Immune-Mediated Hemolytic Anemia

A friend's cat is battling what is presumed to be IMHA and I'm looking for hope and advice for her. She's seen three different vets and gotten varying courses of treatment.

The cat, a 15 yr. old named Ryan, was started on doxy and pred last Thursday but given a poor prognosis. Saturday he went to the ER and, with a PCV of (I think) 9, had a blood transfusion and cyclosporine was added to the treatment plan. PCV only went up to 13 and he was very weak and not eating well. Yesterday she expected to have Ryan PTS and finally got to see her regular vet. PCV was 12. He administered injections of pred and B-12 and told her to discontinue the doxy for now to see if appetite improves.

My friend is just devastated. She rescued Ryan and his mom from the road when he was only 3 weeks old. She doesn't want him to suffer, of course, but also doesn't want to give up too soon if there's a chance he can recover. Any advice or suggestions would be much appreciated.

 

Oh I am sorry .

I believe that this is what Karen (& Rambo's) cat Astrophe has. Maybe she can help?

 

I'm sorry to hear about the kitty. Can he be seen by an internal medicine specialist? I'm afraid that with an elderly cat you may be dealing with cancer rather than IMHA. There are a *lot* of steps to diagnose IMHA--there are a lot of things that mimic it, and the testing and care is best given by a 24-hr referral specialty center.

 

I am so sorry about your friend's kitty. IMHA is a horrible disease. My Astrophe was diagnosed a year ago, and is doing well now, but it was a long and difficult fight. At one point, her PCV was also between 10-12 and we didn't think she would make it ... She is actually still on Pred, but has been nearly weaned off - it is a LONG battle. She is a young cat, which I am sure helped her pull through, so I know it must be so much harder in an older guy.

Are they absolutely sure it's IMMUNE mediated hemolytic anaemia? The immune form is fairly rare - most cases of hemolytic anemia are secondary; they are not caused by auto-immune attack but rather triggered by a primary issue. Has he been tested for all the main causes of hemolytic anaemia? (Parasites, FIV. FLeV, cancer, toxins, etc.) With hemolytic anemia, they need to search for the primary cause. Until the primary cause is addressed, the anemia may not respond to treatment.

The treatment, of course, therefore depends on the cause. If the anemia is due to ingestion of a toxin (Tylenol or antifreeze, for example), or ingesting zinc, several blood transfusions may be needed to maintain blood volume while the toxin works its way out of the system. If the anemia is due to a massive auto-immune attack on the blood, transfusions should be avoided, if possible, because introducing new red blood cells can ramp up the immune response. Immune suppressing drugs, such as prednisone or other corticosteroids, are used in these cases. And if a parasite is suspected or confirmed, antibiotics need to be used in conjunction with the steroids. Doxyclycline is the most commonly prescribed antibiotic for this. Astrophe was put on Doxy while we waited for the blood tests to come back about the parasites.

I'm sorry if this is overwhelming. Needless to say, I've learned more about this nasty disease in the past year than I ever dreamed possible!

If you or your friend are interested in researching this a bit more, there are a couple of good sites :

http://www.marvistavet.com/html/body_imha.html
http://veterinarymedicine.dvm360.com/ve ... =&pageID=2
http://www.petplace.com/cats/immune-med ... page1.aspx

Please tell your friend that I wish her luck, and hope that Ryan will turn the corner soon.

 

Cancer is definitely in her mind and had been mentioned. He had a lump on his side a few months ago that the vet wasn't too concerned about unless it grew, and then it disappeared.

The ER where he spent last weekend is also a referral hospital and they wanted to keep him longer but the cost was too much for her. Those few days, with all the testing and transfusion, were close to $1500. He was negative for FeLV/FIV, and other tests and radiographs didn't show much. Maybe that's why they suspected IMHA.

I spoke with her this morning to pass on the information and she said he's deteriorating. She's been syringe feeding for days and he gets very stressed - crying, mouth-breathing and doesn't want to be moved or touched. She said he looks terrible and feels that since there's been no improvement, it's time to let him go so I'll be going with her this afternoon. I still have his mother and it seems so wrong that he has to leave before her.

Thank you for all the information and I'm so happy that Astrophe is doing well. Please hold a good thought for a peaceful passing for Ryan and also for Cheryl, whose heart is breaking right now.

 

I am so, so sorry .... It's a hard disease to fight, and Astrophe had youth on her side. I think that Cheryl is listening to her heart and to Ryan, and is doing the right thing. She is taking his pain on herself, and setting him free - there is no greater or more unselfish love.

Please tell her that I will be keeping them both in my thoughts today. Wishing Ryan a gentle and swift passing, surrounded by love. Wishing Cheryl peace and strength ...

My deepest sympathies.