Possible Mycoplasma Haemofelis

RE: Possible Mycoplasma Haemofelis

Rosie_Skinner — Wed, 09 May 2018 16:30:28 GMT

sounds good!

For what it's worth I am also doubtful that this is Mycoplasma, given the negative PCR (although it can be sequestered in the bone marrow I believe and these cases may not show up on pcr run on blood samples). I am more on the pancreatitis side of the fence with anaemia of inflammatory disease and haemodilution by fluid therapy causing the drop in pcv. Pred probably helped resolve this !

RE: Possible Mycoplasma Haemofelis

Thomas Johnson — Wed, 09 May 2018 09:23:12 GMT

[quote user="Thomas Johnson"]I did think part of the drop would have been due to rehydration, but I thought it unlikely that it would all be explained by that. I also wondered about whether the rise in bilirubin could be due to pancreatitis, but I thought this unlikely without any changes in the liver enzymes, ALT went from 54 to 49, ALKP from 43 to 35, and GGT was 0 on both.[/quote]

Latest update, I saw him last night, his owner reports that he is back to his normal self, clinical examination was unremarkable and his PCV was normal at 32.1%. As he is doing well I am going to continue with the current treatment plan for IMHA, if he didin't have IMHA the reducing doses of pred should be quite safe, I dropped it to 1mg/kg sid a week ago, so he will continue this dose for another week, then drop to 0.5mg/kg sid, and I will see him again in 2 weeks. He has finished the 3 week course of Ronaxan. Obviously if he becomes unwell again then I'll have another try at getting to the bottom of what's causing his illness, but am very reluctant to do any further testing in a cat that is recovering well.

RE: Possible Mycoplasma Haemofelis

Thomas Johnson — Tue, 08 May 2018 08:48:41 GMT

[quote user="Kate Richardson"]thinking about it further, the drop in pcv could be the rehydration factor and the rise in bilirubin secondary to the pancreatitis and not due to haemolysis- was the smear consistent with a haemolytic picture? And strongly regenerative as mentioned above?[/quote]

I did think part of the drop would have been due to rehydration, but I thought it unlikely that it would all be explained by that. I also wondered about whether the rise in bilirubin could be due to pancreatitis, but I thought this unlikely without any changes in the liver enzymes, ALT went from 54 to 49, ALKP from 43 to 35, and GGT was 0 on both.

RE: Possible Mycoplasma Haemofelis

Beats — Sun, 06 May 2018 21:01:55 GMT

I would say howell-jolly bodies, assuming these were not refractile stain-artifacts.

(i.e. assuming as you changed the focus in and out a little they stayed sharp dots in the rbcs focusing the same as the rbcs themselves and didn't develop a halo round them or anything)

I'm assuming these are actual spun PCVs and not calculated values from a non-spinning automated haemtology analyser. Also assuming no drugs given to change PCV (sedation could drop it by 10% for instance). I'd then think hemolytic anemia most likely. Should have reasonable number of retics by now on NMB stain if was. If the TP dropped too, I'd consider internal hemorrhage. I don't think rehydration likely to have affected it this much alone.

RE: Possible Mycoplasma Haemofelis

Kate Richardson — Sat, 05 May 2018 11:50:21 GMT

[quote user="Thomas Johnson"]

[quote user="David Mills"]

Likewise I don't think this is mycoplasma. To me it's a differential that is always mentioned esp at referral centres but it's prevalence must be miniscule.

[/quote]

Fair enough, but would you agree that with the drop in PCV of 10% in 48hrs and the marked increase in TBil that this is likely to be some sort of haemolytic anaemia?

[/quote]

thinking about it further, the drop in pcv could be the rehydration factor and the rise in bilirubin secondary to the pancreatitis and not due to haemolysis- was the smear consistent with a haemolytic picture? And strongly regenerative as mentioned above?

RE: Possible Mycoplasma Haemofelis

Lindsey Edwards — Sat, 05 May 2018 10:20:51 GMT

I agree - likely to be haemolytic anaemia but doesn't seem like a mycoplasma (could be a drug reaction...rapid deterioration of numbers after initial treatment started?). Interested to know if regnerative or not?

RE: Possible Mycoplasma Haemofelis

Jenny Harris — Fri, 04 May 2018 21:45:28 GMT

And David I’m in a very small first opinion practice and saw that one last year so it’s out there! But I don’t think this is one of them....

RE: Possible Mycoplasma Haemofelis

Jenny Harris — Fri, 04 May 2018 21:43:50 GMT

Oh also obvious question but don’t think you’ve said- is the anaemia regenerative?

RE: Possible Mycoplasma Haemofelis

David Mills — Fri, 04 May 2018 20:51:18 GMT

[quote user="Thomas Johnson"]

[quote user="David Mills"]

Likewise I don't think this is mycoplasma. To me it's a differential that is always mentioned esp at referral centres but it's prevalence must be miniscule.

[/quote]

Fair enough, but would you agree that with the drop in PCV of 10% in 48hrs and the marked increase in TBil that this is likely to be some sort of haemolytic anaemia?

[/quote]

Yes I think it is.

This cat was on fluids so the PCV drop may not be as dramatic as it sounds.

Cats are difficult. They don't really show spherocyres so hemolytic anaemia difficult to call precisely. However I think you have enough to hang your hat on.

As i understand it mycoplasma normally peripheral, and to be causing that level of anaemia normally huge numbers.

So I would increase the pred dose and see what happens. Cats IME often respond rather unpredictably in these cases.

RE: Possible Mycoplasma Haemofelis

Jenny Harris — Fri, 04 May 2018 20:04:01 GMT

Did you send for pcr after starting abx? PCR will become negative very quickly, so needs to be on a pre treatment sample.

shouldnt need pred at all if mycoplasma.

i have had one recently, PCV was much lower to start (10%) and had improved to 25 within 48h of starting tx.

so possibly less likely mycoplasma?

fluids could account for the pcv drop, did it have any?

cholangitis/hepatitis/pancreatitis??

RE: Possible Mycoplasma Haemofelis

Thomas Johnson — Fri, 04 May 2018 18:53:52 GMT

[quote user="Niall Taylor"]Oops, I really must read the posts I'm replying to! PCR is pretty sensitive, isn't a negative result tantamount to a rule out?[/quote]

There's a line at the end of the report that says, "However, a negative PCR result may be caused by the numbers of organisms being below the limit of detection, decreased numbers of organisms following treatment or chronic carrier state, of the occurrence of new strain variations."

[quote user="Martin Atkinson"]What stain did you use?, I could only find it on a Giemsa stain.[/quote]

It was stained with DiffQuik.

RE: Possible Mycoplasma Haemofelis

Niall Taylor — Fri, 04 May 2018 18:20:50 GMT

Unlikely to be anything else I would have thought.

Niall

RE: Possible Mycoplasma Haemofelis

Thomas Johnson — Fri, 04 May 2018 18:15:48 GMT

[quote user="David Mills"]

Likewise I don't think this is mycoplasma. To me it's a differential that is always mentioned esp at referral centres but it's prevalence must be miniscule.

[/quote]

Fair enough, but would you agree that with the drop in PCV of 10% in 48hrs and the marked increase in TBil that this is likely to be some sort of haemolytic anaemia?

RE: Possible Mycoplasma Haemofelis

David Mills — Fri, 04 May 2018 17:51:58 GMT

Likewise I don't think this is mycoplasma. To me it's a differential that is always mentioned esp at referral centres but it's prevalence must be miniscule.

RE: Possible Mycoplasma Haemofelis

Martin Atkinson — Fri, 04 May 2018 16:52:09 GMT

The inclusion bodies look a bit large to me, Mycoplasma are usually smaller and multiple - often paired, these look more like Howell-Jolly bodies. What stain did you use?, I could only find it on a Giemsa stain.

RE: Possible Mycoplasma Haemofelis

Niall Taylor — Fri, 04 May 2018 16:41:46 GMT

[quote user="Thomas Johnson"]PCR was negative[/quote]

Oops, I really must read the posts I'm replying to! PCR is pretty sensitive, isn't a negative result tantamount to a rule out?

Niall

RE: Possible Mycoplasma Haemofelis

Thomas Johnson — Fri, 04 May 2018 15:40:24 GMT

[quote user="Niall Taylor"]

Looks a bit like it to me although I'm no expert. Have you considered PCR?

[/quote]

PCR was negative, that's why I'm questioning the diagnosis a little.

[quote user="Mark Hedberg"]

My head nurse's cat had mycoplasma some years ago, treatment was minimum 28d, and if i remember right, it was extended by the specialist just to be on the safe side. So improvement is a positive indicator.

[/quote]

The BSAVA haematology manual recommends 3 weeks of Ronaxan, and 3 weeks of pred, starting at 2mg/kg bid, but starting to reduce the dose after a few days. This cat is still on Ronaxan, I didn't start the pred dose as high as my understanding is that doses over 2mg/kg/day aren't needed, so it was on 2mg/kg sid for 2 weeks, and I've just dropped it to 1mg/kg sid.

[quote user="Kate Richardson"]Have you sent the smear picture to the lab for their thoughts?[/quote]

That's a good idea, I'll speak to them and see if it's possible.

RE: Possible Mycoplasma Haemofelis

Kate Richardson — Fri, 04 May 2018 14:09:45 GMT

Have you sent the smear picture to the lab for their thoughts?

RE: Possible Mycoplasma Haemofelis

Mark Hedberg — Fri, 04 May 2018 13:10:51 GMT

RE: Possible Mycoplasma Haemofelis

Niall Taylor — Fri, 04 May 2018 12:32:11 GMT

Looks a bit like it to me although I'm no expert. Have you considered PCR?

Niall