[Felvtalk] Anemia and Aranesp

Thu May 10 15:09:16 CDT 2018

Hi all,
I have a Leuk+ girl who is getting very anemic.  Her name is Flaqui.  She showed up at one of the colonies I feed a couple of months ago (already spayed) and was so thin I thought she was an elderly cat with not much time left so I took her home to give her some comfort in her final days.  When I took her to the vet it turned out that she isn't that old (vet things 4-5) but she's Leuk+.   I decided to keep her in my room where I have another Leuk+ guy.  I'm building a little catio for them outside one of the bedroom windows so they can enjoy the outside.
Flaqui's numbers in January 2018 were...
RBC - 4.15 M/ul (5.00-10.00) LOWHCT - 20.2% (30.0-45.0) LOWHGB 6.8 g/dl (9.0-15.1) LOWMCV 48.7 fL (41.0-58.0)MCH - 16.5 pg (12.0-20.0)MCHC - 33.8 g/dL (29.0-37.5)RDW - 20.5% (17.3-22.0)%RETIC - 1.3%RETIC - 53.2 K/uL (3.0-50.0) HIGHWBC - 15.30 K/uL (5.50-19.50)EOS - 1.8 K/uL (0.10-0.79) HIGHPLT - 663 K/uL (175-600)Everything else was normal
I started her on Liqui-Tinic which is a supplement containing iron and B-12 among other things.  Also giving her Vetri-DMG.   She initially had very bad diarrhea but I managed to clear this with Metronidazole.  She's also been dewormed and got Revolution.   Despite eating and showing an interest in food, she has been losing weight (down to 5 lbs) so last week I had bloodwork done again.  Here are the results...
RBC - 3.79 M/ul (5.00-10.00) LOWHCT - 14.8% (30.0-45.0) LOWHGB 8.1 g/dl (9.0-15.1) LOWMCV 39.2 fL (41.0-58.0) LOWMCH - 21.4 pg (12.0-20.0) HIGHMCHC - --- g/dL (29.0-37.5)RDW - 21.7% (17.3-22.0)%RETIC - 1.1%RETIC - 40.7 K/uL (3.0-50.0)WBC - 22.73. K/uL (5.50-19.50) HIGHNEU - 18.48 K/uL (2.50-12.50) HIGHPLT 698 K/uL (175-600) HIGHEverything else was normal
My vet told me to start her on Clavamox since the white blood cell count was high which is indicative on an infection somewhere.  I was really alarmed by the HCT number because I had a cat with chronic renal failure and anemia some years back and I know that once the HCT numbers get below 20% it can be very dangerous.   With that cat, Grayson, I used Aranesp very successfully to treat his anemia.  He eventually succumbed to the kidney failure but the Aranesp kept his anemia at bay.
I've been reading that blood transfusions are one of the things to do with Leuk+ cats once the HCT numbers get low but blood transfusions in my area (South FL) are in the $1000 range and I manage 6 colonies and have other cats at home with medical needs including one that needs a full mouth extraction for stomatitis and I just can't spend that type of money on Flaqui.
Do you guys think that Aranesp is something that would work on her?  She does not have kidney problems.  However, based on the reticulocyte levels, she does seem to have  non-regenerative anaemia.   I read this document at Tanya's Comprehensive Guide to Feline Chronic Kidney Disease that explains that the reticulocyte level needs to be adjusted based on PCV...

In particular, since reticulocytes are commonly expressed in percentage terms, they need to be adjusted to allow for the degree of anaemia, i.e. 1% reticulocytes in a cat with a PCV of 20% is twice as many as 1% reticulocytes in a cat with a PCV of 10%.   Let's assume your cat's PCV is 18% and the measured reticulocyte count is 0.75%. You multiply the PCV by the measured count, then divide the result by the normal PCV level (35% for many laboratories). In this instance, you would get an adjusted result of 0.39%, which indicates non-regeneration. In contrast, if your cat's PCV was 13% and the measured reticulocyte count was 0.75%, your adjusted result would be 0.28. This also indicates non-regeneration, but it is more severe (i.e. the lower the corrected value, the lower the regenerative response).

Flaqui's adjusted reticulocyte level is 14.8HCT X 1.1 RET = 16.28/35 = .46 which indicates non-regeneration.
Any help would be appreciated.  Flaqui has been doing better the last couple of days.  I think the Clavamox helped - but I really wish I could improve those HCT numbers.
Maribel & Flaqui.
"The greatness of a nation can be judged by the way its animals are treated."
-Mohandas Ghandi
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