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Bloodwork in Cats
High white cell count in cat
Blood transfusions in Cats
Pre Surgical Bloodwork panel - how necessary is it
High blood glucose levels
Is high BUN associated with renal failure
also see Kidney
also see Liver
also see Feline Lab work
also see Blood
also see Parasite
Question: Dear Dr. Richards,
I am a subscriber and I am the person who has the dog, Natty, with a high
white count. Now Sally, a calico 11year old dsh has the same thing. Her
white count has been consistantly high. She is, by nature, a "Long Tall
Sally" with long legs and thin body, but now she is very thin at 8.5lbs. The
Dr. thinks it may be strees as I have lots of animals and neighbors animals
drop in too often so she is living happily in the bedroom with only one cat
room mate,I am sending you all of her blood work by mail. The liver problem in 2000
seems to be ok.I should mention that once in awhile she has a deep harsh cough that doesn't
quite sound like a hair-ball but it doesn't seem to bother her.Thank you for all of your help. It is a joy to read your written word.
Sincerely. Mary
Answer: Mary-
I am sorry for the long delay in getting to your question. I did receive
the lab work by mail, as well as this question.To sum up the lab work (the parts that seem relevant to me):
Chemistry test 3/23/2001
abnormalities: high total protein, high globulin
CBC 3/23/2001
wbc 30.6, elevated neutrophil count, elevated monocyte count (the band
count is not worrisome to me at this level)Chemistry test 4/21/2000
total bilirubin high 1.14, globulin 5.15 (high)
QBC (estimated white blood cell count); WBC 16.5 (normal) but neutrophils
elevated 14.1QBC 4/27/2000
tbili 0.72, hct 27.7, wbc 19.6, grans (neutrophils) 16.8 (high)QBC 2/17/2001 (QBC machine set to read canine blood - this causes a small
error only)
hct 25.5, wbc 36.9 (high), grans 31.9 (high)
Chemistry 2/17/2001
albumin 2.5, globulin 4.96 (high normal)After looking over the lab work, the first thing that came to mind was a
blood parasite infection. The reasons for this are 1) high white blood cell
levels over an extended period of time 2) hct (percentage of red blood
cells) dropping over time 3) high globulin levels indicative of high
antibody production 4) elevate total bilirubin counts can indicate
intravascular hemolysis. The lack of anemia makes this diagnosis less
likely, though. We have had at least two or three cat patients who seemed
to have long periods of time in which they had subtle signs before they
became anemic, though. Blood parasites are hard to find (at least I think
they're hard to find). For this reason, we sometimes treat cats on the
suspicion that this problem is present, using doxycycline for three weeks
to see if there is improvement.There are a number of other possible problems, though. Feline leukemia
virus (FeLV) and feline immunodeficiency virus (FIV) could cause these
signs in blood work. Feline infectious peritonitis could, too --- but it
would be odd for Sally to do well for a long time with that problem.
Chronic pancreatitis and inflammatory bowel disease sometimes cause white
blood cell elevations and high globulin levels that persist for long
periods of time. Toxoplasmosis can do this, as well. Bacterial infections
that persist for long periods of time, such as chronic bone, liver or
kidney infections, can also lead to persistently high white blood cell
counts and increased globulin levels. Anemia can occur with any long term
infection, so even though there is not yet a true anemia, the slow drop in
red blood cell count could be due to this sort of problem, as well.I do not know if FIV and FeLV virus tests have been done. If they have not,
it would be reasonable to do these tests. If they are negative, then
testing or treating for blood parasites would be reasonable, too (and might
be even if they are positive). If there is any vomiting or diarrhea it may
be worthwhile to consider ultrasound examination to try to rule out
pancreatitis and/or inflammatory bowel disease. Urinalysis can help to rule
out chronic kidney infections. It may also be worth checking for
hyperthyroidism due to the weight loss.I wish that I could provide a more specific rule out list, but due to the
non-specific nature of increases in white blood cell counts, this is the
best that I can do. Please keep working with your vet to get to the bottom
of this problem, if possible.Mike Richards, DVM
5/1/2001
Question: You may remember I was the one with the two adult cats that caught FeLV
from a kitten I fostered.
One of the cats is doing very poorly - her hemacrit kept going down until
at 11 we did a sort of emergency blood transfusion using a cat that was
living at the vet's. I understand the first transfusion did not have to
be matched/same blood type and my cat was like a new cat for maybe two
days before getting very depressed again.
I have her blood typed, it is AB (I know it's rare), and a big healthy cat
of mine is type A. I had asked the lab to cross match their blood and
they did not, they said it was enough to be the same type and A can be
transfused into AB. I have spoken to several labs across the country
including an animal blood bank and only receive conflicting
information. All say the blood should be typed and cross matched; the lab
that sells blood said only AB blood should e transfused into an AB
cat. Do you have any thoughts on this, time is growing short, I know she
could use another transfusion.
Thanks a lot, Rhoda
Answer: Rhoda-
I can see why you have been receiving conflicting information, because there does
seem to be some question about transfusion reactions when it comes to Type
AB cats. I think that the following information is a correct
interpretation of what I have found, though.There are three blood types in cats. They are A, B and AB. Type A is by
far the most common, Type B is less common but how much less common depends
on the breed of the cat, with American short hairs having only about a 1 to
2% incidence of Type B blood and British Shorthairs having about a 40%
incidence of Type B blood. The AB blood type, as you point out, is
considered to be rare.Cats with Type B blood have naturally occurring antibodies against Type A
blood and will almost always have a severe transfusion reaction if they are
given Type A blood, even for a first transfusion. Cats with Type A blood
form weaker antibodies against Type B blood and usually transfusing a Type
A cat with Type B blood will only result in a minor transfusion reaction or
may not cause a noticeable reaction at all. This much is pretty clear.
However, it was harder to figure out what happens when Type AB cats are
involved. The blood lab's interpretation is the most common one. Only Type
B cats appear to the immune system as having Type B blood. The cat's immune
system does not seem to be able to distinguish Type A blood from Type AB
blood, meaning that the A portion of the blood type is the only part that
is expressed (that produces an antigen on the blood cell surface). That
should mean that it is OK to transfuse Type A blood into a Type AB cat
without problem. Despite this, though, all the texts that I have strongly
suggest crossmatching, anyway. This may just be a precaution but it does
seem like a reasonable one. Crossmatching is not that hard to do and your
vet should be able to do this in the office. It does take some time and is
a little difficult to do well in an emergency, which is a good reason to
know your cat's blood type, as you already know. From a practical
standpoint, it seems like you would almost have to use Type A blood for
transfusions, since it would be hard to find Type AB blood to transfuse
with. Hopefully, if you did have to have another blood transfusion done it
went well.Mike Richards, DVM
1/8/2001
Pre surgical bloodwork panel - how necessary is it
Question: Hi Dr. Richards,
ALso, is it necessary to have a blood test before a cat has his teeth cleaned? My vet does a blood test before a
dental to make sure there are no problems before giving the gas they use to sedate the critter. What do you
think?
Thanks, HelenAnswer: Helen-
I do not think that there is any proof at all that pre-operative lab work helps to eliminate problems
with anesthesia or surgery. There are some pretty good studies in humans that actually refute this
concept (one by the Mayo Clinic is possible to find online). On the other hand, I do think that it isn't
a bad idea to occasionally check lab values for problems that might not be apparent. If that hasn't
been done in a while, there is no reason not to. My biggest fear of pre-operative lab work is that
necessary procedures get put off due to blood values that may, or may not, indicate problems. If a
procedure is necessary, it should be done anyway, in most cases --- which is where the concept of
pre-operative lab work sort of falls apart. Vets that prefer to do these procedures point out that even
if the blood work only makes a big difference in one in 10,000 cases, it is still important to that one
pet. It is a hard point to argue, except that I know of hundreds of cases in which necessary work
was put off, or not done at all, due to lab work changes that may or may not have impacted on the
surgical procedure. Like most things, this is a judgment call, but you have to focus on the importance
of the procedure if unusual lab results do show up and then either compensate for the problems
found or consider treating them after the surgery or dental work is over.Mike Richards, DVM
1/3/2001
Question: Dear Dr. Mike:
My 9-year old cat, Buck, just got the blood test results from his recheck at the Veterinary
dermatologist. He was diagnosed with allergies (mold, wool, dustmites and maybe food although
that has been hard to identify) about a year and a half ago, which seemed to coincide with our
move to a new apartment and my new roommate whose now my husband. He gets a monthly
allergy shot and, when there's a pretty severe flair-up, occasional prednisone treatment. In total,
this amounts to 5mg maybe once a month and 2x a year, 4-5 days of 2pills, 1 pill, 1/2 pill to
control the severe bouts of scratching. I try to be so cautious with the steroids, knowing the risks
involved-- particularly diabetes.My question involves his level of blood glucose, which was reported at 208. The vet alerted me to
the fact that it was a little elevated, but it may have been a result of stress from office visit. Cats can
elevate their glucose simply by being stressed. Buck has always been highstrung so this would not
have been unusual for him to do. She's not worried at this time, but cautioned me to be on the
lookout for any symptoms of diabetes--like frequent urination and drinking, lethargy, weight
loss.Suggested a urinalysis if I was really nervous.Needless to say, I'm a little alarmed, not having any experience with what levels are normal and
what levels are signaling a problem. Could you give me a little more insight as well as your
interpretation of a 208 glucose reading? By the way, due to his allergies, he's been on a
home-cooked diet for about a year -- 1/2 turkey, 1/4 grain, 1/4 steamed vegetables and Taurine
capsules mixed with a little Vitamine C crystals. His hair coat seems healthy, he's very energetic
and has a good, constant appetite. I would say he urinates about 2-3 times in 24 hours, usually
directly after meals or snacks.Thanks for your help, Dr. Mike. You provide a wonderful service!
Donna
Answer: Donna-
We have cats in our practice who can get their blood sugar level up to about 275 gm/dl during
examinations in our office who have never have sugar in their urine when it is tested at home. Sugar
starts to spill over into the urine when blood levels get above 180gm/dl, so we are pretty sure these
cats are not diabetic.Our approach to this problem is to suggest that owners monitor for glucose in the urine, if we have
reason to suspect that diabetes might be present, such as increased drinking or urinating, recurrent
cystitis or weight loss. It is easy to monitor for sugar in the urine. Just get glucose test tape or test
strips from a pharmacy and then scoop about a teaspoonful of wet litter from the litterpan (must be
from the suspect cat), mix it with an equal amount of water and then drain off enough water to wet
the test strip. There should be no sugar in the urine, so all you are looking for is a positive or negative
test. If the test is positive for urine sugar, then you need to talk to your vet.The odds are really high that this is not diabetes but if you wish to check, the urine testing is pretty
easy to do at home.Mike Richards, DVM
1/3/2001
Is high BUN associated with renal failureQ: I recently took my cat to the vet because he had lost a lot of weight in the past 1-2 months. The doctor took a blood panel and said that the cat was existing on about 10% of his liver. The cat is active, he eats, he does not drink alot of water without coaxing. His blood urea nitrogen level is at 134mg/dl , his creatinine is at 6.9 mg/dl his lymphocyte count is low while his neutrophil and monocytes are really high. Is the BUN associated with renal failure? Can the doctor tell from a blood test how much of the cats liver is working? We are to see another vet Sat. Do you have any suggestions?
A: The short answer is no.
The longer answer is that people want to hear some sort of estimate of the amount of damage or the prognosis when their pet is sick. So veterinarians tend to feel compelled to guess. I think this is usually done in an honest effort to appease this desire. But the bottom line is that almost any estimate of this sort is pretty much a guess.
I am curious about one thing. Normally high blood urea nitrogen and creatinine levels are indicative of kidney damage. In general it is felt that these levels won't rise until approximately 75% of the kidney is damaged. If your vet was referring to kidney damage, then this may be where the figure for amount of damage came from.
There are tests more specific for liver damage, such as bile acid response testing. This sort of test can give a strong indication of damage to the liver. Hepatic lipidosis, which can occur secondary to almost any other illness, could explain the weight loss but most cats with this condition don't eat well. Hyperthyroidism can also explain the weight loss with continued appetite, as well as the kidney damage, which can occur secondary to hyperthyroidism. This usually occurs in cats over 5 years of age and is most common around 10 to 12 years of age or so.
In any case in which you are given a very poor prognosis for survival (such as this much liver damage) it is always a good idea to consider a second opinion. With the kidney values you have provided, it is important not to delay treatment seeking a second opinion so I am glad you are getting it quickly.
Mike Richards, DVM
Last edited 01/30/05
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