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Lymphoreticular and haematopoeitic > CS - Lymphadenomegaly case > Flashcards

CS - Lymphadenomegaly case Flashcards

1
Q

2 main differentials for generalised lymphadenopathy

A
  • neoplasia

- systemic infection

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2
Q

Ddx - noisy breathing

A

o URT infection
o FB
o Compression of trachea – neoplasm, inflammation, enlarged tonsils

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3
Q

What is the commonest cause of generalised lymphadenopathy in older dogs?

A

lymphoma

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4
Q

Fastest way to r/o lymphoma

A

LN FNA (not largest LN or submandibular LN)

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5
Q

How do you differentiate lymphoma from leukaemia?

A

Flow cytometry (also to type the lymphoma):

  • CD45 and CD79a positive = BC lymphoma
  • CD34 (stem cell marker) positive = leukaemia
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6
Q

What is a good AB for a dog with lymphoma + neutropaenia?

A
  • bright and afebrile at home: oral ABs e.g. TMS

- sick/ febrile/ GIT signs: IV BS AB e.g. potentiated amoxicillin + enrofloxacin

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7
Q

Is it good to give a blood transfusion for thrombocytopaenia?

A

No - PLTs have short half-life and there are v few platelets in a unit of blood

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8
Q

Tx - thrombocytopaenia d/t lymphoma

A
  • VINCRISTINE: minimally myelosuppressive, used in IMTP tx, causes megakaryocytes to break off into PLT
  • l-asparaginase + prednisolone: not myelosuppressive, helps with thromboctyopaenia and neutropaenia
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9
Q

Chemo protocol - lymphoma + thrombocytopaenia + neutropaenia

A
  • initially start with l-asaparaginase + prednisolone. Otherwise vincristine if owners can’t afford former.
  • aim to progress to COP or CHOP protocol (if marked neutropaenia, reduce dose by 20-25%)
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10
Q

Prognosis - lymphoma

A
  • stage 1 and 2 better than stage 5 (not all studies)
  • substage b worse prognosis than a
  • BC type better than TC for high grade lymphomas
  • hypercalcaemia is a poor prognostic indicator
  • MST 12-13 months with CHOP
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11
Q

Prognosis ALL on chemo

A

only 1/3 respond to tx and of those that respond, MST is around 4 months

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12
Q

Does lymphoma or leukaemia show a less prominent lymphadenomegaly in dogs?

A

Leukaemia

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13
Q

T/F:CS in dogs/cats with lymphadenopathy or splenomegaly are vague and non-specific and usually relate to primary disease rather than the organ enlargement.

A

True

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14
Q

4 categories - splenomegaly

A
  • lymphoreticular hyperplasia
  • inflammatory (splenitis)
  • infiltration with abnormal cells (lymhoma) or substances (amyloidosis)
  • congestion
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15
Q

If you detect hypoproteinaemia on biochemistry, what might be your next step?

A

Run serum protein electrophoresis to detect what types of prtoeins were high/low to indicate infection/inflammation or neoplasia

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16
Q

What is the classic serum protein electrophoresis result for dogs with leishmania?

A

Polyclonal hyperglobulinaemia = high gamma globulins (defined as wide because it was 2-3x the width of the albumin spike, therfore polyclonal, not neoplasia (monoclonal expansion)

17
Q

What tests are done for leishmania?

A
  • PCR (endemic areas)

- Ab titre (non-endemic areas)

18
Q

How quickly do dogs seroconvert with leishmania?

A
  • takes up to 24 months, median 5 months

- long incubation period thus most sick dogs are likely to be Ab positive.

19
Q

Outline PCR in detection of leishmania

A
  • sensitivity BM and LN > skin > conjunctival swab> buffy coat > whole blood
  • qPCR most sensitive: sometimes only 30-40% dogs positive with this develop CS
20
Q

Tx - leishmania

A
  • nothing cures it, only suppresses disaese
  • meglumine antimoniate (leishmanicidal) + allopurinol (leishmanistatic) best combination
  • alteratively amphotericin B (an antifungal)
  • other drugs available if poor response seen
21
Q

Supportive tx of leishmania with marked proteinuria

A
  • combined meglumine antimoniate + allopurinol –> faster reduction of parasite load –> fewer immune complexes deposited in glomeruli
  • low protein, low phosphorous diet
  • omega-3 essential fatty acids
  • anti-hypertensive therapy
  • active vitamin D supplement
  • ranitidine
  • eryhtropoeitin supplement
22
Q

Why do you get lymphadenomegaly with leishmania?

A

d/t increased # and size of lymphoid follicles and marked hypertrophy and hyperplasia of the medullary macrophages in the cords and sinuses.

23
Q

Why do you get splenomegaly with leishmania?

A

increased monocyte and macrophage cellularity and changes in the microvasculature structure with abundant pulp venules and veins and increased reticular fibres.

24
Q

T/F: kidneys are affected in almost all dogs with CanL

A

True

25
Q

Why do you get anaemia with leishmania?

A

• Anaemia present in most symptomatic cases because chronic renal disease or decreased erythropoiesis d/t chronic disease.

26
Q

Why do you get epistaxis with leishmania?

A

d/t (insoluble) immune complexes that form. They also develop a rhinitis. The 2 factors combined mean the nosebleed persists.

27
Q

Ddx - hypercalcaemia

A 
	Neoplasia (lymphosarcoma) - commonest
	Hypoadrenocorticism
	Primary hyperparathyroidism
	Chronic renal failure
	Others
( remember "HARD IONS" for hyperparathyroidism, Addison's disease / hypoadrenocorticism, renal disease, vitaminD toxicosis / dehydration, idiopathic, osteolytic, Neoplastic, spurious - lipaemia or HAEMOLYSIS)
28
Q

Why are hypercalcaemic animals PU/PD?

A
  • impairs ability to concentrate urine by interfering with ADH at kidney tubules
  • acts directly on the thirst centre
29
Q

Tx - anal sac adenocarcinoma + hypercalcaemia

A
  • deal with hyercalcaemia first, give IVFT, possibly furosemide once hydrated
  • advanced LN imaging to ID which are involved and if sx is feasible
  • sx for mass and LNs
  • chemo for incompletely resected or metastatic cases (various drugs, include carboplatin, melphalan, mitoxaantrone, metronomic or toceranib)
  • combination sx, radioation, chemo
  • bisphosphonates (pamidronate) if hypercalcaemia remains uncontrolled post-sx
30
Q

T/F: anal adenocarcinoma tends to metastasise readily to local LNs but can be slow to metastasise further

A

Ture

31
Q

Causes - generalised or localised lymphadenopathy

A
  • GENERALISED: metastatic neoplasia, systemic infxn,

- LOCALISED: localised inflammatory or infectious process, metastatic neoplasia

32
Q

Investigation process - generalised lymphadenopathy

A
  • haematology

- LN biopsy

33
Q

Investigation process - localised lymphadenopathy

A
  • Think about the specific area that the LN is draining as they are important sites for metastases.
  • +/- CBC (less important than generalised lymphadenopathy)

Lymphoreticular and haematopoeitic (21 decks)

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