Is it primary IMHA or is there an underlying cause

[arikanisil]

how is your kitty currently doing? Hope all continues to be good.

May I ask you if you did the bone marrow biopsy? We suspected the same IMHA in our cat Chibi case too but he has low levels in the three lines, and the bone marrow biopsy informs us it was working not working efficently but still working and during a few months that we have gave him prednisolone and cyclosporine it was working ( he had previoously needed two blood transfusions a feed tubing) and he even had a 33% hematocrit but now he's very sick so I was asking you if maybe in any of your reading or consults it was discussed treatment for the bone marrow if the anemia wasn't IMHA.

thank you so much, all my best wishes for you and your kitty

Sorry, in my previous message, i talked only about my cat's status and couldnt provide an appropriate replies to your questions. So, here they are:

I think you're trying to figure out what causes IMHA, or is there any underlying disease... Apart from bone marrow biophsy, here are some elective tests:
Tests for felv, fiv, corona, blood parasites. An ultrasound to check organs. A genetic test for pyruvate kinase deficiency (which is very very rare for cats). If you're done all these and couldnt find any answer, most probably your cat has primary imha.
Additionally, if you're getting response to immunosuppresants (even if the response is not as high as desired), this is another proof for primary IMHA.

If your cat's bw shows high RDW; this means bone marrow is working and producing enough/high blood.

I hope these are helpful and you can find all the answers you need.

Wishing you the best of luck in this treatment

 

[andreiamlm]

Thank you so much for your detailed answer, it's a great help to know what meds you are using, here in Portugal leflunomide is used in dogs and not cats for example! We tried chlorambucil and it didn't help and we suspect made things worse.

I wish you all the best and thank you so much for the quick answer it meant a lot for me and also the info of facebook group I didn't know about.

 

[andreiamlm]

thank you! in detailing your case it help with knowing the meds you tried and if we could use new ones, yes we did blood parasite tests and also ultrasound. The vet's opinion is that this is immune related anemia and a bone marrow disorder in conjunction, and that the pred+cycplosporine combo stopped working. It's all very trial and error. She tried adding a second immunosuppressor the chlorambucil with no answer too, maybe we should had tried the leflunomide, for example.

I know this is a very tough road for us and for the cats and know the pain and mental energy and stress we suffer for trying to help them so I want you to know that all we try is a testament for our love for them.

 

[arikanisil]

Thank you so much for your detailed answer, it's a great help to know what meds you are using, here in Portugal leflunomide is used in dogs and not cats for example! We tried chlorambucil and it didn't help and we suspect made things worse.

I wish you all the best and thank you so much for the quick answer it meant a lot for me and also the info of facebook group I didn't know about.

Ohh chlorambucile... We used that, too. Ift worked well in the beginning, so we tapered off the dosage. We alsontapered off the pred, too. Then my cat relapsed.
We started with highest dosage again. But that time chlorambucile did not work at all.
I guess, my cat somehow develops resistance to all these immunomediators. And i hope you never face such a problem

 

[arikanisil]

thank you! in detailing your case it help with knowing the meds you tried and if we could use new ones, yes we did blood parasite tests and also ultrasound. The vet's opinion is that this is immune related anemia and a bone marrow disorder in conjunction, and that the pred+cycplosporine combo stopped working. It's all very trial and error. She tried adding a second immunosuppressor the chlorambucil with no answer too, maybe we should had tried the leflunomide, for example.

I know this is a very tough road for us and for the cats and know the pain and mental energy and stress we suffer for trying to help them so I want you to know that all we try is a testament for our love for them.

Yes, you're right. This is a kind of testament.

By the way, there is also mycophenolate mofetil. I know from the facebook group that some members' vet prescribed it. And it seems it works. I have also read scientific papers about this med to use for imha. But my vet against mycophenolate mophetil, he said that "he didnt get any response to this med before". Don't know.
Anyway, you can also discuss mycophenolate mophetil with your vet.

 

[BellaBlue82]

Hi all,
I'm fairly new to the cat site group here, but my girl Sadie also has IMHA. We thought she was licking concrete because of a vitamin deficiency too. We were so wrong. She was diagnosed in October 2019 after stroke like symptoms, with hematocrit around 9. We really thought we would lose her. We couldn't find a matching donor for blood transfusion, so we treated aggressively with prednisolone and cyclosporine. It took her a year to fully recover, and through further testing we found her IMHA and IBD were tied to one another. No other underlying conditions, which really threw the vet specialists around here for a loop as they've never really seen a primary IMHA diagnosis before. Sadly, they think getting her vaccinated triggered the initial reaction.
She will be on low dose prednisolone for life, but after two and a half years I've gotten great at learning to read her. Weather changes ironically cause her to fluctuate, so we adjust her dosage in extreme cold. Blood tests are a breeze now, and reading them has become second nature.
I really hope your kitties are doing well after their IMHA diagnoses, all I can say is be very patient and don't give up.

 

[arikanisil]

Hi all,
I'm fairly new to the cat site group here, but my girl Sadie also has IMHA. We thought she was licking concrete because of a vitamin deficiency too. We were so wrong. She was diagnosed in October 2019 after stroke like symptoms, with hematocrit around 9. We really thought we would lose her. We couldn't find a matching donor for blood transfusion, so we treated aggressively with prednisolone and cyclosporine. It took her a year to fully recover, and through further testing we found her IMHA and IBD were tied to one another. No other underlying conditions, which really threw the vet specialists around here for a loop as they've never really seen a primary IMHA diagnosis before. Sadly, they think getting her vaccinated triggered the initial reaction.
She will be on low dose prednisolone for life, but after two and a half years I've gotten great at learning to read her. Weather changes ironically cause her to fluctuate, so we adjust her dosage in extreme cold. Blood tests are a breeze now, and reading them has become second nature.
I really hope your kitties are doing well after their IMHA diagnoses, all I can say is be very patient and don't give up.

fionasmom
S silent meowlook


Hello,

I am sorry for Saide, but also glad that she has such a knowledgable and fighter mum like you. I believe she will live long happy years with you. Even though, she'll be on low dose of pred.

With this regard, I'll also update about my Robin Panda.

The hemolysis didn't stop. Basically.
Whatever we did (this part is long).

Robin Panda had 6 blood transfusions (4 of which happened in February and March). His HCT was decreasing so fast.
We even tried hIVIG (which was used in dogs successfully but not much proof for cats).
hIVIG helped to slow down the hemolysis but didn't become a solution.

His spleen is enlargened a lot. (Doctors told me to remove it but I didn't accept it at first. Because I knew, I experienced that once we control hemolysis, it would shrink back to its original size). But we couldn't.

At the end, I had to accept splenectomy as a last resort, while his HCT was %8. At 11th of March 2022.
And he survived like a miracle! Thankfully...

During the splenectomy, doctors also took sample from his bone marrow. Even though, he was on corticosteroids for long time, some of the bone marrow diseases might not be affacted. That's why we also did it.

Bone marrow results came back good. It seems there's no bone marrow suppression.
Spleen pathology came back with hemophagocytic histocyctic syndrome, secondary to IMHA. (Well, i'm not sure if it's really secondary to IMHA, but the report says that).

After the splenectomy, Panda's HCT decreased very slowly and then started to increase. Not too much, tho.
So the doctor added chlorambucile into his medications.
1 weeks passed, we went to clinic and the HCT decreased again.

This time, they also checked his T4 and it was slightly elevated. We'll figure it out soon.

So far so good, Robin Panda is doing fine after splenectomy. Even though his HCT is fluctiating between %13-15, he's eating well, moving around and looking fairly bright and alert. Which is so good compared to pre-splenectomy.

It seems our journey will be challenging also in the near future. But I'll try to update here as much as I can.


Thanks and best wishes to you all, and to all of your kitties.


-

 

[silent meowlook]

Wow!! I am so impressed he survived surgery! What the ——? That is just crazy!

He is so lucky to have you, and you him as well. Please keep us updated.

 

[arikanisil]

Wow!! I am so impressed he survived surgery! What the ——? That is just crazy!

He is so lucky to have you, and you him as well. Please keep us updated.

His HCT was %8 in the day of splenectomy, but of course he got blood transfusion pre-op. So, he went into splenectomy with a HCT %14,5.
But, yes, it is still a mircale. I'm very grateful.

(As far as I'm told; there were not much bleeding during the operation, only a little. So they gave blood also at the surgery but not much).

I hope the next update will be better and with higher HCT results.

 

[BellaBlue82]

fionasmom
S silent meowlook


Hello,

I am sorry for Saide, but also glad that she has such a knowledgable and fighter mum like you. I believe she will live long happy years with you. Even though, she'll be on low dose of pred.

With this regard, I'll also update about my Robin Panda.

The hemolysis didn't stop. Basically.
Whatever we did (this part is long).

Robin Panda had 6 blood transfusions (4 of which happened in February and March). His HCT was decreasing so fast.
We even tried hIVIG (which was used in dogs successfully but not much proof for cats).
hIVIG helped to slow down the hemolysis but didn't become a solution.

His spleen is enlargened a lot. (Doctors told me to remove it but I didn't accept it at first. Because I knew, I experienced that once we control hemolysis, it would shrink back to its original size). But we couldn't.

At the end, I had to accept splenectomy as a last resort, while his HCT was %8. At 11th of March 2022.
And he survived like a miracle! Thankfully...

During the splenectomy, doctors also took sample from his bone marrow. Even though, he was on corticosteroids for long time, some of the bone marrow diseases might not be affacted. That's why we also did it.

Bone marrow results came back good. It seems there's no bone marrow suppression.
Spleen pathology came back with hemophagocytic histocyctic syndrome, secondary to IMHA. (Well, i'm not sure if it's really secondary to IMHA, but the report says that).

After the splenectomy, Panda's HCT decreased very slowly and then started to increase. Not too much, tho.
So the doctor added chlorambucile into his medications.
1 weeks passed, we went to clinic and the HCT decreased again.

This time, they also checked his T4 and it was slightly elevated. We'll figure it out soon.

So far so good, Robin Panda is doing fine after splenectomy. Even though his HCT is fluctiating between %13-15, he's eating well, moving around and looking fairly bright and alert. Which is so good compared to pre-splenectomy.

It seems our journey will be challenging also in the near future. But I'll try to update here as much as I can.


Thanks and best wishes to you all, and to all of your kitties.


-

Aw, how beautiful Robin Panda is. I will keep you both in my thoughts, I truly understand that slow yet scary roller coaster ride you are on. I was afraid Sadie might have needed a splenectomy, but by some miracle we're able to help her recover without one. I do remember though the fear of her insane heart murmur she developed.... Only for it to reverse a year after being stabilized! So miracles happen. And I will pray that happens for Panda. .

 

[fionasmom]

He is adorable with that little panda mask!

 

[arikanisil]

Aw, how beautiful Robin Panda is. I will keep you both in my thoughts, I truly understand that slow yet scary roller coaster ride you are on. I was afraid Sadie might have needed a splenectomy, but by some miracle we're able to help her recover without one. I do remember though the fear of her insane heart murmur she developed.... Only for it to reverse a year after being stabilized! So miracles happen. And I will pray that happens for Panda. .

Thank you so much. And as I said, so happy for Saide that she has you

By the way, there's a facebook group spesifically for the cats with IMHA. I hope everything goes well at your side and you won't need any additional advice etc... But in case you need, here I share the link.
Immune Mediated Hemolytic Anemia in Cats (IMHA)
Log into Facebook

I will pray for Sadie and you and hoping to receive good news from her.

 

[arikanisil]

He is adorable with that little panda mask!

Thank you so much