Post castration IMHA??

Re: Post castration IMHA??

james herriot lied — Tue, 13 Mar 2012 20:59:10 GMT

I don't think oxyglobin's currently available - or am I behind the times again?

Re: Post castration IMHA??

Kate Richardson — Tue, 13 Mar 2012 18:31:30 GMT

One of my DSH (now RIP 2 years ago due to RTA) was a type B- was quite surprised! So can't help there I am afraid.

There is a synthetic blood fluid available if you are struggling, Oxyglobin I think it is called. Not cheap, but actually equivalent to obtaining samples/performing transfusion etc.

Also wishing you and the little kitty good luck

Re: Post castration IMHA??

Dagmar Steele — Tue, 13 Mar 2012 16:33:48 GMT

depends on the breed methinks. British short hair may be B more often than others, but I remember roughly the same figures.

Re: Post castration IMHA??

Oli_J — Tue, 13 Mar 2012 16:28:31 GMT

I know, what are the chances! 10-15%??

Re: Post castration IMHA??

Dagmar Steele — Tue, 13 Mar 2012 16:23:49 GMT

in this case you were lucky not to transfuse before typing! Good luck for the little one!

Re: Post castration IMHA??

Oli_J — Tue, 13 Mar 2012 15:58:32 GMT

Again, thanks to everybody for their input. The little guy seemed relatively stable overnight (not great but no worse, PCV stil 8% this morning, tolerating syringe feeding well) so did not transfuse him. Got the typing results this morning, along with in-house test kits from the blood bank, and turns out he is type B! 6 donors typed so far are all A, got another 2 siamese cats to type tonight so fingers crossed. In the meantime continuing with pred, ronaxan and atopica PO.

Oli

Re: Post castration IMHA??

james herriot lied — Mon, 12 Mar 2012 23:35:43 GMT

Oli

Realise also that this is a minor possibility, that won't circumvent the need for transfusion (another vote for going ahead on the conditions set out above - but with very informed consent), but rat poison?

Re: Post castration IMHA??

Charlotte Marshall — Mon, 12 Mar 2012 23:11:04 GMT

I will admit to only having done one blood transfusion in a cat but we did a rough crossmatch in house. Mixing some recipient and donor cells/plasma to see what happened. The nurses cat we tried seemed to agglutinate so we tried my cat and it didn't so used that as a donor. No transfusion reaction though obviously we could just have been lucky.

Re: Post castration IMHA??

Michael Woodhouse — Mon, 12 Mar 2012 21:00:46 GMT

In cases like this I would transfuse anyway. I appreciate the risk greater in cats without typing but a transfusion reaction better than watching it die?

Just start very slow and monitor temp and HR/RR.

Re: Post castration IMHA??

Oli_J — Mon, 12 Mar 2012 20:51:50 GMT

Quick scan (by me so not an expert) but no obvious free fluid in abdo, also TP and alb normal on blood screen. I would have expected the protein to reduce with acute haemorrhage, right? No obvious RBC parasites when examined smear in house but already on doxycycline, sent smear/bloods to lab tongiht for typing, smear exam and FIV/FeLV. Very good owner, no obvious parasites, was in great condition. No bloods done prior to castration but MM were not pale and surgery/GA uneventful. I was very disappointed to find that UK pet blood bank only has canine blood products, and it has been impossible to get hold of feline cross matching kit today (have ordered it from the blood bank but will not arrive until at least tomorrow). Do people usually stock these? The delay in getting the blood typing results etc may make all the difference to this poor kitty.

Re: Post castration IMHA??

Gillian Mostyn — Mon, 12 Mar 2012 20:39:03 GMT

Have you ruled out internal haemorrhage?

Re: Post castration IMHA??

Oli_J — Mon, 12 Mar 2012 20:34:41 GMT

Thank you everyone for the input.

Got more blood this morning (as he was unfortunately a lot worse and too ill to put up a good fight) for in-house biochem and CBC. PCV =9%, mild elevation in ALT (cannot remember exact figure as now at home) but rest of bloods WNL. Pred incr to 5mg BID, started ronaxan 25mg SID and atopica 10mg BID. Also emeprid as vomited after syrnige feeding. Temp dropping to 36.5C then down to 35C despite heat pad, blankets etc.Cat very flat, moves when stimulated but otherwise just lying there. PCV this evening = 8%. Blood sent to lab for typing (courier collects only once daily so this is first chance we have had to do this) with a view of transfusion in the morning. I am worried this little guy will not make it through the night though :(

Oli

Re: Post castration IMHA??

Dagmar Steele — Mon, 12 Mar 2012 10:54:21 GMT

There is not much to add to Kate's post. IMHA is an exclusion diagnosis, so you need more blood. It may well be that the operation triggered something as it has been said about vaccinations, but in most cases the trigger remains unknown, so it could be anything. I would start on Doxy and Prednisolone until test results are back and consider blood transfusion, get the blood typing done just in case.

Good luck!

Re: Post castration IMHA??

Niall Taylor — Mon, 12 Mar 2012 10:24:55 GMT

[quote user="Oli_J"]I guess there could be a small chance it is unrelated?[/quote]

I think there's a very good chance it's unrelated to the surgery if it turns out to be true IMHA unless you can think of a specific trigger factor. Coincidences happen all the time, correlation does not equal causation.

Chin up, this is no one's fault, sometimes stuff just happens!

Niall

Re: Post castration IMHA??

Kate Richardson — Mon, 12 Mar 2012 09:05:14 GMT

Grr- just finshed typing an answer and internet connection dropped out! So here goes again!

Cats blood likes to clump due to platelet aggregation, so whilst this doesn't rule out IMHA it doesn't mean it is. Also spherocytes are not a reliable indicator of haemolysis in cats as far as I can recall. You need to obtain more information about this cat, so more bloods needed; sedate if you have to, (although be aware that sedation can falsely alter cbc parameters, so let the lab know if you had to sedate). Or take the blood in stages- clip neck (both sides just in case). Time out. Apply emla. Time out. Take bloods. Use a 23g needle and use your best feline friendly niurse. Someone else to tap the head often helps too. Depending on owner finances, you need to assess haematology and biochemistry, especially protein levels, clotting times, Coombes test and haemobartonella felis PCR. Also worth checking FeLV/FIV status.

Then back to basic principles- is the anaemia due to

1) poor production- was the cat anaemic prior to surgery? You are unlikely to know this as unlikely to have had a pre ga blood screen (not a criticism, rarely done in a 6m cat castrate that appears clinically healthy). I would expect anaemia due to poor production to be non-regenerative, so if is non-regenerative, it would raise alarm bells

2) Blood loss- check the abdomen with ultrasound if you can, and protein levels may give you some clues as well, and the anaemia should be regenerative. Did the cat have any evidence of parasites- heavy flea and/or worm burdens could mean the cat was already anaemic, so check on routine flea/worm treatments.

3)Haemolysis- usually secondary to something, but any stress could trigger this ie recent surgery. Again should be regenerative. Check for H. felis- make your blood smear prior to placing blood in EDTA tube if you can, as you are more likely to see h.felis on a smear.

I would start the cat on doxycycline in case of H.felis, and unless the cat is hypovolaemic, I would go easy with the iv fluids and consider a whole blood transfusion. Worth getting a blood type done on the bloods as well so you are prepared for this, even if you end up referring it, helpful to know in advance so matching donor can be found. Oxygen supplementation also a good idea. Nutrition important, place feeding tube if nec, NO if reluctant to ga, otherwise oesophagostomy tube.

Hope that helps.

Re: Post castration IMHA??

james herriot lied — Mon, 12 Mar 2012 07:53:34 GMT

I'm afraid I'd also not rule out the possibility of a post-op, probably internal haemorrhage - have you been able to scan the abdo? Bear in mind that in a 3kg (?) cat, a blood loss of 100ml wouldn't necessarily cause massively obvious ascites.

Not suggesting surgeon error - it's entirely possible that this cat had an oncoming IMHA / other blood dyscrasia prior to surgery, and your colleague ran into it on the wrong day. We've all been in similar situations.

Re: Post castration IMHA??

Oli_J — Sun, 11 Mar 2012 23:15:46 GMT

Thanks for your reply! He has had 0.15ml 2% dex IV few hours ago and due for 2.5mg pred by mouth 6 hours after that. Here's hoping he will let me collect a blood sample tomorrow morning for some further testing. I have never seen this kind of thing after routine surgery before, I guess there could be a small chance it is unrelated?

Re: Post castration IMHA??

Michael Woodhouse — Sun, 11 Mar 2012 23:08:02 GMT

No-one else is offering you any help. I'd start the glucocorticoids () now. I have used them at the same time as NSAIDS in limited cases in both dogs and cats with fully informed consent and never had a problem. The Metacam yesterday is not even significant as far as I am concerned, if it's IMHA that will kill the cat sooner. Pour some Antepsin down it's throat if it makes you feel better!