http://www.smartgroups.com/message/readmessage.cfm? gid=1423922&messageid=6485&startid=6487 While Dr. L. comments about biliary obstruction are cerrtainly valid, I am taken by the severe anemia in this case, and would want to add the possibility of hemolytic anemia in this case. While many cases of hemolytic anemia degenerate rapidly, the fact that Meiko is already on maximal levels of prednisone may be stalling the progression. I would very much like to see a recheck on the CBC to see what the HCT and RBC count is. Yes, biliary obstruction is a consideration, and gall stones are probably more prevalent that we believe. However, with severe anemia, surgery is a very risky issue here. With kindest regards, Bruce Williams, DVM [Posted in FML issue 4318]