Anemia Developed after Recovering from Jaundice

My 4 y/o male cat Loki recently was Jaundice due to cholangitis and developed fatty liver because of it. we had an esophigal tube put into him a couple days ago and since then his bilirubin levels have fell more than 50% back towards the target zone. However he still has a high ALP level and now he has regenerative anemia. is this normal for cats recently recovering from fatty liver ? I have done some reading and found that sometimes when they’re re introduced to food after not eating a for a few days the spike in insulin can cause their red blood cells to be destroyed. is this something a blood transfusion can help reverse ? Thank you guys for your time

Hello - this is a very interesting question. Did you know that the yellow jaundice pigment, bilirubin, is actually made from red blood cells breaking down within the blood?  So typically, if  red blood cells break down too fast, then both anaemia and jaundice occur - anaemia being low red blood cells and jaundice being the breakdown products of red blood cells.  Usually, in a healthy animal, a small amout of red blood cell breakdown happens all the time:  red cells die in the blood and fresh ones get made. The liver gets rid of bilirubin fast enough that we don't see it.  However, when a lot of cells are broken down all at once for whatever reason, it might be too much for the liver to process all at once, so the yellow pigment is seen.  Alternatively, if the red cells are breaking down at a normal speed but the liver isn't working fast enough to remove the yellow pigment eg because it is damaged, jaundice can be seen (typically in liver patients).  Fatty liver disease is when a lot of fat is laid down in the liver, stopping it from working properly.   There is another pathway for jaundice whereby the breakdown products don't make it from the liver to the faeces but build up in the blood.   I dont know enough about your cat to say what has gone on in this case;  it will be up to your vet go do the tests in order to understand whether eg the anaemia and jaundice are linked, or whether fatty liver is more likely.  Wishing you both all the best with this case.