Noticed Blood In Cough. CT Scan Showed Enlarged Lymph Node. What Is The Cause And Cure?

Posted on Tue, 12 Feb 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 12 Feb 2013 Answered on

Sat, 2 Mar 2013 Last reviewed on

Question : Hello, I have a friend in UK. Her x rays and CT scan showed that her lymph nodes are enlarged. Recently she saw blood in her cough. Doctors have conducted tests and ruled out TB. They also said that it does not look anything like cancer. She tested positive for a D dimer test. Doctors suspected that there might be a clot in her lungs. They conducted some test called angiography ( I am not sure of the name ). The test showed that there was no blood clot anywhere in the body. I want to know what all could be the possible reasons for an elevated d dimer ?? In the worst possible situation, god forbid, even if it turns out to be cancer, can it be cured??

Answered by Dr. Das Arindam (2 hours later)

Hello,

Thank you for posting a question.

Look, d dimer is a fibrin degradation product. It is present in higher amount in cases of XXXXXXX vein thrombosis, pulmonary embolism, disseminated intravascular coagulation (DIC), aortic dissection. That means in a word, it indicates a high chance of thrombosis.

As the tests failed to detect any abnormality in lungs, I think, pulmonary embolism is ruled out.

Most commonly, DIC is associated with sepsis and some hematological malignancy like AML M3. That means in cases of leukemia, there is a chance of getting higher value of d dimer.

So, her complete hemogram should be done immediately. It can provide us basic information about presence of any neutrophilia, or leukemia. If suspicion arises flowcytometric analysis should be carried out. CT guided FNAC from the enlarged lymph nodes should be considered.

One more point is anticoagulant prophylaxis. Whatever is the cause, she has higher tendency for developing thrombosis. So, she should be kept on low molecular weight heparin or any other anticoagulant agent prophylactically to prevent any chance of thrombosis.

So, right now, tell her to consult with her treating doctor about the possibilities I have told. And tell her to consult about the diagnostic approach and the anticoagulant therapy I have mentioned.

Hope this information suffices. Let me know if you have any more question.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Das Arindam (7 hours later)

If it turns out to be leukimia.....can it be cured??

Answered by Dr. Das Arindam (53 minutes later)

Hello,

Thank you for writing back.

Look, if it is a leukemia, prognosis can be commented after doing some more tests like cytogenetic analysis, karyotyping, tumor load, response to chemotherapy and many more.

That means just tell her to consult with her treating doctor and keep following up. Wait for the exact diagnosis. After that you can again ask me.

Hope you have your answers.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar