Management of Critical Anemia and Concurrent Cardiac Disease

Fitso is a 1-year-old cat who was presented to Veterinarium in critical condition due to severe anemia. Several days prior to admission to our clinic, she had already undergone a xenotransfusion (received canine blood). However, the anemia could not be corrected, and Fitso remained in a serious clinical condition. 

Upon presentation to Veterinarium, he was lethargic, febrile, completely anorexic, unwilling to drink water, and experiencing severe vomiting. Clinical examination also revealed severe dehydration, tachycardia, tachypnea, and icteric (yellow) mucous membranes. Hemoglobin concentration was 28 g/L (reference lower limit: 90 g/L), while hematocrit was 12% (reference lower limit: 29%). In addition, thrombocytopenia (decreased platelet count) was identified.

Fitso urgently required a blood transfusion from a feline donor. However, it was equally important to identify the underlying cause of anemia and initiate targeted treatment. Otherwise, transfusion alone would have resulted in only temporary clinical improvement.

Based on blood biochemistry findings, systematic exclusion of potential causes of anemia, and assessment of disease progression, the leading differential diagnosis became Immune-Mediated Hemolytic Anemia (IMHA).

In cats, IMHA is a critical and life-threatening condition. The disease develops as a Type II hypersensitivity reaction (antibody-mediated cytotoxicity). In this process, the immune system produces antibodies directed against antigens located on the surface of erythrocytes, resulting in rapid destruction of the patient’s own red blood cells.

To confirm the diagnosis, a Saline Agglutination Test (SAT) was performed at our clinic and supported the diagnosis of IMHA. This test detects erythrocyte agglutination (clumping) caused by antibodies bound to the erythrocyte surface.

On the very first day of hospitalization, based on the decision of Veterinarium internist Nutsa Besashvili, immunosuppressive therapy was initiated. The patient received intravenous fluid therapy, oxygen support, and antiemetic treatment. The following day, a donor was identified and a blood transfusion was performed.

By day 4 after initiation of immunosuppressive treatment, Fitso’s clinical improvement became evident - she resumed voluntary eating and became noticeably more active. 3 weeks later, repeat bloodwork demonstrated normalization of hematological parameters. Anemia and thrombocytopenia had resolved, and biochemical values had stabilized. 

Importantly, during physical examination, a pathological heart murmur was detected, and Fitso also demonstrated a markedly increased respiratory rate. Prior to referral to Veterinarium, he had already received a diagnosis of cardiac disease and had been started on treatment at another clinic. However, no improvement in the clinical signs associated with cardiac pathology was observed.

For this reason, the Veterinarium internal medicine team decided to perform a comprehensive cardiologic evaluation.

Cardiac ultrasonography revealed signs consistent with endocarditis, left ventricular diastolic dysfunction, and marked enlargement of both the left and right atria. These cardiac abnormalities represented a significant threat to Fitso’s life and also created a considerable risk for thrombus formation.

Given the severity of these findings and the patient’s need for intensive management, Veterinarium’s cardiologist and anesthesiologist, Natia Robakidze, developed and implemented an entirely new cardiologic treatment plan tailored specifically to her condition.

At present, Fitso continues cardiologic treatment and remains under the supervision of Natia Robakidze. His condition has improved significantly. 

Because the cardiac changes remain clinically important and require continuous monitoring, Fitso will continue to undergo scheduled follow-up cardiologic evaluations throughout his long-term treatment plan.

Today, Fitso is doing well and continues treatment at home.