What causes low hematocrit in cats. How is feline anemia diagnosed. What are the symptoms of low hemoglobin in cats. How is low HCT blood treated in felines. Can anemia be fatal for cats. What role do parasites play in feline anemia. How does the feline body compensate for anemia.

Understanding Hematocrit and Hemoglobin in Feline Blood

Hematocrit (HCT), also known as packed cell volume (PCV), is a crucial measure of a cat’s blood composition. It represents the percentage of blood volume occupied by red blood cells. For cats, the normal HCT range is 25-45%. When this percentage falls below 25%, veterinarians consider the cat to be anemic.

Hemoglobin, on the other hand, is the protein within red blood cells responsible for carrying oxygen throughout the body. While HCT measures the volume of red blood cells, hemoglobin concentration indicates the oxygen-carrying capacity of these cells.

The Importance of Red Blood Cells in Feline Health

Red blood cells play a vital role in a cat’s overall health. They circulate for approximately 70-80 days before being replaced by new cells produced in the bone marrow. These cells are responsible for:

• Transporting oxygen to tissues
• Delivering essential nutrients throughout the body
• Maintaining proper cellular function

When a cat’s red blood cell count drops, it can lead to serious health complications, as cells may not receive adequate oxygen or nutrients to survive.

Recognizing the Signs of Anemia in Cats

Anemia in cats can manifest through various symptoms, some of which may be subtle or develop gradually. Recognizing these signs early can be crucial for timely intervention.

Common Clinical Signs of Feline Anemia

• Lethargy and decreased energy levels
• Pale or yellowish gums
• Increased respiratory and heart rates
• Difficulty breathing in severe cases
• Loss of appetite
• Fever (in cases of infection or inflammation)
• Black stools (indicating gastrointestinal bleeding)
• Discolored urine (suggesting red blood cell destruction)

It’s important to note that cats with chronic anemia may not exhibit obvious symptoms, as their bodies have had time to compensate for the condition. Regular veterinary check-ups are essential for detecting anemia before it becomes severe.

The Three Major Categories of Feline Anemia

Veterinarians classify feline anemia into three main categories based on the underlying cause:

1. Loss of red blood cells
2. Destruction of red blood cells
3. Failure to produce new red blood cells

Understanding these categories helps in diagnosing and treating the condition effectively.

Loss of Red Blood Cells: Causes and Mechanisms

Red blood cell loss, or hemorrhage, can occur due to various reasons:

• Trauma or wounds
• Flea and tick infestations
• Hookworm parasites
• Gastrointestinal ulcers or inflammation

In cases of chronic blood loss, the cat’s body attempts to compensate by increasing the production of reticulocytes, immature red blood cells. This response leads to what is known as “regenerative” anemia.

Destruction of Red Blood Cells: Hemolytic Anemia

Premature destruction of red blood cells can occur due to various factors:

• Infectious diseases (e.g., Mycoplasma haemofelis, Cytauxzoon felis)
• Toxin exposure (e.g., acetaminophen, zinc, onions)
• Immune-mediated hemolytic anemia (IMHA)

In IMHA, the cat’s immune system mistakenly targets its own red blood cells, leading to their destruction. This condition can be triggered by various factors, including reactions to drugs, cancer, or viral infections.

Parasitic Infections and Their Role in Feline Anemia

Parasites play a significant role in causing anemia in cats, particularly in kittens and outdoor cats. These organisms can lead to blood loss through various mechanisms.

Common Parasites Causing Anemia in Cats

• Fleas: These external parasites feed on blood, causing significant loss over time.
• Ticks: Similar to fleas, ticks can cause anemia through blood feeding.
• Hookworms: These intestinal parasites attach to the lining of the gut and feed on blood.
• Blood-borne parasites: Organisms like Mycoplasma haemofelis attach to red blood cells, leading to their destruction.

Preventing and treating parasitic infections is crucial in managing and preventing anemia in cats. Regular deworming and flea/tick prevention are essential components of feline healthcare.

Diagnostic Approaches for Feline Anemia

Diagnosing anemia in cats involves a combination of clinical examination and laboratory tests. Veterinarians employ various techniques to determine the cause and severity of the condition.

Key Diagnostic Tools for Feline Anemia

• Complete Blood Count (CBC): Measures red blood cell count, hemoglobin, and hematocrit levels.
• Blood Smear Examination: Allows for visual inspection of red blood cell morphology and detection of blood-borne parasites.
• Reticulocyte Count: Helps determine if the anemia is regenerative or non-regenerative.
• Biochemical Profile: Assesses organ function and can help identify underlying diseases.
• Fecal Analysis: Detects intestinal parasites that may be causing blood loss.
• Bone Marrow Aspiration: In cases of non-regenerative anemia, this procedure can evaluate red blood cell production.

Additional tests may be necessary depending on the suspected underlying cause, such as tests for feline leukemia virus (FeLV) or feline immunodeficiency virus (FIV).

Treatment Strategies for Low HCT Blood in Cats

The treatment of feline anemia varies depending on the underlying cause and severity of the condition. The primary goals are to address the root cause, support the cat’s body in producing new red blood cells, and manage any complications.

Common Treatment Approaches for Feline Anemia

• Blood Transfusions: In severe cases, transfusions may be necessary to stabilize the cat.
• Iron Supplementation: For cases of iron-deficiency anemia.
• Antiparasitic Medications: To eliminate parasites causing blood loss.
• Immunosuppressive Drugs: For immune-mediated hemolytic anemia.
• Antibiotics: To treat bacterial infections contributing to anemia.
• Nutritional Support: Ensuring a balanced diet to support red blood cell production.
• Erythropoietin: In cases of kidney disease-related anemia, this hormone can stimulate red blood cell production.

The duration and intensity of treatment depend on the severity of anemia and the cat’s response to therapy. Regular follow-up appointments and blood tests are crucial to monitor progress and adjust treatment as needed.

Preventing Anemia in Cats: Proactive Measures for Feline Health

While not all cases of anemia are preventable, there are several steps cat owners can take to reduce the risk and maintain their pet’s overall health.

Key Preventive Strategies for Feline Anemia

• Regular Veterinary Check-ups: Annual or bi-annual exams can detect early signs of anemia.
• Parasite Prevention: Consistent use of flea, tick, and worm preventatives.
• Balanced Diet: Providing a nutritionally complete diet to support red blood cell production.
• Indoor Living: Keeping cats indoors reduces exposure to parasites and trauma.
• Prompt Medical Attention: Addressing any signs of illness or injury quickly.
• Avoiding Toxins: Keeping cats away from harmful substances like acetaminophen and onions.
• Stress Reduction: Minimizing stress can support overall immune function.

By implementing these preventive measures, cat owners can significantly reduce the risk of anemia and promote their feline companion’s long-term health and well-being.

The Impact of Chronic Diseases on Feline Hematocrit Levels

Chronic diseases can have a significant impact on a cat’s hematocrit levels, often leading to persistent anemia. Understanding these connections is crucial for comprehensive feline healthcare.

Chronic Conditions Associated with Low HCT in Cats

• Chronic Kidney Disease: Impairs erythropoietin production, essential for red blood cell formation.
• Feline Leukemia Virus (FeLV): Suppresses bone marrow function and red blood cell production.
• Feline Immunodeficiency Virus (FIV): Can lead to chronic anemia through various mechanisms.
• Inflammatory Bowel Disease: May cause chronic blood loss and nutrient malabsorption.
• Lymphoma and Other Cancers: Can interfere with bone marrow function or cause blood loss.

Managing these underlying conditions is often key to addressing chronic anemia in cats. Treatment typically involves a combination of disease-specific therapies and supportive care for anemia.

Monitoring and Managing Chronic Anemia in Cats

For cats with chronic conditions that affect hematocrit levels, ongoing monitoring and management are essential. This may include:

• Regular blood tests to track HCT and other blood parameters
• Adjusting medications and treatments as needed
• Nutritional support tailored to the cat’s specific needs
• Periodic bone marrow evaluations in some cases
• Addressing secondary complications of anemia

By closely monitoring these cats and adjusting treatment plans as necessary, veterinarians can help maintain quality of life and manage the challenges of chronic anemia.

Emerging Treatments and Research in Feline Anemia Management

The field of veterinary medicine continues to advance, bringing new hope for cats suffering from anemia. Researchers and clinicians are exploring innovative approaches to diagnosis, treatment, and management of feline anemia.

Cutting-Edge Approaches in Feline Anemia Care

• Gene Therapy: Potential treatments for genetic causes of anemia.
• Stem Cell Therapy: Exploring the use of stem cells to regenerate bone marrow function.
• Novel Erythropoiesis-Stimulating Agents: Developing more effective drugs to boost red blood cell production.
• Targeted Immunotherapies: For immune-mediated anemias, aiming to modulate the immune response more precisely.
• Advanced Diagnostic Techniques: Improving early detection and classification of anemia.

While many of these approaches are still in the research phase, they offer exciting possibilities for the future of feline anemia treatment. As these technologies develop, they may provide new options for cats with difficult-to-treat or refractory anemia.

The Role of Nutrition in Supporting Feline Hematocrit Levels

Nutrition plays a crucial role in maintaining healthy hematocrit levels in cats. Recent research has focused on the impact of specific nutrients on red blood cell production and function.

• Iron-Rich Diets: Ensuring adequate iron intake to support hemoglobin synthesis.
• B-Vitamin Supplementation: Essential for red blood cell formation and metabolism.
• Antioxidant-Rich Foods: Help protect red blood cells from oxidative damage.
• Omega-3 Fatty Acids: May help reduce inflammation and support overall blood health.

Veterinary nutritionists are developing specialized diets tailored to cats with anemia or at risk of developing the condition. These diets aim to provide optimal nutrient profiles to support red blood cell health and overall feline well-being.

Cornell University College of Veterinary Medicine

Anemia means a decreased number of red blood cells in circulation. Packed Cell Volume (PCV, also often called hematocrit) is the most common way to measure anemia and refers to the percentage of blood volume that is taken up by red blood cells. The normal PCV for a cat is 25-45%, and any PCV below 25% is considered anemic. 

Red blood cells carry oxygen and nutrients to the body’s tissues. These cells circulate for about 70-80 days before being removed from circulation and replaced with new red blood cells from the bone marrow. Without enough red blood cells in circulation, cells will not receive enough oxygen or nutrients to survive, so anemia can become a critical or even fatal situation very quickly.

Clinical Signs

Because anemia starves the body of oxygen (the body’s fuel), the first sign is often lethargy. An anemic cat may have little energy to play or may sleep more than usual. The cat’s gums may appear almost white or even yellow (a condition called jaundice) due to red blood cell destruction. In extreme cases, the cat may have trouble breathing, and respiratory and heart rates can increase as the body tries to compensate for the lowered oxygen delivery by the red blood cells.

Depending on the cause of anemia, fever and loss of appetite may occur due to an infection or inflammatory response. Black stools can be seen if blood loss occurs in the stomach or intestinal tract, and discolored urine can be a sign of red blood cell destruction. The signs of anemia can be very vague, however, and if a cat has been anemic for a long time, their body has likely had time to compensate and the cat may show no signs at home.

Causes of Anemia

There are many causes of anemia in the cat, but they can be broken down into three major categories: loss of red blood cells, destruction of red blood cells, and failure to produce new red blood cells. A discussion of some, but not all of the common causes of anemia from each of those categories is provided below.  Feline anemia is common and can be secondary to many health conditions.

Loss of red blood cells

Loss of red blood cells (hemorrhage) can be due to an obvious source such as a wound or trauma, or from more insidious causes. Flea and tick infestations are a major cause of anemia, especially in kittens, as the parasites suck blood from the body faster than it can be replaced.  The hookworm parasite (Ancylostoma tubaeforme), which feeds on blood in the intestines, can cause anemia in cases of severe infestation. 

Hemorrhage can also occur in the stomach or intestines due to ulcers or inflammation in the gastrointestinal tract. Cats with blood loss in these areas may have chronic vomiting, diarrhea, or black stools.

Reticulocytes are a specific type of red blood cell made and released by the bone marrow when it senses anemia in an attempt to compensate for the low red blood cell numbers. With chronic blood loss through the intestinal tract or from parasites, cats would be expected to show an elevated reticulocyte count. When a cat has a low red blood cell count and high reticulocyte count, this is called a “regenerative” anemia, as the body is reacting appropriately to blood loss. As long as red blood cells are being lost faster than reticulocytes can be released from the bone marrow, however, the cat will remain anemic.

Destruction of red blood cells

Red blood cells that have reached the end of their lifespan (about 70-80 days) are routinely removed from circulation by a cat’s body and replaced by new red blood cells made in the bone marrow. However, certain diseases can cause red blood cells to be broken down or destroyed more quickly than normal, leading to anemia as they are removed more quickly than they can be replaced.

Certain infectious diseases can lead to damage and destruction of red blood cells. These include Mycoplasma haemofelis, Candidatus, Mycoplasma haemominutum, Cytauxzoon felis, and Babesia species infections. These diseases are spread to cats by fleas and ticks, and they then attach to red blood cells, leading to their destruction.

Red blood cells can also be damaged by certain toxins. Oxidative injury to red blood cells secondary to the ingestion of acetaminophen (Tylenol ®), zinc, copper, onions, and some other toxins or medications can lead to anemia in cats.

Occasionally, a cat’s body tags its own red blood cells as foreign, causing them to be destroyed by the cat’s own immune system. This is called Immune-mediated hemolytic anemia (often abbreviated to IMHA). In some cases, there is a trigger causing the immune system to incorrectly destroy too many red blood cells. This trigger can include a reaction to a drug, cancer, or infectious diseases such as Feline Leukemia Virus (FeLV) or feline infectious peritonitis (FIP). If there no underlying cause for the inappropriate activation of the immune system is identified, this disease is called primary IMHA. There is no evidence that this is a hereditary disease in cats.

Anemias caused by loss or destruction of red blood cells are typically regenerative, so an elevated reticulocyte count would be expected as the body tries to compensate for the destruction of red blood cells.

Failure to produce red blood cells

New red blood cells are produced in the bone marrow to replace those that are regularly removed from circulation. A hormone produced in the kidney, called erythropoietin, is the primary signal that tells the bone marrow that more red blood cells are needed in the body. If the bone marrow is not able to produce enough red blood cells to replace those that normally outlive their lifespan, a cat will develop a non-regenerative anemia, with a low reticulocyte count.

One common cause of non-regenerative anemia in cats is chronic kidney disease. Chronic kidney disease is a very common, affecting approximately 15-30% of geriatric cats. When the cells in the kidney degenerate, they release less erythropoietin, leading to lowered red blood cell production by the bone marrow. As chronic kidney disease advances, 30-65% of affected cats will develop some degree of anemia.

Problems within the bone marrow itself can also lead to decreased production of red blood cells. Cancer, immune-mediated disease, or inflammation in the bone marrow can reduce its ability to replace red blood cells. Chronic inflammation elsewhere in the body can also impair the ability of the bone marrow to effectively produce red blood cells. This is often referred to as “anemia of chronic disease”, and can be seen with many other illnesses in cats, including FeLV infections and various cancers.

Diagnosis

The first step in diagnosing anemia is to determine the packed cell volume, or PCV. This test involves spinning down a small blood sample in a centrifuge to determine what percentage of the overall blood volume is made up of red blood cells. Further blood testing can look for evidence of regeneration in the red blood cells, abnormalities in other blood cell types such as white blood cells and platelets, evidence of organ damage such as chronic kidney disease, or the presence of infectious diseases.

Other tests, such as radiographs (x-rays) or an ultrasound to look for causes of bleeding or a bone marrow biopsy, may be recommended by a veterinarian,

Treatment

Treatment for anemia will vary depending on the underlying cause. In some cases, treatment for parasites or infectious diseases will be most important to stop the loss or destruction of red blood cells. Medications can be used to help stop bleeding from the gastrointestinal tract, and steroids and other immune-modulating drugs are essential in the treatment of immune-mediated diseases.

In cases of severe anemia, a blood transfusion may be necessary to replace red blood cells that have been lost or destroyed while the underlying condition is being treated. Cats have two major blood types, so it is important that both the donor and recipient blood be tested to reduce the risk of any reactions to the blood transfusion. 

In the case of chronic kidney disease, a medication called darbepoetin is available to help stimulate the production of new red blood cells in the bone marrow by replacing erythropoietin normally made in the kidneys. This medication requires weekly injections and close monitoring for side effects, but can result in resolution of anemia in 60-65% of cats with chronic kidney disease.

Last updated 2021

Hematocrit (HCT) / Packed Cell Volume (PCV) – Lab Results explained

Hematocrit is the percentage of red cells in your blood. 

Normal levels of hematocrit for men range from 41% to 50%. 

Normal level for women is 36% to 48%.  

What is hematocrit?

The hematocrit level is simply the percentage of red cells in your blood. For example, a level of 38% is considered the minimum needed for donating blood.

Hematocrit is the percentage by volume of red cells in your blood. Blood is made up of red blood cells, white blood cells and platelets, suspended in plasma. Together, those comprise about 45% of the volume of our blood, but the specific percentages of each can vary.

The importance of hematocrit:

Hematocrit is a significant measurement as it can identify whether you have sufficient red blood cells for oxygen transportation and delivery.

Hematocrit is important because red blood cells are essential to your survival. They contain a vital protein component called hemoglobin that binds to oxygen, which fuels all the cells in your body. When red blood cells pass through your lungs, they bind to and transport oxygen to various cells in your body. On their way back to your lungs, they carry carbon dioxide to be exhaled.

Why is the hematocrit test performed?

The hematocrit test checks for anemia, usually along with a hemoglobin test or as part of a complete blood count (CBC). This test can screen for, diagnose, or monitor many conditions and diseases that affect the blood’s proportion made up of red blood cells (RBCs).

What is a normal hematocrit level?

Normal hematocrit levels vary based on age and race, gender, etc.

In adults, normal levels for men range from 41%-50%. For women, the normal range is slightly lower: 36%-44%.  A hematocrit level below the normal range, meaning the person has too few red blood cells, is called anemia. A hematocrit level above the normal range, meaning too many red blood cells, may indicate polycythemia or erythrocytosis.

What are symptoms of anemia?

Symptoms of anemia include fatigue, shortness of breath and dizziness.

What are symptoms of polycythemia?

Symptoms of polycythemia include fatigue, itching, headaches, and sweating.

What are symptoms of erythrocytosis?

Symptoms of erythrocytosis includes headaches, dizziness, shortness of breath, and nosebleeds.

What is the difference between a hematocrit and a hemoglobin test?

Hematocrit is the percentage of red blood cells in your blood. Hemoglobin is a part of your red blood cell. Hemoglobin helps your red blood cells carry oxygen throughout your body. Hemoglobin also gives your red blood cells their color. A hemoglobin test measures the amount of hemoglobin in your red blood cells.

What is the origin of the word “hematocrit”?

The term “hematocrit” (british english: haematocrit) originated from the ancient greek word haimas (= blood) and krites (= judge) and hematocrit means “to separate blood”.

What does it mean if your Hematocrit (HCT) / Packed Cell Volume (PCV) result is too low?

Look for Possible Connected Biomarkers:  Low hematocrit + low RBC count + low hemoglobin indicates anemia. 

Anemia is usually defined as a decrease in red blood cells (RBCs) or hemoglobin in the blood. It can also be defined as a lowered ability of the blood to carry oxygen. 

Some causes of low hematocrit include:

– Nutritional deficiencies such as iron, folate, or B12 deficiency.

– Chronic inflammatory diseases or conditions.

– Excessive loss of blood from, for example, severe trauma, or chronic bleeding from sites such as the digestive tract (e. g., ulcers, polyps, colon cancer), the bladder or uterus (in women, heavy menstrual bleeding, for example).

– Damage to the bone marrow from, for example, a toxin, radiation or chemotherapy, infection, or drugs.

– Bone marrow disorders such as aplastic anemia, myelodysplastic syndrome, or cancers such as leukemia, lymphoma, multiple myeloma, or other cancers spread to the marrow.

-Kidney failure—severe and chronic kidney diseases lead to decreased erythropoietin production, a hormone produced by the kidneys that stimulate RBC production by the bone marrow.

– Decreased production of hemoglobin (e.g., thalassemia)

– Excessive destruction of red blood cells. That is caused by autoimmunity or defects in the red blood cell itself. For example, hemolytic anemia.

What does it mean if your Hematocrit (HCT) / Packed Cell Volume (PCV) result is too high?

Look for Possible Connected Biomarkers: A high hematocrit alongside with a high RBC count and high hemoglobin indicates polycythemia.  

Polycythemia (also known as polycythaemia or polyglobulia) is a disease state in which the proportion of blood volume occupied by red blood cells increases. 

Some causes of a high hematocrit include:

– Dehydration—this is the most common cause of a high hematocrit. As the volume of fluid in the blood drops, the RBCs per volume of fluid artificially rises; with adequate fluid intake, the hematocrit returns to normal.

– Living at high altitudes (a compensation for decreased oxygen in the air)

– Smoking

– Lung (pulmonary) disease—if someone cannot breathe in and absorb sufficient oxygen, the body tries to compensate by producing more red blood cells.

– Congenital heart disease—in some forms, there is an abnormal connection between the two sides of the heart, leading to reduced oxygen levels in the blood. The body tries to compensate by producing more red blood cells.

– Genetic causes (altered oxygen sensing, abnormality in hemoglobin oxygen release)

– Kidney tumor that produces excess erythropoietin

– Polycythemia vera—a rare disease in which the body produces excess RBCs inappropriately.

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Universal Veterinary Clinic, CBC

CBC is a test profile used to describe the quantity and quality of cellular elements in blood and plasma. Most often, in daily practice, this is the first step to assess the condition of the animal. The organism of our patients is exposed to various environmental factors and gives a specific assessment for stimuli. When the indicators of clinical analysis change, we can talk about the possible cause of the disease.

Main indicators of clinical blood analysis:

1) Hemoglobin (HGB) is a pigment contained in red blood cells, whose function is to transport oxygen and carbon dioxide through the vessels. Its determination in the blood is not only of diagnostic value, it is also important from the point of view of disease prognosis, since pathological conditions that lead to a decrease in the content of this indicator lead to oxygen starvation of tissues.

2) Hematocrit (Ht, HCT) – the volume of red blood cells in the blood. An increase in this indicator may indicate erythrocytosis (an increase in the number of red blood cells), dehydration, or a decrease in the volume of circulating plasma.
A decrease in hematocrit indicates severe anemia. Low hematocrit is also characteristic of chronic inflammation, injury, starvation, chronic kidney disease, and cancer.

3) Erythrocytes ( RBC ) – red blood cells containing hemoglobin. The main functions are the transport of oxygen from the lungs to the tissues of the body and the transport of carbon dioxide from the organs to the lungs.

4) Leukocytes ( WBC ) – “white” blood cells with a nucleus. Their main function is to protect the body from various pathological agents, as well as internal pathological processes that are accompanied by inflammation.

Leukocytes are divided into two fractions: granulocytes (neutrophils, basophils, eosinophils) and agranulocytes (lymphocytes and monocytes). Their ratio in the blood plays an important diagnostic role, so their number is described in leukocyte formula .

5) Platelets ( PLT ) – elements responsible for the integrity of blood vessels play an important role in the regeneration and healing of damaged tissues.

A 12-hour fasting diet is recommended for CBC. Blood is taken from peripheral veins in a volume of about 2 ml (depending on the tube). It is carefully mixed and sent to the laboratory at a temperature of + 2 … + 8 degrees Celsius. In our center, the blood immediately goes to the laboratory, where within 5 minutes it is examined on the ProCyte Dx clinical analyzer (IDEXX company), which is currently the “gold standard” of automatic clinical analyzers.

Deciphering the general clinical blood test is carried out only by a veterinarian.

We wish you and your pets good health.

Reticulocytes (blood level determination)

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Reticulocytes are the immediate precursors of mature erythrocytes; the indicator reflects the production of erythrocytes in the red bone marrow (assessment of erythropoiesis).