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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 38949
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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Our cat has been prov. diagnosed with Mycoplasma. Prescribed

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Our cat has been prov. diagnosed with Mycoplasma. Prescribed Ronaxan & Prednicare. Symptoms: sneezing, lack of appetite. Weight dropped from 4kg 6 mths ago to 3.2kg. Blood test (att) reveals low count, requiring transfusion. Cat is likely cat flu career (from birth), & suffers regular cat colds. We gather Mycoplasma never goes away & in cats with other conditions, prognosis generally not great / likely to reoccur. Looking for realistic / pragmatic prognosis / 2nd opinion please. Thanks
Customer: replied 10 months ago.
Customer: replied 10 months ago.
Nursed our last cat through 18 month illness, and was hoping his replacement would be healthy, but seems not. Dreading another heart-breaking round of diagnosis, tests, daily meds (7 tabs a day now), expense, and the stress (to both cat and family). Given prognosis we’ve seen online, is it worth transfusion, ultrasound, PCR tests, steroids and lifestyle changes? Kinder to let him go, or go through months of stress? Looking for honest prognosis. Thanks, Pete
Customer: replied 10 months ago.
Other blood sheet

You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

I'm sorry that your question wasn't answered in a timely manner. I don't see feline leukemia (FeLV)/feline immunodeficiency (FIV) test results. Do you have them, please? Has a bone marrow examination been performed? Mycoplasma may be present (it's a commensal organism in cats and so can be difficult to know if testing reveals a commensal or, instead, infection). Regretfully, regardless of the cause, he's in need of another transfusion at this time but I would be reticent about performing it without knowing about those viruses and bone marrow health.

Customer: replied 10 months ago.
The two sheets are the only test results that I have been provided with by my get. No FeLV or FIV tests have been run. No marrow exam has been completed. Cat visited vet for the first time for this condition two days ago. They performed usual exam, tested the bloods locally (tests took 3 hours). Under a scope, they identified possible Mycoplasma infection (black dots in cells?).To do a more detailed blood analysis requires a sample to be sent to a lab (takes 8 days).Vet says symptoms a match for mycoplasma but can’t be confirmed.Treatment is ronaxan and prednicare. They are considering transfusion as priority over diagnosis, due to 11% HCT red blood cell count.So, we are a little in the dark. Indication appeared to be that transfusion to stabilise was immediate priority.Does that help?Thanks,Pete

Pete, if the very necessary viral testing hasn't been performed you mustn't consider doing anything further. If Timothy is FeLV or FIV positive it's very unlikely that he could survive even with another transfusion. In fact, most of us won't consider transfusing a positive cat due to the grave prognosis of these patients. Bone marrow analysis is needed to see if an aplastic anemia exists. Once again, this would be an indication not to transfuse as my patient's prognosis is grave if transfused or not.

It's important to clarify if Mycoplasma haemophilus (a blood parasite) or Mycoplasma spp. that can cause respiratory infections are present. It appears that he could suffer from both but without testing for these organisms, we're in the dark. It's certainly reasonable to treat with doxycycline and prednisone as he's being treated as it will address both types of Mycoplasma. It may not be reasonable to transfuse, however, for the reasons I posted above. You're correct to acknowledge that a transfusion would be the first priority in such a patients as the severity of his anemia is life threatening...but not if he's viral positive. Please continue our conversation if you wish.

Customer: replied 10 months ago.
Apologies - I need to back up.He has never been tested for FeLV or FIV and the vet has given no indication that either may be an issue.What he has previously being diagnosed (but untested) with is that he’s a cat flu career, and he has a ”cold” 2-3 times a year. Based on visual inspection a year ago when he came down with cat flu. We suspected the current issue as being another instance of cat flu, but it is more serious.He has never had a transfusion before. They are suggesting this is a priority due to low cell count, regardless of cause, to get that number of 11% up.I don’t understand the data on the two blood sheets to know what has actually been tested.So, this would be first transfusion, and no confirmed existing illness (apart from cat flu carrier). Potentially straightforward but acute Mycoplasma infection.Does that clarify?
Customer: replied 10 months ago.
In summary, I’m taking the assumption that my vet knows what she is doing, and is treating for what she believes is Mycoplasma. Our cat is on Ronaxan & Prednicare and due a further blood test to see if count is increasing on its own, or if a transfusion is necessary.I agree that a PCR will give the vet more info, but this will take 8 days, as can’t be tested on-site. Bone marrow and ultrasound are another two diagnostics that will give more information, and vet will presumably look to these when cat is stable.My question is, assuming no other condition and he’s a cat flu carrier with mycoplasm on the two meds I mentioned - what is his prognosis? Quote for detailed tests is hugely expensive and not 100% reliable. If prognosis is not good (based on bloods & flu carrier), do we let the antibiotic course complete and see if bloods return to normal, or spend thousands on tests. Will an 8-day wait be too late? If tests come back confirming mycoplasm, is this life-changing for a flu carrier, or could we have a healthy cat?Appreciate you nor I have the test results to confirm anything, but need a gut feel if he stands a chance, or if we’ll be spending thousands and putting our cat through stress if he’s only got a low survival rate anyway.Thanks,Pete

1) Testing for those viruses is indicated when a kitten or for a newly acquired cat with an uncertain history. Because they're both immunosuppressive and potentially life threatening they predispose to secondary infections and neoplasia (FeLV only). A vet must know the viral status of a cat before treating.

2. You're describing feline herpesvirus (FHV-1) which is found in 100% of cats in some populations. It can come out of its carrier state in times of stress and so Timothy's sneezing at this time could be due to FHV-1 rather than a respiratory Mycoplasma.

3. When you posted "...reveal low count, requiring transfusion" I mistakenly thought that he had been transfused. Yes, without a transfusion you're likely to lose him but without viral testing you can't know if it makes sense to transfuse him. FeLV and FIV testing is a simple 10 minute in-house blood test.

4. Testing included a complete blood count and biochemical analysis. It revealed profound regenerative anemia. I also noticed a lymphocytosis (increase in the white blood cell lymphocyte) which usually indicates immune system stimulation as would occur with Mycoplasma, FHV-1, FeLV, FIV and any number of infectious agents and immune-mediated disorders including immune-mediated hemolytic anemia which can be tested for by seeing if the blood autoagglutinates (not now because he's being given a steroid) or he's positive for ANA (anti-nucleic antibody). Because immune-mediated hemolytic anemia is an important consideration, his steroid dose should be high - an immunosuppressive dose.

His prognosis is very poor to grave but can't be determined with the degree of specificity I want without additional testing. Considering your financial constraints and prognosis, I would perform the simple in house viral testing, continuing doxycycline, and making sure that the steroid dose is immunosuppressive. Please continue our conversation if you wish.

Customer: replied 10 months ago.
OK. Thanks for the clarification, and the honest assessment based on what little we know.One other piece of info has come back to me - when they showed me be close-up of the cells. As well as pointing out the black dots, she highlighted that the cells are ”clumping” together, if that’s significant.I have reviewed our adoption paperwork. We adopted him from the largest UK cat rescue charity, and he received a checkup and his two sets of flu/enteritis/leukaemia jabs within 2 months of birth. We had him neutered and checked over with our get and he gets his annual jabs. The paperwork indicates he was not tested for FIV/FeLV at adoption.Clearly, the first question I need to ask my vet is whether they have tested for FIV/FeLV - they are a reputable vet and if this is a crucial and easy test, I hope they have already done that and ruled it out. It will be my first question when I see them tomorrow!Dosage currently is 30mg/day Ronaxan, 6mg prednicareIf blood count improves on next test, they may hold off on transfusion and proceed with more tests.I agree with you that this may not be respiratory - he had a bout of cat flu prior to the current symptoms, and is not sneezing or having obvious breathing difficulties.Final hypothetical question, then I’ll let you go.I think we have covered the worst case, so let’s flip the coin. Let’s assume the following:1. It’s not FIV/FeLV
2. The meds allow his cell count to creep up meaning that he no longer needs an urgent transfusion
3. He continues on the antibiotics for the full course whilst further tests take place (reading online, 21-40 day course?)Reading online on this topic, I see a consensus of opinions summed up by this one:”Most cats with feline infectious anemia have a good to excellent prognosis, as long as they receive aggressive supportive care and appropriate antibiotic treatment. Cats that have underlying disease, such as feline leukemia virus or feline immunodeficiency virus infection, have a more guarded prognosis and are more prone to recurrent bouts of anemia.”With the above assumptions and best-case, what would his likely FHV-1 carrier status and bouts of cat flu (2-3 times a year) do to the ”good to excellent” prognosis?Again, we’re talking ”best guess” until the next bloods/tests, but I’m just trying to get a feel for best case & worse case so I have the knowledge to discuss options with our vet on the next visit.Thanks again for the advice.Pete

You're quite welcome.

There's clumping (Rouleaux formation) and there's autoagglutination. Rouleaux is common in normal cats. Autoagglutination, however, is pathognomonic (specifically indicative) of immune-mediated disease such as IMHA. Autoagglutination may be differentiated from rouleaux formation by mixing blood with 3-5 times more saline and observing it as a wet mount microscopically. Regretfully, this can't be a reliable test now that steroids are on board.

Yes, ask about viral testing.

Dosing of doxycycline for M. haemofelis is 10 mg/kg daily for a minimum of 14 days. I would give an immunosuppressive dose of prednisolone - 2 mg/kg once daily - in case IMHA exists or a poor response to doxycycline is seen.

His FHV-1 would be a non-issue with that scenario. Should FHV-1 recrudesce (relapse without cure in between events) it wouldn't have any relationship to anemia.

You're quite welcome. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

Dr. Michael Salkin and 2 other Cat Specialists are ready to help you
Customer: replied 10 months ago.
Superb. Thanks very much for all your help.All hangs on the next blood test (and also ruling out virals). If count is increasing after a few days of meds, we wait and see. If no change (or worse), we’ll likely try a transfusion - but with poor prognosis and if doxycycline isn’t making a dent, then further stress on the little chap with invasive / stressful / expensive testing may not be the sensible option.Keep your fingers crossed for us, and I’ll let you know.Not used this service, so will mark as complete. I see an option to ”request you again”, so if OK with you, will make contact again to help translate what they tell me on the next visit.Thanks again, and best regards,Pete

You have a good understanding now. Thank you for your kind accept. I appreciate it. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.