? Anemia / Protein loss Question Theodore

Hi all,
Please help.
I got Theodore's bloodwork and his anemia is consistently declining. See bloodwork attached. What can I do to help him????
What would be causing this?
I read high blood sugar can cause vessels to narrow and it is filtered then through urine (protein in urine) and at the same time when the body doesn't have enough RBCs it creates albumin which is filtered through kidneys and passes through the urine which shows up as protein? Is this correct? Not sure if I understand this 100%
Please help

BLOODWORK:
https://docs.google.com/spreadsheet...ouid=117296490646956874689&rtpof=true&sd=true

@Wendy&Neko
@tiffmaxee

 

I don’t see the range and different labs have different ranges. What’s the cause of the anemia?

 

@tiffmaxee it's above I wrote out the references but I have original result chart here

https://drive.google.com/file/d/1BrpfWc7zD7byyl5x8bhU5gcF4Ise8YUe/view?usp=share_link

They do not know the cause of anemia. He's on b12. He had an ultrasound which remained unchanged since June 2023.

They want to test his poop and put him on some parasite meds to see if that helps...Alternatively if that doesn't they suggested endoscopy (internalist) but vet and I agree that it would be going to far as he's been through enough.. we could look at doing medications for iron deficiency but she said first step would be a fecal test.

It's also add Benzapril is not helping whatsoever.

 

Has the vet said whether it's regenerative or non regenerative? Lots of information here: https://felinecrf.org/anaemia.htm

Bloodwork on the labs tab of the spreadsheet would be easir to see. What meds is he on now? Benazapril can make anemia worse. Maybe telmisartan as an option? More on the link above. Including that just B12 is not enough, you want more B's. Is Theodore seeing an internal medicine specialist?

 

@Wendy&Neko Yes he did see an internalist back on Feb 1, she recommended Benzapril. She wasn't concerned about the anemia as she felt it was due to diabetes. On the contrary my vet is very worried about the anemia constantly dipping. She advised to discontinue the Benz as it is NOT helping and when I changed to Hounds & Gatos that alone improved the protein creatinine ratio more then the Benza.
Sorry what is telmisartan? Also what do you mean I want more B's?


I will work on entering the bloodwork on the diabetes tab tomorrow morning. Just drained now as it's been an emotional day. I feel like I am seeing all these vets and spending a ton with no answers.

 

Benazapril alternative can be telmisartan. More details on the Feline CRF page. Please read it, it also talks about the other B vitamins besides B12 that can be used to treat anemia.

 

I think it’s B Complex you want. It stings if injected so I used tablets and B12 as well. But that was for anemia due to ckd which does not appear to be the case with normal creatinine and SDMA.

 

I will do that. It's scary they provided benzapril if it can cause worsened anemia. I did not know this, risks mentioned were kidneys injury.

 

@Wendy&Neko It mentioned that the other one also carries the risk of anemia? Have you had experience with Darbepoetin?

 

I used it for my ckd cat. It’s my understanding that it’s for no regenerative anemia only but not 100% sure. It’s usually not starts until hct is at 20%. There’s lots of info on Tanya’s about it as Wendy linked above.

 

I see, I asked my vet all these questions after reading on Tanya's CKD site. Theodore is a complex case. I have petinic which I will try giving again. He did not like it last time..I also asked the vet if worthwhile to do a Coombs test. The weird thing I do not understand is why they are recommending kidney diet when he does not have kidney disease with his values. He does have protein in urine but I feel this is due to other issues.

 

Petinic
Ingredients: Corn syrup, water, sucrose, glycerin, beef liver paste, iron proteinate, sodium citrate, caramel color, citric acid, niacinamide, potassium sorbate, cyanocobalamin, thiamine hydrochloride, pyridoxine hydrochloride, riboflavin, cupric sulfate, natural anise flavor, sodium hydroxide.

IMHO, the anemia trumps diabetes. If Theodore will take the petinic, insulin dosing can be adjusted.

 

He's not eating his regular food. I opened probably 4-5 cans of food. He even rejected treats. Checked for ketones, negative. I gave him the kidney dry sample of food which he gladly accepted but he didn't eat a ton. Probably two table spoons mixed with some of the wet Weruva I had opened. I did 1ML petinic today, will do 2 tomorrow. My concern is should I try to put him on antibiotics? He is peeing and drinking more than normal. I was thinking clavamox as some of his bloodwork shows potential infection. I asked vet today to send it for Coomb's test but she said she does not see changes that typically occur with immune mediated hemolytic anemia so felt the test would not be helpful. She did suggest a pathologist review and anemia panel would be more beneficial to rule out diseases/infectious agents so I got that....