Veterinary Answers, LLC 500 Mamaroneck Avenue
Veterinary Consulting Service Suite 320
Phone: 1-877-262-3024 Harrison, NY 10528
||Consultant: Dr. Jennifer Fryer
|Veterinarian: Dr. X
||Clinic: Anytown Veterinary Clinic
|Animal Name: Tigger
||Owner Name: Smith
|Age: 1 yr
||Weight: 14# = 6.36 kg
|Fax or email? Fax
||# or Address: (000) 000-0000
Tigger is an outdoor cat who presented yesterday for inappetance and extreme lethargy. On physical examination, he was about 3-5% dehydrated & tachypneic with normal breath sounds. No jaundice. Equivocally enlarged liver on radiographs. The owners are reluctant to treat and will not refer.
CBC: Marked anemia (Hct 16.1%). Reticulocytes were not measured, although 2+ polychromasia may suggest a regenerative response. Other cell lines are normal. Trace hemolysis may be secondary to venipuncture, less likely due to in vivo hemolysis since there is no bilirubinuria.
Chemistry Panel: Mildly elevated ALT, AST, ALP, Total Bilirubin.
- The elevated ALT is a common finding in severe anemia, related to hypoxia but can also be elevated in primary liver disease.
- The mildly elevated ALP may be due to a biliary abnormality, FIP, LSA, hepatic lipidosis (secondary to his anorexia), or cholangiohepatitis.
- The mildly elevated TBili may be secondary venipuncture, since there is no bilirubinuria. However, hemolysis remains a possibility given his severe anemia.
UA: After 200 ml LRS SQ. 3+ occult blood with no RBCs in sediment is suggestive of hemoglobinuria. No bilirubinuria or RBCs.
In House FeLV/FIV Test: Light positive on FeLV, FIV negative
Saline Aggulutination Test: Negative
Ddx: Mycoplasma hemofelis, FeLV, FIV, Immune-Mediated Hemolytic Anemia, LSA, FIP, blood loss anemia (fleas? Melena? Rodenticide?),
Recommended Further Testing: *Most important
- *FeLV IFA to confirm that this cat is FeLV positive
- Reticulocyte Count
- Coagulation Panel (PT will be the first affected by rodenticide toxicity)
- Blood Type in case transfusion is needed or Crossmatch
- Blood smear of capillary blood (from the ear) to check for Mycoplasma hemofelis organisms
- Mycoplasma hemofelis PCR (need EDTA blood and takes a few weeks)
- Bone Marrow if reticulocyte count does not indicate a regenerative response and there is no response to therapy
Doxycycline 5 mg/kg PO q 12 hrs in case of Mycoplasma hemofelis. Follow each dose with water to prevent esophageal ulceration.
Can add Baytril 2.5 mg/kg PO q 24 hrs since it will be synergistic with the Doxycycline to help clear possible Mycoplasma hemofelis.
Consider Prednisolone 5 mg PO q 12-24 hrs in case of immune-mediated disease or LSA. Discuss with the owners the potential that steroid therapy will make a diagnosis of LSA more difficult to find.
Consider cyproheptadine, syringe feeding, or NE tube feeding to get him to eat.
Monitor PCV/TS daily. Consider transfusion if he becomes tachycardic, hypothermic, or if the PCV continues to drop.
Please do not hesitate to contact me if you need further assistance.
Jennifer S. Fryer, DVM