Transcript IDEXX

Dog with Lethargy and Depression
Dennis B. DeNicola, DVM, PhD, DACVP
Chief Veterinary Educator
IDEXX Laboratories
“Ryan”
7.5 years old
 Neutered male
 Labrador Retriever


Presented with clinical history of recent (several days)
onset lethargy and depression
“Ryan” - 7.5 Year-old, Labrador Retriever
WBC
LYM
MONO
NEU
EOS
BASO
%LYM
%MONO
%NEU
%EOS
%BASO
HCT
RBC
HGB
RETIC
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
88.43
9.45
5.82
70.34
2.34
0.48
10.7
6.6
79.5
2.7
0.5
19.8
2.58
9.3
145.6
K/L
K/L
K/L
K/L
K/L
K/L
%
%
%
%
%
%
M/L
g/dL
K/L
HIGH
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 =
5.6
%
MCV
=
76.8
fL
HIGH
( 60.0
RDW
=
22.2
%
HIGH
( 14.7
MCHC
=
47.0
g/dL
HIGH
( 31.0
MCH
=
36.03
pg
HIGH
( 19.50
PLT
=
747
K/L
HIGH
( 175
MPV
=
19.62
fL
PCT
=
1.5
%
PDW
=
30.3
%
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 )
“Ryan” - 7.5 Year-old, Labrador Retriever
Erythron
HCT
RBC
HGB
RETIC
%RETIC
MCV
RDW
MCHC
MCH
=
=
=
=
=
=
=
=
=
19.8
2.58
9.3
145.6
5.6
76.8
22.2
47.0
36.03
%
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
HIGH
HIGH
( 60.0 – 72.0 )
( 14.7 – 17.9 )
( 31.0 – 37.0 )
(19.50 – 24.50)
“Ryan” - 7.5 Year-old, Labrador Retriever
Erythron
HCT
RBC
HGB

=
=
=
19.8 %
2.58 M/L
9.3 g/dL
LOW
LOW
LOW
Anemia

Moderately severe
( 37.0 – 55.0 )
( 5.50 – 8.50 )
( 12.0 – 18.0 )
“Ryan” - 7.5 Year-old, Labrador Retriever
Erythron
HCT
RBC
HGB
RETIC
%RETIC

=
=
=
=
=
19.8 %
2.58 M/L
9.3 g/dL
145.6 K/L
5.6 %
LOW
LOW
LOW
( 37.0 – 55.0 )
( 5.50 – 8.50 )
( 12.0 – 18.0 )
Anemia

Moderately severe, regenerative
“Ryan” - 7.5 Year-old, Labrador Retriever
Erythron
HCT
RBC
HGB
RETIC
%RETIC
MCV
RDW
MCHC
MCH

=
=
=
=
=
=
=
=
=
19.8
2.58
9.3
145.6
5.6
76.8
22.2
47.0
36.03
%
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
HIGH
HIGH
( 60.0 – 72.0 )
( 14.7 – 17.9 )
( 31.0 – 37.0 )
(19.50 – 24.50)
Anemia

Moderately severe, regenerative, macrocytic and
“hyperchromic” with moderate anisocytosis
Erythron – Data Interpretation

Anemia
Moderately severe
 Macrocytic (MCV)
 “Hyperchromic” (MCHC) – hemolytic specimen
 Regenerative (Reticulocyte Count)
 Moderate anisocytosis (RDW)

Erythron – Blood Film
Erythron – Blood Film
Erythron – Blood Film
Rouleaux
Agglutination
Saline Agglutination Test
Saline Solution
Agglutination
Rouleaux
Erythron – Blood Film
Erythron – Blood Film
Erythron – Blood Film Interpretation

Anemia
Moderately severe
 Regenerative
 Polychromasia
 Anisocytosis
 Immune mediated extravascular hemolysis
 Spherocytosis
 Suggestion of autoagglutination

– Requires saline dilution confirmation
“Ryan” - 7.5 Year-old, Labrador Retriever
Leukon
WBC
=
88.43 K/L
LYM
=
9.45 K/L
MONO =
5.82 K/L
NEU
=
70.34 K/L
EOS
=
2.34 K/L
BASO =
0.48 K/L
%LYM =
10.7 %
%MONO =
6.6 %
%NEU =
79.5 %
%EOS =
2.7 %
%BASO =
0.5 %
Differential algorithm issues.
HIGH
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.
“Ryan” - 7.5 Year-old, Labrador Retriever
Leukon
WBC
=
88.43 K/L
( 5.50 – 16.90 )
HIGH

Leukocytosis

Marked
“Ryan” - 7.5 Year-old, Labrador Retriever
Leukon
WBC
=
88.43 K/L
LYM
=
9.45 K/L
MONO =
5.82 K/L
NEU
=
70.34 K/L
EOS
=
2.34 K/L
BASO =
0.48 K/L
%LYM =
10.7 %
%MONO =
6.6 %
%NEU =
79.5 %
%EOS =
2.7 %
%BASO =
0.5 %
Differential algorithm issues.
HIGH
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 increases in all
leukocyte forms
Confirm with blood smear.
Leukon – Blood Film
Leukon – Blood Film
Leukon – Blood Film
Leukon – Blood Film
Leukon – Blood Film
Leukogram Interpretation

Marked leukocytosis
Increases in all leukocyte forms
 Marked neutrophilia with possible slight left shift
 Inflammation with evidence of systemic antigenic
stimulation (lymphocytosis) and tissue demand for
macrophages (monocytosis)

“Ryan” - 7.5 Year-old, Labrador Retriever
Thrombon
PLT

=
747 K/L
Thrombocytosis

Mild
HIGH
( 175 – 500 )
“Ryan” - 7.5 Year-old, Labrador Retriever
Thrombon
PLT
MPV

=
=
747 K/L
19.62 fL
HIGH
( 175 – 500 )
Thrombocytosis

Mild with enlarged platelets
“Ryan” - 7.5 Year-old, Labrador Retriever
Thrombon
PLT
MPV
PCT
PDW

=
=
=
=
747 K/L
19.62 fL
1.5 %
30.3 %
HIGH
( 175 – 500 )
Thrombocytosis

Mild with enlarged platelets and variably-sized platelets
Thrombon
Thrombon - Interpretation

Mild thrombocytosis
Clumped platelets at feathered edge
 Probable underestimation of numbers
 Enlarged and variably-sized platelets
 Suggesting bone marrow response to a peripheral
demand

“Ryan” - 7.5 Year-old, Labrador Retriever
WBC
LYM
MONO
NEU
EOS
BASO
%LYM
%MONO
%NEU
%EOS
%BASO
HCT
RBC
HGB
RETIC
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
88.43
9.45
5.82
70.34
2.34
0.48
10.7
6.6
79.5
2.7
0.5
19.8
2.58
9.3
145.6
K/L
K/L
K/L
K/L
K/L
K/L
%
%
%
%
%
%
M/L
g/dL
K/L
HIGH
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 =
5.6
%
MCV
=
76.8
fL
HIGH
( 60.0
RDW
=
22.2
%
HIGH
( 14.7
MCHC
=
47.0
g/dL
HIGH
( 31.0
MCH
=
36.03
pg
HIGH
( 19.50
PLT
=
747
K/L
HIGH
( 175
MPV
=
19.62
fL
PCT
=
1.5
%
PDW
=
30.3
%
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 )