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Article

Immune-Mediated Hemolytic Anemia in Cats with Feline Infectious Peritonitis

by
Petra Černá
1,*,
Marieke Knies
2,3,
Marleen Assink
4,
Samantha Evans
1,
Séverine Tasker
5,6,
Danièlle A. Gunn-Moore
7,
Katrin Hartmann
8,
Katharina Buchta
8,
Samantha Taylor
9,10,
Solène Meunier
11,
Regina Hofmann-Lehmann
12,
Nicole Jacque
13,
Allison Koonce
14,
Casandra Jacobs
15,
Ashley Gillett
16 and
Michael R. Lappin
1
1
Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA
2
Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CT Utrecht, The Netherlands
3
AniCura Specialist Referral Centre Haaglanden, Frijdastraat 20a, 2288 EZ Rijswijk, The Netherlands
4
IVC Evidensia Small Animal Referral Hospital Arnhem, Meander 10, 6825 MB Arnhem, The Netherlands
5
Bristol Veterinary School, University of Bristol, Bristol BS40 5DU, UK
6
Mars Veterinary Health, Shirley, Solihull B90 4BN, UK
7
The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian EH25 9RG, UK
8
LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany
9
International Cat Care Veterinary Society, Tisbury SP3 6HJ, UK
10
Lumbry Park Veterinary Specialists, Selborne Road, Alton GU34 3H, UK
11
Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
12
Clinical Laboratory, Department of Clinical Diagnostics and Services, Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
13
Independent Researcher, San Jose, CA 95113, USA
14
Pleasant Valley Veterinary Clinic, Little Rock, AR 72212, USA
15
Desert Veterinary Medical Specialists, Peoria, AZ 85382, USA
16
The Humane Society of Sarasota County, Sarasota, FL 34237, USA
 
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*
Author to whom correspondence should be addressed.
Pathogens 2025, 14(7), 660; https://doi.org/10.3390/pathogens14070660
Submission received: 20 May 2025 / Revised: 24 June 2025 / Accepted: 2 July 2025 / Published: 4 July 2025
(This article belongs to the Special Issue Feline Coronavirus Infections)
Versions Notes

Abstract

Feline infectious peritonitis (FIP) is caused by mutated feline coronaviruses. Immune-mediated hemolytic anemia (IMHA) arises due to immune-mediated erythrocyte destruction and can be non-associative or associative with diseases such as FIP. Records of cats with FIP were reviewed to find those with associative IMHA based on exclusion of other causes of anemia and a positive saline agglutination test and/or Coombs test. The inclusion criteria were met for 45 cats (26 (58%) cats with effusive and 19 (42%) with non-effusive FIP). Median hematocrit was 18% (interquartile range [IQR] 13–20). Anemia was non-regenerative in 36 (80%) cats and regenerative in 5 (11%) cats; 4 (9%) cats had no reticulocyte count available. Concurrent thrombocytopenia was present in 18 (40%) cats. All 45 cats were treated with nucleoside analogs, and 44 (98%) cats with glucocorticoids; in 5 (11%) cats, glucocorticoids were added after starting antiviral treatment due to persistent anemia. Median follow-up was 72 days (IQR 14–246); at the time of last follow-up 33 (73%) cats had survived while 12 (27%) had died or were euthanized. Of the 33 surviving cats, 17 achieved remission of both FIP and IMHA. In three cats, FIP remission was achieved, but IMHA relapsed; in one of these, IMHA relapsed twice. FIP relapsed without IMHA in two cats, and both FIP and IMHA relapsed in one cat. In 9 cats the antiviral and glucocorticoid treatment is still ongoing at the time of the publication. Although FIP is likely an uncommon cause of associative IMHA, as more cats with FIP are treated with antiviral therapy, it is important to consider IMHA as a possible cause of anemia in cats with FIP.
Keywords: FIP; PIMA; IMHA; coronavirus FIP; PIMA; IMHA; coronavirus

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MDPI and ACS Style

Černá, P.; Knies, M.; Assink, M.; Evans, S.; Tasker, S.; Gunn-Moore, D.A.; Hartmann, K.; Buchta, K.; Taylor, S.; Meunier, S.; et al. Immune-Mediated Hemolytic Anemia in Cats with Feline Infectious Peritonitis. Pathogens 2025, 14, 660. https://doi.org/10.3390/pathogens14070660

AMA Style

Černá P, Knies M, Assink M, Evans S, Tasker S, Gunn-Moore DA, Hartmann K, Buchta K, Taylor S, Meunier S, et al. Immune-Mediated Hemolytic Anemia in Cats with Feline Infectious Peritonitis. Pathogens. 2025; 14(7):660. https://doi.org/10.3390/pathogens14070660

Chicago/Turabian Style

Černá, Petra, Marieke Knies, Marleen Assink, Samantha Evans, Séverine Tasker, Danièlle A. Gunn-Moore, Katrin Hartmann, Katharina Buchta, Samantha Taylor, Solène Meunier, and et al. 2025. "Immune-Mediated Hemolytic Anemia in Cats with Feline Infectious Peritonitis" Pathogens 14, no. 7: 660. https://doi.org/10.3390/pathogens14070660

APA Style

Černá, P., Knies, M., Assink, M., Evans, S., Tasker, S., Gunn-Moore, D. A., Hartmann, K., Buchta, K., Taylor, S., Meunier, S., Hofmann-Lehmann, R., Jacque, N., Koonce, A., Jacobs, C., Gillett, A., & Lappin, M. R. (2025). Immune-Mediated Hemolytic Anemia in Cats with Feline Infectious Peritonitis. Pathogens, 14(7), 660. https://doi.org/10.3390/pathogens14070660

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