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Low platelets and white blood cells, clotting issues -- any experience?

drunkenmonkey
October 5th, 2010, 09:15 PM
Our cat Willy, a male domestic shorthair, is five months old. He was born outside and lived that way with his mother for a month, then spent another month in a great foster home before we adopted him. He has a congenital eye deformity but otherwise seemed to be in good health.

About two weeks ago I was brushing his teeth when he lost a baby tooth. I didn't think any of it initially -- I knew he still had some to lose -- but then I noticed blood on the toothbrush. The spot where he had lost the tooth was still bleeding the next afternoon (ended up bleeding for a day and a half) so we brought him in to the vet. They initially suspected a vitamin K deficiency, but a blood test showed that his platelets are really low; a cat's should be between 200-500 and his were 35. His white blood cells were also quite low. Everything else showed up fine -- his red blood cells were slightly low, but that was likely because he'd lost some blood -- and he tested negative for FIV and feline leukemia. He started a two-week course of steroids and antibiotics that he is almost done; we're scheduled to bring him back for a follow-up and another blood test on Saturday. We'll also be bringing in a stool sample for a parasite test then as well, which we were planning to do before this all happened.

He seemed to be doing well, but earlier today my husband noticed that his mouth was bleeding again. As good a look as I can get at it, he seems to have clots now on each side of his top molars. He's also got a red spot on his ear -- seems like it's under the skin instead of an open wound -- that's gotten bigger since Sunday night. He seems to be himself, and has eaten supper and was playing earlier, but of course we're worried. And we have no explanation right now for what's causing the bleeding in the first place.

Has anyone else had experience with this? I wish I knew the cause of the low platelets, and also what we can do to boost his immune system. Any advice or insight?

hazelrunpack
October 5th, 2010, 09:44 PM
Not sure how common ticks are there, but Toronto is at least on the same latitude if not south of here--here, a combination of low platelets and WBC is almost always an indication of tick-borned disease. In particular, that pattern is present in the cases of anaplasmosis we've experienced.

Might be worth having him tested for it, given that he lived the first few weeks outside during the summer.

Treatment in dogs and people is with doxycycline. Not sure if they also treat cats with it.

I hope they figure out what's wrong with Willy quickly and he recovers fully! :goodvibes:

And welcome to the board!

drunkenmonkey
October 5th, 2010, 11:30 PM
Thanks for the advice -- I'm not sure if ticks are an issue here, but I'll definitely mention it at our next appointment.

Dr Lee
October 6th, 2010, 12:32 PM
Our cat Willy, a male domestic shorthair, is five months old ....a blood test showed that his platelets are really low; a cat's should be between 200-500 and his were 35. His white blood cells were also quite low. Everything else showed up fine -- his red blood cells were slightly low, but that was likely because he'd lost some blood -- and he tested negative for FIV and feline leukemia. He started a two-week course of steroids and antibiotics that he is almost done; we're scheduled to bring him back for a follow-up and another blood test on Saturday. We'll also be bringing in a stool sample for a parasite test then as well, which we were planning to do before this all happened.

Has anyone else had experience with this? I wish I knew the cause of the low platelets, and also what we can do to boost his immune system. Any advice or insight?

How low are the white blood cells? Mildly or also severely?

So when we have low blood cell counts, then the causes are: 1) lack of production, 2) loss (ie blood loss) or 3) destruction.

Lack of production could indicate a bone marrow disease. Bone marrow function can be a little different to diagnose as it requires a bone marrow sample. It is unusual that the RBC is near normal but it could still be bone marrow disease. There are other causes of lack of production but we will usually see other clinical signs.

For blood loss, we would not see severely low platelets in contrast to the other populations. With that said, cat blood samples often have artificially low numbers due to platelet clumping however if we have clinical signs and your vet is worried about the platelets, then we are working under the assumption that this number is true.

For destruction, we can have auto immune causes (the reason your vet used steroids), infections (rickettsial disease, viral diseases (other than FeLV and FIV such as a calici variant), bacterial infection, cytauxzoonosis, etc), tumors such as LSA lymphosarcoma, and other causes.

With a number as low as 35, I would recommend daily platelet testing. This may depend upon the size of the cat and the type of blood machine used. Some platelet tests only one or two drops of blood, some require a vial. However it is important to note that a true number of 35 would place the pet at risk for spontaneous hemorrhage which could result in death. So this is very serious.

Many times we do not have the answer to the cause. If your cat is feeling better and the medications work and the numbers are back, then monitoring would be the next step. With a course of antibiotics and steroids then an infection would be the most likely. Primary auto immune disorders will usually require longer than a two week course of medications.

If the numbers are not improving then you may likely have to start running more tests and quickly. If clinical signs or other blood values worsen then blood transfusion may be necessary.

I hope that this helps.

drunkenmonkey
October 6th, 2010, 03:56 PM
Thanks so much for the info.

When tested on September 24 -- the day after he started bleeding -- his platelet count was 35 and neutrophils were 0.35. His hemoglobin and hematocrit were 91 and 27 respectively, so just slightly below the low end of normal. Everything else tested was within the normal range, and he seems otherwise quite healthy; his coat is good, eye is clear (the one with the congenital issue tends to weep), he's growing and eating well, he's playful, etc. He was 20 weeks old at the time of this blood test, and he hasn't yet been fixed.

The thinking in giving him the steroids, as I understand, was to see if that helped in the case of it being immune-related. I suppose he could be on longer than two weeks -- we'll know more when we do the follow-up blood test -- but that's all we have so far. I'm bringing the stool sample for parasite testing in on Saturday as well.

They mentioned to us that a bone marrow biopsy was an option, but we decided to see how these meds and a follow-up blood test went first, because it's less invasive. Are there any other tests we should consider if this hasn't solved the issue?

Is there a product we can purchase commercially that would allow us to test his platelets at home?

mikischo
October 7th, 2010, 03:13 PM
Sorry, I have no suggestions but just wanted to send some :goodvibes::goodvibes::goodvibes: that things start to improve for Willy soon.

Thank you for adopting this deserving boy.

mikischo
October 9th, 2010, 04:28 PM
Thinking of you and Willy.:goodvibes:

Please let us know how the vet appointment went today and what the results of the blood tests were like.

Dr Lee
October 9th, 2010, 05:17 PM
Is there a product we can purchase commercially that would allow us to test his platelets at home?

No, not practically. You would need to have a microscope and be able to read blood smears to do this at home. The machines that run the test range at about $45,000 US on up.

Severely low platelets can be fatal so daily checking to make sure they are going up is important. If not, then additional medications may be necessary. You are correct that the steroids are for immune system diseases however if you have certain infections, then you can have a secondary immune destruction of cells that persists only while the overall infection is present. A common cause of this is tick fever. It is a blood borne disease that can be contracted through tick bites.

Other tests.... the Parvo test for dogs can be used to test for panleukopenia (which is different from feline leukemia or FIV or FIP). While this isn't common for platelets, it can affect the neutrophils and may be have an indirect impact on the platelets. A tick panel may be useful depending upon demographics. Many times the tick is never seen. A tick could have bitten and been then killed by the cat months ago yet have transmitted a rickettsial disease. Doxycycline, an antibiotic, is often used for many tick borne diseases. Further tests like coagulation panel, radiographs and ultrasound, etc. could be helpful to rule out other problems. If any lymph nodes are enlarged, then lymph node aspiration cytology (sticking a needle in it and getting a sample) would be extremely important.

I hope that all goes well, please keep us updated. :pawprint:

hazelrunpack
October 12th, 2010, 10:11 PM
How is Willy doing, drunkenmonkey? :goodvibes:

drunkenmonkey
October 14th, 2010, 07:07 PM
Thanks, all. We had our follow-up appointment on Saturday, and his platelets are improved -- now up to 165 from 35. That's still not at the normal level, but definitely a less dangerous number and indicates that the steroids are helping. We were really happy to see an improvement. The most recent bleeding stopped sooner than last time, and his gums and ear look totally healed now, which is encouraging.

Right now he's taking the steroids and antibiotics for another couple of weeks, and we'll test again. We're not sure, though, if he'll need to be on them long-term or not. Our vet is going to speak to some people at a larger vet hospital in the city -- the main vet at our clinic is on the board there, so they can pick their brains sometimes -- and see if they have any ideas. She didn't think it was tick-related, because it's not really seen in this area, but we're keeping all possibilities in the back of our minds; I think that's one of the things she was going to ask about. I will bring up panleukopenia on our follow-up appointment. He didn't have any enlarged nodes on the last check, on the weekend, but I'll make sure that's checked for again too. Also, his fecal parasite test came back clean.

So still a mystery, but at least improving! Thanks again for the advice and suggestions, very appreciated.

Love4himies
October 15th, 2010, 08:01 AM
Thanks for the update and sending :goodvibes: that he continues to improve.

mikischo
October 15th, 2010, 08:29 AM
Thanks for the update. I'm so glad to hear that Willy is doing better and that his platelet count has risen substantially. :goodvibes::goodvibes::goodvibes: for continued improvement.

Please continue to keep us posted.