Feline Anemia: Dietary Recommendations and Comprehensive Overview

Anemia in cats is a serious condition characterized by a deficiency of healthy red blood cells, which are crucial for carrying oxygen to the body's tissues. This can lead to a range of symptoms, from mild lethargy to life-threatening complications. Understanding the causes, diagnosis, and treatment of anemia, along with appropriate dietary adjustments, is essential for managing this condition effectively.

Understanding Anemia in Cats

Anemia isn't a disease itself but a sign that something is wrong. It means there are fewer healthy red blood cells (RBCs) than normal, which can cause symptoms like tiredness and pale gums. Anemia in cats occurs when there aren't enough healthy red blood cells to carry oxygen to their body's tissues, making the cat tired and weak. It is characterized by a decrease in the number of red blood cells. When a cat is anemic, the decrease in RBCs and/or hemoglobin leads to decreased oxygen flow to the body’s organs.

How Red Blood Cells Affect Your Cat's Health

Red blood cells (also known as erythrocytes) carry oxygen to a cat’s tissues. Hemoglobin is a type of molecule that carries the oxygen within red blood cells, which then use the energy the body needs to perform normal day-to-day activities. Throughout this process, carbon dioxide is left behind as a waste product. Your cat's red blood cells carry the carbon dioxide away from the tissues back to the lungs, where your cat exhales it.

Causes of Anemia in Cats

Anemia can be a temporary, one-time problem, or it can be a long-term condition. Further, anemia can range from mild with no noticeable clinical signs to severe enough to be life-threatening. Because of this, cat anemia treatment varies depending on the severity and cause. The causes of anemia can be broken down into three broad categories. This includes blood loss, destruction of RBCs, and a failure to produce new RBCs.

• Internal or external parasites: A very common cause of anemia in kittens and feral cats, parasites like fleas or roundworms can suck enough blood out of a cat to cause anemia.
• Infectious diseases: Blood-borne parasites, including Mycoplasma and Cytauxzoon felis, can cause hemolytic anemia (destruction of red blood cells). Anemia is also associated with feline leukemia and feline immunodeficiency virus. FeLV and FIV are the most common infectious causes of non-regenerative anemia in the cat .
• Exposure to toxins: Cat-toxic foods, like garlic and onions, can cause anemia. Believe it or not, zinc from pennies minted after 1982, copper toxicosis, moth balls, skunk musk and ibuprofen can all cause hemolytic anemia. Toxins (from accidentally ingesting food, heavy metals, medications, or other substances)
• Autoimmune disease: Autoimmune anemia occurs when the cat's own immune system attacks and destroys red blood cells. Infectious causes, like the ones already mentioned, trigger autoimmune anemia. In addition, chronic bacterial infections, cancer, some medications, vaccine reactions and hormonal changes are also suspected to cause autoimmune anemia in some cats.
• Trauma: Hemorrhage from trauma, such as being hit by a car or bit by a dog, can cause life-threatening anemia if not treated immediately.
• Anemia of chronic disease: Conditions like liver disease, kidney disease, hormonal conditions or cancer can create chronic conditions in the body that reduce the body's ability to create new blood cells, causing non-regenerative anemia. Any chronic disease or illness can lead to anemia due to long-term inflammation that decreases RBC production. Chronic conditions include chronic infection, tumors, and disorders of the hormone system (such as hypothyroidism).
• Bone Marrow Damage: A wide variety of toxins, infectious diseases and cancers can result in damage to or the complete destruction of the bone marrow, which produces red blood cells. Multiple primary (medullary) and secondary (extramedullary) bone marrow disorders cause ineffective erythropoiesis, producing a non-regenerative anemia.

Types of Anemia in Cats

There are two main types of anemia in cats: regenerative and non-regenerative.

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• Regenerative Anemia: Regenerative anemia occurs when your cat's body is producing red blood cells as it should but is unable to meet demand. When the body is creating extra red blood cells, regenerative anemia develops. When the bone marrow produces enough RBCs to correct the anemia. This form of anemia can be caused by blood loss (internal or external) from injury, parasites, tumors, accidents, ulcers, Hemolysis (when the body destroys red blood cells because they appear abnormal), Toxins (from accidentally ingesting food, medications, heavy metals), Infections.
• Non-regenerative Anemia: Non-regenerative anemia happens when a kitty's body is not making a normal amount of red blood cells. Non-regenerative anemia occurs when the body stops producing new red blood cells. When the bone marrow is not able to correct for the deficiency of RBCs, either because it’s not functioning properly or because the body’s resources have been exhausted. Non-regenerative anemia in cats can be caused by Bone marrow disorders, Poor diet, Kidney disease, Chronic diseases. The kidneys produce a hormone called erythropoietin, which stimulates the development of RBCs by the bone marrow.

Signs and Symptoms of Anemia

While anemia is not a disease itself, it is a complication or symptom of certain conditions. In an anemic cat, the blood will carry less oxygen, and you may notice one or more of the following symptoms:

• Weakness
• Lethargy
• Pale pink or white gums
• Decreased appetite
• Increased breathing rate
• Increased heart rate
• Drinking more water
• Collapse

In severe cases, the respiratory effort will also increase as your cat attempts to inhale more oxygen into the lungs to improve the level of oxygen in their body. Lethargy is frequently the first sign of anemia since it deprives the body of oxygen, which requires energy. The energy level of an anemic cat may be low, and it may also sleep much more than usual. Due to red blood cell breakdown, the cats’ gums may appear virtually white or even yellow (jaundice). In severe cases, the cat may experience breathing difficulties. Fever and loss of appetite is also a sign of anemia. It may be brought on by an infection or an inflammatory reaction, depending on the etiology of the anemia. Blood loss in the stomach or intestines can result in cat blood in stool or black stool.

Left untreated anemia can be debilitating for your cat, and may even become life-threatening.

Diagnosis of Anemia in Cats

Anemia in cats is diagnosed with a combination of physical examination findings and laboratory testing. Anemia is detected on a blood test called a complete blood count, which does just that: counts all the blood cells. Your vet will need to collect a Complete Blood Count (CBC) from your cat so it can be tested to tell him or her how many red blood cells, hemoglobin, white blood cells, and platelets your pet has. Your vet will also use this blood test to determine the type of anemia that your cat is experiencing. Anemia can also be detected on a blood smear, and if there are any parasites or other red blood cell defects causing the destruction of red blood cells, those can be seen as well.

Because anemia in cats is a secondary problem, it's also necessary to run tests to determine what is causing the anemia. Once the anemia itself and type have been determined through your cat's diagnosis, your vet may require further testing. These tests can include any or all of the following: blood work, testing for infectious disease, urine tests, X-rays or other imaging studies, biopsy of abnormal organs or tumors, and more. A urinalysis should be performed to check your cat’s organ function and assess other causes of anemia. Your vet may also take a fecal sample from your cat. If there is concern the cat’s bone marrow is not responding properly, your veterinarian may recommend a bone marrow aspirate or biopsy to collect a sample of bone marrow for analysis. For this procedure, your cat is usually under anesthesia. A needle is inserted into the bone to collect a sample of the marrow.

Read also: Guide to Raw Feeding for Cats

Treatment of Anemia in Cats

As noted above, cat anemia treatment depends on the severity and cause of the anemia. Treatment will depend on the severity of the condition, as well as the underlying cause. In some cases, this may include a change in diet or medication, surgery, blood transfusion, or other treatments. In some cases, this may include a change in diet or medication, surgery, blood transfusion, or other treatments. Treatment of anemia usually revolves around treating the root cause, which - when healed - allows the cat to heal the anemia (grow new blood cells) on its own. In some cases, such as certain autoimmune diseases or anemia due to chronic kidney problems, there is no cure to the root problem. If the anemia is severe enough to be life-threatening, then your cat may need to have a blood transfusion. Severely anemic cats will likely need to be hospitalized for two to seven days while they receive treatment.

Dietary Recommendations for Cats with Anemia

If your cat is found to be iron deficient or has anemia, foods rich in iron can be an addition to a cat’s diet. It is also one of the easiest and most effective ways to maintain the cat’s iron count. The easiest way to increase iron levels is to include additional iron-rich foods in your cat's diet. As a complement to professional veterinary treatment, adding iron-rich foods to your cat’s diet could help boost red blood cell production.

While the underlying issue is being treated, supportive care for the anemia may be needed, such as blood transfusions or hospitalization. Although iron deficiency anemia is rarely caused by a lack of iron in the diet, providing good nutrition is still an important part of keeping cats healthy overall.

Iron-Rich Foods for Cats

When it comes to treatment with blood transfusions, multiple transfusions may be needed before the cat’s body can create enough red blood cells on its own. If you need to boost your cat’s red blood cells, iron-rich foods may help. Iron is a mineral your cat needs in small amounts to replenish and maintain their body’s supply of red blood cells. These specialized cells are responsible for carrying oxygen throughout the body, and they naturally die off and get replaced by new red blood cells about every two months.

• Lean Meats: Lean meats, including cooked chicken, pork, or beef (only ensure that you will trim the fat as they can cause pancreatitis), can be a tasty treat and enhance your cats’ protein consumption. Beef has a high iron content, and as an animal protein is suitable for most cats. Beef is packed with protein for your cat, providing all the essential amino acids they need to build and maintain healthy muscle. Like all animal proteins, beef is also rich in iron. Per 100 grams, beef contains about 2.5 mg of iron (depending on the cut). To offer your cat beef, choose the leanest cut possible and cook it through. Some sources suggest grass-fed beef may contain higher levels of iron than factory farmed beef due to the higher iron content of their diet. As a leaner alternative to beef and lamb, pork is a protein-rich option that also provides plenty of iron.
• Lamb: For cats with food allergies or sensitivities to beef, lamb is an excellent alternative. It’s a novel protein for many cats and, as a bonus, picky eaters frequently seem to enjoy the taste. In addition to being rich in iron, lamb is a good source of zinc, selenium, taurine, and B vitamins including niacin and riboflavin. To offer your cat lamb, opt for a leaner cut like lamb leg or lamb loin.
• Poultry: When it comes to high protein and low fat content, poultry is generally a stronger choice than red meat. While poultry is generally leaner than red meat, it’s not quite as high in iron. Per 100 grams, chicken or turkey breast only provides a little more than 1 mg of iron. Like red meat, poultry should be thoroughly cooked before offering it to your cat. If you’re more concerned about iron than fat content, duck may be preferable to chicken and turkey. Though still classified as a white meat like other poultry, duck meat tends to be darker in color due to higher levels of myoglobin. While hemoglobin carries oxygen in the red blood cells, myoglobin holds it in the muscle cells.
• Fish: Fish is a favorite food for domestic cats, who happily eat, whether raw or cooked. It is worthwhile to spend the time and effort to boil the fish beforehand because frequent ingestion of raw fish might result in a vitamin B deficiency. Even though cats must eat meat, a diet consisting only of fresh fish can be unhealthy. Fish is rich in protein and it tends to be a leaner option than red meat like beef and lamb. Small, oily types of fish like sardines and anchovies contain a lot of fat but it’s primarily in the form of omega-3s. When it comes to iron content, those oily fish tend to win out. Anchovies provide about 4.6mg of iron per 100 grams while a similar serving of sardines contains about 2.9 mg. Iron content varies among larger fish. Fresh skipjack tuna provides about 1.3 mg of iron per 100 grams while white canned tuna only provides 0.7 mg. For Atlantic salmon, farmed salmon provides about 0.3mg per 100 grams while wild-caught salmon offers more than double that, around 0.8mg. Tuna and other types of fish (like sardines, mackerel, and haddock) are rich in iron as well as other essential nutrients. Due to the risk of mercury poisoning, however, fish should not be the foundation of a daily diet for cats.
• Eggs: Like meat and poultry, eggs are a biologically appropriate source of protein for obligate carnivores like your cat. One medium egg (44g) contains about 63 calories with 5.5 grams of protein, 4.2 grams of fat, and 0.8 mg of iron. Eggs are also rich in omega-3 fatty acids, B vitamins, and vitamins A, D, and E. When it comes to iron content, duck eggs have the edge over chicken eggs. Always cook eggs before offering them to your cat and keep in mind that most of the iron is concentrated in the yolk.
• Organ Meats: Organ meats are often described as superfoods due to their high nutrient content. The organs with the highest iron content are liver, kidney, brain, and heart. The iron content of organ meat depends on the animal of origin and, to some extent, that animal’s diet. Beef liver is the highest in iron with about 1.4 mg per ounce. If you want to offer your cat a concentrated source of iron without significantly increasing their caloric intake, pieces of freeze-dried liver or heart may be a good choice.
• Shellfish: Like organ meats, shellfish offers a higher concentration of micronutrients by weight than red meat and poultry. Clams, oysters, and mussels are particularly rich in iron. Per ounce, clams contain 24 calories with about 4.2 grams of protein and 0.5mg of iron. Oysters contain between 4.6 and 5.8 mg of iron per 100 grams, though the iron content may differ depending on the variety and whether the oysters are farmed or wild.
• Plant Foods: Though cats are carnivores, adding cat-safe, iron-rich fruits and vegetables that your cat will tolerate is a method to help improve your cat’s red blood cell count, changing the diet cats eat. While animal-based foods are more biologically valuable for your cat, certain plant foods offer a decent amount of iron as well. The iron in plants is called non-heme iron. Good sources include broccoli, potatoes, sweet potatoes, and leafy greens like spinach and swiss chard. Some of the strongest plant sources of iron are legumes, including peas, beans, and lentils. These are common ingredients in grain-free cat food.

Commercial Cat Foods High in Iron

All commercial cat foods formulated according to AAFCO nutrient profiles must contain at least 80 mg/kg of iron measured as dry matter. High-protein cat food may contain more than the minimum, though bioavailability may depend on the protein source.

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Iron Supplements

Cats being treated with ESAs or for iron deficiency anemia require iron supplementation. The recommended dosage is 50-100 mg/cat/day PO for a total of 8.8-25 mg of elemental iron. Cats with iron deficiency or anemia related to underlying health problems should be treated medically (or surgically, in some cases) by a veterinarian. Oral iron supplements for cats with iron deficiency anemia usually contain ferrous sulfate.

Important Considerations

• Consult Your Veterinarian: Anytime you plan to alter your cat's diet, you should speak with your vet. They can help with recommendations and help to avoid serious complications such as allergic reactions. Remember, always check with your veterinarian before giving your cat supplements or making changes to their diet.
• Balance is Key: Even though cats must eat meat, a diet consisting only of fresh fish can be unhealthy.
• Treats, Not Meals: Iron-rich foods should be given as a supplement to your cat's regular diet, not as a replacement for a balanced meal.

How to get an anemic cat to eat?

Anemic cats may benefit from appetite stimulants like maropitant citrate (Cerenia®). You can also try feeding something extra special like warm canned food.

Prevention of Anemia

There are many ways you can protect your cat from things that cause anemia. Not all causes of anemia in cats are preventable, but there are steps you can take to decrease your cat’s overall risk. Follow your veterinarian’s recommendations for how often your cat needs wellness exams and blood work. This will help you catch conditions, such as chronic kidney disease, early.

• Indoor Lifestyle: Keeping your cat indoors or taking your cat outside only for supervised fun will help protect your cat from trauma and infectious disease.
• Parasite Prevention: If your cat does spend time outside, staying up-to-date on external and internal parasite prevention like flea control and regular deworming will keep anemia-causing parasites away. Prevent blood-sucking parasites by keeping your cat on a regular parasite control plan as directed by a veterinarian.
• Regular Veterinary Check-ups: Ensure your cat is getting all the nutrients he needs in his diet, and reduce the risk of blood loss by scheduling routine wellness exams to have him checked for parasites and other health issues. Also, stay up to date on vaccines and parasite prevention. Regular blood tests, such as a complete blood cell count (CBC), can show if a cat is anemic and offer additional clues about how severe the anemia is, what type of anemia it is, and the potential underlying cause.

Non-Regenerative Anemia in Detail

Non-regenerative anemia, or anemia with reticulocytopenia, is frequently encountered in feline practice. A wide variety of diseases may underlie feline non-regenerative anemia. Erythropoiesis can be decreased due to an absolute or a relative lack of erythropoietin, or secondary to a decreased bone marrow response to erythropoietin. Ineffective erythropoiesis can be secondary to absolute deficiencies in the nutrients essential for hemoglobin or RBC biosynthesis, such as iron. The disease processes underlying non-regenerative anemia are many and diverse. All veterinarians caring for cats will face the diagnostic and therapeutic challenge of non-regenerative anemia.

Diagnosing Non-Regenerative Anemia

A reticulocyte count is required to differentiate regenerative from non-regenerative anemia and an elevated reticulocyte count indicates a regenerative anemia. The definition of reticulocytosis in the cat ranges from >0.045 x 1012/l to >0.060 x 1012/l. However, interpreting reticulocyte counts is more complex than just assessing the absolute number of reticulocytes. Cats produce two types of reticulocytes: punctate and aggregate. Aggregate reticulocytes are released by the bone marrow and then mature into punctate reticulocytes while in circulation. Aggregate reticulocytes are those considered to represent the regenerative response. Feline reticulocytes can be counted using manual and automated techniques.

If initial hematology, biochemistry and infectious disease testing and diagnostic imaging do not identify the cause of non-regenerative anemia, the presence of cytopenias, abnormal blood cells identified on a blood smear, organ enlargement or diagnostic imaging abnormalities should prompt additional testing such as blood smear review, bone marrow cytology or organ aspiration cytology. The degree of anemia can also help to prioritize differentials.

Common Causes of Non-Regenerative Anemia

FeLV and FIV are the most common infectious causes of non-regenerative anemia in the cat. Iron deficiency is typically related to chronic blood loss in the cat (gastrointestinal, parasitic from severe flea infestation, or anecdotally reported in cases of chronic hematuria). Iron stores are depleted over time as the bone marrow compensates for ongoing losses, resulting in a progressive non-regenerative anemia.

Multiple primary (medullary) and secondary (extramedullary) bone marrow disorders cause ineffective erythropoiesis, producing a non-regenerative anemia. These include: PRCA, NRIMHA, AA/pancytopenia, primary and secondary MDSs, myelofibrosis and primary and secondary myelophthisis.

Treatment Strategies for Non-Regenerative Anemia

Identifying the underlying cause of non-regenerative anemia is important for tailoring the patient’s treatment plan. Treatment of non-regenerative anemia includes supportive therapy such as increasing the oxygen-carrying capacity of the blood via RBC transfusion or with ESAs. RBC transfusion can be used to rapidly increase oxygen-carrying capacity in non-regenerative anemia of any etiology.

If chronic blood loss is suspected to be the cause of iron deficiency resulting in anemia, treatments to control bleeding and prevent further loss are indicated. Treatment options vary depending on the underlying disease and the source of the bleeding.

Cats being treated with ESAs or for iron deficiency anemia require iron supplementation. Parenteral iron supplementation is preferable given its more reliable absorption, especially if iron deficiency is secondary to malabsorption. Oral iron supplementation, however, is the least expensive form of supplementation and is also considered the safest.

Prognosis

Many cats with mild anemia-when treated early, and in overall good health-will typically make a full recovery and have no long-term effects. Severely anemic cats or those with autoimmune conditions or cancer can have poor or uncertain prognosis.

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