At a glance
About: Anemia is a reduction in the number of red blood cells, which are responsible for transporting oxygen around the body.
Causes: There are many causes in two forms, regenerative or non-regenerative. Regenerative means the red blood cells are produced but they are not replaced fast enough. Non-regenerative occurs when there is inadequate production of red blood cells.
Symptoms: Lethargy, pale gums, rapid breathing, increased heart rate.
Treatment: Address the underlying cause as well as providing supportive care which may include volume replacement, blood transfusions, hormones to stimulate red blood cell production and iron supplements.
What is anemia?
Anemia is a condition characterised by a reduction in the number of red blood (erythrocytes) cells. Is not a disease in itself but a symptom of an underlying condition. It may be caused by blood loss, red blood cell destruction (hemolysis) or inadequate red blood cell production.
Role and composition of red blood cells
Blood is composed of three different types of cells which are suspended in plasma, the liquid component of blood. All blood cells are made in the bone marrow, the spongy internal core of the bones. Bone marrow makes stem cells, which develop into one of the three types of cells within the blood. Red blood cells, white blood cells, and plasma.
Red blood cells are the most abundant cell in the body and make up approximately 40% of the blood’s volume. The role of red blood cells is to carry oxygen from the lungs to the tissues via the circulatory system (the heart, which pumps the blood and the blood vessels which transport it around the body) and remove carbon dioxide. Red blood cells contain a protein called hemoglobin, which is composed of four globulin chains, within the chain is heme, which contains an iron atom that carries the oxygen in the red blood cells. It is heme which gives blood its red colour.
Red blood cells remain in the circulation for approximately 73 days before they are broken down and recycled by the spleen, liver and bone marrow.
There are two forms of anemia, regenerative and non-regenerative.
- Regenerative anemia: This is the most common type of anemia in cats. The bone marrow can produce red blood cells but this may not occur quickly enough to replace red blood cells which are lost. Regenerative anemia can be further broken down into diseases which cause blood loss (such as trauma or certain parasites) and diseases that cause red blood cell destruction (hemolytic anemia).
- Non-regenerative anemia: Inadequate red blood cell production is classified as non-regenerative anemia. This is where the body is unable to produce enough red blood cells in the bone marrow.
Regenerative anemia (due to blood loss):
|Hemorrhage (blood loss)||The danger of sudden blood loss is twofold. Hypovolemic shock is the reduction of blood (more importantly, blood plasma, the fluid component of blood) which makes it harder for the heart to pump blood around the body resulting in multiple organ failure.|
|Hemorrhagic anemia||Due to the loss of circulating red blood cells|
|Parasites||Worms, fleas that feed on the cat’s blood, kittens are particularly vulnerable, as are cats with heavy parasite burdens.|
|Certain tumours||Cancers of the gastrointestinal tract can cause anemia due to frequent bleeding.|
|Blood clotting disorders||Hemophilia, thrombocytopenia which prevents the blood from clotting.|
|Gastric ulcers||Open sores develop in the layers of the stomach which expose the delicate tissues to stomach acid resulting in internal bleeding.|
The most common causes of blood loss in young cats are parasites, older cats are more likely to suffer from tumours or gastrointestinal ulcers.
Regenerative anemia (due to red blood cell destruction):
|Blood parasites||Hemobartonella, ehrlichiosis, and cytauxzoonosis cause anemia due to the destruction of the red blood cells.|
|Immune-mediated hemolytic anemia (IMHA)||A disease in which the cat’s own immune system can become directed against its own red blood cells.|
|Feline leukemia virus and feline immunodeficiency virus||Both of these feline retroviruses can cause anemia by increased red blood cell destruction as well as decreased red blood cell production (see below).|
|Heinz-body hemolytic anemia||Ingestion of certain medications, foods or toxins such as acetaminophen, naphthalene mothballs, propylene glycol, copper, zinc, onion can cause the formation of Heinz bodies on the red blood cells which results in their destruction by macrophages (a type of white blood cell).|
|Neonatal isoerythrolysis (blood type incompatibility)||This life-threatening condition occurs when a kitten with type A blood nurses from its mother who has type B blood in its first 24 hours of life. Colostrum is made by the mother cat and contains naturally occurring antibodies against the kitten’s type A blood leading to the red blood cells being destroyed.|
|Aplastic anemia||A failure of the bone marrow to produce enough blood cells. There are several causes including certain medications such as antifungals, chemotherapy drugs, certain antibiotics, radiation, toxins, bacterial or viral infections.|
|Feline leukemia virus and feline immunodeficiency virus||Anemia can develop due to the virus-suppressing red blood cell production in the bone marrow as well as produce bone marrow abnormalities such as abnormal maturation or malignant transformation of cell lines.|
|Chronic renal disease||As the kidneys become damaged, they don’t produce enough erythropoietin (EPO), a hormone that stimulates the bone marrow to produce more red blood cells. Blood loss from ulcers may also play a role in anemia in cats with CRD.|
|Nutritional deficiency||If the diet contains inadequate amounts of iron, necessary for red blood cell formation, then anemia can develop, this may also occur due to poor absorption of food.|
|Chronic inflammatory disease||Known as anemia of chronic disease (ACD), any long-term inflammation, chronic infection, and malignancy can ultimately lead to a decrease in red blood cells. This is known as anemia of inflammation. The cause is still not fully understood, but increased numbers of cytokines (molecules secreted by immune system cells which act as chemical messengers) are believed to cause a reduced response to EPO (the hormone which stimulates the production of red blood cells), reduced formation of new red blood cells and inhibits the release of iron from stores.|
|Certain cancers||Primary cancers such as leukemia and multiple myeloma, or secondary cancers which metastasise to the bone marrow can affect blood cell production because cancerous cells crowd out healthy stem cells.|
Symptoms of anemia relate to a deficiency in the amount of oxygen (hypoxia) reaching cells within the body.
- Pale mucous membranes: When oxygen levels drop, the body compensates by prioritising blood flow to the vital organs such as the brain and liver. Capillaries in the skin contract, which makes it harder for the blood to make its way there, therefore shunting the blood flow to the vital organs. This gives the skin and mucous membranes their paler colour.
- Yellow skin and mucous membranes (jaundice): If the red blood cells are being destroyed (known as hemolysis) too quickly such as immune-mediated hemolytic anemia, Heinz body hemolytic anemia, neonatal isoerythrolysis or certain parasites which destroy blood cells, bilirubin can build up causing the yellow discolouration.
- Rapid breathing and pulse (tachypnea).
- Tachycardia (increased heart rate): The heart tries to compensate for reduced oxygen levels in the blood by increasing output which can eventually lead to heart failure.
- Sleeping more than usual.
- Lethargy: Due to reduced oxygen in the tissues.
- Black, tarry stools (melena) can develop if your cat is bleeding internally.
Miscellaneous symptoms of anemia may also include:
Other symptoms may also be present depending on the underlying cause of anemia.
Your veterinarian will perform a complete physical examination of your cat and obtain a medical history from you. Presenting symptoms may alert the veterinarian to anemia, but it will be necessary to find out the underlying cause and establish if it is regenerative or non-regenerative.
- Complete blood count: A series of tests that evaluates the cellular components of blood (red blood cells, white blood cells, and platelets). Elevated numbers of reticulocytes (immature red blood cells) would point to regenerative anemia. Regenerative anemia is indicative of either blood loss or red blood cell destruction.
- Packed cell volume (PCV): A measure of the percentage of red blood cells in circulating blood. An anemic cat will have a PCV of < 24%.
- Blood smear: To check for the presence of blood parasites, reticulocytes, and abnormalities of the red blood cells.
- Biochemical profile: To evaluate the overall health of your cat and check liver and kidney function.
- Fecal examination: If gastrointestinal blood loss is suspected and to check for parasite eggs.
- Xray: To check for foreign objects, evaluate the organs and look for tumours.
- Bone marrow biopsy: For cats with nonregenerative anemia to determine why the bone marrow isn’t producing enough red blood cells as well as to check for cancers.
- Coombs test (antiglobulin test or direct antibody test): To detect the presence of antibodies that can bind to the surface of red blood cells.
The goal of treatment is to find and address the underlying cause as well as provide supportive care.
- Volume replacement: Hypovolemic shock is a life-threatening condition that occurs when a large portion of the blood is lost. Immediate treatment for this is volume replacement to ensure blood volume to prevent ischemia (restricted blood supply to the tissues, which results in lack of oxygen and glucose), shock and multi-organ failure.
- Blood transfusion: May be necessary for acutely anemic cats or cats who have suffered significant blood loss or kittens who have neonatal isoerythrolysis. Blood typing must be carried out before a blood transfusion. Cats have three blood types, Type A, Type B and Type AB. Type A cats can only receive type A blood, Type B cats can only receive type B blood and Type AB cats can receive blood from type AB blood or type A blood.
- Erythropoietin: The kidneys produce a hormone, erythropoietin, which instructs the bone marrow to produce red blood cells. Cats with kidney failure often have a low red blood cell count. Only the human form is available and some cats may eventually recognise this substance as foreign and antibodies will be created against it.
- Oral iron supplementation for cats with iron deficiency.
- Oxygen therapy for severely anemic cats.
Treat the underlying cause:
- Intestinal worms: Anti-parasitic medication to kill the parasites. Repeat treatments will be necessary.
- Feline infectious anemia: Antibiotics oxytetracycline or doxycycline and high doses of immunosuppressive drugs such as prednisolone to diminish the immune-mediated component of the disease process.
- Zinc toxicity: Surgery to remove the objects.
- Viral infection: Anti-viral medication will be prescribed to cats with FIV or FeLV, supportive care is also necessary.
- Poor diet: Feed the cat a good-quality, nutritionally complete diet.
- Medications: Where possible, discontinue or change medications that cause anemia.
- Gastric ulcers: Stomach acid-reducing medications such as cimetidine, ranitidine or famotidine as well as Sucralfate, which forms a gel-like substance to cover ulcers and prevent further blood loss (and damage).