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3 March 1997
Evaluation of the
FOCAL POINT
Feline Erythron in
★Mechanisms of anemia in
cats are often multifactorial;
Health and Disease
determining the mechanism in a
particular case can be difficult.
Kansas State University
Mosette Eibert, DVM
KEY FACTS David C. Lewis, BVSc, PhD
Hematocrit (%)
20 – Punctate
reticulocytes
– 25 demand.
Hematocrit In cats with mild hemorrhagic
15 – – 20 or hemolytic anemia, however, the
– 15
Aggregate increase in aggregate reticulocytes
10 – reticulocytes
can be mild and transient and a re-
– 10 generative response may be over-
5 – _ 5
looked unless punctate reticulocytes
are enumerated17 (Figure 8).23 Ac-
0 cordingly, only aggregate reticulo-
0
0 2 4 6 8 10 12 14 16 cytes must be counted in cats with
Days moderate or marked anemia (HCT
less than 20%), but both types of
reticulocytes should be evaluated in
Figure 7—Mean corrected reticulocyte percentage and hematocrit from three cats
cats with mild anemia.
subsequent to removal of 45% of blood volume.
CAUSES AND
CHARACTERISTICS OF
35 40 ANEMIA IN CATS
Some of the causes and charac-
– 35 teristics of feline anemia are unique
30 –
to cats (see the box). Others, al-
Corrected reticulocyte %
– 30
25 – though evident in various species,
Hematocrit (%)
Punctate
– 25 reticulocytes
have distinct effects on the feline
20 – erythron.
– 20 Hematocrit
15 – Chronic Disease
– 15
Nonspecific chronic illness and
Aggregate
reticulocytes
10 – – 10 inflammation suppress the ability
of the bone marrow to produce
5 – – 5 RBCs. Various localized or general-
ized infectious, inflammatory, or
0 0 neoplastic diseases can cause or
0 2 4 6 8 10 12 14 16 contribute to anemia in cats with
Days chronic disease. Although the ma-
jor mechanism of anemia associated
Figure 8—Mean corrected reticulocyte percentage and hematocrit from three cats
with chronic disease is seques-
subsequent to removal of 15% of blood volume. tration of iron in bone marrow
macrophages, the rapidity with
which anemia can develop indicates
than 20%) but often underestimate the regenerative re- that reduced RBC life span (by mechanisms that are
sponse in cats with mild anemia (HCT greater than not well understood) makes a significant contri-
20%).8 In cats with moderate to marked anemia caused bution .7,25,26 Anemia associated with chronic disease is
by blood loss, aggregate reticulocytes are released with- nonregenerative and mild to moderate (HCT not less
in 4 to 7 days of the onset of the loss (Figure 7).23 than 15%).25 Unlike dogs, cats can develop anemia
Punctate reticulocyte numbers peak during the ensuing from chronic disease in as little as 3 to 4 days.7,25,26 The
1 to 2 weeks and can be increased for as long as 4 rapid development of anemia associated with chronic
disease in cats is believed to on the course of the disease and concurrent illness.33,34
Causes and be affected by (1) the shorter Typically, hemolytic anemias have the strongest regen-
Characteristics of life span and increased sus- erative response because the recycling of hemoglobin
Feline Anemia ceptibility to oxidative dam- provides ample substrate for erythropoiesis. However,
age of feline erythrocytes and hemobartonellosis can be peracute or acute, and cats
■ Chronic disease (2) the smaller total RBC presented with severe anemia might have had insuffi-
■ Feline leukemia virus mass of cats. cient time to develop a regenerative response. In addi-
tion, concurrent chronic disease, FIV infection, or
infection
Feline Leukemia Virus FeLV infection may compromise erythropoiesis.
■ Feline Infection Hemolysis caused by H. felis results from splenic se-
immunodeficiency Anemia is common in questration of damaged RBCs or immune-mediated
virus infection cats infected with feline hemolysis.7,33 H. felis organisms are small and appear as
■ Hemobartonellosis leukemia virus (FeLV) and bacilli, cocci (singly or in chains), or ring forms on the
■ Cytauxzoonosis can have a variety of mecha- RBC surface (Figure 9).
nisms.27,28 Anemia associated Feline hemobartonellosis can be difficult to confirm
■ Increased number of
with chronic disease can because organisms are present on the RBCs intermit-
Heinz bodies result from FeLV-induced tently, often in very small numbers, and can resemble
■ Hypophosphatemia opportunistic infections. 27 stain precipitate and Howell-Jolly bodies. Stain precipi-
■ Liver disease FeLV can predispose cats to tate can be distinguished from H. felis organisms be-
■ Chronic renal failure hemolytic anemia related to cause it becomes refractile when the focus of the micro-
■ Congenital disorders immune mechanisms, Heinz scope is changed, whereas H. felis remains basophilic.
body formation, or infection Howell-Jolly bodies tend to be larger and stain more
■ Immune-mediated
with Hemobartonella felis.28 homogeneously than do H. felis organisms. Blood
hemolytic disease Anemia due to bone marrow smears that contain numerous, heavily parasitized
disease in cats infected with RBCs are the exception.33
FeLV can be caused by pure RBC hypoplasia, myelo- Many cats with hemobartonellosis are direct anti-
dysplasia, or hematopoietic neoplasia.28,29 Anemia that globulin test (DAT)–positive, or Coombs’ test–positive,
is nonregenerative but macrocytic is frequently at- even when organisms are not detectable. Organisms
tributable to FeLV infection.28 tend to separate from the RBCs in anticoagulated
blood and are most likely to be detected when blood
Feline Immunodeficiency Virus Infection smears are made from freshly collected, nonanticoagu-
Anemia is uncommon in asymptomatic cats infected lated blood from a peripheral vein (e.g., the lateral
with feline immunodefi- marginal ear vein).3 In light
ciency virus (FIV) but is a of the difficulty of confirm-
frequent finding in clinically ing a diagnosis of hemobar-
ill cats.30,31 Anemia is of vari- tonellosis, empirical treat-
able severity, can be regener- ment with oral doxycycline
ative or nonregenerative, (2.5 to 5.0 mg/kg every 12
and is often accompanied by hours for 21 days) is war-
other cytopenias. 31,32 Ane- ranted if H. felis is suspect-
mia in FIV-infected cats can ed.33,34
be caused by viral suppres-
sion of hematopoietic cells, Cytauxzoonosis
chronic disease due to op- The protozoal organism
portunistic infections, hemo- Cytauxzoon felis is an invari-
bartonellosis, malnutrition, ably fatal cause of hemolytic
or malignancy. anemia and has been report-
Figure 9—H. felis organisms—demonstrating bacilli, cocci, ed in the midwestern and
Hemobartonellosis and ring forms—from a cat with feline leukemia virus in- southeastern United States.35,36
Anemia caused by H. felis fection. Note the two polychromatophilic (blue-gray stain- Bobcats are reservoir hosts
infection varies in severity ing) red blood cells. These cells would appear as aggregate
for C. felis, and ticks are the
reticulocytes if stained with new methylene blue. (Wright’s
and can be regenerative or proposed vector. Clinical
stain, original magnification ×100)
nonregenerative depending signs include depression,
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