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586 Leukemias, Acute

metabolic, nutritional/neoplastic, infectious/ • Echocardiogram PROGNOSIS & OUTCOME
inflammatory/ischemic/immune-mediated, • CT or MRI Prognosis depends on the cause. The patient
VetBooks.ir • VINDICATE’M scheme: vascular, infectious/ TREATMENT and diagnostic plan need to be re-evaluated if
trauma/toxin, vascular disease
clinical signs persist or worsen despite initial
inflammatory, neoplastic, degenerative/
deficiency/drugs, idiopathic/intoxication/
Treatment should be targeted to the defini-
iatrogenic, congenital, autoimmune/allergic/ Treatment Overview treatment.
anatomic, traumatic, endocrine or environ- tive or suspected diagnosis and/or aid in the PEARLS & CONSIDERATIONS
mental, metabolic comfort of the patient. For most situations,
antibiotics, glucocorticoids, and nonsteroidal Comments
Initial Database antiinflammatory drugs (NSAIDs) should be Glucocorticoids and NSAIDs inhibit the
• CBC, serum biochemistry profile, urinalysis withheld until a diagnosis is reached or when arachidonic acid cascade and therefore essential
with sediment exam the potential benefits greatly outweigh patient prostaglandins. Inhibition of prostaglandins
• Noninvasive blood pressure risk (e.g., broad-spectrum antibiotics for fever may result in damage to the protective GI
• Retroviral testing (cats): feline leukemia virus/ of unknown origin). mucosal barrier and acute kidney injury.
feline immunodeficiency virus (FeLV/FIV) These treatments should be recommended on
Acute General Treatment a case-by-case basis and should be avoided in
Advanced or Confirmatory Testing • Ideally, treatment should be specific to the situations of malperfusion or shock.
Advanced testing depends on the results of underlying disease process.
initial diagnostic tests but may include: • Symptomatic outpatient therapy (e.g., bland Technician Tips
• Diagnostic imaging: thoracic/abdominal diet, gastroprotectants, ± antiemetic for Serial physical exams may aid in disease or
radiographs, abdominal ultrasound animals with GI signs) may be appropri- problem localization. Frequent evaluation of
• Arterial or venous blood gas exam ate for patients showing mild, nonspecific mental status, respiratory rate/effort, pulse rate/
• Endocrine testing: ACTH stimulation test, signs. strength, and comfort is essential.
thyroxine/thyroid-stimulating hormone (T 4 / • Antibiotics should be administered only if
TSH), low-dose dexamethasone suppression infection is documented or highly suspected. SUGGESTED READING
test (LDDST) Antibiotic choice should be based on the Brewer FC: Weakness. In Ettinger SJ, et al, editors:
• Fluid analysis (abdominal, thoracic, joint, likely pathogen, confirmed by culture and Textbook of veterinary internal medicine, ed 8, St.
cerebrospinal fluid [CSF]) sensitivity, and de-escalated when possible. Louis, Saunders, 2017, pp 91-94.
• Infectious disease testing/titers: consider AUTHOR: Meghan Harmon, DVM, DACVECC
regional prevalence, additional clues (e.g., Possible Complications EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
puppy – parvovirus ELISA; Lyme serology Client follow-up is essential in cases of non-
in northeastern United States) specific lethargy because failure to respond to
• Cytology or histopathology (fine-needle empirical therapy or time may warrant addi-
aspiration, bone marrow biopsy) tional diagnostics, treatment, and/or referral.

Leukemias, Acute Client Education
Sheet

BASIC INFORMATION • Myelodysplastic syndromes can progress to PHYSICAL EXAM FINDINGS
AML. • Lethargy, weakness, pallor, weight loss,
Definition dehydration
Acute leukemias (ALs) are clonal proliferations ASSOCIATED DISORDERS • Fever
of malignant immature lymphoid or hemato- • ALL in dogs: hypercalcemia • Tachypnea/dyspnea, tachycardia (anemia)
poietic (myeloid) progenitor cells in the bone • AML in cats: myelofibrosis, hypercalcemia, • Hepatomegaly, splenomegaly
marrow/blood. glomerulonephritis • Lymphadenopathy (mild)
• Petechiae, ecchymoses, epistaxis, gastro-
Epidemiology Clinical Presentation intestinal (GI) bleeding
SPECIES, AGE, SEX DISEASE FORMS/SUBTYPES • Hyphema, uveitis, retinal hemorrhage
• Young cats and dogs more commonly Acute Lymphoid Leukemias: • Neurologic signs
affected; acute lymphoblastic leukemias • Contradictory reports of most common
(ALLs) in dogs: median age of 7 years phenotype in dogs Etiology and Pathophysiology
• Purebred large-breed dogs predominate (e.g., • T-cell leukemia: most common immuno- • ALs are diseases of the bone marrow.
German shepherd dogs and retrievers). phenotype in cats Leukemic cells crowd normal cells, change
Acute myeloid leukemias: the marrow microenvironment, and secrete
RISK FACTORS • Reports suggest more common than ALL suppressor factors (myelophthisis). Normal
• Feline leukemia virus (FeLV) infection: • Classified based on type of blasts (p. 1432) hematopoiesis decreases, causing anemia,
historically, > 60% of cats with ALL were neutropenia, and thrombocytopenia.
FeLV positive and ≥ 90% of cats with HISTORY, CHIEF COMPLAINT Cytopenias result in weakness, secondary
acute myeloid leukemias (AMLs) were • Lethargy, weakness, inappetance, weight loss infections, and hemorrhage.
FeLV positive. Current infection rates • Vomiting, diarrhea • Hepatic and splenic infiltration results in
are unknown but thought to be lower • Hemorrhage (e.g., epistaxis, petechiae) organomegaly, abdominal distention, and loss
(p. 329). • Lameness (bone pain) of appetite. Other sites may be involved,
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