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Question:

After analyzing the history, physical examination and clinicopathologic results, what are your current rule-outs for the cat's polyphagia and weight loss?

Question:

Did you notice Mikey's low TCO2?
What are your rule-outs for his low Total Carbon Dioxide?

Current Status:

As soon as Mikey's abscess was lanced and drained and antibiotic therapy was initiatied (cefazolin), he readily ate the palable food offered.  Because he was eating and drinking, insulin was administered (2 units of Ultralente, SQ).
That evening the cat's temperature was 101.4, and the cat was grooming and active in his cage.

The Next Morning:

Mikey appeared apathic and weak.  He had pale mucous membranes, and his temperature was 99.0  (a cool kitty). 
His PCV was 15%, and blood was submitted to the Laboratory for evaluation.

Questions:

CLICK HERE to look at photographs of  blood smears from animals with specific types of anemia

Questions:

Is this anemia most likely due to hemorrhage or hemolysis?

What are your rule-outs (big categories) for hemolytic anemia?

What is the significance of the hypophosphatemia?

Outcome:

Parenteral phosphorus, as potassium phosphate, was administered (added to the intravenous fluids).  As the serum phosphorus contrations increased, the hemolysis stopped.  The hypophosphatemia resolved over the following 24 hours. 

Does the abscess explain the history of polyphagia with weight loss?

No, although weight loss may accompany infection and inflammation, usually, the weight loss in these cases primarily is due to decreased caloric intake.

Rule-outs for Weight Loss with Polyphagia

What are your current rule-outs for the cat's history of polyphagia and weight loss?

In this case, the combination of hyperglycemia and glucosuria is diagnostic for diabetes mellitus.   Remember, stress in cat may cause marked hyperglycemia (> 300 mg/dl), so the detection of hyperglycemia alone, is not sufficient evidence to diagnose diabetes mellitus in a cat.

What are your rule-outs for the low Total Carbon Dioxide?

TCO2 is an estimate of serum bicarbonate.  Decreased TCO2 may be an indicator of acidosis.  An artifactually low TCO2 may occur if the red top tube is only partially full.   Over time, the CO2 will come out of the serum and end up in the air space within the tube.  In this case, in the presence of ketonuria, we can conclude that Mikey is a ketoacidotic diabetic.

How would a serum biochemical profile be helpful in a cat that is anemic?

What can one learn by examining the blood smear from a cat that is anemic?

In animals with anemia, erythrocyte morphology may be helpful in determining the cause of the anemia. REMEMBER The best type of preparation to evaluate RBC morphology is by examining a freshly made slide [rather than from a lavender top tube sent to the laboratory, where the smear is made several hours (or days) after the blood was collected].

How can you determine if this anemia regenerative or nonregenerative?

We can look at the reticulocyte response (see below).

Is this anemia most likely due to hemorrhage or hemolysis?

Because the total protein (albumin and globulin) are not decreased, and there is hyperbilirubinemia with normal liver enzyme concentrations, hemolysis is most likely in this case.

What are your rule-outs for hemolytic anemia?

What is the significance of the hypophosphatemia?

Phosphorus is necessary for normal cell metabolism (ATP production, in addition to 2,3 DPG in the erythrocytes). Mikey's severe hypophosphatemia present in Mikey's results is rare in dogs and cats, but may be responsible for Mikey's hemolytic anemia by causing decreased intracellular ATP, leading to cell swelling and consequential decreased RBC deformability, resulting in hemolytic anemia.  In dogs and cats, severe hypophophatemia most commonly is associated with treating ketoacidotic diabetes mellitus.