Causes

 

Anemia in cats is commonly called "Anemia of Chronic Disease" which is why it's not listed in my "Symptoms" category. Anemia occurs when there is a decrease in the number of red blood cells. It can develop from loss, destruction, or lack of production of red blood cells.

Anemia is also classified as a regenerative or nonregenerative form. In regenerative anemia, the bone marrow responds appropriately to the decreased number of red blood cells by increasing red blood cell production.

In nonregenerative anemia, the bone marrow responds inadequately to the increased need for red blood cells. This form is typically a result of having kidney disease, as it decreases the production of red blood cells through bone marrow suppression. In this case, the kidneys produce less of a hormone called erythropoietin, which helps the bone marrow produce red blood cells.

Symptoms

The most easily observed and common clinical sign of anemia is a loss of the normal pink color of the gums; they may appear pale pink to white when examined. Pale gums and lethargy indicate the need to perform blood tests.

Anemic cats can feel cold and have little stamina or energy, so they seem listless or tire more easily. Anemic cats may have signs of blood loss (bloody nose, blood in the stool, urine, or vomit). Pale gums and lethargy indicate the need to perform blood tests.

Several tests are performed on blood samples to diagnose anemia. These tests are often performed as part of a complete blood cell count (CBC). The most common test to diagnose anemia is the packed cell volume (PCV), also called the hematocrit (HCT). In a normal cat, 25% to 45% of the blood will be red blood cells. If the PCV is below 25%, the cat is anemic.

Other tests to determine anemia include the red blood cell (RBC) count and the hemoglobin (Hb or Hgb) count.

Bloodwork Summary Chart

I have prepared a "Bloodwork Summary Chart" that is available for download in two formats. This chart will help you keep track of the important blood tests during your visits to the vet.

Click here for the Excel version of the chart.
Click here for the PDF version of the chart.

I have also prepared a guide called "Common Blood Tests For Cats." This guide will help you identify the more commonly prescribed blood tests by your vet.

Click here for the PDF version of the guide.

My Cat's Progress

Here are Motor's Anemia lab results for the last six months under my treatment plan:

Hematocrit (HCT/PCV)  24.1 - 28.3 (improvement)
Red Blood Cells (RBC)  5.2 - 6.44 (improvement)
Hemoglobin (HGB)  7.6 - 9.8 (improvement)

Treatment

NOTE:
With regard to treatment, I decided to list the B12 Injections and Chicken Hearts first, as they are the healthiest and safest approaches to take. The medication which is listed last, is still a viable treatment option, but it does not come without risk. I would only recommend using the meds if your cat's PCT (HCT) level was in the teens. Otherwise, I would suggest trying the B12 Injections and Chicken Hearts first. Also, please know that positive results typically take a few months to take place.

B12 Injections
B vitamins are essential for good health. However, they are water-soluble, so they are often lacking in CKD cats, who lose much of their vitamin B through the increased urination associated with the disease.

Vitamin B12 is important for nerve cells, energy production and red blood cell production. A lack of vitamin B12 in cats may contribute to a variety of problems, including anemia and cognitive dysfunction.

Although vitamin B12 is often included in vitamin B complex formulations, there is usually too little vitamin B12 for it to be of much use. Therefore, many people with CKD cats give both a vitamin B complex and a separate vitamin B12 product.

A commonly used dose for injectable B12 (Cyanocobalamin) is 0.25 to 0.5ml once every week for 4-6 weeks, followed by once every two weeks for one month, then once a month.

B vitamin supplements are very safe and can often help a CKD cat feel better. Injectable Cyanocobalamin can take several weeks of treatment before improvement is seen and is metabolized in the body much better than oral methods.

NOTE: If you're already giving your cat fluid therapy, it's easy to inject the B12 directly into the drip set's Y-site injector port near the needle end of the drip set. Make sure you inject the B12 with no less than 10 seconds left of finishing the fluids. This allows all of the B12 to pass through and flush the line.

The needed syringes and needles, etc. are listed below.

Chicken Hearts
If your cat's hematocrit level is low, another more nutritional approach is through the use of animal organ/muscle meats. Chicken Hearts contain one of the highest levels of iron, which helps to raise hematocrit levels in cats. Chicken Hearts also provide Vitamin A, B6, and B12, in addition to taurine and niacin. These vitamins and minerals will also help to improve cardiovascular, vision, immune and digestive function in cats. Note: Chicken Hearts are typically low in phosphorus.

If you can find Chicken Hearts locally, you can boil and serve them to your cat each day as a treat. My cat Motor likes the Freeze Dried Raw Chicken Hearts that I found for him on-line at Chewy. The suggested serving is 2-3 per day to help boost your cat's Hematocrit (HCT) level. I give Motor 3 pieces daily, and typically cut each one into about 15-25 small pieces to make it easy for him to eat.

Medications
Until May of 2023, there weren't any treatments offered that had proven consistent success rates for treating anemia in cats. Aside from blood transfusions, Erythropoietin Stimulating Agents such as Erythropoietin (EPO) and subsequently Darbepoetin (DPO) were the suggested treatment, but many vets were hesitant to recommend EPO and DPO, as there were just too many risks involved.

In May of 2023 however, the U.S. Food and Drug Administration conditionally approved Varenzin-CA1 (molidustat oral suspension), the first drug for the control of nonregenerative anemia associated with chronic kidney disease in cats. Varenzin-CA1 requires a prescription from your vet, and can be purchased online at EntirelyPetsPharmacy.

Developed exclusively for cats, Varenzin-CA1 features a mode of action that induces the genetic transcription of EPO, increasing both EPO and red blood cell production in a cat’s body.

The dosage of Varenzin-CA1 is 2.3 mg/lb (5 mg/kg) body weight administered orally once daily for up to 28 consecutive days, rounded up to the nearest 0.1 mL using the dosing syringe provided in the package.

It is suggested to start treatment of Varenzin-CA1 when the cat's PCV falls below the reference range.

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