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Y4 SA - haematology > Diseases of the myeloid and lymphoid: diagnosis & treatment > Flashcards

Diseases of the myeloid and lymphoid: diagnosis & treatment Flashcards

1
Q

Common stimuli of the immune system

A
  • physiologic leukocytosis (‘fight or flight’)
    – epinephrine
  • physiologic stress (‘stress leukogram’)
    – corticosteroid (incl. exogenous)
  • iatrogenic antigenic stimulation (vaccines)
  • inflammation
  • infection
  • parasites/FBs
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2
Q

Clinpath of fight or flight

A
  • approx. 30 mins
  • mild neutrophilic (mature cells, no left shift)
  • lymphocytosis
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3
Q

Clinpath of stress leukogram

A
  • neutrophilia
  • lymphopaenia
  • monocytosis
  • eosinopaenia
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4
Q

Non-neoplastic disorder of the spleen

A
  • torsion
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5
Q

Non-neoplastic disorders of the thymus

A
  • haemorrhage
  • infarction
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6
Q

Non-neoplastic disorder of the major lymph vessels

A
  • chylous effusions
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7
Q

Non-neoplastic disorder of the intestinal lacteals

A
  • lymphangiectasia
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8
Q

What is chyle?

A
  • mixture of lymph and chylomicrons
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9
Q

What are chylomicrons?

A
  • lipids absorbed from the intestine -> transported via lymphatics
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10
Q

What can chylous effusions result from?

A
  • rupture (e.g. trauma) or obstruction (e.g. neoplasia) of thoracic duct or other major lymphatic vessel
  • often idiopathic, site of leak not always determined
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11
Q

Are chylous effusions common?

A
  • no, both thoracic and abdominal effusions are rare
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12
Q

Normal distribution of a chylothorax

A
  • usually a bilateral pleural effusion
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13
Q

Treatment of chylous effusion

A
  • may involve ligation of the thoracic duct
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14
Q

Pathophysiology of lymphangiectasia (‘lacteal dilation’)

A
  • intestinal lymphatics dilate and lose chyle into the lumen -> PLE
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15
Q

Aetiology of lymphangiectasia

A
  • congenital: may be inherited
  • acquired obstruction, e.g. neoplasia
  • but most cases idiopathic
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16
Q

Is lymphangiectasia common?

A
  • common in dogs
  • rare in cats
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17
Q

Management of lymphangiectasia

A
  • low fat diet +/- immunosuppressives (e.g. preds)
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18
Q

Lymphangiectasia - history

A

GI signs
- Weight loss
- Diarrhoea (chronic)
- Vomiting

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19
Q

Lymphangiectasia - physical exam

A
  • poor body condition
  • ascites
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20
Q

Lymphangiectasia - biochem

A
  • parameters suggestive of PLE (e.g. hypoalbuminaemia)
  • hypocholesterolaemia (component of chyle)
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21
Q

Lymphangiectasia - haematology

A
  • lymphopaenia (loss of chyle)
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22
Q

Lymphangiectasia - imaging

A
  • US (hyperechoic lacteals)
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23
Q

Lymphangiectasia - biopsy

A
  • consider endoscopic vs surgical
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24
Q

What is aplastic anaemia?

A
  • failure of myeloid cell production
  • multiple cell lines may be depleted (pancytopaenia)
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25
What is aplastic anaemia normally secondary to?
- toxicity - adverse drug reaction - infection: Ehrlich, Parvo, feline leukaemia virus
26
Circulating lifespan and production time of canine neutrophils
- circulating lifespan: 4-8h - production: 6d
27
Circulating lifespan and production time of canine platelets
- circulating lifespan: 5-7d - production: 12d
28
Circulating lifespan and production time of canine erythrocytes
- circulating lifespan: 110-120d
29
Examples of myeloid neoplasia
- myeloid leukaemia -- acute (immature cells) --chronic (differentiated cells) -> polycythaemia vera (erythrocytes) - myeloid cells --MCT --histiocytoma --transmissible venereal tumour (TVT)
30
How is TVT usually transmitted?
- during mating
31
Origin of TVT
- thought to be histiocytic
32
Is TVT endemic to the UK?
- no - may see more with increased number of imported dogs
33
Tx of TVT
- can respond well to chemotherapy e.g. vincristine
34
Prevalence of histiocytoma
- common neoplasm in SA practice
35
Histiocytoma signalment
- young dogs (<2y)
36
Histiocytoma - benign or malignant?
- classically benign
37
Histiocytoma - tx
- can regress independently over several weeks
38
MCT signalment
- usually older dogs but any age at risk - some breeds more susceptible --boxers --labs --GRets --SBTs --Boston terriers --pugs
39
How to MCTs usually present?
- skin masses
40
MCT prevalence
- common -- up to 20% of all canine skin tumours
41
Diagnosis of MCT
- cytology very sensitive -- FNA of suspect skin masses recommended
42
Why are MCTs so bad?
variable grades -lower grades can be managed by excision and monitoring -higher grades can spread to LN, liver, spleen, bone marrow locally invasive -for high grades, recommendation of 3cm margins and 1-2 fascial plane(s) deep to tumour --referral to oncologist recommended if high grade -revisional surgery may be required risk of degranulation -mass histamine release can produce anaphylaxis -many sources recommend H1 blockers (e.g. chlorphenamine) if tumour likely to be damaged during biopsy or surgery
43
How to grade MCTs
- grading on histopathology (not FNA) Patnaik -grade I (benign) -grade II (intermediate) -grade III (malignant) Kiupel -low-grade -high-grade evaluation of proliferative activity per high power field: -mitotic index -multinucleated cells -atypical nuclei (shape and size) -guided by anisokaryosis
44
Forms of feline MCT
cutaneous form -if well differentiated may act benign visceral form -poorer prognosis -originates in spleen, LN, liver -intestine may be diffuse
45
Prognosis with feline MCT
- association with mitotic index and survival time -- 5+ mitoses per high power field is not good prognosis
46
Examples of lymphoid neoplasia
- lymphoid leukaemia --T-, B- or natural killer (NK) cell --acute or chronic --rare - lymphoid cells --plasmacytoma -> usually benign cutaneous mass -lymphoma
47
Plasmacytoma locations
- skin - oral cavity - colon/rectal mucosa -solitary osseous (rare)
48
Plasmacytoma - benign or malignant?
- usually benign - but can be locally invasive - complete excision of solitary lesion should be curative - cutaneous plasmacytosis (multiple skin tumours) more aggressive
49
Are plasmacytomas common in cats?
- no they're rare
50
What is lymphoma?
- malignant transformation of lymphocytes
51
Lymphoma subtypes
- B cell -- better response to therapy - T cell -- T-zone 'indolent' lymphoma -> surgical removal of affected node may be attempted
52
Types of lymphoma (in descending order of prevalence)
- multicentric - alimentary - cutaneous - mediastinal - renal - CNS
53
What are the more common types of lymphoma in cats
- extra nodal types -- alimentary, mediastinal, nasal, renal multi centric and mediastinal were once most common -associated with FeLV -> increased vaccination thought to have reduced incidence
54
WHO staging system for lymphoma
Stage I - Single lymph node or lymphoid tissue in a single organ (excluding bone marrow) Stage II - Multiple regional lymph nodes Stage III - Generalised lymphadenopathy Stage IV - Liver and/or spleen (+/- generalised lymphadenopathy) Stage V - Bone marrow or extranodal disease (e.g. blood)
55
Lymphoma substages
a = without systemic signs b = with systemic signs
56
What is myeloid tissue?
- bone marrow
57
What is lymphoid tissue
- LN - thymus - spleen - etc
58
What is stage V lymphoma?
= lymphoma in bone marrow - lymphoma with a leukaemic phase
59
Acute leukaemia (Clinpath findings)
- proliferation of immature cells (blasts) - usually arise in and replace bone marrow - mild to moderate organomegaly - blood: bi/pancytopaenia, no to many blasts - marrow: >20 (AML) or >25% (ALL) blasts (definition)
60
Lymphoma with a leukaemia phase (Clinpath findings)
- cells mimic primary tumour (small to large) - primary tumour arises in extra medullary tissue - document lymphoma in periphery - moderate to marked organomegaly - blood: no to low numbers of lymphoma cells, mild or no cytopaenias - marrow: no/mild infiltrates (usually <25%, focal)
61
Chronic leukaemia (Clinpath findings)
- neoplastic proliferation of mature cells - myeloid arise in marrow, lymphoid arise in peripheral lymphoid organs (spleen, nodes) - blood: increased counts of involved cell type, usually no/mild cytopaenias, no/rare blasts - marrow: relevant cell hyperplasia (e.g. myeloid)
62
What is polycythaemia vera?
- RBC overproduction
63
Histiocytoma appearance
- red/pink raised cutaneous tumour - tend to look awful when regressing -> crack & bleed
64
Medullary plasmacytoma
= multiple myeloma - originates in bony tissue
65
Signalment for T-zone indolent lymphoma
- labs more commonly affected

Y4 SA - haematology (6 decks)

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