Transcript Erythron

Dog with Icterus
Dennis B. DeNicola, DVM, PhD, DACVP
Chief Veterinary Educator
IDEXX Laboratories
“Coalie”
5 years old
 Spayed female
 Lhasa Apso


Presented with clinical history of anorexia, lethargy and
icterus
“Coalie” - 5 Year-old, Lhasa Apso
WBC
LYM
MONO
NEU
EOS
BASO
%LYM
%MONO
%NEU
%EOS
%BASO
HCT
RBC
HGB
RETIC
=
=
*
*
=
=
=
=
*
*
=
=
=
=
=
72.99
2.77
16.70
51.57
1.51
0.44
3.8
22.9
70.7
2.1
0.6
19.8
2.73
5.8
215.4
K/L
K/L
K/L
K/L
K/L
K/L
%
%
%
%
%
%
M/L
g/dL
K/L
HIGH
HIGH
HIGH
HIGH
HIGH
(
(
(
(
(
(
5.50
0.70
0.10
2.00
0.10
0.00
LOW
LOW
LOW
( 37.0
( 5.50
( 12.0
%RETIC =
7.9
%
MCV
=
72.4
fL
HIGH
( 60.0
RDW
=
21.1
%
HIGH
( 14.7
MCHC
=
29.2
g/dL
LOW
( 31.0
MCH
=
21.10
pg
( 19.50
PLT
=
83
K/L
LOW
( 175
MPV
=
29.78
fL
PCT
=
0.2
%
PDW
=
25.3
%
Differential algorithm issues. Confirm with blood smear
– 16.90 )
– 4.90 )
– 1.40 )
– 12.00 )
– 1.49 )
– 0.10 )
–
–
–
55.0 )
8.50 )
18.0 )
–
72.0 )
–
17.9 )
–
37.0 )
– 24.50 )
–
500 )
“Coalie” - 5 Year-old, Lhasa Apso
Erythron
HCT
RBC
HGB
RETIC
%RETIC
MCV
RDW
MCHC
MCH
=
=
=
=
=
=
=
=
=
19.8
2.73
5.8
215.4
7.9
72.4
21.1
29.2
21.10
%
M/L
g/dL
K/L
%
fL
%
g/dL
pg
LOW
LOW
LOW
( 37.0 – 55.0 )
( 5.50 – 8.50 )
( 12.0 – 18.0 )
HIGH
HIGH
LOW
( 60.0 – 72.0 )
( 14.7 – 17.9 )
( 31.0 – 37.0 )
(19.50 – 24.50)
“Coalie” - 5 Year-old, Lhasa Apso
Erythron
HCT
RBC
HGB
=
=
=
19.8 %
2.73 M/L
5.8 g/dL
LOW
LOW
LOW
( 37.0 – 55.0 )
( 5.50 – 8.50 )
( 12.0 – 18.0 )
“Coalie” - 5 Year-old, Lhasa Apso
Erythron
HCT
RBC
HGB

=
=
=
19.8 %
2.73 M/L
5.8 g/dL
LOW
LOW
LOW
Anemia

Moderately severe
( 37.0 – 55.0 )
( 5.50 – 8.50 )
( 12.0 – 18.0 )
“Coalie” - 5 Year-old, Lhasa Apso
Erythron
HCT
RBC
HGB
RETIC
%RETIC

=
=
=
=
=
19.8 %
2.73 M/L
5.8 g/dL
215.4 K/L
7.9 %
LOW
LOW
LOW
( 37.0 – 55.0 )
( 5.50 – 8.50 )
( 12.0 – 18.0 )
Anemia

Moderately severe, regenerative
“Coalie” - 5 Year-old, Lhasa Apso
Erythron
HCT
RBC
HGB
RETIC
%RETIC
MCV
RDW
MCHC
MCH

=
=
=
=
=
=
=
=
=
19.8
2.73
5.8
215.4
7.9
72.4
21.1
29.2
21.10
%
M/L
g/dL
K/L
%
fL
%
g/dL
pg
LOW
LOW
LOW
( 37.0 – 55.0 )
( 5.50 – 8.50 )
( 12.0 – 18.0 )
HIGH
HIGH
LOW
( 60.0 – 72.0 )
( 14.7 – 17.9 )
( 31.0 – 37.0 )
(19.50 – 24.50)
Anemia

Moderately severe, regenerative, macrocytic and
hypochromic with moderate anisocytosis
Erythron – Data Interpretation

Anemia
Moderately severe
 Macrocytic (increased MCV)
 Hypochromic (decreased MCHC)
 Regenerative (increased Reticulocyte Count)
 Moderate anisocytosis (increased RDW)

Erythron – Data Interpretation

Anemia
Moderately severe
 Macrocytic (increased MCV)
 Hypochromic (decreased MCHC)
 Regenerative (increased Reticulocyte Count)
 Moderate anisocytosis (increased RDW)


No significant morphologic features to help identify
underlying etiopathogenesis
Erythron – Data Interpretation

Anemia
Moderately severe
 Macrocytic (increased MCV)
 Hypochromic (decreased MCHC)
 Regenerative (increased Reticulocyte Count)
 Moderate anisocytosis (increased RDW)

No significant morphologic features to help identify
underlying etiopathogenesis
 Additional clinical information – recent bleeding into
gastrointestinal tract

“Coalie” - 5 Year-old, Lhasa Apso
Leukon
WBC
=
72.99 K/L
LYM
=
2.77 K/L
MONO *
16.70 K/L
NEU
*
51.57 K/L
EOS
*
1.51 K/L
BASO
*
0.44 K/L
%LYM =
3.8 %
%MONO *
22.9 %
%NEU *
70.7 %
%EOS *
2.1 %
%BASO *
0.6 %
Differential algorithm issues.
HIGH
HIGH
HIGH
HIGH
HIGH
(
(
(
(
(
(
5.50 – 16.90 )
0.70 – 4.90 )
0.10 – 1.40 )
3.00 – 12.00 )
0.10 – 1.49 )
0.00 – 0.10 )
Confirm with blood smear.
“Coalie” - 5 Year-old, Lhasa Apso
Leukon
WBC
=
72.99 K/L
HIGH
( 5.50 – 16.90 )
“Coalie” - 5 Year-old, Lhasa Apso
Leukon
WBC
=
72.99 K/L
( 5.50 – 16.90 )
HIGH

Leukocytosis

Marked
“Coalie” - 5 Year-old, Lhasa Apso
Leukon
WBC
=
LYM
=
MONO *
NEU
*
EOS
*
BASO
*
%LYM =
%MONO *
%NEU *
%EOS *
%BASO *
72.99
2.77
16.70
51.57
1.51
0.44
3.8
22.9
70.7
2.1
0.6
K/L
K/L
K/L
K/L
K/L
K/L
%
%
%
%
%
HIGH
HIGH
HIGH
HIGH
HIGH
(
(
(
(
(
(
5.50 – 16.90 )
0.70 – 4.90 )
0.10 – 1.40 )
3.00 – 12.00 )
0.10 – 1.49 )
0.00 – 0.10 )
“Coalie” - 5 Year-old, Lhasa Apso
Leukon
WBC
=
LYM
=
MONO *
NEU
*
EOS
*
BASO
*
%LYM =
%MONO *
%NEU *
%EOS *
%BASO *
72.99
2.77
16.70
51.57
1.51
0.44
3.8
22.9
70.7
2.1
0.6
K/L
K/L
K/L
K/L
K/L
K/L
%
%
%
%
%
HIGH
(
(
(
(
(
(
HIGH
HIGH
HIGH
HIGH

5.50 – 16.90 )
0.70 – 4.90 )
0.10 – 1.40 )
3.00 – 12.00 )
0.10 – 1.49 )
0.00 – 0.10 )
Leukocytosis


Marked with neutrophilia,
monocytosis, eosinophilia
and basophilia
Normal lymphocytes
Leukogram Interpretation

Marked leukocytosis
Neutrophilia, Monocytosis, Eosinophilia, Basophilia
 Inflammation with prominent tissue demand for
macrophages
 Potential relatively established inflammation since no
obvious lymphocytopenia (“glucocorticoid influence”)

Erythron – Blood Film
Erythron – Blood Film
Erythron – Blood Film
Erythron – Blood Film
Erythron – Blood Film
Erythron – Blood Film
Erythron – Blood Film
Erythron – Blood Film
Leukogram Interpretation

Marked leukocytosis
Neutrophilia, Monocytosis
 Mild neutrophil toxicity
 Inflammation with prominent tissue demand for
macrophages
 Potential relatively established inflammation since no
obvious lymphocytopenia (“glucocorticoid influence”)

“Coalie” - 5 Year-old, Lhasa Apso
Thrombon
PLT

=
83 K/L
Thrombocytopenia

Moderate
LOW
( 175 – 500 )
“Coalie” - 5 Year-old, Lhasa Apso
Thrombon
PLT
MPV

=
=
83 K/L
29.78 fL
LOW
( 175 – 500 )
Thrombocytopenia

Moderate with enlarged platelets
“Coalie” - 5 Year-old, Lhasa Apso
Thrombon
PLT
MPV
PCT
PDW

=
=
=
=
83 K/L
29.78 fL
0.2 %
25.3 %
LOW
( 175 – 500 )
Thrombocytopenia

Moderate with enlarged platelets and variably-sized
platelets
Erythron – Blood Film
Thrombon - Interpretation

Moderate thrombocytopenia
Clumped platelets at feathered edge
 Possible underestimation of numbers
 Enlarged and variably-sized platelets
 Suggesting bone marrow response to a peripheral
demand

– Peripheral consumption (Inflammation, DIC, etc.)
– Peripheral destruction
“Coalie” - 5 Year-old, Lhasa Apso
WBC
LYM
MONO
NEU
EOS
BASO
%LYM
%MONO
%NEU
%EOS
%BASO
HCT
RBC
HGB
RETIC
=
=
*
*
=
=
=
=
*
*
=
=
=
=
=
72.99
2.77
16.70
51.57
1.51
0.44
3.8
22.9
70.7
2.1
0.6
19.8
2.73
5.8
215.4
K/L
K/L
K/L
K/L
K/L
K/L
%
%
%
%
%
%
M/L
g/dL
K/L
HIGH
HIGH
HIGH
HIGH
HIGH
(
(
(
(
(
(
5.50
0.70
0.10
2.00
0.10
0.00
LOW
LOW
LOW
( 37.0
( 5.50
( 12.0
%RETIC =
7.9
%
MCV
=
72.4
fL
HIGH
( 60.0
RDW
=
21.1
%
HIGH
( 14.7
MCHC
=
29.2
g/dL
LOW
( 31.0
MCH
=
21.10
pg
( 19.50
PLT
=
83
K/L
LOW
( 175
MPV
=
29.78
fL
PCT
=
0.2
%
PDW
=
25.3
%
Differential algorithm issues. Confirm with blood smear
– 16.90 )
– 4.90 )
– 1.40 )
– 12.00 )
– 1.49 )
– 0.10 )
–
–
–
55.0 )
8.50 )
18.0 )
–
72.0 )
–
17.9 )
–
37.0 )
– 24.50 )
–
500 )