"It's a miracle that she's still alive"

Editor's note: Today's post is about a kitten. During the epidemic, this one-year-old kitten suddenly developed severe anemia and was given a critical illness notice by the doctor... The cat owner wrote about the kitten's tenacious survival experience; in addition, Calendar Girl also found a veterinarian and shared a practical knowledge at the end of the article: What causes anemia in cats?

"It's a miracle that she's still alive."

When the doctor handed me the critical illness notice, Miao Kaixin was still looking out of the cat bag, as if our conversation had nothing to do with her, as if "her life might be in danger at any time" was not describing her at that moment.

I also felt that all this was not real, until I was sitting in the waiting area waiting for further test results to come out, when I couldn't stop the tears from flowing.

A cat named Miao Kaixin

Miao Kaixin was once a stray cat, but she is surprisingly friendly. She would let me touch her belly and purr comfortably, but she never "stepped on my milk"; when I pinched the back of her neck, she would not lie there immediately like other cats. These details tell me that she must have frequent contact with humans, and may even have been raised by humans.

One day in late July 2021, Beijing issued a red alert and heavy rain poured down. A friend heard the cat's scream downstairs, rescued her, and found an adoptive parent for her on WeChat Moments.

A few days later, the cat arrived at my place. She arrived on August 4, which happened to be my birthday. I named her Miao Kaixin. Miao was found in ancient books and is considered the original surname of the cat family. I originally wanted to call her "Kangle", but I thought "Happy" was more catchy, so I just called her Happy. I hope she can be happy after she ends her wandering life. I also think that I, who suffers from bipolar disorder, will get better if I call myself "Happy" and "Happy" every day.

Miao Kaixin was very active, curious, and not afraid of people. She quickly became familiar with me. The more I looked at her, the more I liked her. Later, I changed my profile picture to her photo and my pen name became "Miao Kaixin".

I didn't know her birthday. She was about 3 months old at that time, so I set her birthday on May 4. This year, May 4 was her first birthday, and I wanted to write about my story with her. On May 9, before I finished writing the article, I saw her licking the wall. I thought about her loss of appetite and reduced activity in recent days, and I was worried that she was lacking trace elements or infected with parasites, so I prepared to buy her some trace element tablets and anthelmintics.

On the morning of May 10, her cat food was barely touched. My roommate told me that she tried to jump onto the windowsill today but failed, which made me even more worried. Due to the epidemic, all nearby pet hospitals were closed, so I could only take her to a pet hospital farther away, which was also the headquarters of its chain.

At 4 p.m., I signed the critical illness notice

We arrived at the hospital around 2pm. She was very nervous, but in a relatively normal mental state. She would walk out of the cat bag and explore around in the clinic, and she also cooperated with the blood test. She has always been very well-behaved, and was also the case when she was vaccinated before. Even if she was jumping around at home, she would lie there obediently without making a sound or struggling when she was injected.

After the blood test, there was an ultrasound. For an ultrasound, the hair on the abdomen needs to be shaved, and then a coupling agent is applied, just like for human examinations. I held her four feet, and the nurse used the instrument to probe her belly. She was very resistant and even made a "whine", which was a sound she would make when she was extremely uncomfortable. The ultrasound results were available immediately, and everything was normal, and all organs were in good condition. However, the blood test results more than an hour later exceeded our imagination.

The normal hematocrit of a domestic cat is 30.3% to 52.3%, but the result of her blood test showed a glaring "4.8%" - there were not many red blood cells in her blood vessels. Other indicators related to red blood cells were also extremely low, and platelets, neutrophils and eosinophils were also lower than normal. The doctor told me that she was now severely anemic and could be in danger of death at any time. The most urgent need at the moment was to transfuse blood as soon as possible, and then find out the specific cause of the anemia. As for whether she ate food or licked the wall, it was no longer an urgent matter to consider at the moment.

A little after 4 p.m., I signed the critical illness notice.

The doctor calculated that based on Miao Kaixin's weight, in order to meet the minimum blood standard, he would need a blood transfusion of 230 ml. A cat can only draw 40 to 50 ml of blood at most, which is far from enough; and the bigger problem is where should I find blood.

I faced a difficult choice: to find a cat owner willing to donate blood, or to contact cat blood dealers directly.

I chose the latter, which made my moral system constantly question me. The living conditions of many "blood cats" are not good - there seems to be a mountain between cats, and some cats are pressed under the mountain, and their job is to transfuse blood to cats on the top of the mountain. Blood cats are an unregulated market in China, and my purchase is to support this economy.

But if we don’t find a cat blood dealer, Miao Kaixin, whose “life may be in danger at any time,” will have to wait to find a cat owner willing to donate blood and a cat that is able to donate blood, wait for those cats to arrive, and wait to find one among those cats that can match her... Looking at that “4.8%”, I was scared and I didn’t dare to wait.

I know that my act of looking for bloody cats will be criticized, but I still choose to write it down. If there are any critical voices, I am willing to listen and accept them.

The cat blood dealer brought four cats

Blood transfusion requires blood type testing. Fortunately, Miao Kaixin has type A blood, which is the easiest to match. Later I learned that the last cat with a similar condition to her admitted to this hospital took 9 matches before it was successfully matched.

At about 4 p.m., I called the cat blood dealer. Nearly an hour later, a bald middle-aged man with a big belly, wearing Buddhist beads and a bodhi string on one hand and carrying an airline box in each hand came in.

He brought 4 cats, all weighing more than 12 catties. I thought I only needed one cat, but I realized that cats with the same blood type also need to undergo a matching experiment, and matching only one cat may not be successful. Selling cat blood is his profession, and he is very professional.

The doctor said to match three cats first, which required drawing blood to separate red blood cells and plasma, and then matching them one by one to find the most compatible one. If none of the three cats matched, then the probability of matching was very small.

I knew she had something she didn't say, which was the worst possible outcome. At this time, the doctor took out a second agreement, informing me of the risks of blood transfusion, and I signed my name again.

The waiting time for matching was quite long. I had calmed down a little by then and felt hungry because I hadn’t eaten lunch yet. Seeing that Miao Kaixin was doing well, I looked around through the window in the cat bag. I asked someone to help look after her and went out to buy some food.

However, Miao Kaixin's diet was much worse. She only ate two freeze-dried pills today and didn't drink much water. She refused to eat or drink when she arrived at the hospital. The nurse gave her some pet milk powder, but she just sniffed it and huddled in the cat bag.

The anxiety and restlessness I felt while waiting enveloped me and pressed against me. I almost cried more than once, but I held it back. The more I felt at this moment, the more I had to stay calm, because she only had me.

At 8 p.m., the cat blood dealer came out of the laboratory and told me that 80 ml of blood had been drawn, and he showed me the payment code. I was surprised that so much blood had been drawn, and I felt sorry for his cat, but the blood had already been drawn.

20 minutes later, Miao Kaixin was taken to the infusion room to have an indwelling needle implanted and began infusion. At this time, her two hind feet were each given an injection for blood tests and wrapped with tape, and the indwelling needle for blood transfusion was implanted in her front feet.

Blood transfusion is very slow, one drop per few seconds

Before the blood transfusion, diphenhydramine is first transfused, which is an antihistamine used to suppress allergic reactions. After more than ten minutes, the blood transfusion begins, and the diphenhydramine is switched back after the blood transfusion. This is to suppress the allergic reaction and also to bring out the blood remaining in the infusion tube - blood is very precious, whether you are standing from the perspective of the cat owner, the cat receiving the transfusion, or the cat having the blood drawn.

The blood transfusion was very slow, with one drop every few seconds. The infusion and blood transfusion took 6 hours and ended at 2:30 in the morning.

But these six hours were not as long as I imagined. When people are concentrating, time always passes quickly. I kept a close eye on Miao Kaixin and the infusion tube. The doctor told me a lot of precautions, such as observing whether her face and feet were swollen, whether she had a fever, and whether she had difficulty breathing. At the same time, I also had to shake the blood bag every 10 minutes to keep the blood and anticoagulant fully mixed.

After a whole afternoon of stress, Miao Kaixin was nervous. I put her in a cat bag, which gave her some sense of security. Later, the small cat bag caused her body temperature to rise, so I opened the lid of the cat bag to let her breathe more.

Around 10 p.m., there were no other patients in the outpatient area, and she and I were the only ones left in the infusion room. The hospital fell silent, and the low hum of the instruments and the faint barking of dogs in the cages in the inpatient area next door gradually became clearer. She was in good spirits, and would stick her head out of the cat bag, sniffing around, and swearing when the nurse took her ear temperature.

I continued to eat the "lunch" that I hadn't finished in the afternoon, and also made her some pet milk powder, and she finally started drinking water. I was very surprised that she could drink water, so the situation was not so bad. Maybe it was just that the coming and going of people and dogs in the afternoon scared her, and now she feels safer and dares to eat.

I simply took her out of the cat bag, and the nurse opened a small can of food for her and melted a piece of milk cake. She licked the can and didn't touch the milk cake. I said she was "still picky at this age", and I felt relieved.

After eating, Miao Kaixin began to explore the table she was on, and even wanted to jump off the table. When I stopped her, she protested with a cry. Fortunately, she did not really resist me. When I put my nose close to her, she would also stretch her nose up and rub it against me. This is how we always communicate. At this time, her body temperature also dropped, and her breathing was not as rapid as in the morning.

Around 0 o'clock in the morning, she felt a little sleepy and lay down in the corner with her eyes closed to rest, but at the slightest movement she would immediately become alert and move around a few times.

0:45, there was no more blood in the blood bag, only the infusion tube was not finished, and the nurse changed it back to diphenhydramine. Seeing Miao Kaixin always wanted to get off the table, the nurse guessed that she wanted to pee, so she brought the cat litter box. She was very wary of the cat litter box at first, but later she peed a little bit, and the urine color was normal.

At exactly 1 o'clock, she ate a few more freeze-dried pieces, and the tip of her nose turned from pale at the beginning to a light pink.

Around 1:30, the hospital received a call and vaguely heard that a cat had lost its breath and consciousness. Later, the nurse told me that the cat owner had hit his cat on the head and that the cat was definitely beyond saving.

At 2:20, the nurse brought the litter box again, and she urinated again. This time, the amount of urine was much larger, close to her normal urine output. At this time, the nurse first removed the tape on her two hind legs. She felt some pain and began to struggle and curse, but the resistance was not as intense as when she did the ultrasound in the afternoon.

The nurse was very responsible. She provided Miao Kaixin with various foods, took care of her urination, and came to check on her from time to time and measure her ear temperature. In the last 20 minutes, the nurse kept shaking the infusion tube so that the last bit of precious blood in the infusion tube could be completely infused into Miao Kaixin's veins.

Bring Miao home happily

At 2:40, the infusion tube finally turned almost completely transparent. Because they were not sure what would happen to Miao Kaixin after she returned home, the nurse did not remove the indwelling needle, but fixed it on her front leg. The nurse and the doctor on duty reminded her of many precautions, including observing her condition and diet, whether she had blood in her urine (red urine, soy sauce color, brown urine, etc.), whether her skin turned yellow (meaning hemolysis), whether her skin itched or had spots (meaning allergies), whether her front paws were swollen, whether her body temperature was normal, whether her face and ears were swollen, etc.

I thanked the nurse and the doctor on duty, and happily went home with Miao.

After arriving home, Miao happily ate the cat food left over from the morning and familiarized herself with the home environment again. She was very tired and had been yawning in the hospital, but it took her three hours to fall asleep. She was still quite alert when she first fell asleep, but later she went from sleeping on her stomach to lying on her back with her legs spread out - she realized that she was safe.

But I didn't dare to sleep, she was not really out of danger, I had to stay with her. I was afraid that when I woke up, I would no longer be able to feel her body temperature.

There are four main causes of anemia, and the first one to be ruled out is hemorrhagic anemia. Her ultrasound examination showed that everything was normal, with no internal bleeding, blood in urine, blood in stool, or trauma.

The second is hemolytic anemia. I was worried that she might have eaten onions or something, but if it was hemolytic anemia, the plasma would turn red, and Miao Kaixin's plasma was light yellow.

The third is nutritional anemia. I thought it couldn't be this problem at first, because the cat food and canned food that Miao Kaixin had been eating were well-received and she had no absorption problems. But later I found out that the online store where I bought the cat food had been complained about quality issues before. I'm trying to test the quality of the cat food, but there is no result yet.

The last possibility is aplastic anemia, which means that there is a problem with her hematopoietic function. In this case, we need to find out the cause of the impaired hematopoietic function first, such as whether there are viruses or parasites in the blood. The pet hospital is not able to independently investigate the cause, so we sent the blood sample to the testing agency.

Went to the hospital again

The next afternoon, I took Miao Kaixin to a follow-up visit. She was in good condition, with no rejection reaction, and the blood transfusion was successful.

The doctor prescribed prednisolone (a hormone) and blood-enriching medicine for Miao Kaixin. The main ingredients of blood-enriching medicine are various amino acids, which provide raw materials for protein synthesis. I also bought blood-enriching cream, which mainly contains iron and vitamins, which complement the blood-enriching medicine prescribed by the doctor.

The seller of the blood-replenishing cream was honest and told me that the blood-replenishing cream smelled bloody and that cats might not like it. The instructions said that it could be applied to the cat's nose to trick it into licking it off. In the following days, feeding Miao Kaixin medicine and blood-replenishing cream did become a big problem, and it also threatened the intimacy between us at all times. She later became more fond of resting in her roommate's room, rather than lying at the end of my bed as before. She was avoiding me.

On the third day, Miao Kaixin didn't seem to like eating anymore. I saw her nose turned white again, and I couldn't help but panic. I also received a call from the hospital and learned that the blood screening results were out. I planned to take Kaixin to the hospital again.

Because of the epidemic, I couldn't get a taxi in the area where I was, so I had to ride my bike to a place one stop away to get a taxi. Seeing her condition getting worse, on the way to the hospital, my mind was full of thoughts about what to do, what if the cause could not be found and blood transfusion was useless.

"If it doesn't work, then don't bother her. Instead of letting her suffer so much, it's better to buy her some good food and drinks to make her last days a little easier." This thought flashed through my mind.

Unexpectedly, Miao Kaixin became active again when she arrived at the hospital. I was surprised that she was so active today, but I was still very happy because it was a good thing that she was active.

At this time, the tip of her nose was also quite red. The nurse told me that cats’ noses also turn red when they are nervous. I realized that I might be too nervous - I used the color of her nose tip after a blood transfusion in the hospital as a comparison standard. The redness of her nose tip at that time might also be due to nervousness. It was normal for the color of her nose tip to fade after she returned home.

The cause is still unknown

The anemia pathogen qPCR test report showed that feline hemophilus mycoplasma, feline leukemia virus, feline AIDS, feline Q fever, cat scratch fever, feline proleukemia virus, and feline Babesia were all negative. There was no feline infectious peritonitis in this test, but the doctor thought that she was unlikely to have feline infectious peritonitis based on the existing test results.

In other words, the specific cause of Miao Kaixin's anemia is still unknown. The doctor said that if you want to know more, you need to do a bone marrow puncture to check whether it is bone marrow cancer or necrosis.

Do I really want her to suffer so much more? I kept thinking about this question before the blood test results came out.

Fortunately, Miao Kaixin's blood condition recovered well, and the hematocrit level increased from 4.8% to 20.9% - an emergency blood transfusion was necessary that day, but now it is approaching the critical point between requiring an emergency blood transfusion and not requiring a blood transfusion.

The doctor roughly calculated that the 80ml of blood transfused that day could only raise her hematocrit to about 15% at most, and the remaining 5% should be the result of Miao Kaixin's own hematopoietic system working. This is the best news. If she can still produce blood on her own, there is hope.

Three days later, I was worried and took her to the hospital again. To my delight, the blood test results showed that her hematocrit had risen to 25.6%, changing from severe anemia to moderate anemia.

What made me even more delighted was that her reticulocyte count was 154.6K/μL, which is a mature red blood cell. The normal value is 3~50 K/μL. This means that her hematopoietic system is working at an accelerated pace and producing red blood cells continuously.

I don't know what the future holds for this cat, but I will stay with her and continue to write our story. This is a cat called Happy, and we must work hard together and live happily.

Veterinary Reviews

What is anemia?

In veterinary clinic, when the red blood cell or hemoglobin concentration of an animal is lower than normal, it is considered anemia.

The reason why blood is red is because red blood cells contain red hemoglobin. Red blood cells and hemoglobin carry oxygen and energy to various organs of the body along with the blood flow, providing energy and oxygen for various organs and tissues. When an animal is anemic, the body cannot absorb enough oxygen from the blood. The more severe the anemia, the more obvious the symptoms, such as pale mucous membranes (the mouth and conjunctiva look bloodless), depression or drowsiness, weakness, and in severe cases, symptoms of hypoxia, such as shortness of breath, etc.

Under what circumstances does anemia occur?

This requires a discussion of the history of red blood cells and hemoglobin. Red blood cells spend their infancy in the bone marrow, and when they grow into adolescence, they are released by the bone marrow into the blood vessels. After 24 to 48 hours, they become healthy and mature red blood cells and begin to circulate blood to supply blood and oxygen to various organs.

The life span of a dog's red blood cells is usually around 110 days, and that of a cat's red blood cells is usually around 70 days. When red blood cells reach old age, they enter the body's "red blood cell recycling station" (liver, spleen, bone marrow) and die. The body controls the renewal of red blood cells in the blood to ensure that healthy red blood cells function normally. If there is a problem in the above links, resulting in a decrease in red blood cells or hemoglobin, anemia may occur.

The most common situation is blood loss, such as heavy bleeding caused by trauma, or continuous bleeding in the digestive tract, urinary tract, etc., which will cause a decrease in the number of red blood cells in the body.

Another common condition in dogs and cats is hemolysis, which is the rupture of red blood cells in blood vessels. Onion poisoning, heavy metal poisoning, blood parasite infection and other reasons may cause hemolysis.

Anemia can also occur if the development of red blood cells during childhood and adolescence is affected. This can be caused by bone marrow disease, iron deficiency, kidney disease, feline HIV and feline leukemia virus infection, etc.

How do you know if your pet has anemia?

Observing the stool and urine of dogs and cats more often is an important means of monitoring their health status. If your pet has long-term or intermittent soft stools, it may be due to a lack of nutrients such as VB12 and folic acid; if the stool is black for a long time, you need to check whether it is caused by food pigments or blood in the stool. Long-term blood in the stool can cause chronic anemia and iron deficiency anemia. If it is not taken seriously in time, the body will gradually adapt to the condition of chronic anemia. When the problem is finally discovered, it is likely to be in a state of severe anemia.

Do not let your pet come into contact with foods such as onions, garlic, and ginger. Compared with heavy metal toxins, these foods are more likely to appear in the home and be exposed to pets. Once ingested by mistake, they may cause hemolysis and acute symptoms.

In addition, regular deworming and immunization, regular physical examinations, and understanding of the health status of the pets. A simple blood test can detect whether the animal is anemic. If you find that your pet has any abnormalities at home, you can consult a veterinarian for help in time.

References:

[1] Textbook of Veterinary Internal Medicine

[2] BSAVA Manual of Canine and Feline Clinical Pathology

Author: Miao Kaixin

Editor: Mai Mai

All pictures are provided by the author

This article comes from the Species Calendar, welcome to forward

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