Persistent neutrophilia/lymphocytosis

Re: Persistent neutrophilia/lymphocytosis

Kate Richardson — Sun, 25 Jan 2015 18:48:49 GMT

Hi Laura

I agree with repeating a full biochem as well as you have raised liver enzymes on the initial sample and potassium is low normal, and often artefactually higher on external bloods due to leakage from cells, so if cat still inappetant, may well be more severely hypokalaemic by now which may not be the underlying problem but will need addressing.

Reassess proteins and liver enzymes- bloods certainly suggest bone marrow stimulation and the monocytosis indicates chronic inflammation, unlikely primary bone marrow disease as rbcs and platelets normal.

See what repeat biochem shows and do a urinalysis and start thinking about imaging.

Clinically are there are any other symptoms other than weight loss and inappetance? Was the inappetance present on initial presentation? Temp normal? no history of vomiting/diarrhoea (no matter how infrequent or 'normal' the owners think it is?)

Re: Persistent neutrophilia/lymphocytosis

Laura Marshall — Sat, 24 Jan 2015 10:29:25 GMT

Thank you for the Graham, I'll send you a message!

Re: Persistent neutrophilia/lymphocytosis

Graham Bilbrough — Fri, 23 Jan 2015 20:51:02 GMT

Thank you.

I don't have too much to add to the case as I am not a clinical pathologist or an internal medic. Did you call our internal medicine team?

I'm surprised there is no lymphadenopathy. I am thinking of chronic immune stimulation: toxo, FeLV/FIV, IBD, pancreatitis... I am sure the others will have better ideas. Is there money for an abdominal ultrasound? Later, we might consider flow cytometry.

In the meantime, I would like to investigate your in-clinic analyzer. Please send me a private message with your practice details and I will look into this.

Thanks

Graham

Re: Persistent neutrophilia/lymphocytosis

Laura Marshall — Fri, 23 Jan 2015 20:32:24 GMT

Results are external from IDEXX rather than on internal machine (as results are always asterixed on our machine and unreliable, to which we're getting no resolution with IDEXX but that's a separate issue!). I have no dot plots for the results.

Re: Persistent neutrophilia/lymphocytosis

Graham Bilbrough — Fri, 23 Jan 2015 18:40:31 GMT

Can you give us the full set of results please? I am particularly interested in the graphic output of the haematology analyzer.

Thanks

Graham

Re: Persistent neutrophilia/lymphocytosis

Hannah Wynne Richards — Fri, 23 Jan 2015 18:34:45 GMT

Definitely do FELV/FIV

Wynne

Re: Persistent neutrophilia/lymphocytosis

Laura Marshall — Fri, 23 Jan 2015 18:15:03 GMT

On all occasions, and no abnormalities have been reported.

Re: Persistent neutrophilia/lymphocytosis

Anthony Dennison — Fri, 23 Jan 2015 14:14:23 GMT

Has a blood film exam been done to examine the lymphocytes? Might be worth doing to see if they do look abnormal

Re: Persistent neutrophilia/lymphocytosis

Laura Marshall — Fri, 23 Jan 2015 13:19:29 GMT

OK, take two!

11yo FN DSH - presented for weight loss

Clinical exam - weight loss, bilateral lower lid entropion (apparently present for some years)

Bloods taken for haematology, biochemistry and tT4.

Haem- neutrophils 20.41 (2.5-12.5), lymphocytes 15.79 (2-7), monocytes 1.16 (<0.6), eosinophils 1.16 (0-0.7)

Biochem - globs 53.4 (25-45), ALT 223.7 (5-60), ALKP 77 (<60)

tT4 norm.

Tx with cefovecin (owners couldn't tablet...) and reassessed after 2 weeks with repeat haematology.

Owners report brighter, appetite good and weight gain on clinical exam.

Haem - neut 13.59 (2.5-12.5), lymph 7.41 (2-7), mono 3.21 (<0.6) otherwise normal.

Tx continued with another inj of cefovecine.

Rechecked this week (2nd 2week check). Two days of inappetance (resolved) and weight loss again.

Haem - neut 19.75 (2.5-12.5), lymph 14.36 (2-7), mono 1.44 (<0.6).

So, after initially thinking I was getting a response, things now look the same again. I am quite concerned about this haemogram and whether this is reactive or neoplastic. I'm thinking I need to repeat full bloods (on writing this not sure why didn't repeat biochem as well) and add a FeLV/FIV. I don't think I've ever had such a high persistent lymphocytosis before!

Thanks in advance!

Re: Persistent neutrophilia/lymphocytosis

Laura Marshall — Thu, 22 Jan 2015 13:55:50 GMT

Ok, no idea why this has only posted 1/3 of what I've written. I guess not iPad friendly? I'll post it again when I'm home!