Anaemia occurs when the total number of red blood cells ( RBCs ) in the circulation of an animal is reduced below the normal range . This can happen for a variety of reasons , but in cases of flea anaemia it occurs due to external blood loss caused by adult fleas feeding on the host . Given the small size of the adult flea ( around 3 mm ), an impact on the circulating blood volume sufficient to cause anaemia requires large numbers of adults . This process occurs over weeks or longer , making flea anaemia a chronic condition , which will worsen to the point of death if intervention does not occur .
This disease has an increased risk of mortality in young and / or small animals [ 4 ] due to their body size and smaller circulating blood volume . In these patients , fewer adult fleas are needed over a shorter period of time to create severe anaemia , compared with an adult or a larger species of animal . VNs are most likely to see this condition in kittens and puppies that have presented as a stray or from a household where no prophylactic ectoparasite control is in place .
This article focuses on the nursing care of feline patients , which can be more complicated than the care of canine patients but many of the same principles apply . Common presenting clinical signs will be reviewed , along with ways to assess the nursing requirements for a patient . Common nursing interventions will also be discussed for these challenging , but often rewarding , cases .
Learning outcomes
• Recognise the common clinical signs and presentation of feline flea-anaemic patients .
• Analyse the needs of the flea-anaemic patient to create a tailored nursing care plan .
• Evaluate the risks and benefits of different interventions used in the treatment and nursing care of flea anaemia in cats .
Presenting signs
A flea-anaemic cat may be admitted via a consultation with a veterinary surgeon ( VS ), but VNs could be presented with these cases during a nursing consultation or through triage , so they should be aware of the common presenting signs . These patients invariably have no history of adequate preventative ectoparasite control and may be presented as a stray animal . Adult fleas will be visible and present in large numbers , along with considerable amounts of ‘ flea dirt ’, unless the patient has already been bathed and / or had the adults removed . Given the chronic nature of the condition , the coat will often be poor quality with areas of alopecia . Scabbing , signs of self-trauma and pruritus are also often apparent [ 5 ] .
Although cats of any age can present with this condition , it is more common in kittens , due to their size and smaller blood volume . Affected kittens tend to be malnourished with a poor body condition score , which may reflect the situation in which they were found but can also occur and progress due to the disease . Signs of dehydration are common ( e . g . skin tenting , tacky mucous membranes and sunken eyes ) due to the body ’ s need to preserve the circulating blood volume in response to the ongoing blood loss caused by the fleas . This is often exacerbated by inadequate nutrition .
Body temperature is usually at the low end of the normal range or considered mildly hypothermic , which can be attributed to the poor body condition , lack of nutrition and / or decreased fur coverage . These factors all impact the patient ’ s ability to thermoregulate , which compounds their physiological status , resulting in a weak , lethargic kitten which may not even have the energy or muscle mass to be able to move , shiver or behave normally .
It is important to remember that there are different types and causes of anaemia in cats ( Figure 1 ), and the degree of anaemia can vary at the time of presentation . However , severe cases will present with pale mucous membranes , which can make it challenging to determine a capillary refill time . Interestingly , because the anaemia progresses slowly in these cases , the impact on other parameters of the cardiovascular system is less noticeable than with causes of acute haemorrhage . The heart rate is often normal , due to an increase in the stroke volume of the heart , but femoral pulse quality can be subjectively hyperdynamic [ 6 ] . The presence of any of the aforementioned clinical signs should alert the VN to notify a VS . The presence of multiple signs is likely to result in the patient being admitted to the practice .
Haematological findings
In these cases , VNs are likely to be asked to spin a packed cell volume ( PCV ) to determine the number of RBCs in circulation and , as such , the extent of the anaemia . Gaining a blood sample from these patients can be difficult and it is essential to take the smallest quantity of blood possible . Given that intravenous ( IV ) access is often also needed to correct dehydration , the author would recommend using the blood from the back flash into the stylet when placing the IV cannula to fill the haematocrit tube .
A normal feline PCV ranges from 25 % to 45 % [ 7 ] but this can vary , particularly if the haematocrit is being measured by a machine , in which case the reference range for the equipment should be used . To the author ’ s knowledge there is no published range of PCVs from flea-anaemia patients reported in the literature . However , an example of a low PCV from a feline fleaanaemic patient is shown in Figure 2 .
40 Veterinary Nursing Journal