My 16 year old kittah is having a persistent problem with her blood count. Here is a little background.





In early January, she was diagnosed with Hyperthryoidism. Two treatment options were available. Radioactive Iodine treatment and a pill called Felimazole. Since the Felimazole seemed like a less intrusive option, we decided to give it a try first. The main issue is that it lowers the cats blood count. We went back in about 6 weeks to check the progress and her blood count was very low. Vet said to discontinue the Felimazole and we would go with the iodine treatment as soon as the blood count was back up.





Now, it's been going on 10 weeks and her blood count is still way too low. The Felimazole should not have been this persistent and vets aren't sure what the problem is, but likely isn't the Felimazole.  Our vet has consulted with at least 3 other vets and pathologists and no one knows why it is still low. So far, we have aspirated bone marrow from her hip and it shows a normal amount of immature blood cells waiting to enter the blood. The platelets are back up to about normal, but the white and red are still low. Vet did an ultrasound of her spleen on the last visit and it is slightly enlarged. Vet also gave her a course of antibiotics and she is on prednisone 5mg twice a day. Vet says there is no sign of internal bleeding or cancer. Really no way she could have fe-luk as she has no contact with other cats and has been vaccinated since year 1.





We're just at out wits end. Vet has just about conceded defeat, but we're not ready to give up. If there is anyone out there who might have some idea on where to go next, My wife and I would be very greatful.










 

Feed her the blood of the innocents?

What about getting a young kitty for blood transfusions? Has the vet said anything about this?

I'm sorry about your furball. She's very pretty. I like her big round head and white bib.

Maybe feed her liver?

We can do a transfusion, but it's only temporary. I need someone to help find the root of the issue.And, we cant get the iodine therapy for her thyroid problem until we get the blood fixed.

I'd search google and maybe make calls to try to find a specialist in the problem that the cats having. I'd guess you'd need to need to pay some kind of consulting fee. Maybe call some respected schools of veterinary medicine, see if they can suggest anyone.

Were the white and red blood cell counts checked before starting the Felimazole?  (I'm sure it was but just checking.)

You can give erythropoietin to boost red cell counts but I'm not sure how expensive it would be.

Can they target the thyroid more tightly? Without messing with the other parts of the kitty?

What is the cats diet like?  Sufficient taurine, carnitine, iron?

Yes. They were WNL. Googling erythropoietin now.



ETA: Ok, it's EPO. EPO signals the marrow to make RBC's. Her bone marrow is making them, but they are either not getting out of the marrow, or dying rapidly, or going somewhere. EPO might be an answer to boost production and thus more for her blood, but if they just die or leech out, not much point. But, It's something I can ask the vet about. The real puzzle is what is happening to them.

How about just making the cat as comfortable and happy as possible?

It is a 16 year old cat.   That has got to be around 70-80 years old in cat years.

In 37 years I have only seen maybe 4(out of 20 or so) of the family cats make it to 16-18 years old.   I am a cat person and like cats but there is a point at which you can only go so far or do so much.   Various people will go to various lengths but at 16 years old giving the cat a good life on the shady side of the hill seems better than constantly hauling it into the vet for things they may screw up.

Spoken after having one of our older cats go in for an ear cleaning only to have an ear drum punctured by the vet and the cat nearly dying of starvation while it's equalibrium was so screwed to hell it had to relearn to walk.

Longest living cat we had was a siamese that got smacked by a car.   Pinned leg, knocked out teeth making it drool when it purred, and it loved to 19-20.

My mom had a cat that had thousands put into it when it was younger and it paid off living to 17-18.   But in the final years we backed off.

A 22l...


...never mind...

They won't administer the radioactive iodine in the diminshed capacity she is currently in. Iodine 131 IV goes directly to the offending part of the thyroid and kills it. Definitive treatment for hyperthyroidism with near 100% success rate. Cat is radioactive for up to several weeks after and special handling practices are mandated. She stays at the treatment center for 3 days after.



 

If she were suffering, I would agree with you. She is otherwise very healthy. Kidneys are great. We go on walks every afternoon. It's not like she is on her deathbed. She is up and active, and eating well, but she tires quickly and is susceptible to infection with the WBC's as low as they are. And, they won't do the hyperthyroid treatment she needs. The WBC/RBC's are sort of stable, just sort of stable at a very low point. She has been comfortable and happy as possible for the last 16 years. We're just looking for a way over this current issue.
 

I looked into that when it looked like one of my cats had hyperthyroidism (fortunately he didn't). It looks like an effective treatment with no real downside. Best of luck with getting him to the point to get there.

Thanks. My wife found what looks like one of the better vet school in Raleigh. Trying to figure out how best to see if they will consult on this.



 

I'd recommend taking her to a vet school. Auburn here in AL has saved both our #1 dog (cancer) and my in-laws dog as well (thrombocytopenia).

At least here, your vet will need to make a referral. This also helps with continuity of care.

OK, good.  The answer may be the spleen as you posted:


In humans, a red blood cell is battered by going through the small capillaries.  After about 90 days, the spleen plucks the red blood cell from the blood and recycles the components.  If the spleen is enlarged, it could be that red blood cells are being destroyed by the immune system (autoimmune hemolytic anemia) or something else.  The cats immune system could be attacking the red blood cells.  The bone marrow, as shown by the aspirate, is normal.  So it's an issue of destruction and the enlarged spleen indicates that as well (it's overflowing with red blood cells it's trying to process).

That may be why the vet started the steroid which suppresses the immune system and therefore reduces the attack on the red blood cells.  The steroids will reduce the lymphocyte count which would give a low white blood cell count.  But the WBC's were low even before the steroids (prednisone) so that's not likely a factor here.

This is a complex case in an elderly cat.  But if it's not suffering, and you have the extra money, it sounds like it's worth pursuing to a reasonable extent.

Last CBC showed RBC up slightly, and WBC's down slightly from prior CBC, so sounds logical that this may be what is going on. We check it about every 2 weeks.





She just finished a regimen of amoxil 50mg twice daily. Would this clear up Mycoplasma haemofelis if it were a secondary AIHA? I can't think of any other possibility than Mycoplasma haemofelis. She finished the amoxicillin yesterday, and I'll have to say she appears a little more active the last several days.
 

Ok I'll bite.

I deal with this daily.
first- how anemic are we talking?

a hct of 12, or 21?

how is the cat physically? weight loss? neurologic issues?

there is quite a bit of laboratory and physical data that is missing from your post.

its normal for elderly animals to become anemic to a certain degree. the Hyperthyroid issue certainly plays into over all health.

when Vets call for a consultation the first thing I ask is where is the blood going? out or not being put into circulation.  the cat could have a GI bleed of some sort, possible FIP. you name it.

100 reasons for a cat to have issues, especially a 16 year old cat.

does the Vet have any kids in College? or need braces?
feel free to IM me.


FIA is always a possibility- but easily identified.

Auto Immune Hemolytic Anemia can be caused by dozens of things and is treated by steroids.

I'm sorry, but I'm not sure of the last RBC count, but I believe 22 was mentioned.



Cat is physically normal for advanced age, but active. She was down to 6lb 12oz three weeks ago, but was up to 7lb 02oz Monday. She is also eating better this week so I expect the last weight to increase next Monday. No neurologic issues noted. Where the cells are going is what we want to know. I wish I could tell you where they were going, but there are no indications of internal bleeding or cancer



If you're willing to help, tell me what you want and I will call the vet office and get that information.



Vet doesn't have any kids, but could probably use braces herself.



 

I'm off to bed for now, back on tomorrow. gotta make some money to pay for vet appointments.

Methimazole can cause both anemia and low wbc count from bone marrow suppression.  It can also cause hemolytic anemia (red blood cell destruction).  I would bet you have both going on. I can see hemolytic anemia causing the low HCT but what's going on with the WBC count?  Granted IMHA isn't that common in cats but I'd expect there to be an inflammatory response and elevated WBC if it were just IMHA.

What are the WBC counts and RBC morphology and platelet count?  How about the bilirubin level?

As for EPO, it may or may not work.  Cats will form antibodies to it rather quickly so it's not that useful.

I suspect it's all secondary to the methimazole and it's going to get better over the next few weeks.  Have they talked about putting in a feeding tube?  It's relatively easy and safe and can be done quickly and is a good way to help keep up the caloric intake until the cat is feeling better.

I'm kidding about the kids in College and Braces. those 2 seem to be the biggest comments from pet owners when they call our lab bitching about their Vets Fee's ( when their Vets aren't even our clients). they go interweb hopping and somehow  find our website and 800 number and decide to call for a consult. I never get involved, but do get an earful about the cost or their opinion of the Veterinarian in question. I need to post some of the emails I get from crazy horse women.  those are like reading the personal ads on Craigslist.

a lot of people are shocked at the cost of Veterinary Care in this day and age. but a gallon of milk is $4.50.

I do know that each week we get dozens of anemic, geriatric animals that are seemingly fine- just rolling thru life the best they can. I reported out a Panel this week on a 22 year old cat. with good genetics and quality owner and veterinary care, cats can live decent lives well into their late teens in some cases.

of course I see a lot of the other dynamic as well, owners who can't let go and refuse to put very sick, geriatric dogs and cats down as well.

this would be my guess. as well. I am usually hesitant in saying too much without seeing reports. I've found that a lot of times their are certain amounts of miscommunication between Vet and Owner.

we get a lot of positive DAT's on cats and when we look at their records MMZ is almost always listed on the scripts- but dozens of things can cause a positive DAT.

I will say that season changes - winter to spring and summer to fall bring about a massive number of hematology issues ranging from hemolytic anemia's to onset of leukemia's and lymphoma's. I've reported out 6 full blast crisis leukemia's this week and 10 AIHA's on dogs and cats.

to the OP's credit-
I have never had a client send in a Bone Marrow Aspirate on a cat in 15 years and 2,000 clients. that alone is impressive.

Agree on the MMZ, but if so, it would be incredibly persistant. She has not had any in two months at least. She is eating fine now. After a period if weight loss, has gained 6oz in two weeks.





Called vet at 8am. Paperwork should be coming in shortly.





Just received her notes.





Anyone who wants to look, here they are in PDF.  (second thought, I don't want to do that.( Link removed) (PM for report.)





OKnativeson, sent to your phone as requested





Thank you to everyone. I'm off to work
 

Talk with your vet to see if Acetyl l-carnitine is safe for cats.   In humans, it is useful in hyperthyroidism treatment.
http://www.lef.org/Magazine/2007/12/report_thyroid/Page-02?checked=1

Just a post to thank everyone who offered ideas and are currently helping. We appreciate it guys. If any other Vet wants a copy of the med records and labs, just IM me.

...Except that it costs about $2000. Or more. It depends on where you have it done. But it's expensive.



 

I found this article Cat Info. I don't know if it will help, but it is interesting.

Good luck with kitty.

It was about $950 for our 13 yo cat. It included all testing and followups in addition to the treatment + a 3 day stay at the vet until the radiation level dropped. We had to 'save' her used litter for a 80 days before we could throw it in the trash to let the background radiation bleed off. Apparently dumps/trash haulers have radiation detection equipment installed and they can be set off by the radioactive poop which can cause all sorts of headaches. I never realized how much litter a cat produces in 80 days. It was enough to fill a 32 gallon trash can.

Op This thread is hard to read, I just lost
My cat last week of sudden onset anemia
At 15 years old

I wish you and your cat the best of luck

Op

Any improvement?

I had this thread all wrong.

I was also quite impressed that someone did an aspirate.  If the cellularity seemed ok and red precursors were plentiful, it would seem like consumption was the culprit but that may not really be the case.  If there was drug induced suppression and the offending agent has been removed for a while you could catch the marrow in a state of regeneration and this might be interpreted as normal when really more time is needed for a full recovery.  The rising rbc would point this way.  A repeat marrow may help but is probs overkill.  maybe just following retic count/percentage would be just as useful and way easier on kitty.  But you've got to put some common sense into it.  Judge the cat, not the number.  If the cat is acting lethargic and is truly hyperthyroid then the anemia is probably symptomatic and should be treated not just studied (transfuse).  That's the pathologist talking.

The cat owner now says:  if you think your cats symptoms from anemia are mild enough that they could handle the iodine I'd look for another place that would do it - or at least do it in conjunction with a transfusion.  Our cat looked, felt, and acted like junk at 14years, failed topical treatment, and had the iodine.  It worked like a charm.  I swear it's like she's 8 years old again (she 15).  I would pay for it again easily.  

I hope things work out for you.

Ours was closer to the 900 also, but that was with a steep discount since wife is a vet.  IIRC the place we used also wanted closer to the $2k mark.  Although we are in Alabama we didn't use Auburn.  We used a place in Baton Rouge since they didn't keep the cat as long.  there just aren't many places that do this so I guess they can demand the dollars.  As I said above though - our experience was really good and I would recommend it to someone on the fence.