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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 28533
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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My female 5 yr old cat was diag with heinz disease. She is

Customer Question

My female 5 yr old cat was diag with heinz disease. She is weak now and being treated with meds. she has lost wt but still weighs 5lbs can feel her bones. Is the prognosis good with treatment. I have to give her liquids now with dropper h2o and pedilight . thx Chrisitne
Submitted: 9 months ago.
Category: Cat Veterinary
Expert:  Dr. Michael Salkin replied 9 months ago.

You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply.

Expert:  Dr. Michael Salkin replied 9 months ago.

Christine, did you mean a Heinz body anemia which can be caused by toxins such as methylene blue, acetaminophen, phenacetin, phenazopyridine, propofol, proplylene glycol, salmon-based diets, canned meat-based baby foods containing onion powder, and diseases including diabetes mellitus, hyperthyroidism, renal failure and lymphoma?

Customer: replied 9 months ago.
she was diag. with heinz body anemia with hyperthyroid. Since she is weak, with meds and nutrican is it sucsessful? Feeding her a/d cat food giving fluids q2 hrs. She only has been on meds for 3 days now ursodiol 30mg 1 qd, tryro tabs .1mg 1qd. have no clue what happened, have 3 other cats with now problem. But she has gone outside from time to time. We just move about 6 months ago, she stared loosing wt thought she had a pericite from mice or who knows. Dig on 10/13/15
Expert:  Dr. Michael Salkin replied 9 months ago.

Thank you for the additional information. A Heinz body anemia is usually transient and abates when the underlying disorder is well-controlled. Once she becomes euthyroid (normal blood thyroid level) this type of anemia should resolve. I don't know what else is going on with her, however. I see that she's been prescribed ursodiol which suggests that she suffers from biliary stasis/sludging but I don't know why she's been prescribed thyroxin if she's hyperthyroid. Can you clarify this for me?

Customer: replied 9 months ago.
T4- 0.7, TSH 0.15, T4 Free by Immunoassay 0.40, hemoglobin 7.7 hemacrit 19.1
Expert:  Dr. Michael Salkin replied 9 months ago.

Thank you. Overdosed with methimazole and now hypothyroid? Stopping the methimazole should be curative. I'm concerned that her hematocrit is so low. I need to know if that anemia is regenerative (she can replace the red blood cells she lacks) or nonregenerative (she can't efficiently replace the red blood cells she lacks). Heinz body anemias are usually regenerative which gives a better prognosis for recovery. I'm also concerned that methimazole can cause bleeding due to thrombocytopenia (low blood platelets) but I don't see any information about it causing a Heinz body anemia. And because I can't help being a devil's advocate, I must say that diagnosing hyperthyroidism in a 5 year old, while not impossible, is highly unusual.

Customer: replied 9 months ago.
Should I ask my vet to possibly give her sub q fluids from home to keep her hydrated? giving her fluids my mouth is alittle stressful. This way I know how much she is getting. Also for past 2 days have to force feed but does eat. Feel bad doing this to feed her.
Expert:  Dr. Michael Salkin replied 9 months ago.

Certainly.

I'm just happy she's eating.

Customer: replied 9 months ago.
What is methimazole?? Do you have a fax I could send to labs Monday. I'm just so concerned she has a twin sister. They are blk with yellow eyes. Her name in Fannie, and her sister is Sperrow
Expert:  Dr. Michael Salkin replied 9 months ago.

Methimazole is the most common drug used to treat hyperthyroidism. You said that she was diagnosed with Heinz body anemia with "hyperthyroid". What I see is that she's anemic and hypothyroid but the hypothyroidism is likely due to non-thyroidal illness (her thyroid glands are normal)...and that illness is what I need to know more about to be able to prognosticate for you. Can you upload a copy of Fannie's test results to our conversation? I understand that you might not have a copy at home but her vet can give you one which you can scan into your computer and then give me the file link or you can photograph the pages and upload them by using the paperclip icon (if you can see that icon) or by using an external app such as dropbox.com/ I don't have a fax.

Customer: replied 9 months ago.
tryro tabs.1mg ?? for thyroid hyper or hypo now I'm confused. I thought they said hyper thyroid with her weight loss?? also what is this ursodial 30 mg used for. Monday I will picture message labs. Should I still give her these meds?? You said one of the meds could cause bleeding, only gave her thyroid for 3 days. platelet count 408, wbc10.6,
Expert:  Dr. Michael Salkin replied 9 months ago.

Thyrotabs (thyroid hormone) were prescribed because her test showed that she was hypothyroid but it's not necessary. She's not hypothyroid because her thyroid glands are sick but, instead, because another disorder is affecting her thyroid glands and preventing them from working efficiently. If the vet said hyperthyroidism is causing the weight loss, the vet is very confused. Ursodial is used to promote bile flow. I need to see her blood and urine work to see if there's evidence of liver/gall bladder disease.

I mentioned that methimazole can cause bleeding but she's not taking methimazole...which is prescribed to address hyperthyroidism... which she doesn't have.

I'll watch for your next post. I have to leave my computer for the night. I'll get this straightened out for you.

Customer: replied 9 months ago.
Thank You so much for all your input...I'll talk to you when I send you everything you need. Good Night
Expert:  Dr. Michael Salkin replied 9 months ago.

You're quite welcome.