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Common APBT Health Issues
I. Common Diseases/health problems
II. Von Willebrand's Disease
Below is a list of links to various health
topics. Click on Heading and you will be taken to an article about each
topic.
Click on each topic for an article about topic.
Von Willebrand's Disease
Von Willebrand’s Disease is a genetic bleeding disorder.
Dogs affected with vWD will have a reduction in the amount or function of a
blood protein which binds platelets to blood vessels. This blood protein is
commonly referred to as Von Willebrand’s Factor (vWF). The factor can come from
plasma, endothelial cells, or the subendothelium. The absence or deficiency of
the factor can be life threatening by leading to uncontrolled bleeding episodes.
It is a complex and difficult disorder to deal with, because genetics,
diagnostic abnormalities, and sometimes-conflicting clinical signs are all
involved. vWD has been discovered in the American Pit Bull Terrier, and the
American Stafforshire Terrier. There are three different forms of vWD. Types
III, II, and I. Type III is a very serious disorder, primarily found in
Scotties, which are affected with a total absence of vWF. It has a high
mortality rate. Type II has only been located in some lines of German
Shorthaired Pointers. This Type has more severe bleeding problems, because of an
absence of higher molecular weight of multimers. Type I vWD is the most common
form, Dobermans, Shetland sheepdogs, and many other breeds are commonly
affected. Dogs with Type I have all multimers decreased. We are still unsure
which category the APBT and the AST fit into, though it is believed they are of
Type I also.
Testing for vWD is not a routine procedure, unless the vet was actively
suspicious that there was a problem. You would need to ask for it. Unless there
were symptoms present, or unless the vet had dealt with a positive APBT or AST
before.
CLINICAL SIGNS
The clinical signs of vWD are typical of a platelet
function defect, such as spontaneous hemorrhage for mucosal surfaces, epistaxis,
hematuria, melena and excessive hemorrhage from surgery or trauma. Stillbirths,
neonatal deaths, prolonged bleeding at tail docking, ear cropping or dewclaw
removals are other common manifestations. Bleeding from gums, excessive
umbilical cord bleeding at birth, excessive bleeding from toenails cut too
short, and bleeding after elective procedures. Some other clinical signs are:
bloody stools, feces, hematochezia , forelimb lameness, forelimb swelling,
generalized lameness or stiffness, head, face, ears, jaw, nose, nasal, swelling,
hematuria, hemorrhage of any body part or clotting failure, hind limb lameness,
hind limb swelling, hyphema, neck swelling, pale, pelvic or perennial swelling,
petechiae or ecchymoses, red or brown urine, swelling skin or subcutaneous,
swelling, mass external abdomen, tachycardia, thoracic swelling..
Not all dogs with vWD will show clinical signs.
BLOOD TESTING AND RANGES
Diagnosis can be preformed by measurement of plasma
concentrations of vWF. The blood test is called the Von Willebrand’s Factor
Assay also known as the Enzyme-Linked Immunosorbent Assay (ELISA). This method,
developed by Dr Jean Dodds, has been validated for use in dogs, including the
APBT and the AST. This blood test is preformed at a Veterinary Hospital and then
sent into a laboratory for a rating of vWF. Daily variation in vWF can be high,
so multiple measurements may be necessary to establish the Von Willebrand status
of a dog. Hematology Laboratory of Cornell University established the following
ranges:
Normal range: 70-180% *Considered to be free from vWD, and
are unlikely to transmit the disease
Borderline range: 50-69% *Is equivocal, cannot be classified definitively but
may be clinically or genetically significant*
Abnormal range: 0-49% *May or may not be clinically expressed but are diagnosed
as carriers of vWD and can transmit the trait to offspring*
It is believed that dogs testing less than 30% vWF have an
approximately 75% chance of having the clinical signs for vWD expressed. And
dogs testing above 30% have a 25% chance of expressing clinical signs.
STRICT PROTOCOL YOU MUST FOLLOW FOR TESTING
Von Willebrand’s factor is a protein, the largest circulation protein in the
body, and it is delicate. It is easily damaged in the sampling procedure. The
more protein is damaged during testing, the more inaccurate the test result will
be.
Make sure dog is healthy and has not been on medication or
antibiotics for 60 days.
Dog needs to be unstressed.
Females should be tested mid cycle (90 days after heat ends), not while
pregnant, lactating or in heat.
Hormones and adrenaline can affect the test results, so it is not recommended to
test a male being breed.
Puppies as young as 7 to 8 weeks can be tested.
Vaccinations can interfere with results, wait at least two weeks after.
Do not test after a recent blood transfusion, wait at least 2 weeks.
Recent surgery, vWF may participate as an acute-phase reactant protein and
increase with inflammation or stress.
PROTOCOL FOR VETERINARIAN
This information should be printed up and given to your
Veterinarian before you run a vW test. Proper collection and handling is very
important in obtaining an accurate result. Before you test your APBT or AST make
sure your Veterinarian understands the manner in which a sample should be
obtained.
Speciamens should be collected in a manner, which minimizes stress and results
in a 'clean' collection with a minimal numbers of needle-sticks, rapid blood
flow, anticoagulation and avoidance of haemolysis. For the APBT and AST this may
be accomplished by using one of the two options listed below. Use only plastic
syringes and tubes.
The correct ratio of citrate anticoagulant to blood should be: a minimum volume
of 3.0 ml of blood is recommended to ensure that an adequate volume of plasma is
obtained. Collection of 5.0 ml of blood is preferred, if possible, since tests
are routinely run in duplicate.
Option #1: Use a 3.0 ml blue top, plastic Vacutainer tube
containing 3.8% Tri-sodium citrate anticoagulant with a 20-22 gauge needle. Draw
blood directly into the tube. Do not draw blood into a dry syringe and then
transfer it to the Vacutainer tube. Be sure to fill the tube as much as the
vacuum will allow to ensure the correct ration of anticoagulant and blood. Mix
gently but thoroughly to prevent formation of a clot that may result in a
lowering of vWF, or extension of clotting times.
Option #2: Use a plastic syringe and a 20-22 gauge needle.
Draw the blood into a plastic syringe in which there is 3.8% tri-sodium citrate
anticoagulant. Anticoagulant can be drawn out of a blood collection tube.
Observe the ration of 1 part anticoagulant with 9 parts blood. (ex: For final
volume of 3 ml, place 0.3 ml of anticoagulant in syringe and collect 2.7 ml of
blood).
DO NOT SQUIRT BLOOD THROUGH A NEEDLE FOLLOWING COLLECTION. THIS MAY RESULT IN
HAEMOLYSIS.
Remove the needle from the syringe and gently expel blood down the side of a
clean, sterile, plastic tube that can be used for centrifugation. Usually a
minimum volume of plasma for testing. Submission of at least 1.0 ml of plasma is
requested. Although they handle all specimens with care, submission of
additional plasma is recommended to ensure that an adequate volume is available
for testing.
Volume of Citrate in Syringe to Volume of Blood
0.3ml Draw up to 3 ml mark
0.4ml Draw up to 4 ml mark
0.5 ml Draw up to 5 ml mark
0.6 ml Draw up to 6 ml mark
After the specimen is collected it must be gently but
thoroughly mixed. The blood and anticoagulant must be mixed to help prevent clot
formation and to ensure that there is no activation of haemostasis that may
lower the level of vWF.
IF A CLOT IS PRESENT, THE SPECIMEN SHOULD NOT BE SUMITTED. RECOLLECT.
The next step is to Centrifuge and separate the plasma. Prompt centrifugation
and separation of plasma from blood cells is required. Usually centrifugation at
2000-3000 rpm for 10-15 minutes is sufficient. Attention to proper balancing of
the centrifuge is important since vibration due to inadequate balancing may
result in haemolysis.
IF HAEMOLYSIS IS PRESENT, THE SPECIMEN SHOULD NOT BE SUMITTED. RECOLLECT.
Carefully pipette plasma, taking care that erythrocytes are not aspirated. Use a
plastic pipette and transfer plasma to a clean, plain plastic tube that does not
contain additional anticoagulant.
Immediately freeze the plasma specimen.
Submit the frozen specimen to the laboratory by overnight delivery as soon as
possible. Ice packs or dry ice should be included with the specimen packaging.
Do not send specimens on Friday since the weekend may delay delivery.
Specimens ageing at room temperature over 1 to 12 days indicate a decline in vWF
concentration of up to 37%. Decreases of up to 18% may occur with only 2 days at
room temperature with progressive, but smaller decreases occurring up to 7 days.
After 7 days there appears to be more variation in levels with possible plateau
effect. Studies of specimen stability while frozen at -20 degrees Celcius for 1
week indicate no significant decrease in vWF concentration during this time.
This is important since thawing of plasma specimens during prolonged transport
may cause decreases that would change the interpretation of the test results.
For additional information or consultation about Coagulation testing Animal
Health Trust Diagnostic Services can be reached at 01638 552 993.
THINGS THAT DO NOT AFFECT TESTING
Age: Should not put your dog into a different category of
Von Willebrands. The levels of antigen will fluctuate a little over time, but
not enough to change status. It is advised to run a thyroid test before running
an vW test on an older dog. It is very common for old dogs to develop thyroid
problems with age, and this will affect the status on the ELISA test.
Sex: This disorder is not sexed linked (autosomal) meaning both male and females
can have it.
Worming: It is believed that medications used to de-worm a dog will not affect
the testing.
Food: The diet you choose to feed your dog will not affect the testing. This
includes feeding them before testing, or feeding them treats.
Heart Worm Preventative: Heart Guard or any other type of heart worm
preventative will not affect the vWF in the blood
Flea Control: Program, or any other type of flea control products will not
affect the vWF in the blood.
BREEDING
All APBT and AST breeders should be testing their dogs for vWD before breeding.
Please refer to the Blood test ranges above.
*Breeding of a borderline dog to another borderline dog,
most likely you will have 25% normal, 50% borderline, and 25% abnormal
offspring.
*Breeding of a borderline dog and an abnormal dog, most likely you will have 50%
to 100% abnormal offspring.
*Breeding of a borderline dog to a normal dog, most likely you will have 50%
normal and 50% borderline offspring.
*Breeding of an abnormal dog to a normal dog, most likely you will have 100%
borderline offspring.
*Breeding of an abnormal dog to an abnormal dog, most likely you will have 100%
abnormal offspring.
*Breeding of a normal dog to a normal dog most likely you will have 100% normal
offspring.
Notice I said “most likely” after each pair. With the
inaccuracy of the ELISA blood test, it is hard to determine the exact status of
the dog without multiple testing, therefore it is hard to truly determine the
exact percentages of abnormal offspring. But as you can see a borderline dog
will transmit an abnormal offspring 50% of the time.
*Dogs that are abnormal for vWD should not be used for breeding. (Even if the
dog does not show the clinical signs for vWD, it may produce abnormal dogs that
do). It may not be feasible however to remove all carriers from a breeding
program. If breeding a Borderline dog (it is necessary to preserve important
bloodlines or type) breed symptom free borderline dogs to normal mates, and
BLOOD TEST ALL PUPPIES. It is also recommend to test all puppies if you are
breeding two Normal dogs that both test between 70-79%. On average, one half of
the litter should be normal and the other half borderline. DO NOT MATE TWO
BORDERLINE DOGS TOGETHER, one quarter of the litter on an average will be
abnormal and possible bleeders!
DNA TESTING
DNA vW testing is a very accurate (much different from the
current blood test we are using). They take a sample of your dogs DNA (from the
cheek area) and the lab can determine weather a dog has vWD, if it is a carrier,
or if it is clear. Currently DNA testing is not available for the AST or the
APBT. VetGen Laboratory is currently working on developing a DNA test for our
breed. They are requesting that anyone with an ELISA blood test below 20% to
send in a sample (all cost paid for by VetGen) so they can determine were the
DNA for vWD is carried. Each breed is very different and they do have a DNA test
for numerous other breeds, but they must go though a process of targeting before
a DNA test can be developed for the APBT or the AST. VetGen would like to have
around 20 samples in order to develop this test. If you have tested your APBT or
AST and your results have been below 20% I strongly recommend contacting VetGen
at HealthyDog@vetgen.com. More information about DNA testing is available on the
VetGen web site at
http://www.vetgen.com/
BMBT
A Buccal Mucosal Bleeding Time (BMBT) should be evaluated
in any dog tested below normal for vWD. However, not all dogs with vWD will have
prolonged BMBT times. Dogs with a prolonged BMBT should be considered at risk
for hemorrhage during any invasive procedure (ex. ear crops, spay, neuter, etc).
Many Vets recommend having a BMBT done prior to any type of surgery, even on
dogs untested for vWD, as well as dogs that have tested as affected. It gives
you a clear picture on how the dog is clotting that day.
If the BMBT is abnormal the animal should not be used for breeding.
The BMBT is measured by determining the duration of
hemorrhage from small-standardized cuts in the upper lip. Folding back the upper
lip using gauze tied around the maxilla. This maneuver exposes the inner surface
of the upper lip and causes mild vascular engorgement. A disposable,
spring-loaded device is used to make two small-standardized incisions in the
mucosa. Visible blood vessels are avoided when one chooses the site to incise.
As blood is shed, it is blotted with filter paper at 5-second intervals below
the incisions to prevent formation of a fibrin coagulum over the wound. This
blotting should not disturb the wounds; otherwise the forming platelet plug will
be disrupted. The end point for the test is cessation of hemorrhage from the
incisions. The values obtained from the two incisions can be averaged. Normal
dogs have a BMBT of less than 4 minutes.
The BMBT is not always reliable in predicting bleeding, but if it is prolonged,
you know there is increased risk. If not prolonged, you don't always know.
CBT
Some recommend running a Cuticle bleeding time (CBT) test
on dogs testing abnormal for vWD. However not all dogs affected with vWD will
have an abnormal bleeding time on this test. Dogs with a prolonged CBT should be
considered at risk for hemorrhage during any invasive procedure. Ex. Ear crops,
spay, neuter, etc.
The CBT tests the duration of hemorrhage from a toenail that is cut short enough
to bleed. BMBT is preferred over the CBT test, because the CBT is also prolonged
in coagulopathies such as hemophilia A and B.
THYROID DYSFUNCTION
There is a direct correlation between Thyroid Dysfunction
and vWD. Evaluation of dogs with low plasma vWF levels should include evaluation
for thyroid dysfunction. In dogs with the congenital form of vWD, their bleeding
tendency becomes clinically severe when Hypothyroidism is present. Frequently,
dogs developing thyroid disease have lower levels of vWD. Hyperthyroid dogs also
may exhibit low platelet counts. Finding low or low-normal levels of vWD and/or
platelet numbers may be early indications of thyroid dysfunction in your stock.
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