Bart the Cat
Patient is a two-year-old male domestic short hair feline (cat). The owner brought the cat in because he had not been eating and was very lethargic.
The owner stressed that they were limited on funds, but this was a very special cat. The owner suffered from PTSD and Bart played a major role in helping in his recovery. Clients tell me all kinds of stories when they bring their pets in, but for some reason this one was extra special.
What are some important questions to ask about the patient’s history?
When was the patient’s last regular meal?
Is it an indoor or outdoor cat?
Has it been vaccinated?
Is it on flea/tick preventative?
The owner admitted they had fallen behind on vaccines and had not put any flea/tick preventative on him in a while. Bart was both indoor and outdoor. The owner did say Bart ran off a couple weeks ago and when he came back he was doing poorly. He wasn’t sure if he had eaten at all during that time.
Exam:
I examine Bart and notice his mucous membranes are extremely pale, very white. His temperature was 104.0 (high). Heart and respiratory rate were within normal ranges. When palpating (feeling) his abdomen though, his spleen was very enlarged.
Numerous fleas were also noted in the exam. Despite having multiple issues he still seemed fairly alert and responsive.
With these clinic signs in mind, I start thinking of differentials:
Parasites
Viral
Bacterial
Diagnostics:
And…. we need to do some major diagnostics. Remember, this owner has some financial constraints so I can’t run every diagnostic test in the book. So what do we start with? Think about the physical exam – what were some major things that we found?
Enlarged spleen palpated (felt)
Anemic (losing blood)
Fleas
Fever
With these in mind I can narrow down my list by thinking about what can cause these symptoms.
What could be causing the anemia in Bart?
Fleas
Internal bleeding
Blood parasites
Intestinal parasites
… Just to name a few.
What could be causing the enlarged spleen (splenomegaly)?
Blood parasites
Drugs (medication, sedatives)
Neoplasia (cancer)
What could be causing the fever?
Infection
Parasites
Viral
Looking at my list, knowing I have limited funds, I decide that blood work is the best place to start. I am mostly concerned about blood parasites, because of Bart’s history, these can be deadly and I need to rule these out before I pursue other diagnostics.
Fecal: I always check a patient’s fecal. If Bart has a lot of intestinal parasites, this can lower his immune system and make it much more difficult to treat him. His fecal came back positive for tapeworms. Because he has numerous fleas, this result did not surprise me.
CBC/Chemistry: This is the most important diagnostic in this case. A complete blood count will help us determine if Bart needs a blood transfusion or not and if there is active infection. We will also need to see a blood smear. This allows us to see the blood cells (white blood cells, red blood cells, platelets, blood parasites, etc.).
The chemistry allows us to see what his liver, kidney, protein, and electrolyte values are so we can treat appropriately.
Bart’s red blood cell count was extremely low, meaning he was anemic and needed a blood transfusion right away. His white blood cell count was also high, indicating infection. On the blood smear, mycoplasmas were found.
Diagnosis:
With the physical exam and blood work. This gave us A LOT of information. Bart was diagnosed with Haemobartonella felis, now known as Feline Infectious Anemia. Finding the mycoplasmas (parasite) in Bart’s blood, the enlarged spleen and the anemia all confirmed this diagnosis.
Treatment:
We gave Bart a blood transfusion right away and started him on a round of antibiotics. We also continued supportive care with fluids and flea/tick treatment.
Outcome:
After just a few days, Bart was already on the mend! He was able to go home with his family and continue to provide them love and support.
I love when I have cases like this. I was able to help a family and a patient. Life is good :)