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Treating a Sick Cat With No Diagnosis

November 19, 2009

Nicco was anemic, jaundiced, dehydrated, lethargic, not eating, full of fleas, and generally looking like crap.  (Yes, that’s the official scientific term.)

So, the quest for the reason began.  First, I determined Nicco’s Minimum Database Laboratory, which at my hospital consists of a complete blood count, with microscopic cytologic examination of the blood, 12 chemistries of the blood, including liver enzymes, kidney-related toxins, electrolytes, proteins, calcium, sugar, a urinalysis chemistry and microscopy.  In this case, we also checked for diseases that ticks spread, because many of those disease can cause bleeding internally, anemia, and jaundice.

No feline leukemia or feline AIDs on his tests.

These preliminary tests showed anemia, which was regenerative, high liver enzymes, high blood values related to dehydration, concentrated urine (which is good; he was dehydrated, so his body should keep in fluids as much as naturally possible), and high bilirubin in the blood.

Now, if I see anemia and jaundice, I worry that something is destroying blood in the body and the release hemoglobin from the dead red blood cells overloads the liver and leads to extra bilirubin.  So Nicco also had some tests for auto-immune hemolytic anemia.

Well, long, boring laboratory story short, we could not identify a reason for the blood problems.  I treated Nicco with doxycycline, an antibiotic for mycloplasma hemofelis, an infection that attacks blood and is spread by fleas.  I rehydrated him, and retested his blood the next day.

Nicco was much, much worse!!!  Yikes!

Radiographs (x-rays) of his body revealed no reason for hemolysis and anemia and jaundice.  Ultrasound revealed nothing unusual.  Because of anemia, we looked for problems in his bone marrow.  The specialist called and said she had never seen bone marrow like Nicco’s before.  It was abnormal, but she couldn’t say that it fit any particular syndrome.

Meanwhile, Nicco still was not eating well, his bilirubin was still fairly high, and things were not looking bright for the little guy.  I started, as a doctor, thinking, maybe there is hidden cancer somewhere, or a reaction where his body is attacking the blood.  If I am right, predisolone (steroid) will save him.  If I am wrong, and it is an unidentified infection, steroids could kill him.

After discussion with his mom and several specialists, we decided to try prednisolone.  A horrifying, and unexpected result made me question everything I ever knew about medicine.  (More tomorrow…)

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