14yo cat with severe anemia - autoimmune hemolytic anemia

[emipou]

We took our cat in to the vet this week because she was acting very “off”, listless, tired, losing weight.

The vet ran a bunch of tests and came back with severely anemic. The vet said one of two things might be causing this: a tumor that is bleeding internally, or her body is attacking her own red blood cells. They did an ultrasound to look for tumors and didn’t come up with anything significant.

At this point in time, they are thinking it is the latter. The vet made it sound like not as big of a deal,… like she was on the mend and we would medicate and hopefully she would get better. Then my husband took her back in to the office today and saw a different vet who painted a much bleaker picture of things. He was saying that if she does not start eating soon, we would have to hospitalize her.

My husband is a mess over this. He loves this cat so much (I do too, but he had her since she was a kitten).

I’ve been trying to find out more about this and came up with this - Autoimmune Hemolytic Anemia.

Just wondering if anyone else has dealt with this before and has any hope they can shed on the situation.

[emipou]

I should add, yesterday after the ultrasound, they gave her a shot of prednisone and sent her home with prednisolone and doxycicline.

[jen-s]

I punted this to a good friend who’s on several of the cat boards. She may have some ideas. In the meantime, I’m still jingling!!

[emipou]

Thanks Jen!

[Horsegal984]

1)did they test for auto agglutination? That’s one of the BIG markers for IMHA.

2. was a blood sample sent to the lab to look for blood parasites?

3. how long has she been not eating? More than three days is a big red alarm for cats.

Finally, how low is “severely anemic?” She may need a transfusion to get back on her feet.

[emipou]

[QUOTE=Horsegal984;8018852]
1)did they test for auto agglutination? That’s one of the BIG markers for IMHA.

2. was a blood sample sent to the lab to look for blood parasites?

3. how long has she been not eating? More than three days is a big red alarm for cats.

Finally, how low is “severely anemic?” She may need a transfusion to get back on her feet.[/QUOTE]

Thank you for your response.

I’m taking her back in to the vet tomorrow afternoon and will ask those first two questions. After reading some things online earlier, I had already realized that I needed to be asking more questions, like regarding parasites. This sounds like a pretty rare condition which makes me wonder if the doctors are missing something.

She was losing weight and looking pretty sick last year too, it turned out she (and the other cat and the dog) had tape worms. So maybe it’s something like that? hope hope hope.

As far as the last question… She hasn’t been eating much and I’m not sure exactly for how long because her typical behavior is to be sort of off on her own and hidden up in the bedroom.

She was downstairs with us all day long today though (which also means no water, no potty) and wouldn’t touch some baby food we tried to give her. In an act of desperation, I went out and got the cheap canned food that we know she likes just a short bit ago and she has been eating some of it. Not A LOT, but some. I’ll make sure she goes up with me to bed tonight and gets water, though she isn’t looking dehydrated.

If she doesn’t turn around real soon, they want to hospitalize her.

[djangology]

My cat has had some recurring anemia issues.

He’ll present with sudden inappetence, lethargy, and a marked change in behavior- hiding in his litterbox cubby, as opposed to sauntering around the house. It should be noted that Milton is a strictly indoor cat and I keep a safe house- no rodent bait, no insecticides, no significantly harmful plants, so it was unlikely to be caused by a toxic exposure. Milton also has a mild case of cerebellar hypoplasia, in addition to chronic FLUTD, nasopharyngeal polyps, and vestibular syndrome. Yes, I know: he’s a trainwreck.

His anemia has popped up twice for him, about 18 months apart. If that spacing is any indicator, we’re due for it to start up again right about now.

For diagnostics the first time, we ran a mycoplasma PCR, and ran some basic bloodwork (I can probably dig up what sets of values we checked if you need me to). I was tight on cash, so I asked the vet to try to keep the bills minimal.

The vet didn’t have a great idea of what caused it, so she put him on prednisolone and doxycycline, prescribed mirtazapine, and sent me home with a subq fluids kit. I forcefed him with a syringe for 48 hours and he bounced back and acted like nothing happened… until the same symptoms popped up 18 months later.

We skipped the mycoplasma PCR this time around, but redid FeLV/FIV testing as it was possible he’d been exposed via my various foster cats. We also ran extensive bloodwork and discovered that his reticulocyte count was basically non-existent, meaning that he’d essentially stopped producing red blood cells.

This makes it a non-regenerative anemia, suggesting a bone marrow issue. My vet offered to do a bone marrow biopsy, but I declined- it seemed like an expensive and uncomfortable procedure that would either give me very bad news or no new information at all.

Instead, we did doxy and pred, with mirtazapine and subq fluids at the ready for support. Once again, a day or so of forcefeeding with a syringe, and he’s back to normal in just a few short days.

I don’t have answers- no one really knows why Milton’s body decides to stop producing red blood cells. The good news is that doxy and pred is just what the doctor has ordered for him each time and he’s snoring happily next to me on the couch right now.

Maybe ask your vet about mirtazapine as an appetite stimulant. Subq fluids are easy to administer on a cat that’s under the weather and they can’t really make the situation worse. Don’t be afraid to assist your kitty in eating- mix up one of the mushy (not chunky) cat foods with some warm water, use a large-ish syringe to get some calories in him. The last thing you want to deal with is hepatic lipidosis on top of the anemia.

Good thoughts for your kitty and do let me know if you need more detailed info on the bloodwork we ran.

[2tempe]

Not to be a downer here, but my dog developed IMHA (or AIHA - same thing) very suddenly, it was described as an aggressive case w/ poor prognosis, so I let him go. Treatment protocol for dogs is several drugs, including steroids, typically over long period w/ regular testing. It does not get “cured” but rather put into remission.

It is serious, for sure. My dog wouldn’t eat, not even treats. Jingling for your cat. I would get to a specialty clinic ASAP.

[emipou]

I think we will be practical about it. This is really bad timing for us, money-wise. But if there will be long-term suffering, we will do our best to make the right decision for her.

I was sitting on the couch last night reading through these forums when I heard a funny noise. I looked up and she was laying there with her nose/face smooshed into the couch cushion. I thought she died. I lifted her head and she was all dazed and her little tongue was sticking out. This freaked me out.

I went and got her a little cup bowl of water and gave it to her. She drank. And drank. And drank. And drank. And drank. And drank. She had the food and water in front of her and kept looking at the food but couldn’t seem to eat any of it. She drank almost an inch of water out of this little cup-bowl. What the hell were we thinking all day? Why didn’t it occur to me to give her water earlier?
Anyway, took her up to the litter box and she peed. After that, she hopped out and went to the big water dish and started drinking more. I locked her in the room so the other cats would not bother her. When I went up for bed an hour later she was waiting for me on the bed.

I appreciate all the advice so far. I will try to use this as wisdom to take in to the vet with me. I had to administer fluids to my last cat who had kidney disease. So if it comes down to that, I can do that, but I don’t want to make her linger if she isn’t feeling good. It’s a hard decision we might need to make soon.

[emipou]

[QUOTE=djangology;8018925]
My cat has had some recurring anemia issues.

He’ll present with sudden inappetence, lethargy, and a marked change in behavior- hiding in his litterbox cubby, as opposed to sauntering around the house. It should be noted that Milton is a strictly indoor cat and I keep a safe house- no rodent bait, no insecticides, no significantly harmful plants, so it was unlikely to be caused by a toxic exposure. Milton also has a mild case of cerebellar hypoplasia, in addition to chronic FLUTD, nasopharyngeal polyps, and vestibular syndrome. Yes, I know: he’s a trainwreck.

His anemia has popped up twice for him, about 18 months apart. If that spacing is any indicator, we’re due for it to start up again right about now.

For diagnostics the first time, we ran a mycoplasma PCR, and ran some basic bloodwork (I can probably dig up what sets of values we checked if you need me to). I was tight on cash, so I asked the vet to try to keep the bills minimal.

The vet didn’t have a great idea of what caused it, so she put him on prednisolone and doxycycline, prescribed mirtazapine, and sent me home with a subq fluids kit. I forcefed him with a syringe for 48 hours and he bounced back and acted like nothing happened… until the same symptoms popped up 18 months later.

We skipped the mycoplasma PCR this time around, but redid FeLV/FIV testing as it was possible he’d been exposed via my various foster cats. We also ran extensive bloodwork and discovered that his reticulocyte count was basically non-existent, meaning that he’d essentially stopped producing red blood cells.

This makes it a non-regenerative anemia, suggesting a bone marrow issue. My vet offered to do a bone marrow biopsy, but I declined- it seemed like an expensive and uncomfortable procedure that would either give me very bad news or no new information at all.

Instead, we did doxy and pred, with mirtazapine and subq fluids at the ready for support. Once again, a day or so of forcefeeding with a syringe, and he’s back to normal in just a few short days.

I don’t have answers- no one really knows why Milton’s body decides to stop producing red blood cells. The good news is that doxy and pred is just what the doctor has ordered for him each time and he’s snoring happily next to me on the couch right now.

Maybe ask your vet about mirtazapine as an appetite stimulant. Subq fluids are easy to administer on a cat that’s under the weather and they can’t really make the situation worse. Don’t be afraid to assist your kitty in eating- mix up one of the mushy (not chunky) cat foods with some warm water, use a large-ish syringe to get some calories in him. The last thing you want to deal with is hepatic lipidosis on top of the anemia.

Good thoughts for your kitty and do let me know if you need more detailed info on the bloodwork we ran.[/QUOTE]

I will definitely let you know if it comes down to wanting to see your results. I appreciate the offer.

I’m wonder how you force fed, or rather WHAT you force fed.
The vet gave us baby food. Between the baby food, canned food and her kibble, we’re seeing her eat a few bites here and there but nothing significant.

[emipou]

Just got back from the vet. Her levels are still dropping. I think the vet said they are at 14%? Or 13%? Why do I always forget these numbers??

Anyway, I asked about blood parasites. They were checked for already but the possibility to do a more in-depth test for blood parasites is on the table.

The auto agglutination test was performed and wasn’t really found.

We are going to get through the weekend and have another follow-up for Monday. If levels are still dropping, we will consider doing an anemia panel, which covers a number of specific parasites and other causes for anemia.

The possibility of bone marrow tests came up and I asked her how invasive and helpful it would actually be in the end and she sort of agreed with me and said that it was a bit invasive and might not really do much for her, even if it comes up positive.

In the meantime, she sent me home with appetite stimulants and some high calorie food that I can mix with water and feed through a syringe.

If anyone reads this, please send any love and positive thoughts you can to my poor cat. Thanks!

Thank you for helping me be a more informed kitty mama guys! The vet sounded impressed with my questions.

[dsedler]

We lost a dog 12 years ago to AIHA. She was 2 years old. I took her to the vet because she was just not acting right. Didn’t want to play ball, didn’t want to eat, really didn’t want to do anything but sleep. I took her in on a Thursday and we had to put her down on Monday. We did everything we could at the time, including blood transfers, steroids, and a day spent in an oxygen cage because she wasn’t doing too good. In hindsight, we tried for too long. The end was pretty bad. But, from what I remember, as someone else said, you don’t really cure it, you just put it into remission. When I was reading about it, I remember reading that there will always be ongoing maintenance and chances for flair ups.

I wish I could remember more about the treatments that we did and some of the stuff that I read at the time, but I honestly try not to think about it or remember much of it, because it really was awful for myself and my husband. I’m also sure alot has changed in what treatments are available now that weren’t there 12 years ago.

Good thoughts coming your way!

[Pancakes]

[QUOTE=Horsegal984;8018852]
1)did they test for auto agglutination? That’s one of the BIG markers for IMHA.

2. was a blood sample sent to the lab to look for blood parasites?

3. how long has she been not eating? More than three days is a big red alarm for cats.

Finally, how low is “severely anemic?” She may need a transfusion to get back on her feet.[/QUOTE]

All this, plus, is the anemia regenerative or non-regenerative?
A reticulocyte count should be able to tell you.
The possible diagnosis changes GREATLY if you can classify the anemia.

[djangology]

[QUOTE=emipou;8019361]
I will definitely let you know if it comes down to wanting to see your results. I appreciate the offer.

I’m wonder how you force fed, or rather WHAT you force fed.
The vet gave us baby food. Between the baby food, canned food and her kibble, we’re seeing her eat a few bites here and there but nothing significant.[/QUOTE]

The appetite stimulant is probably mirtazapine- it should help.

The high cal food is likely Hill’s A/D diet. Take a quarter of a can, mix it with just enough warm water to make it goopy and draw it up into a syringe. I’d squirt it into his mouth 1 or 2 ccs at a time.

It gets messy, but A/D is the best for it as it’s a very fine particulate mush. Anything that comes as a patè will work, but most other cat foods are my roughly textured and it can be hard to work with in a syringe (and don’t even try the shreds or chunks unless you get a blender involved).

[SquishTheBunny]

Imha is not common in cats like it is dogs. Dogs generally do very well but it’s a commitment … meaning sometimes several blood transfusions while the immune system stops attacking the blog cells.
I would recommend seeing an internal medicine specialist asap. If you have financial concerns then just go for the consult and bring a copy of the ultrasound and bloodwork…they will review dduring the consut and give a more educated opinion on what may be going on amid treatment options.

Jingles

[Snowflake]

Strange question… but what color is her poop?

[emipou]

I’ve been following this thread via email so haven’t had a chance to respond much.

As far as poop, I haven’t seen her poop. I’ve had to start physically placing her in the litter box (she’s being brought downstairs and far from the litter box while we are up during the day) to make sure she goes, and all I have seen her do is pee.

So, here is the latest. We took her back in to the vet yesterday and checked levels again. And her levels have stayed the same! Which is GOOD. But she is down half a pound, not good.

At this point, we have pretty solidly ruled out blood parasites, tumors and bone marrow. We believe it’s the body attacking itself, which does make this a rare case and the vet is giving it a 50/50 shot.

We were feeling a little more positive because she started eating on her own a bit the other day but then last night things took a bad turn. I’m just going to copy out what I wrote to the vet earlier this morning…

We went to take BK up to bed last night. I put the water in a more accessible place for her by the side of the bed. We turned the lights out. A few minutes later, there is a failed attempt to hop up on the bed. She tried but then fell. So I pick her up and put her on the bed and Wesley is hugging her and she starts making this siren noise. It just keeps going and going. We turn the light on and she has her mouth open and she’s sort of hyperventilating and doing this meow siren. ?
I put her on the ground. It seems like she was choking, or wanted to cough up something. She couldn’t stand, so when I dropped her, she would go limp. We really thought she was going to die. After a minute or so of this, we put her back up on the bed. She’s drooling a little and still holding her mouth open. Breathing heavily.
After a bit, she sort of calmed down again. She spent the rest of the night between us on the bed.
This morning after I woke, I went back up and she was on the ground with her head hanging out in the water dish.

I gave her a bunch of food to try out this morning and she appears to be starting to eat it slowly.

We don’t want her to be in pain. If she does that again, we will need to consider PTS.

So,… not feeling particularly good about the situation at this point in time. The vet replied back agreeing that if quality of life is not improving, then we should consider PTS. :’(

[emipou]

the vet’s response to my email:

Hello,

Thank you for the update. I’m sorry to hear Baby Kitty went through that episode last night. I’m sure that was very scary for all of you. It’s hard to say exactly what was going on with her during that episode, if her anemia is getting worse she may be having a hard time properly getting oxygen to her brain and other organs. I would agree with you that if she continues to have episodes like that she is not having good quality of life and we should consider putting her to sleep. Please keep me updated on her condition.

[Snowflake]

http://www.chronofhorse.com/forum/showthread.php?458023-Possible-FIP-Diagnosis-I-m-Devistated! <-- Read this post. It sound not too different than what I went through with my kitty. She was so weak and thin that she wasn’t able to jump up on the couch and bloodwork showed severe nonregenerative anemia. Vet thought FIP at first but after a consult with a veterinary internist, we got a proper diagnosis and have been treating with great results. If you want to really dig deeper into what’s going on, I would recommend getting your cat to a specialist ASAP.

[emipou]

I really appreciate your response. I’m going to look into this further.

From what I recall, we already did an ultrasound. It was the first thing they did when her tests came back anemic. All her organs looked pretty normal, or normal considering. The pancreas was mentioned at one point. I think they said it was slightly enlarged which was normal considering that her body was dealing with such severe anemia, but I might have the wrong organ and the wrong description at this point.

What I did, since I was running out the office door when I saw your message, was take a screen shot of your update post with the info about the pancreas and the resolution, and I sent that screenshot to our vet to make sure this avenue had already been considered. I really believe this is a good vet (this case actually has become a team effort at the clinic at this point) and will wait to see her response.

If her levels continue to drop and this vet isn’t cutting it for us, I agree that it would be wise to seek a second opinion from a specialist.

She is eating on her own right now !!! I can hear her purring from across the room