Critical Cell Values - Seeking Advice and Guidance for Josie

[!6r6JAtVp44n]

Seeking medical advice for Josie, who has severe cell values and is in need of immediate intervention or euthanasia. If anyone can offer insight and provide recommendations on potential causes for her condition, diagnostics, treatments, etc., we would greatly appreciate your help.

Some background information and notes:

3/15/22:

• Annual Examination at Vet
• Rabies vaccine
• Manual stool extraction
• Started Miralax for constipation

5/6/22:

• Adopted and brought home 2nd cat named Leo. He had a history of ringworm and was rescued from a flea infested area. His ringworm and fleas were resolved prior to adoption.

6/14/22:

• Discovered Leo had tapeworm
• Treated both Josie and Leo with OTC Dewormer (Bayer praziquantel)
• Applied Frontline Plus

6/24/22:

• Josie’s mouth was hanging open and had bloody lower left gum
• Brought to ER Vet 1, they were booked so we left. She was sitting in her carrier on top of a transport cart while I called around ERs.
• Admitted to ER Vet 2, and sent home with antibiotics (Clindamycin 25mg/ml OralSusp 20ml bottle, 2ml every 12 hours) and pain meds (3x Onsior 6mg, 1 every 24 hours)

6/29/22:

• Progress exam at Vet

Mid-July:

• Applied Frontline Plus

7/26/22:

• Discovered Josie limping on front leg
• Exam at Vet
• Sent home with 3x Onsior 6mg for suspected minor sprain

7/28/22:

• Josie was still limping/elevating paw
• Follow up exam at Vet
• Weight was slightly lower than in June
• They shaved underside of paw and suspected an old puncture wound
• Sent home with 10x Enrofloxacin 22.7 tablets and topical Chlorhexiderm solution

Late July/Early-Mid August:

• Discovered scab around Josie’s neck. Suspected Leo had scratched her.
• Observed Josie losing clumps of fur and aggressively scratching her head/neck area.
  • Suspected possible fleas. I did not find fleas on her (I found white flecks in the flea comb and suspected dead skin), however I gave her a bath with flea shampoo and reapplied Frontline Plus.
• Observed Josie hiding in odd spots around house. She’s always been a bit of a scaredy cat and has always slept or hung out on the bed, under the bed, or on the couch. She’s been avoiding her usual areas and have found her:
  • inside dresser
  • in closet
  • in bathtub
  • on dressers
  • on windowsills
  • next to air vent

8/19:

• Called Vet because I was concerned about scabs around her neck which were getting larger

8/23:

• Exam at Vet
• Vet noticed elevated heart rate, agitation, and weight loss
• Area around scabs was shaved. Told to use Chlorhexiderm.
• Bloodwork done (Idea FeLV Antigen and FIV Antibody by ELISA Add-on, HealthCheck Plus Profile)
• Sent home with 21x Prednisolone 5mg

8/24:

• Blood results came in
• Vet discussed transfusion, possible bone marrow biopsy/cancer, ultrasound, euthanasia

8/25:

• Brought back to Vet to have blood redrawn and retested (no results yet, vet said blood appeared thin)
• Started Clavamox 15ml (given 1ml every 12 hours)
• Comment from vet at University of Minnesota: “It could be feline leukemia or FIV, cancer,immune mediated hemolytic anemia, or immune mediated neutropenia, immunemediated pancytopenia.There is an anemia panel apparently that can be run. The owners either need to be all in to treat and hope they can fix it or they need to consider humane euthanasia. Those cell counts are pretty severe.”

Present symptoms/behavior and general information:

• Using litter box (more urine than stool)
• Stools are hard and small
• Urine output is lower
• Confining herself to my bedroom. I had them separated for a week or so and keep the bedroom door shut at night as Leo can stress her out.
• Scratching has diminished greatly, but she occasionally will frantically scratch/lick paws, neck, and ears
• Appetite is decreased but she is still eating some. She tends to eat more after steroids and if I eat at the same time as her.
• Occasional meows that seem/sound unusual (not yowling, just different)
• Not as interested in getting pets/scratches, but will purr at times when she is scratched
• Sleeps in bed next to me at night
• Tired at times and general lethargy
• Not active
• Alert
• Drinking water occasionally (she never drinks from her water dish and I’ve always mixed water into her wet food)
• Her general diet is wet canned food (Sheba, Fancy Feast, Wellness, Weruva). Only since adopting Leo has she had some dry food because he needs to gain weight so it sits out (Orijen original)

*Further records and documentation are available since rescue/adoption

Thank you,
Sara & Josie

 

[Antonio65]

Josie looks like one of my feral cats who, in October 2019, had a severe weight loss over few weeks, and when I took her to the clinic they found similar blood values, low RBC, HCT, Hgb, etc.
The diagnosis was immunomediate non-regenerative anemia, and they advised me on euthanasia.

I insisted to treat her before taking an irreversible decision, and now she's still fine.
The treatment was long term therapy with prednisolone and monthly checks on her blood.

Hopefully your Josie may benefit of the same luck and therapy.

 

[Astragal14]

I am so sorry that these vets are already discussing euthanasia, that's terrible! This could be many things, and could definitely be treatable!

Did all of Josie's symptoms start after Leo's arrival? My first guess is that Leo brought something with him and passed it to Josie. Her lab work could indicate several different things, but it also fits the pattern of anemia due to blood loss from fleas, ticks or other parasites - which is definitely treatable.

Your vet can review different treatment options, but be sure to ask about controlling inflammation because that will greatly help her body prevent further blood loss. Two easy treatments that help with inflammation are fish oil and B12 injections. Fish oil takes about 6 weeks to build to a mild effect, so discuss stronger, short-term options with your vet that would have a more immediate impact.

There are many causes of anemia in the cat, but they can be broken down into three major categories: loss of red blood cells, destruction of red blood cells, and failure to produce new red blood cells.
...
With chronic blood loss through the intestinal tract or from parasites, cats would be expected to show an elevated reticulocyte count. When a cat has a low red blood cell count and high reticulocyte count, this is called a “regenerative” anemia, as the body is reacting appropriately to blood loss. As long as red blood cells are being lost faster than reticulocytes can be released from the bone marrow, however, the cat will remain anemic.

Anemia

 

[silent meowlook]

Hi. I am sorry your cat is so sick. Have they checked for micro plasma, aka hemobartonella, or FIA? It is a blood parasite. Has anyone discussed a blood transfusion? Kitty really needs a specialist at this point. Ask for a referral to an internal medicine board certified specialist.

 

[!6r6JAtVp44n]

Thanks everyone for your input. They checked for Hemobartonella/Feline Hemotropic Mycoplasma and it was negative. Her retested blood came back and her RBC were about the same, platelets were lower, and WBC had a minor increase.

She’s on daily prednisolone and antibiotics. She’s at extreme risk for infection, and she’s on antibiotics should the steroids help initiate an infection.

We’ve discussed transfusions. My vet said she would likely need multiple RBC transfusions and a platelet transfusion. I called around and got an estimate from an ER for a transfusion and they estimated 2.5-3k. That doesn’t include the cost for a bone marrow biopsy or additional procedures.

My last cat passed away from Cushing’s disease back in 2019 and I drained my finances trying to treat him. I rescued Josie later in 2019 after she was thrown from a car, severely emaciated (2.25 lb), and jaundiced. She’s averaged 12 pounds since being brought back to health, but she was around 11 pounds (give or take) in June and is now around 10 lb. If I had the possibility of going into further debt to save her, I would do so in a heartbeat, but I’m maxed out.

I’ve been feeding her chicken baby food today as she doesn’t have a big appetite for her normal wet food. She’s been pretty tired and I’ve been laying with her for the past few days, but she will get up and go look outside or groom herself.

My vet said she could start having trouble breathing, have a seizure, or start bleeding, and at that point I’d have to bring her to the ER (or my vet if they are open) to euthanize. I want to avoid that stress and any suffering on her at all costs. I also don’t want to end her life prematurely, especially if any miracles are out there. I had in home euthanasia set up for tonight, but I canceled it because she is still stable. I’m just in a battle with myself on what to do.

My vet is a feline only vet and I have the utmost faith in her, who believes this is bone marrow cancer. I’m just looking for whatever help I can get at this point and hoping someone has gone through something similar that may have some advice.

 

[!6r6JAtVp44n]

Also I asked my vet about a few things yesterday and this was her response:

There are multiple reasons why I would rule out Hemobartonella. Her blood was checked at the lab for hemobartonella (now called Feline Hemotropic Mycoplasma) and no organisms were seen. If those results are true and she still has such a severe pancytopenia, her slide will be scanned again for Hemobartonella. I also checked a slide at the clinic. Hemobartonella does not tend to cause this severe of an anemia in most cases (in some it can) and it does not cause the changes in white blood cells or platelets like we see in her. We also tend to see what is called a regenerative response with Hemobartonella which tells us new red blood cells are being created...we see none of that in Josie and there are multiple criteria we look at. I have never seen a cat with Hemobartonella be itchy.

Depomedrol is a type of steroid that is given as an injection and stays in their system for a significant amount of time. We do not use it in our clinic because once you put it in a cat's body you can not take it out. You also have no control over dosing. For her, using a steroid is indicated, in case this is auto-immune and she is already on a steroid in the form of prednisolone. Because she is at such high risk of infection, with prednisolone we can discontinue the steroid if an infection were to develop whereas with Depomedrol you could not and if she got an infection the depomedrol would make it much worse. Besides that, because her platelets are so low, giving her any kind of injection is a risk for significant bleeding.

Epogen is a synthetic form of a hormone that is necessary to help produce red blood cells and is used typically in cats with renal failure (this hormone is produced in the kidneys). Josie has no evidence of kidney disease so this would not help. Even if it were....it would not help enough to get her red blood cell count to a place that is even close to normal. It is given as an injection, which is problematic for her as well.

You can see some anemias that have to do with cobalamin or folate deficiency but that isn't a logical consideration for Josie since anemia is not her only problem...again, her problem is along all cell lines. So while these things may not hurt, they will not do anything to treat her pancytopenia.

I promise Sara, if there was something else to do that I thought would make her better...I would be doing it. If you want to treat her, she needs a transfusion (if not multiple) and hospitalization and a full work up which would include x-rays, ultrasound and bone marrow. Like we discussed, this will be costly and unfortunately without guarantees.

I know you want all the information you can to help you make the best decision. I'm happy to answer your questions. As much as you want more answers, the internet is a double edged sword and full of incorrect info. If you need a second opinion, I would understand and if so, please let me know because I want to be sure you go somewhere with good doctors and experience.

 

[!6r6JAtVp44n]

Josie looks like one of my feral cats who, in October 2019, had a severe weight loss over few weeks, and when I took her to the clinic they found similar blood values, low RBC, HCT, Hgb, etc.
The diagnosis was immunomediate non-regenerative anemia, and they advised me on euthanasia.

I insisted to treat her before taking an irreversible decision, and now she's still fine.
The treatment was long term therapy with prednisolone and monthly checks on her blood.

Hopefully your Josie may benefit of the same luck and therapy.

Thank you Antonio. Did your kitty have low WBC and platelets also? She started prednisolone 5mg on Wednesday but my vet bumped it up to 7.5 mg yesterday 1x/day) when we added in the antibiotics to counteract the chance of infection due to the steroids effect on her immune system.

 

[!6r6JAtVp44n]

I am so sorry that these vets are already discussing euthanasia, that's terrible! This could be many things, and could definitely be treatable!

Did all of Josie's symptoms start after Leo's arrival? My first guess is that Leo brought something with him and passed it to Josie. Her lab work could indicate several different things, but it also fits the pattern of anemia due to blood loss from fleas, ticks or other parasites - which is definitely treatable.

Your vet can review different treatment options, but be sure to ask about controlling inflammation because that will greatly help her body prevent further blood loss. Two easy treatments that help with inflammation are fish oil and B12 injections. Fish oil takes about 6 weeks to build to a mild effect, so discuss stronger, short-term options with your vet that would have a more immediate impact.


Anemia

They looked for hemobartonella/Feline Hemotropic Mycoplasma , and no organisms were seen.

I posted some responses that discuss the B12, but did not ask her about fish oil. I will certainly do that.

She was fine around Leo for the first few months, so I don’t know if there’s a correlation there. My vet said she’s likely been pretty sick for at least a few months. She also said “her values are severe...the worst I have seen in 25 years of being a feline vet.”

 

[mrsgreenjeens]

This is probably not important at the moment, but did the itching start up with the Frontline Plus application? And in the same spot? I'm wondering if it's that and the timing to her bloodwork is just coincidental. Have you used it before on her?

I was able to find an old thread where the cat had Hematocrit of 9 (Josie's is 10) (Hematocrit is also know as PCV) and they were able to save her, however, it did require transfusions and hospitalization. Have you checked into Care Credit? Here is that thread in case you are interested: Liquid Medicine - Atopica & Prednisone (for IMHA)

 

[Astragal14]

There was a recent thread discussing anemia, blood transfusions and how to pay for veterinary bills (Care Credit was discussed, I don't recall if other options were mentioned). It's a lengthy thread but very detailed.
Possible anemia-Desperately needing support

I don't want to add to what is surely information overload, but there was an unexpected spike in cases of pancytopenia in the UK last year. A few different foods/ingredients were suspected but no definitive link was proven. You may want to check to see if Josie was exposed to any of these foods/ingredients (I recognized the Applaws brand as one also sold in the US), or you could ask your vet if anything about Josie's case resembles what happened in the UK.

Rise in feline pancytopenia cases, what should cat owners do? - Vet Help Direct
Cat food has NOT been proven to be the cause of pancytopenia, so what is happening to our cats? - Vet Help Direct
Severe feline pancytopenia in cats fed certain types of dry cat foods

 

[!6r6JAtVp44n]

This is probably not important at the moment, but did the itching start up with the Frontline Plus application? And in the same spot? I'm wondering if it's that and the timing to her bloodwork is just coincidental. Have you used it before on her?

I was able to find an old thread where the cat had Hematocrit of 9 (Josie's is 10) (Hematocrit is also know as PCV) and they were able to save her, however, it did require transfusions and hospitalization. Have you checked into Care Credit? Here is that thread in case you are interested: Liquid Medicine - Atopica & Prednisone (for IMHA)

I’m honestly not sure if the itching started at the same time. I applied it in June, July, and August. Her scab is on the side of her neck and the FLP was applied between her shoulder blades. I don’t know if I applied it correctly the first and potentially second time - meaning I don’t know I got all of it all the way down to her skin. She has very dense fur.

I can ask my vet about Atopica, it sounds kind of dangerous in her case with her WBC so low.

I still have a Care Credit account from my last cat. My balance would potentially cover 1 transfusion, but she’s going to need a few transfusions to start with. Unfortunately the APR is 26.9%.

I asked my vet about the itching and scabs:

The scab on her neck is likely an innocent scratch but because of her low platelet count it has continued to bleed and scab, which bothers her so she scratches more and likely has a superficial infection. As far as her problems go...it is SO minor and likely has no significant link as far as being a cause or a symptom of her major issue which is pancytopenia, a decrease in all her cell lines (red blood cells, white blood cells and platelets). And her values are severe...the worst I have seen in 25 years of being a feline vet.

 

[!6r6JAtVp44n]

There was a recent thread discussing anemia, blood transfusions and how to pay for veterinary bills (Care Credit was discussed, I don't recall if other options were mentioned). It's a lengthy thread but very detailed.
Possible anemia-Desperately needing support

I don't want to add to what is surely information overload, but there was an unexpected spike in cases of pancytopenia in the UK last year. A few different foods/ingredients were suspected but no definitive link was proven. You may want to check to see if Josie was exposed to any of these foods/ingredients (I recognized the Applaws brand as one also sold in the US), or you could ask your vet if anything about Josie's case resembles what happened in the UK.

Rise in feline pancytopenia cases, what should cat owners do? - Vet Help Direct
Cat food has NOT been proven to be the cause of pancytopenia, so what is happening to our cats? - Vet Help Direct
Severe feline pancytopenia in cats fed certain types of dry cat foods

Hi Astragal,

It sounds like their kitty is okay, which is wonderful. Did they find out what the underlying cause was/is? I read through all of it, but I’ve been either sleeping or crying the past few days so I might have missed that detail being so drained.

As far as the UK food goes, how absolutely awful for cat owners to have gone through that. We are here in the midwest US, and she really doesn’t eat dry food. She’s eaten a bit of Leo’s Orijen Original here and there, but her diet is primarily wet. She’s been pretty hungry today and thankfully their Chewy shipment arrived.

She’s always been a really picky eater and dips her paw in her food at first to taste it before eating. A cute quirk of hers that has me in tears again. I’m happy she still has a little bit of an appetite, probably because of the steroids. I’m just hoping for a miracle at this point.

 

[silent meowlook]

Hi, It sounds like you have a good veterinarian. I wouldn't do Atopica at this time due to the blood count being so low. It sounds like you are doing everything you can. I have seen adult cats get extremely anemic from mycoplasma, but it sounds like you ruled that out. Keep her as quiet as you can and do all you can to remove any stress from her life. I am sorry you and she are going through this.

 

[!6r6JAtVp44n]

Josie crossed the rainbow road. Thank you all for your support.

 

[mrsgreenjeens]

I'm so sorry to read this. I know you are heart broken, as we all are right along with you. No words can ease your pain right now, but know we are with you

 

[Astragal14]

You gave her so much love. I am so, so sorry for your loss.

 

[silent meowlook]

I am so very sorry for your loss. I hope you can find comfort in the good memories you have of her.

 

[fionasmom]

I am very sorry for your loss. When a cat passes on, we lock the thread out of respect. If you would like to post a memorial to Josie in our Crossing the Bridge forum, you are welcome to do so. Josie lived a wonderful life with you and, in time, hopefully happier memories will return to comfort you.

Crossing the Bridge