Severe Non-Regenerative Anemia

sarah super

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Hi all,

Our cat Hank female - picture to the right - has very severe non-regenerative anemia. At present, we don't know the cause, but she's tested negative for FIV and FLV.

On Friday her PCT score was 5%, and we took her to an emergency vet hospital on Saturday, where she had 2 blood transfusions. The first had no impact on her score, but the second increased her score to 18%. Over the course of Saturday night it fell back to 14% where it appears to have stablised for the moment. We're taking her to our regular vet tomorrow for another test.

Currently she's on Pred, a medication to prevent gut problems from taking that and the regular antibiotic to treat for the blood parasite. We're currently not contemplating doing a biopsy of her bone marrow or a sonogram of her intestines, as we recognise that she's a really really sick kitty, and feel that we want to see her start to improve before subjecting her to further testing. We have the option of additional transfusions if necessary and I think we would be prepared to do this if her blood count falls again. What we're focusing on now is on trying to keep her eating and drinking. Fortunately she now does have some appetite and is eating about half of what she would eat if she was fully well.

We're currently feeding her fancy feast wet food, as it seems to be the best thing to get her to eat - she still won't really eat her regular food - some treats and Whiskas cat milk. We're going to speak to the vet tomorrow to see if there's a type of food he'll recommend to ensure that she keeps eating, but in the meantime, does anyone have any recommendations for highly palitable and highly nutrituous food for her?

Please keep her in your thoughts - she was a feral kitten who we rescued and she's only 2 years old....
 

denice

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There is a prescription food called Hills A/D that is for critically ill animals.  My kitty was on it when he had fatty liver.  He got it through a feeding tube but others here have said that kitties seem to really like it.

I hope your kitty can beat this and recover.
 

quiet

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Hi

5% is crazy low. Think you need a specialist. You might want to ask your vet for a referral. You have to be careful with to many transfusions as the chance of a bad reaction increases with each one. A bone marrow aspirate will probably yield the most information.

I understand why you don't want to do any more testing for now. Not sure I would want to either.

I hope you are aware that she needs to be kept as quiet as can be with minimal movement. Every bit of her energy needs to go for making more blood cells. What antibiotic is she on?
 
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sarah super

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The Vet Hospital she was an inpatient at over the weekend is both a specialist and a treatment centre for urgent cases. They actually have cat blood donators on site and she was crossmatched before treating the infusions. Their care has been awesome and I have absolutely no complaints. When Hank was admitted on Saturday, it was via referral from our regular vet and they immediately started treatment. As she was severely dehydrated, the assumption has always been that her PCV was lower than 5%... They not only transfused, they also IV'd fluid to solve her dehydration.

I'm not sure what the antibiotic is, and I'm at work, but I know that she has to take it for a month, possibly Doxycycline in liquid form, but I'll need to double check at home.

We are absolutely keeping her inside and minimising her movements - would you suggest that we also restrict her to one room or a smaller space...

Many thanks for your input, as I'm sure you're aware, she's a very sick kitty and the next few days are going to be critical for helping her pull through this.
 

red top rescue

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 If you get a more definitive diagnosis as to the cause of her anemia, please let us know, as every bit of information we get on this site may help someone else in the future.  We'll be praying for Hank. 
 

ldg

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If her HCT (hematocrit) remains stable, then you at least know her bone marrow is working.

Does she go outdoors?

Fancy Feast (the classics) is at least a high protein, low carb food (anything with gravy has lower protein and a lot more carbs). High protein, low carb is is appropriate. If she's eating it, keep feeding it. If you want a higher calorie food, you can use Nature's Variety Instinct cans or EVO. This are high protein, low carb, but with more fat, which adds calories.

My kitty, Tuxedo, had an autoimmune disease that caused severe anemia. He was also treated for a blood parasite, and that helped for a while but as it wasn't a blood parasite, it didn't continue working. In the end, pred was used to suppress his immune system. When that stopped working, he needed shots of depomedrol. The mechanism of action was different enough from pred that it worked. We did give him shots of epigen (erithropoeitin) along the way to boost his production of red blood cells.

Vibes for your Hank! :vibes: :vibes: :vibes: :vibes: :vibes:
 
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sarah super

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I asked the Emerg Vet yesterday about the test for the blood parasites, and she said that as they were already giving antibiotics for that, then she didn't recommend testing for it at that point. Thanks for the heads up about HCT, I'll ask my other half, who'll be taking her to the vet for her PCV retest tomorrow if the vet can release the blood results so I can take a detailed look at them, and to see what her HCT scores are like. I do take some comfort from the fact that even very severe anemia can be at least managed, and the severity of it doesn't automatically mean bad news. This in no way changes the fact that she's a very seriously ill kitty. When we took her into the ICU on Saturday, I wasn't at all hopeful that she would make it through the night. The worst thing for me is the waiting and hoping in the absense of clear information on a root cause, but to have done a full battery of tests as well as stablising her would have cost us $5,000, when we were very uncertain that she would last the night. If she gets through this week ok, then I think we'll be looking at considering further testing.

The hardest thing about when our animals are ill is the fear that we didn't do enough too soon. I wish we could have noticed her anemia before it had become super critical, but up until less than a week ago, she didn't really have symptoms other than weight loss, and she's gained weight over Winter for the last 2 years, and then started to lose it when it gets warmer. She also has longish fur, which means that it's hard to spot significant weight loss. I feel really guilty because I always try to take really good care of our girls and I'm annoyed with myself  that I missed this.
 

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If they are treating with doxycycline and that is specific for the parasite they suspect, then it's probably what we used to call hemobartonella, but that's usually a regenerative anemia caused by a form of mycoplasma which isa  type of bacteria, and much more common in fighting males.  I don't know if it's seen that often anymore, and there's no need to test of it if they are already treating for it.  Regenerative means there is nothing wrong with the bone marrow, it's just that something is destroying the red cells, and the bone marrow is trying to produce more as fast as it can inresponse, so let's hope that's what she has because that is treatable.  Nonregenerative means that the bone marrow is not producing new cells or at least not enough to keep up with the need.  That can be caused by toxins or poisons.  Both those things are much more likely if she goes out and unlikely if she stays in all the time, unless she got into something she shouldn't.  It sounds like your vets are covering all bases, transfusions to give her enough red blood cells to carry oxygen so her organs don't die, and doxycycline to kill the parasite if she has it, won't hurt if she doesn't, and watching her blood levels (PCV, HCT) to see if her bone marrow is working.  It takes 2-3 days for the newly formed red cells to appear in the general circulation so that's what they are looking for. They are probably giving her B12 also to help the new red blood cells mature.  Fingers crossed she's got the good kind they can treat!  Don't beat yourself up by not noticing it sooner.  Cats are masters of hiding illness.  At least you noticed it IN TIME!
 
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sarah super

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So Hank just got back from the vet for new bloodwork. We should get the updated results tomorrow, but the vet weighed her and she's now 3.2 kg compared to the 2.8 she was last week. She's still severely underweight, and I'm not getting too excited given that she she still has a long way to go.

That being said, she's more alert today - she tried to kick me this morning when we gave her her antibiotics and her breathing appears to have slowed a little and her gums, paws and mouth seems to look a little pinker. I'm trying not to get too excited though, as I'm fully aware that she's still very sick and has a very long way to go. However, she's certainly not any worse than she was when I brought her back home on Monday.

I'll update with the updated PCV score when I get it, and the other bloodwork results....
 

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:heart2:

Our vet always drew enough blood so they could run just the HCT in-office and send the blood out for the profile. Once Tuxie was on the upswing, and it wasn't critical, we used to joke and make "bets" on what his HCT would be. Because his was an autoimmune problem, his battle was an active 2 - 4 years, and finally went into remission (!!!) after 7. We just had to take him in to have a lump (benign cyst) removed from his shoulder. His HCT was 45%, and everyone that was there at the time he went through it was just in absolute awe at how well he's doing. I hope you will know this feeling - without investing that much time! :vibes: :vibes: :vibes:
 
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sarah super

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Just got the test results. A mix of both good and bad news.

The good news is that Hank is making her own red blood cells again, which means that her anemia is regenerative, not non-regenerative. So fingers crossed, this means that she should start fighting back of her own accord and that her anemia is more likely to be caused by Mycoplasma haemofelis (FIA)  rather than by kidney failure or bone marrow failure (fingers crossed). She's also stronger, although far away from being at full strength.

The bad news is that her PCV has fallen again - she's now at 10% which is still shockingly low. Our family vet is consulting a specialist as she feels that we need to increase her dosage of pred, to reduce the degree that her white blood cells are killing off red blood cells.

So, mixed bag really. She looks better and has more energy, but I'd've been much happier to see an at least stable red blood cell count. We'll probably do another blood test early next week.
 

red top rescue

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I hope they are giving her vitamin B12 injections too, as that helps the immature red blood cells mature.  You can also add chicken liver and beef liver to her diet to help with iron needed for the red blood cells.  10% is really very low so you may need another transfusion in the future, but at least that's an option to keep her going until her own system can catch up.  Keep calm, keep HER calm, and keep us posted.
 
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sarah super

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Just thought I'd post a quick update.... Hank seems to be doing really well at the moment. She's eating really well - though I'm not sure how much of this is a result of the Pred stimulating her appetite. However, she's putting on weight and is looking much more like her old self. Her gums and paws are pinker, but a bit lighter than where I'd like them to be. That being said, they're much better than 10 days ago. Apparently the vet has been giving her B12 injections, and has put her on an additional anti-inflammatory treatment recommended by a blood specialist he consulted with.

We got the new medication on Monday, and felt that it wasn't really necessary given the massive improvements we've seen in her energy, strength, eating and breathing. We have been giving her it anyway, as we both feel that it won't harm her, and may help her get fully well.

Her next blood test is not until next Monday, but I'm increasingly confident that she will be able to pull through. Our only challenge is that we're going away for four days at the end of next week, and aren't sure who should look after her - normally we'd have someone visit, but as she needs five different medicine doses at three different times in the day, this may prove to be a bit of a challenge. Our other option is a pet hotel, but I'm a bit worried about what the upheaval will do to her improving health.
 

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Glad she's feeling better and hoping she continues to do so.

Do you know any young people who are cat people and would love to get out of their parents' house for a few days and a few bucks?
 

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I'm so glad she is improving and eating and making new blood cells.  Regarding your upcoming four-day trip, my advice is definitely do NOT board her!  That will add stress and that decreases the immune system.  She needs to stay in her own comfy house.  @cocheezie has a good idea about a live-in sitter,especially since it is summer and the college kids are home.  You you wouldn't even need someone to live there, just to be there three times a day to give medications.  Are there any pet sitting businesses where you live?  I've worked for one before and we had no problem with being places three times a day if needed, and I had a diabetic cat to care for who lived a half hour's drive away and he needed insulin twice a day and I handled that with no problem  Many dog people need sitters to come three times a day to take the dog out, so it is not too much to ask.  Most pet sitters are bonded and knowledgeable and also have back up should they get sick or their car break down. 
 
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sarah super

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Just back from my weekend away. Hank stayed at home and was very well looked after.

We just had our latest round of blood tests and her PCV is now at 28% - a massive improvement of 18% over 10 days. Her other blood measures are also improving, but are still below what the vet would like. Her red blood cell count has tripled, but is still about halfway away from where it should be and her hemaglobin count is similar (half it should be but significantly better)

I found this chart in my investigations which is a great explanation of how M Haemofelis develops in Cats - note the relatively long time til it becomes chronic, and how long it takes to respond to medication. Anyway, we're optimistic about her future, and looking forward to when she comes off the meds - she's now been on the antibiotics for about 3 weeks. We can tell that she's getting a lot better, as she's now refusing to eat pills in pockets and has learnt that enduring the oral medicines means a treat straight after - once the syringes are empty she makes a beeline for where we feed her treats....



I'll continue to update on her condition until she's off getting weekly or so blood tests. And many many thanks for all the support from her as we've been slowly nursing her back to health.

My main observation is that any cat can be desperately, desperately sick with anemia and pull through and back to normal health....
 

red top rescue

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This is a really valuable thread, and I'm sure it will help a lot of people in the future!  Thanks for sharing your journey, and I'm so glad it's having a happy ending.
 

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Kind of going though this with my little buddy trust took him in last Sunday and red blood level was 8, he has since had a transfussion that brought him up to the 24 range and has since slowly dropped on both his check ups at 18 and 16.5 he goes back in the morning for another recheck. Reading this has given me hope for him as he acts normal right now but his levels say other.
 
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sarah super

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So I'm sad to report that Hank has relapsed, and again has pretty serious anemia. The good news is that because I was checking her gums and her breathing every few days, we managed to catch it before it became as severe as last time.

I'm still waiting to hear the test results from the vet, basically because they won''t change much - me and the other half decided on a treatment plan for her if she got sick again, and as we agreed not to subject her to more blood transfusions, we have to hope and pray and hope that the medication starts to work. We got her tested to see if, as she had regenerative anemia last time, that it's as a result of blood parasites, or as seems more likely now, that she has an autoimmune disease. It seems from reading others experiences that it's often a case of one step forward two steps back with this.

She's back on meds and eating, but her appetite is not quite as healthy as I'd like and she's very lethargic. I'm comforted a little that she's made it through the last five days, but we're still taking every day as it comes.
 
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