Metabolic Anemia in Cats

Hemolytic anemia (in which the red blood cells are being destroyed) is often found in acute cases of severe anemia. Neonatal isoerythrolysis can result in kittens developing hemolytic anemia from antibodies in their mother's milk. Hypophosphatemia, often caused by a diseased liver, may also deplete red blood cells in the bloodstream. Various ingestion of toxins can cause hemolytic anemia to occur. Chronic kidney disease may lead to uremia, which creates a toxin within the body that kills red blood cells too soon. It also results in low levels of the enzyme that makes heme porphyrins (flat rings which surround iron atoms) build up.  

Anemia is the classification of abnormally low red blood cells and hemoglobin circulating through the body. Certain conditions that involve metabolic function, including immune disorders and inhibited enzyme production, can lead to anemia. This, in turn, hinders all other metabolic function within the body. In some instances, the body's response system is triggered to attack existing red blood cells, depleting the needed amount and resulting in oxygen starvation throughout the body. 

The first sign of any anemia in cats is generally extreme exhaustion. If an internal hemorrhage is present, it may not be visually obvious unless it has become very severe. All symptoms to watch for include:

• Weakness
• Lethargy
• Inability to exercise
• Dyspnea (difficulty breathing)
• Hyperpnea (increased rate of deep breaths)
• Pale gums
• Blood loss
• Red or brown teeth and urine
• Abdominal mass or distention
• Fever
• Bad breath
• Mouth ulcers
• Dark or tarry stools
• Diarrhea

In cases of metabolic anemia, something within the body, or something that has been ingested, causes red blood cells to be destroyed prematurely. Hemolytic anemia often results secondary to another disease. All known causes are as follows:

• Chronic inflammation of the kidneys
• Hereditary blood disorders
• Dysfunctional immune system
• Gastrointestinal tract ulcers
• Iron deficiency 
• Internal or external hemorrhage
• Medication
• Bacterial or viral infections
• Differing blood types of a mother and her kittens
• Ingestion of toxins

If your cat is exhibiting symptoms of anemia, take it to a veterinary clinic to be assessed. You will need to provide the veterinarian with your cat's full medical history to identify possible contributing factors to the anemic state of the animal. A physical examination will be performed with thorough palpation of the abdominal cavity for enlargement and abnormal masses. While listening to the heart with a stethoscope, the vet may notice a murmur in the heartbeat. 

Many blood tests will need to be performed to properly determine what type of anemia is present and what the underlying cause of the condition is. The blood-to-anticoagulation ratio will be gathered. A complete blood count including packed cell volume (PCV) and total protein (TP) measurements will be run. There may be an increased number of reticulocytes (immature red blood cells) in cats with uremia or hemolytic anemia. The more severe the anemia, the higher the count of reticulocytes may be. 

An iron panel may be used to reveal decreased iron serum indicating a deficiency in the mineral. Immune mediated hemolytic anemia (IMHA) can be confirmed with a Coombs test. Urinalysis can indicate pigment or blood in the urine, and can shed light on kidney function. Feline leukemia virus should be tested for, as it is a common cause of IMHA in cats. 

The overall goal in treating metabolic anemia is to remove or decrease whatever is causing the early destruction of red blood cells. The appropriate course of treatment will depend on the diagnosis that has been made. Hospitalization is often required for severe cases of anemia.

Neonatal Isoerythrolysis 

Remove kittens from the mother to prevent nursing. Colostrum from a cat with a matching blood type or feline formula may be used to nourish the kittens.

Hemorrhage 

If blood loss has occurred, it will need to be located and stopped if possible. Blood transfusions and intravenous fluid administration may be needed to recover lost volumes and red blood cell counts.

Immune-mediated Hemolytic Anemia 

Often an infection is found exacerbating this health condition. The infection should be identified and treated. If it is bacterial, antibiotics may be prescribed. After the infection has been addressed, a low dose of immunosuppressive medication or corticosteroids may be prescribed. Blood Transfusions may be necessary to stabilize the cat prior to medications being given.

Poisoning 

If a toxin has been ingested that results in damage to the red blood cells, it should be pumped from the stomach. Supportive care including intravenous fluids should be given while the cat's system recovers.

Uremia 

While kidney disease is often not reversible, an erythropoiesis stimulating agent (ESA) may be given to help counteract the toxins being released and increase the lifespan of red blood cells in the body.

Iron Deficiency

This can be corrected with oral supplementation of iron. Only administer these supplements after the cat has been confirmed clear of infections. 

Hypophosphatemia 

Phosphate supplements can help relieve this condition. If the case is mild, oral supplementation may be all that is necessary. In severe cases, phosphates should be given intravenously.

If the proper diagnosis has been reached and treatment is given accordingly, many types of hemolytic anemia can be reversed. Ensure all possible toxins are kept out of your cat's reach. Keeping your cat indoors may help with limiting it's exposure to possible poisoning factors. This can also limit the cat's interaction with infections. If a cat has been diagnosed with feline leukemia virus, while the resulting anemia can be treated, the long term prognosis is poor. 

Administer all medications as prescribed by your veterinarian. In many cases of IMHA, medication is only needed for approximately three months. Repeated vet checks will be requested to measure the blood cell counts in your cat and to lower doses of immunosuppressive drugs if possible. While a cat with kidney disease is often not curable, the quality and length of life can be greatly increased by proper treatment. Any cat who has suffered from metabolic anemia is likely to exhibit a better well-being and higher energy after the problem has been medically addressed.