Sally, Not a good report, but not entirely without hope either. Do you happen to know the specific numbers on the CBCs? Get a copy of the reports. Read them carefully - vets miss things sometimes and don't always remember to convey all the information they have when they meet with you. It happens, not intentionally or maliciously.
Here is specifically what I would like to know: 1. Reticulocyte count for each CBC you had done- if this number is increasing (I would like to see by way of thousands or tens of thousands) than you are certainly on the right path and need only wait until those cells become mature enough to replenish the RBCs in the peripheral blood. A regenerating anemia is defined as a reticulocyte count greater than 15,000 (for most labs). An exact number and change in numbers over time would give me a better idea of what is going on in his bone marrow. Understand that it takes time for these cells to mature before they become fully functional for his needs - in the meantime a blood transfusion could be necessary. 2.Hematocrit - most vets will transfuse around 18 or 19. If this is his first transfusion and he has a hematocrit around 14-15, I would not hesitate to transfuse. In general the first transfusion is kind of a freebee. They generally do not have a reaction until subsequent transfusions. Your vet, however, should make sure that the transfused blood is a match for Lukey. You can do a type and cross or a full panel (~$100.00). If she is uncomfortable about this I would go to an emergency vet or someone who feels comfortable doing them. It should be a slow transfusion and he should be monitored for any signs of a reaction. If there is, you simply stop the transfusion. It is a risk/benefit analysis. In my opinion, a hematocrit of 15 is certainly worth transfusing. I would not hesitate - not even one day. Again, I would like to see the numbers. 3. Lymphocytes - this number should be increasing as a sign of stimulated immune response (a sign the LTCI is working)- I would like to know all results from the first to the last blood draws. 4. Platlets - an increase in these also suggests a stimulated bone marrow indicating the LTCI is working. Autumn had a hematocrit of 10, I believe, when I brought her in for the first visit. She had a hematocrit of 4 when I transfused her. I would not recommend waiting this long. She was dying, a matter of hours and she would have died. Do not wait until this point. Here's the concept. Mature RBCs live about 2 1/2 to 3 months in most cats, at the end of that time, the spleen destroys the old cells in anticipation of new ones. It is likely that Lukey has had a suppressed production of RBCs for quite some time and now the old RBCs are being destroyed. If his bone marrow sort of woke up after the LTCI injection, it takes weeks for the bone marrow to generate the cells and then more time for them to mature. So in the cycle of normal bone marrow production of RBCs and destruction by the spleen, Lukey's cycle was interrupted and now weeks later when the old RBCs are dying there aren't any new mature ones to take their place. If there is evidence that the bone marrow is waking up (increased reticulocyte count, lymphocyte count and platelet count) what you need to do is provide supportive care until those cells can mature and do their job. This may very well include a transfusion. I would not fear the transfusion because of a reaction if he is that severely anemic. Everyday his old cells are dying. It is a race between new maturing RBCs and destruction of the old ones. The statement that Lukey has a regenerative anemia is very promising. Right now is a very difficult time for you and for him as he is in the lull between the suppressing effects of Felv+ and the hopefully productive effects of LTCI. You are seeing a clinically diminishing status but his lab work suggests improvement. I would rely on the labs and take heart in the promising numbers. If you give me the numbers I can tell you how happy or not happy I would be with the presence of and rate of improvement. Take heart knowing that the clnical improvement will be slow and delayed from the lab tests. What you see improving in lab values you should see reflected in clinical improvement with time. Be patient but don't hesitate to transfuse if necessary. This is my opinion and how I would evaluate and proceed with an animal of my own. There is never a guarantee, but I will pray for you and for him. If there is anything more I can do, please don't hesitate to ask. Jenny _______________________________________________ Felvtalk mailing list [email protected] http://felineleukemia.org/mailman/listinfo/felvtalk_felineleukemia.org
