Needless supplementation? No. Giving a bit of a supplement when there has been a serious blood loss? I would.

I don't recall the owner ever saying she did -- IV fluids were probably enough to resuscitate volume lost. If the PCV wasn't low enough to indicate a transfusion was necessary, then the horse should be fine.
I don't know how to make it more clear that iron supplementation is NOT INDICATED in acute blood loss not severe enough to require a transfusion. It's not like all the iron in the body is carried in the RBCs...there is enough elsewhere to support the creation of new ones!

In fact, supplementing iron without having veterinary instruction to do so (i.e. make sure the blood parameters do indeed show it is needed) can result in imbalance of absorption of other minerals such as copper and zinc.


Actually it might be in acute blood loss, depending on how much is lost. The OP mentioned 30% blood loss. Probably a little high, but 80% of the body's iron is stored in red cells, so this horse just lost 1/4 of it's total iron stores. That will make him deficient. On the other hand, he will recover naturally over time since there will not be ongoing blood loss, however he would recover faster with appropriate supplementation. Maybe it doesn't matter to this horse, but maybe it does... Depend on what the owner wants to do.

[Countryclips]

Things are not looking good with the wound at this time. I think the blood supply was limited to the tissue below the cut and it has now broke apart, the stitches have come undone on the back half and it looks infected. I was instructed to give 5 days of antibiotics in a sulfer pill form.. That ended last friday. On day 8 yesterday it just blew apart. The vet is coming out tonight to see what I am so upset about. I also see some proud flesh. I have been flushing with saline and wrapping it tighter. Got more antibiotics today- but the same kind. Wondering if good old Procaine Pennicillin would be better.

[Rick Burten]

Things are not looking good with the wound at this time. I think the blood supply was limited to the tissue below the cut and it has now broke apart, the stitches have come undone on the back half and it looks infected. I was instructed to give 5 days of antibiotics in a sulfer pill form.. That ended last friday. On day 8 yesterday it just blew apart. The vet is coming out tonight to see what I am so upset about. I also see some proud flesh. I have been flushing with saline and wrapping it tighter. Got more antibiotics today- but the same kind. Wondering if good old Procaine Pennicillin would be better.

You might want to discuss with your veterinarian, the use of Sugardine on the wound. I suggest Betadine rather than Povodine Iodine.

http://www.lesspub.com/s3/site/pdf/afj/_Sugar_dine.pdf
http://www.patentstorm.us/patents/5879717/description.html
http://equineink.wordpress.com/2008/10/31/surgardine-as-a-thrush-and-wound-treatment/

[Countryclips]

My vet was out and said the wound was not showing proud flesh just the granulation at this time. But there is a surface infection. Keep the bandage off is his advice, and flush twice daily with betadine or nolvasan. I read with interest about the sugardine, anyone ever tried this? He drew blood to test her hemoglobin and plateletes. He thinks they should be close to normal range after this many days. I am going to keep her in the barn for as long as it takes to start looking better. We still have clean snow and no mud, but it just looks like it could tear apart. She is being a good patient and can walk about and look out the door. Will put her on a lose dose bute when we no how her blood work is.

[Rick Burten]

My vet was out and said the wound was not showing proud flesh just the granulation at this time.
Proud flesh is exuberant granulation tissue.

But there is a surface infection. Keep the bandage off is his advice, and flush twice daily with betadine or nolvasan.

How does he propose you keep the wound(s) clean between treatments?

I read with interest about the sugardine, anyone ever tried this?

I have and so have several of my clients. Worked like a charm. :)


]

[trakehner013]

I know a horse who hurt himself on a trailer and he literally lost half his hoof. He was loosing a lot of blood, but they got him to a vet nearby. He is fine now and his hoof grew back.

[Thomas_1]

Things are not looking good with the wound at this time. I think the blood supply was limited to the tissue below the cut and it has now broke apart, the stitches have come undone on the back half and it looks infected. I was instructed to give 5 days of antibiotics in a sulfer pill form.. That ended last friday. On day 8 yesterday it just blew apart. The vet is coming out tonight to see what I am so upset about. I also see some proud flesh. I have been flushing with saline and wrapping it tighter. Got more antibiotics today- but the same kind. Wondering if good old Procaine Pennicillin would be better.
If it were mine, I'd be inclined to get the wrapping off unless you can do it very frequently and be sure of keeping it clean.

I'd also want to get the wound very clean and blasted with saline or icing sugar as a drawing agent for infection.

Also a broad spectrum antibiotic might be a good plan

[Countryclips]

The vet called me with the blood work and said the plateletes are at 51,000 and the RBC is only at 2.6, Normal is 6-12. I do have her on Redcell.

[deltawave]

Why the low platelets, I wonder? That is one anemic horse! I think you're on the right track keeping her quiet and low-key. And on Red Cell. Hope she continues to make progress. :)

[foggybok]

The vet called me with the blood work and said the plateletes are at 51,000 and the RBC is only at 2.6, Normal is 6-12. I do have her on Redcell.

poor pony! That's pretty severe anemia!

Keep up the good work, she should recover fine

[Pancakes]

Has the vet considered a transfusion? It would provide platelets, hemoglobin, clotting factors, and RBCs all in one. Give a quick good boost. At this point I'd be worried about inability for the wound to heal if the horse is that anemic/thrombocytopenic.