scott@vtx-cpd.com
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Hello everyone.
This is an interesting case. Thanks for sharing the article Emma.
I totally agree that it sounds like removing the offending drug, in this case, is the most sensible first step. With almost all other haematological abnormalities I would say wait and see. My only thought here is the fact that it is platelets and there are none. I suppose the biggest issue is the high risk of really serious bleeding (brain and lungs). I honestly might be inclined to start immunosuppression (steroids) while we wait for a rebound after drug removal. Other options would be one-off vincristine or human intravenous immunoglobulin. I may be overreacting but I worry about the 0 platelets and the wait for them to normalise. This would be a case that you could then taper quickly.
Thoughts?
Scott 🙂
Replying to austeja Zykute 13/07/2021 - 06:19
Hello.
Lovely to hear from you. I hope you are enjoying the course. You are welcome to ask any questions at any time! I welcome that at any stage!
I have added some new links that should work.
Looking forward to hearing from you.
Scott 🙂
Hey.
Sorry the links did not work. Not sure why! Have posed again below. I will also email round to avoid any confusion:
https://drive.google.com/file/d/1luJw-Ts646S96zNz61q8Vg-fw8T81LJE/view?usp=sharing
https://drive.google.com/file/d/1eagajbyPpOpLIIImt_x9llnQ-DBxd4W3/view?usp=sharing
https://drive.google.com/file/d/17OIrqhk6MQkFvf_jn7SaZ9ARqA_F_kVZ/view?usp=sharingHope to see you there.
Scott 🙂
Replying to Lucy Morley 07/07/2021 - 12:50
Hey Lucy.
Lovely to hear from you. I am so glad you are enjoying the course. I know how mad things are out there at the moment, I hope you are managing to get out on the tennis course. I am certainly enjoying watching it!!!
I am really glad you are enjoying the course.
Let me know if you have any questions at any time.
Scott 🙂
Replying to austeja Zykute 05/07/2021 - 09:59
Hello Austeja.
Really lovely to hear from you. I am so excited you are joining us all the way from Lithuania.
I am really passionate about chronic liver disease, so really hope we can help you manage these cases better.
Remember to let me know if you have any questions at any time.
Scott 🙂
Sorry again for delay.
Liz is editing now, so should be up ASAP.
Scott
Replying to scott@vtx-cpd.com 22/06/2021 - 13:47
Hey.
See email below from RVC. Zoom this evening regarding an update with the cats. Free for veterinary professionals to join:
Dear All,
Please see below the link to join us on zoom, tomorrow night, Thursday June 24th at 9PM. We have set this meeting up via our college account and therefore, should not be limited in regards to participants. Please feel free to forward to colleagues that we may have missed on the list; but ensure that it is only distributed in the veterinary profession.
We can give a short update on the data we have collected so far; but as mentioned earlier main aim would be for all of us to share some of our experiences we have collected so far in regards to treating these patients, and we are very keen to hear from colleagues that have had some survivors.
Topic: RVC Discussion on recent cluster of severe feline pancytopenia
Time: Jun 24, 2021 09:00 PM LondonMeeting ID: 983 9890 8494
Passcode: 3wiL5+hTLooking forward seeing you all tomorrow.
Best wishes Barbara and KarenReplying to Rosie Webster 21/06/2021 - 20:10
I have another one today! It is a Sphinx cat so the bruising is really obvious.
The platelets are the thing that seems to be most effected first. The cat was not anaemic on presentation, but I am sure that will follow.
We are considering using the following drug which has not been used in cats before:
https://pubmed.ncbi.nlm.nih.gov/32096575/
We also might consider a granulocyte colony stimulating factor… all unknown territory though!
Scott
Replying to Areti Tsioka 19/06/2021 - 10:29
Hey.
We are still not sure. We have covered with antibiotics (amox/clav) and we have given immunosuppressive doses of steroids to some. Blood transfusion has been necessary for some too.
At the moment it is still not clear if steroids will help.
Scott 🙂
Replying to Nikki McLeod 19/06/2021 - 10:29
I think you will be getting a lot of requests for haematology!
Scott x
Replying to Liz Bode 18/06/2021 - 20:48
Hello again.
Following on from my last post. I have some updated information from the work the RVC are doing:
“Based on the evidence to date, the one aspect of these cases that formed a consistent pattern was the diet of the affected individuals.
Data obtained from the survey so far (June 13th) :
• Number of affected cats: 108 (June 16th – 142)
• Median age at presentation: 2.21 years (IQR 0.75 – 6.15, range 0.08 – 14.92)
• Median duration of clinical signs prior to presentation: 2.00 days (IQR 1.00 – 3.00, range 0.00 – 68.00)
• Most common clinical signs were lethargy (75.9%), anorexia/inappetence (65.7%), pyrexia (34.4%) and signs of bleeding (petechiae – 18.5%; haematochezia 13.9%; oral haemorrhage 13.0% and haematuria 10.2%); vomiting and diarrhoea are not consistent clinical signs
• FIV testing negative in all tested cats (77.8%)
• FeLV testing negative in all tested cats (76.9%)
• Parvovirus testing on bone marrow – positive in one cat (1.5%) and negative in 14 other cases, further testing of samples is pending
• Bone marrow sampling -if performed – revealed 53.6% hypoplasia, 39.3% aplasia – some cats were sampled post euthanasia, and examination of those samples are still pending.
• 44.4% indoor only, 55.6% indoor and outdoor, remaining unknown
• 33.3% from a single household, 66.7% from a multi-cat household, for 65.3% of the multi-cat household both cats were affected
• 55.6% of cats received flea/dewormer, 34.3% no treatment, remaining unknown
• 10.2% were vaccinated within 1 mth of presentation, 88.0% did not receive a recent vaccination, not recorded in 1.8%
• For 75.9% (n=82)of the cats, specific details to diets were recorded, 45.1% of the cats were fed on a dry diet only, 2.4% on wet only, and 52.4% on a combination of dry and fed.
• 69 cats (84.1%) were fed on one of 3 dry dietsGiven this apparent association with diet, we welcome the Food Standards Agency’s (FSA) product recall notice. While we have not definitively established diet as the cause of pancytopenia in these cats, we are continuing to liaise with the pet food industry and regulatory bodies to investigate the matter and identify the possible underlying causes of this extremely serious condition.
We are still very keen to collect epidemiological data +/- residual patient samples and feed samples, so PLEASE continue logging your cases. https://rvc.onlinesurveys.ac.uk/pancytopenia
Initial investigations have not identified a causative agent yet:
• Copper and zinc – unremarkable
• Cobalamin, folate – within reference in majority of cases
• Oestrogen concentration – low in tested animals
• Heavy metals concentration on blood – no lead, though some have a very short half-life in blood, further testing underway
• Post mortem examinations so far have not found any other significant abnormalities beside the bone marrow findings and changes that might result from this; in particular no gastrointestinal, hepatic or renal changes are noted.Further feed analysis is underway currently. The recalled diets are:
Sainsbury’s:
Sainsburys Hypoallergenic Recipe complete dry cat food with salmon 1+years 800g
Sainsburys Hypoallergenic Recipe complete dry cat food with chicken 1+years 800g
Pets at Home:Ava Kitten Chicken 300g and 2kg
Ava Adult Chicken 300g, 2kg and 4kg
Ava Adult Fish 2kg
Ava Mature Chicken 7+ 2kg and 4kg
Ava Senior Chicken 12+ 2kg
Ava Sensitive Skin & Stomach 1.5kg
Ava Weight Management 1.5kg
Ava Hairball 1.5kg
Ava Oral Care 1.5kg
Ava British Shorthair 1.5kg
Ava Persian 1.5kg
Ava Maine Coon 1.5kg
Applaws products (best before date between December 2022 to June 2023 with a site reference code of GB218E5009):Applaws Cat Dry Chicken 400g, 2kg and 7.5kg
Applaws Cat Dry Senior Chicken 400g, 2kg and 7.5kg
Applaws Cat Dry Chicken & Salmon 400g, 2kg and 7.5kg
Applaws Kitten Dry Chicken 400g, 2kg and 7.5kg
Applaws Cat Dry Chicken & Lamb 400g, 2kg and 7.5kg
Applaws Cat Dry Chicken & Duck 400g, 2kg and 7.5kg
Applaws Cat Dry Ocean Fish 350g, 1.8kg and 6kI hope that helps.
Scott 🙂
Replying to Areti Tsioka 10/06/2021 - 16:07
That is really disappointing.
You did all the right things with this case. I think you are right, sounds like there were lots of concurrent issues.
Scott 🙂
Replying to Areti Tsioka 10/06/2021 - 16:09
Yes!
That would definitely exclude it from your list!
Scott 🙂
Sorry for delay!
I will get that uploaded!
Scott 🙂
Replying to Areti Tsioka 15/06/2021 - 12:22
It is a good question!
I think the main issue is that the HDDST is not 100% sensitive or specific, so you could still be left with the question of whether to image.
Imaging these cases is definitely something that I think is worth offering. It can change what we do if owners would consider surgical removal of an adrenal mass or would consider surgery or radiotherapy of a pituitary mass.
If owners are not keen for that then it is still totally appropriate to use trilostane, as it will still deal with the clinical signs regardless of the location of the disease!
Hope that makes sense.
Scott 🙂
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