January 2015 Case of the Month

Blood and bone marrow smears from a young cat

Case information

A 1.5-year-old female spayed, domestic shorthair cat presented for a two-day history of lethargy and inappetence. The primary care veterinarian identified a severe anemia (hematocrit 5%), a grade II/VI left sided parasternal heart murmur, and moderate hypothermia. The cat was current on core vaccinations, tested negative for FeLV and FIV, and had no pertinent prior medical history. On presentation at referral, she was quiet but alert and responsive with a low temperature of 99.3F and a heart rate of 202 bpm. Her mucous membranes were pale white and tacky, and a grade II/VI parasternal heart murmur was auscultated. The remainder of her physical examination revealed no other abnormalities. Blood was drawn for a complete blood count and chemistry panel. A bone marrow aspirate was obtained.

Evaluate the abbreviated CBC and chemistry results (Tables 1 and 2), blood smear, and bone marrow aspirate images (Figures 1, 2a and 2b) below, and then consider the following questions:

1. Characterize the anemia based on the CBC and blood smear image. Is the anemia regenerative?
2. What is the predominant population on the bone marrow smear? Is the myeloid to erythroid ratio normal?
3. How do you explain the increases in ALT, AST and hyperferremia? Hint: Think of possible consequence of this severe an anemia.

Table 1: Abbreviated CBC results
Test	Results	Units	Reference interval
Hct	5 L	%	31-48
MCV	42	fl	40-52
MCHC	33	g/dL	32-35
Retic %	2.5 H	%	0.1-0.7
Abs Retic	3.2 L	thou/μL	8.5-60.7
WBC	19.2 H	thou/μL	5.1-16.2
Seg Neut	12.1 H	thou/μL	2.3-11.6
LYM	6.3 H	thou/μL	0.9-6
PLAT	981 H	thou/μL	195-624
RBC morphology: Agglutination, no polychromasia

 

Table 2: Abbreviated chemistry results
Test	Results	Units	Reference interval
ALT	924 H	U/L	35-176
AST	643 H	U/L	15-44
Iron	272 H	U/L	53-145

 

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