Inappetent pyrexic cat

RE: Inappetent pyrexic cat

Luciano Nebiante PGCertSAS — Tue, 22 Dec 2015 22:17:24 GMT

Thanks everyone for the interesting thoughts. Aside from the possible cardiomegaly, can you see anything else on the lateral radiograph?

Meantime, I have introduced Doxycicline and started her on Prednisolone today.

This morning her temperature was back to normal.

Blood samples have been sent to the lab for haematology, smears, and Mycoplasma DNA PCR.

For one of the question, the TP at presentation were 78 g/L (57-89).

And Potassium has been always normal.

RE: Inappetent pyrexic cat

Virginia Campbell — Tue, 22 Dec 2015 22:01:15 GMT

[quote user="Silvia Maldonado"]Haemoplasma?[/quote]

IDEXX do a nice haemoplasma PCR panel, maybe worth getting some blood to send (if you want to give antibiotics for any reason get some pre treatment blood for this if possible).

I don't trust my own blood smear reading abilities hugely so would often send blood smears to the lab to see what they think too, and quite often ring them to chat to the pathologist.

RE: Inappetent pyrexic cat

Kate Richardson — Tue, 22 Dec 2015 21:33:29 GMT

[quote user="David Mills"]I often find with IMHA that they will often look non-regenerative for a few days before the marrow kicks in, but depends on when the destruction started.[/quote]

Agree, and some IMHAs can be slow and chronic rather than acute.

[quote user="David Mills"]I often find IMHA can have various cardiac abnormalities, arrhythmias, murmurs, linked to likely cardiac ischaemia or blood thinning. Bacterial endocarditis is exceptionally rare in cats, and would normally expect a sudden-onset highish-grade murmur.[/quote]

Yes, any anaemia can cause cardiac abnormalities, I just felt the heart was enlarged on the xrays which I wouldn't expect with anaemia, so if it is a true cardiomegaly, then more likely suggests concurrent cardiac pathology, not necessarily associated with the current signs. Unless chronic hypertension, would you get cardiomegaly with chronic anaemia? And yes a murmur may be present due to anaemia. Bacterial endocarditis was me thinking out of the box a bit given the pyrexia and poss underlying cardiac pathology, but yes, rare, and hard to definitively diagnose as well!

[quote user="David Mills"]Have you seen bilirubinuria with inappetant cats? Can't say I remember seeing such.[/quote]

I commonly see mild to moderate hyperbilirubinaemia in inappetant cats and if it's high enough (and can be variable) then it will spill into the urine, I think it has to be over 40 from memory?

[quote user="David Mills"]A fair few IMHAs have abdominal pain cranially, always assumed its due to splenic inflammation/enlargement from extravascular destruction.[/quote]

Interesting, must admit don't see many cats with IMHA compared to dogs, but makes sense, but detecting pain in cats is often difficult anyway, or certainly localising it, sometimes a sick cat appears painful everywhere! I assume it's just their way of saying 'F off and leave me alone!

[quote user="David Mills"]None of the above is meant as critical of Kate's post, just throwing ideas around.[/quote] Thankyou, I like throwing ideas around, thinking out loud is something I do a lot!

RE: Inappetent pyrexic cat

David Mills — Tue, 22 Dec 2015 12:32:26 GMT

[quote user="Kate Richardson"]

Pancreatitis still possible despite the normal PLI- add buprenorphine for pain relief.

Characterise the anaemia with a smear- is it regenerative or non, does it look like a haemolytic picture. Also can check wbcs further, assume bloods are in house? the wbc picture needs confirming/assessing further, high lymphocytes and low neuts seems odd, you would expect the reverse even if just a stress leukogram, but neuts could be low due to sequestration- is the cat still pyrexic? Not convinced cefovecin would be the best choice of antibiotic

have you checked electrolytes- especially potassium, if low it may explain the continued inappetance.

Heart looks subjectively enlarged on the xrays, and with the poss arrhythmia, an echo woud be a good idea if funds allow? How this fits in am not sure, but I guess if still pyrexic, consider bacterial endocarditis.

Bilirubin often high in sick inappetant cats with no pre-hepatic/post-hepatic/hepatic cause

[/quote]

I often find with IMHA that they will often look non-regenerative for a few days before the marrow kicks in, but depends on when the destruction started.

I often find IMHA can have various cardiac abnormalities, arrhythmias, murmurs, linked to likely cardiac ischaemia or blood thinning. Bacterial endocarditis is exceptionally rare in cats, and would normally expect a sudden-onset highish-grade murmur.

Have you seen bilirubinuria with inappetant cats? Can't say I remember seeing such.

A fair few IMHAs have abdominal pain cranially, always assumed its due to splenic inflammation/enlargement from extravascular destruction.

What was the TP at presentation? This would give some idea re dehydration and effects on PCV.

None of the above is meant as critical of Kate's post, just throwing ideas around.

RE: Inappetent pyrexic cat

Anthony Todd — Tue, 22 Dec 2015 11:26:24 GMT

Sorry, reread the OP

RE: Inappetent pyrexic cat

Kate Richardson — Tue, 22 Dec 2015 11:10:50 GMT

Pancreatitis still possible despite the normal PLI- add buprenorphine for pain relief.

have you checked electrolytes- especially potassium, if low it may explain the continued inappetance.

Bilirubin often high in sick inappetant cats with no pre-hepatic/post-hepatic/hepatic cause

RE: Inappetent pyrexic cat

Anthony Dennison — Tue, 22 Dec 2015 09:38:40 GMT

[quote user="Luciano Nebiante"]However the saline agglutination test was negative, would you still think of IMHA?[/quote]

Slide agglutination can be quite hit and miss - same with Coomb's test - I think I was told up to 40% could be false negatives.

RE: Inappetent pyrexic cat

Silvia Maldonado — Tue, 22 Dec 2015 01:08:22 GMT

Any recent penicilline treatment or vaccine? Haemoplasma? History of travellig abroad (erhlichia, babesia)?

RE: Inappetent pyrexic cat

Luciano Nebiante PGCertSAS — Mon, 21 Dec 2015 23:26:28 GMT

I see.

The PCV was 35 as far as I remember, but she was dehydrated at the time. So I think she has had anemia since the beginning.

RE: Inappetent pyrexic cat

David Mills — Mon, 21 Dec 2015 23:08:54 GMT

[quote user="Luciano Nebiante"]However the saline agglutination test was negative, would you still think of IMHA?[/quote]

Yes, not always that reliable in cats IME. Has the PCV dropped to 20 overnight or was it low on the first day as well?

RE: Inappetent pyrexic cat

Luciano Nebiante PGCertSAS — Mon, 21 Dec 2015 22:49:58 GMT

Hi David,

yes I looked at a blood smear, I could only see crenated RBC. But today it was a busy day, maybe I will repeat it tomorrow.

However the saline agglutination test was negative, would you still think of IMHA?

RE: Inappetent pyrexic cat

David Mills — Mon, 21 Dec 2015 22:20:21 GMT

Did you look at a blood smear today? Regenerative anaemia? Were there spherocytes?

IMHA until proven otherwise I think. Pred time.