Anemia in Cats: A Guide for Pet Owners

Red blood cells work to transport oxygen and nutrients around the body, allowing other cells to carry out all of their major roles. Hemoglobin is the protein that carries the oxygen. When there is a lack of red blood cells or hemoglobin, or when they're not working as they should, this is called anemia. Anemia is a common disorder that can cause a range of signs including fatigue, rapid breathing, and pale gums. Sadly, severe anemia can be fatal. Understanding how anemia affects cats, including its causes and symptoms, is vital for ensuring their health and prompt treatment.

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What is anemia in cats?

When anemic, it may be that the body is not making enough red blood cells, or that they are being broken down or lost quicker than they can be replaced. Normally, the packed cell volume of a cat is from 25–45%, and anything less than 25% means they are anemic. These cells live for about 10 weeks, before being replaced by new red blood cells made in the bone marrow.

Hemolysis is the destruction of red blood cells, and triggers can include cancers and infections. Without oxygen (their fuel), cells cannot function and the body soon starts to fail.

Types of anemia in cats

In veterinary medicine, anemia is broadly classed into two groups. Knowing which type of anemia a cat has can help their vet determine the most effective therapy.

1. Regenerative anemia. When anemia is regenerative, the bone marrow responds to the lack of red blood cells and starts to make more. There will be evidence of this in blood testing.
2. Non-regenerative anemia. It occurs when the bone marrow isn't able to address the lack of circulating red blood cells in the body appropriately.

Causes of anemia in cats

There is a huge list of potential causes of feline anemia. Some of the more common causes include:

• Parasites. A heavy burden of fleas, ticks, or intestinal worms can deplete a cat's red cell reserves. This is more often seen in very small and young kittens, who have a limited number of red blood cells in the first place.
• Chronic diseases. Ongoing diseases such as cancer or chronic kidney failure generally result in anemia. This tends to be a mild anemia, and pets can usually cope with this for a long time.
• Blood loss due to injury or surgery. If a large amount of blood is lost rapidly, even the healthiest cat won't be able to replace their red blood cells in time. Large volumes of blood can be lost after a road traffic accident, or if a blood vessel is nicked during surgery. Vets can also see internal blood loss, in the case of GI ulcers and ruptured tumors, for example.
• Infection. Feline leukemia virus, feline immunodeficiency virus, and feline infectious peritonitis are examples of some common infectious diseases that lead to anemia.
• Immune-mediated disease. Immune-mediated hemolytic anemia is a potentially devastating disease that causes sudden anemia when a cat's immune system attacks its own red blood cells. Younger cats are at risk, with the average age of the first episode being between six months and two years.

Less common causes

In addition to the causes mentioned above, there are other conditions a vet might consider if initial causes are ruled out. These less common conditions can be more challenging to diagnose and may necessitate more advanced or invasive testing.

• Genetic diseases. There are a number of recognized inherited diseases that can cause anemia. One example would be pyruvate kinase deficiency (PKD), which is most often diagnosed in Abyssinians.
• Nutritional deficiencies. Though common in humans, iron deficiency anemia in cats is actually quite rare. As obligate carnivores, kitties tend to have no trouble consuming plenty of meat, which is iron-rich. When there is a deficiency, it is usually caused by trouble absorbing the nutrients in the gut.
• Liver disease. Another underlying condition to be on the radar, liver disease can cause anemia due to GI bleeding from toxin buildup and lower production of the hormone responsible for stimulating red blood cell production when oxygen levels are low (EPO).

Clinical symptoms of anemia in cats

Keep in mind that cats are good at hiding signs of disease, and initially, symptoms tend to be quite vague. Many cats hide signs well until they suddenly cannot cope and then become unwell rapidly.

• Lethargy and weakness. You may notice your cat sleeping more than usual, or showing much less interest in playing.
• Pale or white gums and nose. Their gums should be a pale, salmon-pink color. In cases of red blood cells being broken down or liver disease, one may see yellow-tinged gums. Though some cats will have pigmented, black gums, try to find a patch that is not pigmented to assess.
• Loss of appetite. Those with anemia have a low interest in food and may need to be encouraged to eat.
• Rapid breathing or heart rate. When resting, we would expect a breathing rate of no more than 30 breaths a minute in an adult, or 40 breaths a minute in a kitten.

Severe symptoms

As anemia progresses and oxygen levels become lower, signs will be more dramatic. You may see:

• Extreme weakness or collapse
• Jaundice (yellowing of skin, gums, and eyes)
• Swollen abdomen (due to fluid accumulation)

How to diagnose anemia in cats

Your vet will check your cat from nose to tail, noting the color of their gums, and their pulse and checking for any abnormalities such as a fever or excess fluid within the abdomen.

Your vet will also get a medical history from you. They will ask about your cat's signs and when they started. They'll also want to know about your pet's vaccination status and worming history, the diet they're on, and any possible toxin exposure or trauma.

Blood tests

Blood tests are the 'bread and butter' of diagnosing anemia, and on top of general hematology, will include biochemistry and blood clotting profiles, as well as a blood film exam or blood smear (when the blood is visually examined under a microscope).

Common blood tests include complete blood cell count and packed cell volume tests.

Diagnostic imaging

Diagnostic procedures like ultrasound or X-rays help pinpoint problems such as fluid buildup, enlarged organs, or heart disease.

Bone marrow biopsy

This is quite a specialized procedure and will require a general anesthetic. Certain infections and cancers can be diagnosed in this manner.

Your cat's treatment plan will depend on how unwell they are, as well as the cause of their anemia. If concerned for your cat, have them seen by a professional right away.

Immediate care

With acute blood loss or very severe anemia, your pet may require emergency vet intervention to save their lives. This sort of medical treatment can be costly, which is a reason why insurance is advised for all cats.

Blood transfusion (providing extra red blood cells)

Transfusions are complex, as not all cats have compatible blood types and transfusion reactions are not uncommon. With chronic anemia, your vet may suggest a blood transfusion with a hematocrit of 15% or lower.

Oxygen therapy

With a lack of red blood cells, there is going to be less oxygen available to your cat. Supplementing oxygen helps the red cells that are present do their job.

Long-term treatment

The mainstay of therapy will be to address what has caused the anemia, when possible. Your vet may advise on the following:

• Dietary changes and supplements. Iron-rich foods (such as liver and beef) and B vitamins make it easier for the cat to generate new red blood cells.
• Medications. For something like IMHA, your cat may be dispensed strong corticosteroids or Cyclosporine to dampen the immune system response. Those with low EPO levels may be started on Erythropoietin injections. Any bacterial infections present would be addressed using antibiotics. Gastroprotectants can be started for those with gastritis or ulcers.

Home care and management

Until your cat's red blood cell levels have risen, they will be less capable of exercising and will need plenty of rest. You can reduce stress levels by offering calm activities, such as food puzzles or 'cat TV.'As their circulation is impaired, they may feel colder. Be sure to have the home warm and cozy.

Seek immediate veterinary care if you notice any 'red flag' signs such as visible blood loss, white gums, rapid breathing, abdominal swelling, or weakness.

How to prevent anemia in cats

Frustratingly, we cannot always prevent feline anemia. However, there are some things that may be useful.

1. Prevent parasites. Ensure your cat is protected from parasites like fleas, ticks, and worms, as they can deplete your cat's blood supply.
2. Feed a balanced diet. Provide a diet tailored to your cat’s life stage, ensuring they receive all necessary nutrients for optimal health.
3. Keep vaccinations up to date. Regularly update your cat’s vaccinations to protect against diseases such as Feline Leukemia Virus (FeLV).
4. Breed from health-tested animals. When breeding, choose cats that have been health-tested to minimize the risk of genetic conditions.
5. Neuter your cat. Neutering reduces the risk of trauma and infectious diseases, especially for cats that go outdoors.

Final word

Anemia in cats is a complex disease with many triggers, including immune-mediated hemolytic anemia, bone marrow disorders, sudden blood loss, and parasites. Affected cats can show a range of signs and a blood test is usually one of the first tests requested in order to reach a diagnosis. Anemic cats are treated in a range of ways, depending on the underlying cause.