Generalized Lymphadenopathy Overview

Definition

• Lymphadenopathy is defined as significant enlargement of lymph nodes.
• Criteria for enlargement: >1 cm in axillary and cervical regions; >1.5 cm in inguinal nodes.

Etiology

• Infections
  • Bacterial: tuberculosis, disseminated skin infections.
  • Viral: infectious mononucleosis, cytomegalovirus, HIV.
  • Fungal: histoplasmosis in immunocompromised individuals.
  • Protozoal: toxoplasmosis.
• Malignancy
  • Includes non-Hodgkin lymphoma, Hodgkin lymphoma, acute lymphoblastic leukemia, and histiocytosis.
• Collagen Diseases
  • Rheumatoid arthritis and systemic lupus erythematosus can also cause lymphadenopathy.

Diagnosis and Differential Diagnosis

• Diagnosis includes thorough history and physical examination.
• Acute onset of symptoms suggests viral or bacterial infection; slow onset may indicate TB or malignancy.
• Symptoms such as anorexia, night sweats, weight loss, and family history of TB are indicative of tuberculosis.
• Signs like fever, erythema, and tenderness hint at bacterial infections or abscess formation.
• Non-tender, matted lymph nodes could indicate tuberculosis; firm, hard nodes may suggest malignancy.

Investigations

• Initial Tests
  • Tuberculin test.
  • Complete blood count (CBC) with differential.
  • Serum antibody titers for cytomegalovirus and infectious mononucleosis.
  • Chest X-ray.
• Excisional Lymph Node Biopsy
  • Recommended for persistent fever, significant weight loss and night fever, hard fixed nodes, lymph node size increase despite treatment, or lack of response to therapy.
• Bone Marrow Examination
  • May be indicated for further evaluation.

Treatment

• Treatment approach is based on comprehensive history and meticulous examination.
• Antibiotic therapy is indicated for suspected bacterial infections, especially antistaphylococcal antibiotics.
• If there’s no improvement after 1-2 days, imaging (ultrasound or CT) should be undertaken.
• Drainage of pus is necessary, accompanied by culture and sensitivity tests, gram stain, and Ziehl-Neelsen stain.
• Lack of response within 10-14 days warrants further investigation.

Storage of Blood

• Use blood screened negative for transfusion-transmissible infections.
• Avoid blood past expiry or out of refrigeration for over 2 hours.
• Rapid transfusions (>15 ml/kg/hour) of chilled blood (4°C) may induce hypothermia, especially in infants.

Problems with Blood Transfusion

• Blood can transmit infections such as malaria, syphilis, hepatitis B and C, and HIV.
• Screening of donors for various infections is crucial.
• Only perform blood transfusions when absolutely necessary to minimize risks.

Indications for Blood Transfusion

• Acute blood loss (20-30% of total blood volume with ongoing bleeding).
• Severe anemia.
• Septic shock (if IV fluids alone cannot maintain circulation alongside antibiotic therapy).
• Providing clotting factors when specific components are unavailable.
• Exchange transfusion for neonates with severe jaundice.

Giving a Blood Transfusion

• Confirm blood group matches patient identity on both the bag and documentation.
• Ensure no leaks in the transfusion bag and that it has not been outside refrigeration for more than 2 hours.
• Perform baseline assessments: temperature, respiratory rate, and pulse.
• Start with 20 ml/kg of whole blood transfused over 4 hours.
• Administer 1 mg/kg of furosemide IV at the start if heart failure signs are present.
• Do not inject into the blood pack to prevent contamination.

During Transfusion

• Utilize an infusion device to regulate transfusion rate.
• Monitor for transfusion reactions, especially in the first 15 minutes.
• Record vital signs (appearance, temperature, pulse, and respiratory rate) every 30 minutes.
• Document transfusion start and end times, the volume transfused, and any reactions.

After Transfusion

• Reassess the child. If additional blood is required, transfuse a similar volume and repeat furosemide if previously given.

Transfusion Reactions

• If reactions occur, verify blood pack labels and patient identity.
• Stop transfusion immediately upon discrepancies; notify blood bank for further action.

Mild Reaction

• Caused by mild hypersensitivity; symptoms include itchy rash.
• Management involves slowing down the transfusion and administering chlorpheniramine (0.1 mg/kg IM).
• Continue transfusion at a normal rate if symptoms remain stable for 30 minutes; escalate treatment if symptoms persist.

Moderate to Severe Reaction

• Caused by moderate hypersensitivity or bacterial contamination; symptoms include severe itchy rash, fever, and restlessness.
• Stop transfusion, keep IV line open with normal saline, administer hydrocortisone or chlorphenamine, and send samples to the blood bank.
• Restart transfusion slowly if improvement is noted; if no improvement within 15 minutes, treat as life-threatening.

Life-Threatening Reactions

• Results from hemolysis, contamination, fluid overload, or anaphylaxis; symptoms include fever, confusion, and dark urine.
• Stop transfusion, maintain airway, administer oxygen, and give epinephrine, hydrocortisone, and a bronchodilator if wheezing occurs.
• Report to the doctor and blood laboratory promptly; ensure renal protection with IV furosemide and consider antibiotics for septicemia.

This quiz focuses on the definition and etiology of generalized lymphadenopathy, highlighting significant lymph node enlargement and the various infectious causes. It is designed to enhance your understanding of the underlying factors contributing to this medical condition.