Cat with persistent/worsening leucocytosis

RE: Cat with persistent/worsening leucocytosis

Mark Hedberg — Mon, 30 Nov 2015 09:22:39 GMT

[quote user="Linda Filshie"]

Is there a "smiley" for tearing your hair out??!

[/quote]

No, but there is one for banging your head against the wall, is that any good?

RE: Cat with persistent/worsening leucocytosis

Linda Filshie — Mon, 30 Nov 2015 00:39:14 GMT

An update!

I don't have an FIP titre, Wynne. Given that his cell counts gave been climbing since the summer and he's not clinically unwell I'm not sure if this would add value at this stage. Any opinions?

I do have bone marrow aspirate/biopsy results - consistent with myeloid hyperplasia and mild erythroid hypoplasia. I'll post the comment if there is interest.

I've discussed his case with an internal medicine specialist with an interest in haematology and she discussed it with her oncologist colleague. I've also discussed with the pathologist at the lab.

Opinions are:

1. The oncologist thinks leukaemia unlikely given left shift evident and we should be looking for peripheral disease.

2. The internal medicine specialist thinks leukaemia is the most likely diagnosis.

3. The pathologist thought at the time of bone marrow sampling (when his white cell count was about 60 x109) that he was pre-leukaemic.

Is there a "smiley" for tearing your hair out??!

His latest white cell count (Friday) is 80 x 109! Red cell count slowly dropping but hct still >30. The cat is still clinically well. I've asked the pathologist who I spoke to to review his blood film. Again, watch this space.

RE: Cat with persistent/worsening leucocytosis

Hannah Wynne Richards — Fri, 13 Nov 2015 17:43:47 GMT

He's a bit old, but what's his FIP titre?

Wynne

RE: Cat with persistent/worsening leucocytosis

Anthony Todd — Fri, 30 Oct 2015 22:37:37 GMT

I suppose you all have googled "unexplained leucocytosis" but this seemed to be a start?

http://asheducationbook.hematologylibrary.org/content/2012/1/475.full

I didn't go through the 89,200 links though....

RE: Cat with persistent/worsening leucocytosis

Linda Filshie — Fri, 30 Oct 2015 21:03:41 GMT

Chest XRs NAD. Got what seemed like a good aspirate and biopsy, so shall await results.

Cat is still fine in himself. Put on weight since last seen!

RE: Cat with persistent/worsening leucocytosis

Linda Filshie — Fri, 23 Oct 2015 19:40:37 GMT

So FIV /FeLV negative, serum protein electrophoresis results:

"Albumin is normal on the trace. There is a marginal increase in beta globulins with a marginal increase in gamma globulins comprising a discrete narrow band in the gamma region of the trace with a more diffuse band towards the cathode. Other globulin fractions are normal.

Comment

The narrow gamma band may represent an oligoclonal (restricted polyclonal) or monoclonal peak superimposed on a polyclonal gamma globulin response. In an older cat, this may be reactive, may be associated with FIP or may be associated with B cell neoplasia (lymphoma or multiple myeloma)."

I examined the cat again on Wednesday when I took the bloods. (BTW WCC has now climbed to 60, neutrophil count about 56 x 109.)

Pathologist comment on the smear: no abnormal white cells seen.

I put the cat on broad spec AB for a 10 day period in late summer and it made bugger-all difference to the WCC, in fact it rose during the course of treatment.

His appetite remains normal, his weight is stable, behaviour normal at home, abdominal palpation NAD, no locomotor problems, ocular exam including fundus ok, peripheral LNs normal size, chest ausc : he has a grade 1 murmur. He's had this murmur for years and has had an echo twice, most recently within the last 12 months. He's not currently tachycardic or showing any signs of CHF. The lung fields sound clear. His respiratory rate in the clinic is about 24, respiratory effort is normal. I'm confident that he hasn't got a nice juicy CBA waiting to pop.

He's hopefully coming in for chest rads (and catogram, why not) and bone marrow biopsy next week. No access to in house ultrasound at the moment.

Watch this space...

RE: Cat with persistent/worsening leucocytosis

Anthony Todd — Wed, 21 Oct 2015 15:05:50 GMT

What happened or is happening?

Honestly, and I await the shower of something smelly, but BITD, we diagnosed "an unfound septic focus", "abscess" covered it, and put them on a week's broad spectrum A/Bs.

If that didn't fix it we usually found something obvious when they came back....er, FIP etc. and go for bloods, chest or abdo tap etc.

RE: Cat with persistent/worsening leucocytosis

Laura Marshall — Wed, 14 Oct 2015 17:45:58 GMT

I would also think about getting a pathologist to look at a blood smear.

RE: Cat with persistent/worsening leucocytosis

Kate Richardson — Wed, 14 Oct 2015 11:02:47 GMT

Protein electrophoresis- should help you differentiate hyperglobulinaemia of inflammation from neoplasia

RE: Cat with persistent/worsening leucocytosis

Linda Filshie — Wed, 14 Oct 2015 10:34:02 GMT

Anthony - we did an abdo scan 6 weeks ago - all ok bar mild mesenteric lymphadenopathy. No effusion, no organomegaly. Could repeat it of course. We don't have a scanner at the moment (soon, soon!) so would need to borrow one, send him elsewhere or get the mobile scanner back again.

Martin - the mouth looks great at the moment. Tiny amount of inflammation in one of the fauces but looks so much better than it has done in ages.

I think FeLV/FIV and chest rads +/- bone biopsy sounds like the way to go.

RE: Cat with persistent/worsening leucocytosis

Martin Atkinson — Wed, 14 Oct 2015 10:22:28 GMT

Most likely there is some nidus of infection - how active is the gingivitis? Its always worth doing FeLV/FIV tests and a chest X-ray in cats. But it might be a chronic myeloid/granulocytic leukaemia. Imaging might show hepato/splenomegaly and a bone marrow biopsy will show intense hyperplasia of the neuthrophil series although these tend to look normal in the marrow and the blood.

RE: Cat with persistent/worsening leucocytosis

Anthony Dennison — Wed, 14 Oct 2015 09:29:25 GMT

I would suggest some imaging - ultrasound can be used to look at the abdomen and check for pleural fluid if you have one? Cat-o-gram radiographs may be useful too.