Once a nursing assessment has been completed , a tailored NCP for the patient can be implemented , based on the facilities and personnel available at the practice . For the feline flea-anaemic patient , this NCP would focus on the elimination of the flea burden ( groom self ) and supporting the circulatory system ( drink adequately ), followed by normalisation of the remaining dependent abilities ( eat adequately , maintain body temperature , mobilise adequately ).
Elimination of fleas
One of the first priorities for these patients is to eliminate the adult fleas , which are continuing to feed and worsen the anaemia . The patient should be combed thoroughly to remove as many adult fleas and eggs as possible . This will benefit the patient and protect other patients in the practice , as well as staff members who could also be bitten . When as many of the parasites as possible have been removed , the patient should be treated with an appropriate licensed anti-ectoparasite medication to kill any remaining adult fleas that have been missed .
In very young and / or small kittens , the number of licensed products is limited , but Frontline Spray 0.25 % is licensed for use on kittens from 2 days old [ 11 ] and is commonly used in UK practice . Other products ( e . g . Stronghold Plus Spot-on ) are licensed for use in kittens from 8 weeks old , weighing 1.25kg [ 12 ] . Regardless of which product is used , the VN should ensure it is used correctly and that excellent contact is achieved between the product and the skin of the patient .
In recent years , there has been increased speculation about flea resistance to some anti-ectoparasite medications , which is worth discussion . Studies investigating Ctenocephalides ' resistance have identified mutations associated with low-level resistance [ 13 ] but , at present , there is little evidence of resistance to veterinary-grade medication , including fipronil and imidacloprid [ 14 – 16 ] . However , it should be noted that resistance will vary by region / country and these studies may not represent the flea population in the VN ' s practice area . Additionally , with the emergence of mutations aiding resistance , this problem may continue to progress in the coming years .
In response to this , in the first instance , the VS should investigate any concern relating to resistance to a product by first ensuring it has been used correctly . For adulticide ( rather than repellent ) products , this includes clarifying that the adult fleas are not dying after biting a correctly treated pet . If there is genuine concern over resistance to a flea product , then an alternative should be selected following consultation with a VS or suitably qualified person ( SQP ), and the pharmaceutical company must be informed .
Hydration
Most feline flea-anaemic patients will present with a degree of dehydration , as water is shifted from the intracellular compartment to the intravascular compartment to maintain the circulating blood volume . It stands to reason that the worse the anaemia is , the greater the dehydration will be , particularly as these patients become weaker and less able to take in water through eating and drinking . Dehydration is best corrected with the use of intravenous fluid therapy ( IVFT ) with an isotonic crystalloid solution ( e . g . Hartmann ' s ). This can be a controversial decision in these patients , as rehydrating the patient will lower the PCV further . However , it should be remembered that any dehydrated patient will have an artificially high PCV , and it is the serum component that decreases with dehydration , not the number of RBCs . By rehydrating an anaemic patient , the veterinary practitioner is not reducing the number of RBCs ; they are revealing the true number available within the circulation and improving the ability of the RBCs to travel to where they are needed .
The rate of IVFT administration should be calculated based on the percentage dehydration , and dehydration should be corrected over 24 hours . Due to the chronic nature of this disease , a shock bolus of fluids may or may not be warranted , and this should be addressed by the VS . Given the relatively small volumes typically administered , the VN may find the use of an electronic drip pump ineffective . As an alternative , small boluses of fluid can be given at regular intervals ( e . g . every hour ) through an IV cannula ( Figure 3 ). This has the added advantage of regular checks being carried out on the patient , but it is labour intensive .
Figure 3 . Kitten recovering from flea anaemia managed with boluses of IV fluids due to the animal ' s size .
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