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 )