Page 220 - Problem-Based Feline Medicine

212 PART 4 CAT WITH URINARY TRACT SIGNS

hepatitis complex, feline infectious peritonitis ● Marked thrombocytopenia is present if it is the
and lymphosarcoma are most common. cause of the bleeding disorder or if associated with
● ALT, GGT and/or alkaline phosphatase activities DIC.
are abnormal. ● Coagulation tests are prolonged if associated with
● Liver function tests, such as provocative serum bile rodenticide poisoning or clotting factor deficiency.
acid concentrations or blood ammonia concentra-
Hematuria is present; however, white blood cell counts
tions, are abnormal.
are usually < 5–10/hpf.
● Abdominal radiography and ultrasonography may
reveal focal or diffuse hepatomegaly with abnormal
echotexture. HEMOGLOBINURIA
● Liver biopsy or fine-needle aspiration is necessary
to confirm the underlying disease. Classical signs
Bile duct obstruction (posthepatic cause of bilirubine- ● Urine is red or pink.
mia and bilirubinuria) is associated with cholestatic ● Mucous membranes may be pale if
icterus, and is most commonly associated with pancre- associated with anemia.
atitis, pancreatic or duodenal neoplasia, or sludge bile
syndrome. See main reference on page 532 for details (The
● Alkaline phosphatase activity is usually Anemic Cat) on hemolytic anemia.
extremely elevated relative to other liver enzyme
activities.
Clinical signs
● Enlarged bile duct may be observed by abdominal
ultrasonography. Hemoglobinuria indicates severe intravascular
hemolysis has occurred.
Urine is usually red or pink due to excretion of hemo-
COAGULOPATHY OR THROMBOCYTOPENIA
globin, which has exceeded the saturation limit of the
CAYSING HEMATURIA
carrier plasma protein (haptoglobin).
Classical signs Pale mucous membranes may be present and the cat
may be weak or may collapse due to anemia.
● Hematuria may occur.
● Tachypnea and tachycardia may be present.
● Other evidence of hemorrhage is usually
present. Other signs suggestive of intravascular hemolysis and
hemoglobinuria include acute illness, fever, pale
See main reference on page 487 (The Bleeding Cat) for mucous membranes, +/− jaundice, +/− splenomegaly or
details on coagulopathies. acute lethargy.
Marked hemoglobinuria is most common in kittens
Clinical signs with neonatal isoerythrolysis. Kittens are normal at
birth but develop acute lethargy or death in the first 1–3
Hematuria may be the only clinical sign, but hemor-
days of life. In adult cats, hemoglobinuria is very
rhage may occur from other orifices or in body cavities;
rarely associated with Mycoplasma haemofilis or
petechiations may be present.
immune-mediated anemia.
There may be a history of exposure to an anticoagulant
toxin.
Diagnosis
Pale mucous membranes.
Although urine is red or pink, RBCs are not observed
on microscopic examination of urine sediment.
Diagnosis
Hemoglobinuria may be differentiated from myoglo-
Anemia due to blood loss is present. binuria by examination of plasma or serum; plasma