Anaemic cat

Re: Anaemic cat

Graham Bilbrough — Sat, 03 May 2014 14:50:42 GMT

Hi, Kate

From the data we have (MCHC, MCH, HGB:HCT etc), there is no evidence of intravascular (or artefactual) haemolysis. But, yes, if it was happening slowly... We haven't seen the chemistry profile or the plasma yet. However, there are red cell fragments on the dot plot. Like you, my bet is on there being something happening in the bone marrow and that this isn't an acute process.

Thanks, g

Re: Anaemic cat

Kate Richardson — Sat, 03 May 2014 14:17:55 GMT

[quote user="Graham Bilbrough"]

* Despite the cat being sedated, I think it is highly unlikely that an anaemia of this magnitude is secondary to chronic disease. What else is going on?

Personally, when I was in practice, I would have referred this cat for treatment and a BM aspirate. This is not because I could not do the procedure. Rather, there is a good chance it will need a blood transfusion and the sort of monitoring that I could not have offered.

[/quote]

What I meant was more that I don't think anaemia of this magnitude is due to an acute crisis haemolytic or hamorrhage, especially given the cats sounds reasonably well- needing to be sedated for a blood sample doesn't fit with acute loss of RBCs. I totally agree, bone marrow sampling is probably the next step, and given cat is insured, I would be strongly recommending referral for the same reason as Graham for the monitoring/blood transfusion side of things.

Graham- do you think there is evidence of haemolysis? It's not to say the cat couldn't be slowly haemolysing alongside a more chronic or underlying bone marrow ppatholgy?

Re: Anaemic cat

Graham Bilbrough — Sat, 03 May 2014 09:40:28 GMT

Thank you, Dave, for the scan of the print-out.

I will comment just on what I can see on the dot plots and leave others to consider how it fits into the case.

[Caveat: it's more challenging in B&W than colour]

Some bullet points:

* No evidence of regeneration in the peripheral blood

* Large platelets or platelet aggregations--not interfering with the WBC differential

* HGB, HCt and [RBC] have 'moved' in unison

* Red blood cell fragments present--what's breaking these?

* MCHC within the reference interval--sample quality probably good

* The clusters ('clouds') on the WBC differential are well separated--high degree of confidence in the WBC differential. Stress leukogram present; no inflammatory leukogram.

* Despite the cat being sedated, I think it is highly unlikely that an anaemia of this magnitude is secondary to chronic disease. What else is going on?

All the best

Re: Anaemic cat

Kate Richardson — Sat, 03 May 2014 08:11:21 GMT

Has the cat been sedated for bloods each time? As this can decrease PVC and I think possibly also wbcs. Even if you factor this in it probably still means the cat is anaemic but may not be as severe as initially seems? I still think the anaemia is chronic in origin though and the vomiting likely a red herring. Question the owners a bit more about the past few weeks/months behaviour and any vague clinical signs.

Re: Anaemic cat

Graham Bilbrough — Fri, 02 May 2014 17:27:40 GMT

A scan of the CBC, including the important dot plots, would work perfectly well. You can either upload them to this site--after redacting the owner details--or email them to me.

Re: Anaemic cat

Dave Cumber — Fri, 02 May 2014 16:45:59 GMT

Hi Graham,

Thank you for your interest.

I have the dot plots but am presently not able to connect the Vetlab suite to the internet. I could scan the dot plots and email?

Dave

Re: Anaemic cat

Graham Bilbrough — Fri, 02 May 2014 12:44:36 GMT

Hi, Dave

It would be interesting to see the flow cytometry from your ProCyte. I tried to 'fetch' them from your analyser via the Internet, but it not connected. If you happy for the group to see the dot plots, can you please share them directly or reconnect the VetLab suite?

Thanks and best wishes

Graham

Re: Anaemic cat

Dave Cumber — Fri, 02 May 2014 12:11:24 GMT

Thanks for your thoughts.

Initially presented with history of vomiting in past 3 days. Bile only. Approx 9 X daily. 6kg cat. Lost 0.3kg in past 2 months. "O" reported that the cat had been eating cat litter for past 1-2 weeks. No diarrhoea. Physical exam Mucus membranes pink, CRT 1-2 seconds, no dehydration, Purring loudly so difficult to auscultate lungs, abdo relaxed, no discomfort, no FB palapable, rectal temp 102.6. An attempt was made to take a blood sample but the cat became very aggressive and very stressed. An offer was made to pre-oxygenate and try again but the owner opted to trial medication (emeprid and zantac) and the owner was asked to return the next day when the cat was sedated, bloods were taken and the cat had X-rays and ultrasound. Initial DDX was linear FB, pancreatitis, infectious cause. Snap fPL normal, biochem panel all within normal ranges, FeLV neg, FIV neg. X-rays and ultrasound unremarkable (mildly enlarged heart). In-house haematology (Procyte) revealed HCT 11.8% so sample submitted to external lab for morphology.We did not test a urine sample.

Insured cat and very caring owner.

Re: Anaemic cat

Richard Carter — Fri, 02 May 2014 12:02:46 GMT

the anaemia of mycoplasma is auto-immune extravascular haemolysis - the parasites have damaged the Ag coating and the re system cleans them out. The problem is getting the system to stop after the parasites have been cleared and for this preds are probably still the best option.

Re: Anaemic cat

Dave Cumber — Fri, 02 May 2014 11:52:16 GMT

As I understand it, the Mycoplasmas sit on the erythrocytes and it is this that causes the immune response. The problem I have is that I have also read that giving preds to a cat with Mycoploasmas can increase the risks of recrudescence and are therefore contraindicated if there is a suspicion of Mycoplasma infection.

Re: Anaemic cat

Martin Atkinson — Fri, 02 May 2014 10:35:30 GMT

[quote user="Richard Carter"]I have cat with similar. It did have mycoplasma originally (3 - 4 years ago) was treated successfully only to then have recurrence severe anaemia [/quote] Is it not true that mycoplasma felis can induce a concurrent AHA which makes things rather challenging?

Re: Anaemic cat

Richard Carter — Fri, 02 May 2014 10:10:19 GMT

I have cat with similar. It did have mycoplasma originally (3 - 4 years ago) was treated successfully only to then have recurrence severe anaemia (similar PCV) with splenomegaly - tests to check for recurrence of mycoplasma were negative both on smear and lab tests, there is a moderate regeneration - few normoblasts, some polychromasia. Slight response to trial rx doxy and preds - pcv up to about 20% now but splenomegaly been consistent. Am now trying to get he owner to agree to a splenectomy for biopsy/ remove some of the system taking out the rbc

Re: Anaemic cat

Kate Richardson — Fri, 02 May 2014 09:38:35 GMT

It is difficult to answer your questions without more information.

How long had the cat been ill before presenting?

Physical exam?

Any weight loss?

Biochem results? Urine sample?

What are the owners wishes re treatment and finances?

I would be seriously concerned about a 4 year old cat with a HCT that low and I still think haemolysis is unlikely as non regenerative plus the negative Coombs although this doesn't rule it out. Speak to your lab about the results- ask them how sure they are re haemolysis in the face of a non regenerative anaemia and a negative Coombs test. If it is haemolysing then why is it not showing any signs of regenerating. Yes wait for the mycoplasma PCR but I would be looking elsewhere for other pathology at the same time. You will do no harm with the doxycycline and if the HCT isn't dropping then I would hold off preds until I had more information. But I am concerned there is a lot more to this than meets the eye.

Re: Anaemic cat

Dave Cumber — Fri, 02 May 2014 08:19:14 GMT

Many thanks for the helpful replies.

Absolute reticulocyte count was 3.2 (ref <=50.0). No abnormal white cells seen.

After 3 days of Doxycycline (no preds), cat improving clinically (no longer vomiting), results as follows:-

HCT = 13% (Prev 11%)

Absolute reticulocyte count 3.9 (Prev 3.2) (Ref <=50.0)

Neutrophils 2.38 (Prev 1.27) (Ref 2.50 to 12.50)

Lymphocytes at first sample were 0.99, after 3 days Doxycycline 1.23 (Ref 2.00 to 7.00)

Lab comment RBC's show agglutination, mild anisocytosis, a few ghost cells seen. No abnormal white blood cells seen. Small platelet clumps.

Marked non-regenerative anaemia currently. Blood film features suggest immune mediated haemolysis. Immune mediated haemolytic anaemia in cats is usually secondary in origin (e.g. retroviral infections, haemotropic mycoplasma, neoplasia). Neutropaenia may reflect acute inflammation, myelosuppression or immune mediated destruction (rare).

Carry on with Doxycycline alone whilst awaiting mycoplasma PCR?

Add Preds?

Arrange or perform bone marrow biopsy?

Re: Anaemic cat

Kate Richardson — Thu, 01 May 2014 23:10:22 GMT

Re performing bone marrow sampling and blood transfusion yyourselves I would do it if referral wasn't an option or was declined or in the case of transfusion if it was in an emergency situation and transporting the cat wasn't in its best interests.

Re: Anaemic cat

Kate Richardson — Thu, 01 May 2014 23:05:23 GMT

I am confused as why the lab talk about imha when it should be markedly regenerative if so. If cat "well" with hct of 11 then would definitely suggest chronic and agree with neutfopaenia as well then bone marrow sampling would be useful. Alternative ideas would be increased neutrophil consumption due to an inflammatory/infectious process with secondary anaemia of chronic disease. What do the wbcs look like? any band neutrophils? What's the biochem doing?

Re: Anaemic cat

Laurence Webb — Thu, 01 May 2014 22:19:22 GMT

[quote user="Dave Cumber"]

RBC's show agglutination with many ghost cells.

Coombs test negative.

[/quote]

If it is agglutinating it should be Coombes positive. Was this an in-house or external lab exam that found the agglutination? If it's external then find out which is incorrect. Rouleaux can be mistaken for rbc clumping. I generally mix 1 drop of blood with 3-5 drops saline on a slide and mix them and drop a cover slide on to check for agglutination - whole blood will clump a bit anyway.

If definitely agglutinating or Coombes +ve then I'd probably use steroids.

As the PCV has managed to drop down to 11% without the cat dropping dead I'd assume the anaemia has been chronic in onset. That would suggest that the bone marrow should have had a chance to start regenerating. Did the lab comment on retuculocytes, macrocytosis/anisocytosis etc?

Assuming it's truely non-regenerative I'd think about bone marrow aspitates, Easy to do in practice and takes a few minutes at most. Just make sure you know what you are going to do before you start - it's dead easy but the aspirate must be put onto slides immediately. I normally take some aspirates but also a biopsy as backup.

If you're going to biopsy hold of steroids until you've taken the samples but, if it's got evidence of immune mediated destruction, I'd probably start them alongside doxycycline once I'd taken the samples

Re: Anaemic cat

Rob Loxley — Thu, 01 May 2014 19:55:00 GMT

I would treat with doxycycline, but with a number of cell lines depressed consider BM biopsy - should be entirely doable in 1st opion practice IMHO, but send to a good clinical pathologist. I'd consider a transfusion depending on the status of the cat and response to treatment. If BM biopsy is a potential, then I'd hold off preds until done.