Leon’s anaemia

Leon had a rough start in life as he was only 10 months old when he was referred to me as a critically ill patient. He had a 2 week history of increasing lethargy over the preceding 2 weeks. His appetite was reduced and he had started to eat bits of cat litter and lick coal, there are several potential causes of this but typically it suggests anaemia. Sure enough, blood tests showed a packed red cell volume (PCV) of 5%; this is barely compatible with life as the normal count is between 24 and 50%.

On examination Leon was surprisingly bright for the degree of anaemia, suggesting that the red cell count had been decreasing slowly over time and his body had gradually had to adapt. His heart rate was fast and his pulse bounding, as his circulatory system was now doing all it could to compensate for the anaemia, but there were no other abnormal findings.

The causes of anaemia in cats are wide ranging, including blood loss, red blood cell destruction, and bone marrow failure. Infectious diseases, including the feline AIDS or leukaemia viruses, red blood cell parasites (mycoplasma infection, rarely Ehrlichia), must be considered, and also conditions such as underlying tumours, and genetic defects of the red cells. Iron deficiency is rare in cats but could occur secondary to intestinal disease. Many causes can be excluded or identified with blood tests and imaging, but in Leon’s case it was necessary to take a bone marrow sample as the initial tests showed that the bone marrow was failing to produce any red blood cells. This required a general anaesthetic, which cannot be safely undertaken in a severely anaemic patient, and to stabilise Leon for anaesthesia, he required 2 blood transfusions because the anaemia was so severe. We were very fortunate to find not one but two compatible feline blood donors as this is not always easy.

Happily, Leon coped well with the procedures, and the bone marrow sample showed a benign condition called pure red cell aplasia (PCRA). This is an uncommon condition that usually occurs in quite young cats, and typically leads to a severe anaemia. In many cases PRCA will respond to treatment that prevents the immune system destroying red cell precursors within the bone marrow, although response can take many weeks. Leon showed an excelled response, with evidence of red cell production occurring within 3 weeks, and a normal PCV after 6 weeks. A long term good response is expected. In the face of such grave concerns at the outset, everyone involved in Leon’s case was delighted to achieve such a happy outcome for the gorgeous Leon and his devoted owner.