cat in pain with lymphocytosis

Re: cat in pain with lymphocytosis

Evelyn Barbour-Hill — Fri, 19 Apr 2013 14:00:35 GMT

[quote user="Martin Atkinson"]

so it should be neutrophilocytosis and lymphocytocytosis to be grammatically correct.

[/quote]

The former I quite agree, the latter I do not.

[quote user="Martin Atkinson"][quote user="Evelyn Barbour-Hill"]Such as why people refer to "neutraceuticals" [/quote]Well that should be nutraceuticals as they are nutritional supplements masquerading as pharmaceutical substances![/quote]

Quite so. Masquerading is the mot juste. But it should be "nutroceuticals".

Re: cat in pain with lymphocytosis

Martin Atkinson — Fri, 19 Apr 2013 12:52:14 GMT

[quote user="Evelyn Barbour-Hill"]'Cos the cells in question are called neutrophils (lovers of stain of neutral pH) and lymphocytes (cells from lymph). [/quote] Of course I am playing Devil's Advocate but if we're going to be pedantic, actually neutrophilia just means a tendency to love neutral stain not an increase in numbers you still have to have a suffix to indicate that, so it should be neutrophilocytosis and lymphocytocytosis to be grammatically correct.

[quote user="Evelyn Barbour-Hill"]Such as why people refer to "neutraceuticals" [/quote]Well that should be nutraceuticals as they are nutritional supplements masquerading as pharmaceutical substances!

Re: cat in pain with lymphocytosis

John Flynn — Fri, 19 Apr 2013 10:49:27 GMT

[quote user="Martin Atkinson"]this is in danger of getting silly[/quote]

The danger has passed. It is now officially silly

Still, kept our minds active while the cat concerned herself with the more important business of getting better - glad to hear she's doing well

Re: cat in pain with lymphocytosis

Evelyn Barbour-Hill — Fri, 19 Apr 2013 10:23:09 GMT

[quote user="Martin Atkinson"]PS why do we talk about a neutrophilia yet lymphocytosis - why not neutrocytosis and lymphophilia? [/quote]

'Cos the cells in question are called neutrophils (lovers of stain of neutral pH) and lymphocytes (cells from lymph).

I suppose you could speak of a neutrophilocytosis, but lymphophilia would be nonsense (the cells are not lymphophils).

When the numbers are down, strictly speaking "neutropaenia" and "lymphopaenia" are wrong. They ought to be "neutrophilopaenia" and "lymphocytopaenia".

There are more important things to worry about. Such as why people refer to "neutraceuticals" and why Belgravia House thinks I have something called "principle premises".

Re: cat in pain with lymphocytosis

Martin Atkinson — Fri, 19 Apr 2013 09:36:10 GMT

[quote user="John Flynn"]

[quote user="Martin Atkinson"]PS why do we talk about a neutrophilia yet lymphocytosis - why not neutrocytosis and lymphophilia? [/quote]

No good reason other than current convention, I suspect - I'd have a pretty good stab at comprehension, in the relevant context, if you said neutrophilosis / neutrocytosis / neutrophilcytosis etc! I'll leave the etymology to the classical scholars, but I bet it's pretty obscure - I didn't do much Greek at school, but neuter sounds decidely latin in origin, so I'm guessing neutro-philia may be the haematological equivalent of tele-vision. Lymphophilia would seem slightly less intuitive to me, but again would probably get the right end of the stick in a suitable context :-)

Would be interested in any follow-up you get on the kitty

[/quote] Although I begged the question, this is in danger of getting silly. Latest report is cat is running around as good as new so a few more days NSAIDs/antibiotics I guess

Re: cat in pain with lymphocytosis

John Flynn — Thu, 18 Apr 2013 21:29:58 GMT

[quote user="Martin Atkinson"]PS why do we talk about a neutrophilia yet lymphocytosis - why not neutrocytosis and lymphophilia? [/quote]

Would be interested in any follow-up you get on the kitty

Re: cat in pain with lymphocytosis

Martin Atkinson — Thu, 18 Apr 2013 18:27:11 GMT

Thanks for pointing out the typo John I did of course mean neutropaenia, what you say about feline stress leucograms shows we live and learn every day.

PS why do we talk about a neutrophilia yet lymphocytosis - why not neutrocytosis and lymphophilia?

Re: cat in pain with lymphocytosis

John Flynn — Thu, 18 Apr 2013 15:09:52 GMT

[quote user="Martin Atkinson"]plan is to treat with pain relief + precautionary antibiotics and re-test in a couple of weeks.[/quote]

Sounds like an excellent plan!

Re: cat in pain with lymphocytosis

John Flynn — Thu, 18 Apr 2013 15:08:47 GMT

[quote user="Martin Atkinson"][quote user="John Flynn"]but would think stress at time of blood sampling was top of the differential list for the lymphocytosis?[/quote] Despite the hyperglycaemia (14.3mmol/l), this cat was not visibly stressed, certainly no more than most and less than many and in 38 years I have never seen a lymphocytosis like that in a healthy cat. And anyway surely this is the exact opposite of a stress leucogram? - we also have an absolute neutropaenia and eosinophilia.[/quote]

Regarding stress-associated lymphocytosis in cats:

A "stress leucogram" as you refer to it refers to glucocorticoid-induced changes in the haematology, seen most classicly in dogs - this gives you a lymphopenia, along with eosinopenia, mature neutrophilia and monocytosis classicly.

Cats have higher percentages of marginated leukocytes (i.e. those adherent to vessel walls etc rather than circulating) and, given their adrenaline "fight-or-flight" rushes, are more prone to adrenaline-induced leukocytosis; this is caused by decreased adherence of leukocytes and increased blood flow (i.e. under adrenaline, you sample more of the marginated leukocyte population as well as the circulating leukocyte population in a cat). Or at least that's what I was led to believe a number of years ago - can't say I've ever looked at the primary literature that this much-cited phenomenon is based on. 38 years without a stress-indcued lymphocytosis in a cat would suggest either that this information is bogus, or that the reference interval you use incorporates this phenomenon, or you have a nurse with a very calming kitty nature, or that you sensibly don't blood sample healthy cats!

In terms of absolute numbers:

"Excitement... (in cats)... Lymphocyte counts can reach up to 20 x 10^9/L" (Idexx Guide to Haematology, Rebar et al. 2002)

I see your point about the neutropenia (you'd put neutrophilia in your first post I think, but I think the absolute neutrophil count is about 2.5 x 10^9/L and is a neutropenia as you say); with an adrenaline-associated lymphocytosis, I'd typically expect neutrophil numbers not to be depressed, so perhaps I'm back to considering false-negative FeLV test and this could be small lymphocytic leukemia then? I don't know enough about cat blood to know if it's possible to get an adrenaline-associated lymphocytosis without increasing the neutrophil count also?

I'd probably recheck virus status with an appropriate reference lab before doing the other tests suggested, but that's just me.

I make the eosinophil count 0.75 x 10^9/L I think which is within the reference interval I use.

Re: cat in pain with lymphocytosis

Martin Atkinson — Thu, 18 Apr 2013 14:47:30 GMT

[quote user="Christopher Saul"]

With regard to the lymphocytosis... I guess you could send blood for flow cytometry to see if you can better characterise the lymphocytes. They may look normal grossly but you can never be 100% sure.... Otherwise you could monitor with repeat CBCs to see if repeatable perhaps? WRT the reverse stress leukogram, addison's is v rare in the cat but a basal cortisol isn't too expensive and a high reading would eliminate it.

I take it Ca was normal? what about serum globulins? I'm probably barking completely up the wrong tree but thinking along the multiple myeloma line here... maybe do a serum electrophoresis?

Just a few thoughts

Chris :)

[/quote] Ca was normal, hyperglycaemia should rule out Addison's as should normal electrolytes and renal parameters. As said is a CP cat so funds limited, plan is to treat with pain relief + precautionary antibiotics and re-test in a couple of weeks.

Re: cat in pain with lymphocytosis

Christopher Saul — Thu, 18 Apr 2013 11:39:43 GMT

I take it Ca was normal? what about serum globulins? I'm probably barking completely up the wrong tree but thinking along the multiple myeloma line here... maybe do a serum electrophoresis?

Just a few thoughts

Chris :)

Re: cat in pain with lymphocytosis

Mark Hedberg — Thu, 18 Apr 2013 11:15:06 GMT

Call it a shot in the dark, but have you tested for toxoplasma? Most cats don't show symptoms, but we're talking about fever, altered behaviour, possibly hypersensitive, and an elevated leukocyte count...IgG and IgM can be done at Axiom but unless they look for it they won't find it - direct blood smear examination can be unreliable.

Re: cat in pain with lymphocytosis

Martin Atkinson — Thu, 18 Apr 2013 09:43:57 GMT

[quote user="John Flynn"]but would think stress at time of blood sampling was top of the differential list for the lymphocytosis?[/quote] Despite the hyperglycaemia (14.3mmol/l), this cat was not visibly stressed, certainly no more than most and less than many and in 38 years I have never seen a lymphocytosis like that in a healthy cat. And anyway surely this is the exact opposite of a stress leucogram? - we also have an absolute neutropaenia and eosinophilia.

Re: cat in pain with lymphocytosis

John Flynn — Wed, 17 Apr 2013 20:14:38 GMT

[quote user="Martin Atkinson"]

...Stop press... Axiom lab result confirms lymphocytosis, mostly small normal looking lymphocytes

[/quote]

I'd have to check absolute numbers against reference intervals, but would think stress at time of blood sampling was top of the differential list for the lymphocytosis?

Ed: I make that 11.6 x 10^9/L lymphocytes assuming the wbc count was accurate and the differential of 77% lymphocytes was accurate; the reference interval I have for feline lymphocytes is 1.5 - 7.0 x 10^9/L

Stockham&Scott (2nd ed) suggests that up to 2 x the upper reference limit (i.e. up to 14 x 10^9/L) can be due to stress (adrenaline) lymphocytosis.

Re: cat in pain with lymphocytosis

Martin Atkinson — Wed, 17 Apr 2013 19:22:46 GMT

[quote user="Kate Richardson"]

Were your white cell numbers from an automated machine? I have had cases where machine says high lymphocytes and lab result comes back as neutrophilia- sometimes the machine reads cells and categorises them wrongly eg if bands/abnormal cells etc so you may find that you don't even have a lymphocytosis. If it is high I don't know how worried I would be about the lymphocyte count unless it was persistent or if the cells were abnormal so it will be interesting to see what the lab thinks.

Acute pain- partial thromboembolism that then moved on? Any clinical suggestion of cardiac disease- would be interesting to scan if not and could also scan aorta, but costs. Otherwise spinal pain/infection as you are thinking or myositis- were CK and AST included on your biochem?

Common things are common so cat bite wound somewhere seems most likely!

[/quote] The total count was on a QBC and flagged a relative neutrophilia (I find total counts on these accurate but don't trust the diffs) but as said in the OP I did a stained smear examination and confirmed an absolute lymphocytosis. My biochem panel doesn't include CK and AST, these were offered as an add on but declined due to cost (this is a CP rescue cat) on the basis that it was unlikely to radically alter the treatment protocol. Other examination does not indicate any cardiac disease or ATE. But why would an active cat bite infection give a neutrophilia surely it would be the opposite?

...Stop press... Axiom lab result confirms lymphocytosis, mostly small normal looking lymphocytes

Re: cat in pain with lymphocytosis

Kate Richardson — Wed, 17 Apr 2013 10:53:54 GMT

Common things are common so cat bite wound somewhere seems most likely!

Re: cat in pain with lymphocytosis

Martin Atkinson — Wed, 17 Apr 2013 08:49:58 GMT

[quote user="John Flynn"] Small, silent-looking lymphocytes or larger active or atypical lymphocytes?[/quote] A mixture, mostly small but some that looked half way to being monocytes, I'm sending the smear to Axiom for evaluation.

[quote user="John Flynn"]xrays for diskospondylitis would probably be my next shot rightly or wrongly.[/quote] Good quality X-rays and NAD anywhere, IME discospondylitis has always resulted in a neutrophilia and characteristic 'nibbled out' lesions in the affected vertebrae but its on antibiotics and NSAIDS just in case.

Re: cat in pain with lymphocytosis

Mark Rowland — Tue, 16 Apr 2013 22:55:43 GMT

Could it be deferred renal pain, does the right feel any bigger?

Re: cat in pain with lymphocytosis

Michael Woodhouse — Tue, 16 Apr 2013 22:25:32 GMT

Steroids!

Re: cat in pain with lymphocytosis

Elisabeth Knappett — Tue, 16 Apr 2013 21:50:17 GMT

Any neurological signs? Could it be an embolus/thrombus? Would also be wondering about false negatives on in house tests, ditto about the smear - what did the white cells look like?

Re: cat in pain with lymphocytosis

John Flynn — Tue, 16 Apr 2013 20:40:20 GMT

I think cats can get an (adrenaline) stress lymphocytosis if it disliked the blood sampling that could be one explanation? False negative on in-house FeLV testing always a possibility too, or lymphocytosis due to another virus. Small, silent-looking lymphocytes or larger active or atypical lymphocytes?

I've embarassed myself a couple of times by missing a small abscess brewing in the lumbar spine region, and I've seen a colleague embarass himself by doing spinal rads on a cat in oestrous (the owners mistook "calling" for the equivalent of "blood curdling screaming"), but sounds like you've covered the usuals and xrays for diskospondylitis would probably be my next shot rightly or wrongly.