VNs should examine the smear for reticulocytes . These are immature RBCs that have been released early from the bone marrow into the bloodstream . Reticulocytes will appear larger than normal RBCs ( macrocytic ) and paler ( hypochromic ) as the amount of haemoglobin present in each cell is spread over a greater area . Although these findings can be seen using widely available rapid stains ( e . g . Diff-Quik ), identification can be aided with the use of specific stains , such as new methylene blue ( NMB ) ^[ ⁷ ^, ⁸ ^] , which stains the organelle contents of these immature cells , distinguishing them from normal , organelle-free RBCs .

It is important to note that cats , unlike dogs , have two types of reticulocytes ^[ ⁷ ^, ⁸ ^] : aggregate reticulocytes , which contain large clumps of ribosome organelles , and more mature punctate reticulocytes , which contain two to six dots of ribosomes when stained with NMB . For VNs looking to calculate an absolute reticulocyte count or corrected reticulocyte percentage , only the aggregate reticulocytes should be counted , as these represent current active bone-marrow regeneration .

Nursing care assessment

As many cases of feline flea anaemia will be admitted to the veterinary practice and require intensive nursing care , it is considered good practice to formally assess the needs of the patient . The Ability Model ^[ ⁹ ^] is a commonly reported means of nursing care assessment , which can aid in the creation of individualised nursing care plans ( NCPs ). As an example , the Ability Model used to assess a stray kitten with flea anaemia can be seen in Table 1 . It has been modified to include the Roper – Logan – Tierney model ^[ ¹⁰ ^] , which highlights patient dependency and the abilities needing increased nursing intervention .

Table 1 . Assessment of a stray kitten with flea anaemia using a modified version of the Ability Model .

Ability ( dependency )

Current state Actual problem Potential problem Long-term goal

Eat adequately ( dependent )	No voluntary food intake	Resting energy requirement ( RER ) not being met	Weight loss , hypoglycaemia , seizures	Ensure RER is met and ideally exceeded , weight is maintained and ideally gained
Drink adequately ( dependent )	Minimal voluntary water intake	Dehydrated , requires intravenous fluid therapy ( IVFT )	Worsening of dehydration , death	Rehydrate patient , patient able to maintain hydration status without IVFT
Urinate normally ( independent )	Minimal urine produced	Dehydrated , expect to normalise once this is corrected	No urine output due to kidney failure	Normal urine output , patient able to mobilise to use the litter tray
Defaecate normally ( independent )	No faeces yet produced	Inadequate food intake , expect to normalise once this is corrected	Constipation due to dehydration and prolonged time between defaecations	Normal faecal output and frequency , patient able to mobilise to use the litter tray

Breathe normally ( independent )

Normal	None	Could increase with
		worsening of anaemia
		or with stress

Resolve underlying cause of anaemia and maintain normal respiration

Maintain body temperature ( dependent )	Mild hypothermia	Poor body condition and nutrition status	Worsening of hypothermia , death	Patient able to remain normothermic without assistance
Groom self ( dependent )	Heavy flea burden , areas of alopecia , too weak to groom self	Too weak to groom , fleas causing pruritus and hair loss	Poor coat / skin condition , continued pruritus , depression	Eliminate flea burden , fur regrowth , patient able to self-groom
Mobilise adequately ( dependent )	Too weak to move around	No energy available for mobility due to anaemia and poor body condition	Weight loss could lead to muscle wastage , decubital ulcers from prolonged recumbency , worsening hypothermia	Improve energy state to allow for normal mobilisation , weight to be maintained and ideally gained
Sleep / rest ( independent )	Sleeping a lot	Increased sleeping due to low energy state from anaemia and malnutrition	Can interfere with ensuring adequate food and water intake	Ensure adequate rest , excessive sleeping should resolve with improvement of anaemia and nutrition
Express normal behaviour ( independent )	Minimal normal behaviour seen	Too weak to interact normally due to anaemia and poor condition	Could be masking signs of fear or pain , could become phobic of veterinary procedures	Improve energy levels to allow ability for normal behaviour to be observed and assessed

42 Veterinary Nursing Journal

VNJ Volume 38 (2) April 2023 | Page 42