Transcript IDEXX

“Algorithm Issues”
in a Canine Hemogram
Dennis B. DeNicola, DVM, PhD, DACVP
Chief Veterinary Educator
IDEXX Laboratories
11 year-old, intact male Beagle
WBC
LYM
MONO
NEU
EOS
BASO
%LYM
%MONO
%NEU
%EOS
%BASO
HCT
RBC
HGB
RETIC
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
18.69
3.00
2.73
12.24
0.62
0.11
16.0
14.6
65.5
3.3
0.6
52.5
7.80
19.5
38.9
K/L
K/L
K/L
K/L
K/L
K/L
%
%
%
%
%
%
M/L
g/dL
K/L
HIGH
HIGH
(
(
(
(
(
(
HIGH
( 37.0
( 5.50
( 12.0
HIGH
HIGH
5.50
0.70
0.10
2.00
0.10
0.00
%RETIC =
0.5
%
MCV
=
67.3
fL
( 60.0
RDW
=
15.5
%
( 14.7
MCHC
=
37.2
g/dL
HIGH
( 31.0
MCH
=
25.03
pg
HIGH
( 19.50
PLT
=
156.
K/L
LOW
( 175
MPV
=
29.38
fL
PCT
=
0.5
%
PDW
=
19.8
%
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 )
11 year-old, intact male Beagle
Erythron
HCT
RBC
HGB
RETIC
%RETIC
MCV
RDW
MCHC
MCH
=
=
=
=
=
=
=
=
=
52.5
7.80
19.5
38.9
0.5
67.3
15.5
37.2
25.03
%
M/L
g/dL
K/L
%
fL
%
g/dL
pg
HIGH
( 37.0 – 55.0 )
( 5.50 – 8.50 )
( 12.0 – 18.0 )
HIGH
HIGH
( 60.0 – 72.0 )
( 14.7 – 17.9 )
( 31.0 – 37.0 )
(19.50 – 24.50)
11 year-old, intact male Beagle
Erythron
HCT
RBC
HGB
RETIC
%RETIC
MCV
RDW
MCHC
MCH

=
=
=
=
=
=
=
=
=
52.5
7.80
19.5
38.9
0.5
67.3
15.5
37.2
25.03
%
M/L
g/dL
K/L
%
fL
%
g/dL
pg
Hyperchromasia
HIGH
( 37.0 – 55.0 )
( 5.50 – 8.50 )
( 12.0 – 18.0 )
HIGH
HIGH
( 60.0 – 72.0 )
( 14.7 – 17.9 )
( 31.0 – 37.0 )
(19.50 – 24.50)
11 year-old, intact male Beagle
Erythron
HCT
RBC
HGB
RETIC
%RETIC
MCV
RDW
MCHC
MCH

=
=
=
=
=
=
=
=
=
52.5
7.80
19.5
38.9
0.5
67.3
15.5
37.2
25.03
%
M/L
g/dL
K/L
%
fL
%
g/dL
pg
HIGH
( 37.0 – 55.0 )
( 5.50 – 8.50 )
( 12.0 – 18.0 )
HIGH
HIGH
( 60.0 – 72.0 )
( 14.7 – 17.9 )
( 31.0 – 37.0 )
(19.50 – 24.50)
Hyperchromasia


Physiologically impossible
Extracellular hemoglobin (hemolysis)
Erythron Interpretation
No significant abnormalities
 Hyperchromasia

Physiologically impossible
 Probable in vitro or in vivo hemolysis
 Extracellular hemoglobin present

11 year-old, intact male Beagle
Leukon
WBC
=
18.69 K/L
LYM
=
3.00 K/L
MONO =
2.73 K/L
NEU
=
12.24 K/L
EOS
=
0.62 K/L
BASO =
0.11 K/L
%LYM =
16.0 %
%MONO =
14.6 %
%NEU =
65.5 %
%EOS =
3.3 %
%BASO =
0.6 %
Differential algorithm issues.
HIGH
HIGH
HIGH
HIGH
(
(
(
(
(
(
5.50 – 16.90 )
0.70 – 4.90 )
0.10 – 1.40 )
2.00 – 12.00 )
0.10 – 1.49 )
0.00 – 0.10 )
Confirm with blood smear.
11 year-old, intact male Beagle
Leukon
WBC
=
18.69 K/L
( 5.50 – 16.90 )
HIGH

Mild leukocytosis
11 year-old, intact male Beagle
Leukon
WBC
=
18.69 K/L
LYM
=
3.00 K/L
MONO =
2.73 K/L
NEU
=
12.24 K/L
EOS
=
0.62 K/L
BASO =
0.11 K/L
%LYM =
16.0 %
%MONO =
14.6 %
%NEU =
65.5 %
%EOS =
3.3 %
%BASO =
0.6 %
Differential algorithm issues.
HIGH
(
(
(
(
(
(
HIGH
HIGH
HIGH

5.50 – 16.90 )
0.70 – 4.90 )
0.10 – 1.40 )
2.00 – 12.00 )
0.10 – 1.49 )
0.00 – 0.10 )
Mild leukocytosis

Minimal neutrophilia
Confirm with blood smear.
11 year-old, intact male Beagle
Leukon
WBC
=
18.69 K/L
LYM
=
3.00 K/L
MONO =
2.73 K/L
NEU
=
12.24 K/L
EOS
=
0.62 K/L
BASO =
0.11 K/L
%LYM =
16.0 %
%MONO =
14.6 %
%NEU =
65.5 %
%EOS =
3.3 %
%BASO =
0.6 %
Differential algorithm issues.
HIGH
(
(
(
(
(
(
HIGH
HIGH
HIGH

5.50 – 16.90 )
0.70 – 4.90 )
0.10 – 1.40 )
2.00 – 12.00 )
0.10 – 1.49 )
0.00 – 0.10 )
Mild leukocytosis


Minimal neutrophilia
Mild monocytosis
Confirm with blood smear.
11 year-old, intact male Beagle
Leukon
WBC
=
18.69 K/L
LYM
=
3.00 K/L
MONO =
2.73 K/L
NEU
=
12.24 K/L
EOS
=
0.62 K/L
BASO =
0.11 K/L
%LYM =
16.0 %
%MONO =
14.6 %
%NEU =
65.5 %
%EOS =
3.3 %
%BASO =
0.6 %
Differential algorithm issues.
HIGH
(
(
(
(
(
(
HIGH
HIGH
HIGH

5.50 – 16.90 )
0.70 – 4.90 )
0.10 – 1.40 )
2.00 – 12.00 )
0.10 – 1.49 )
0.00 – 0.10 )
Mild leukocytosis


Minimal neutrophilia
Mild monocytosis
Confirm with blood smear.

Minimal basophilia
11 year-old, intact male Beagle
Leukon
WBC
=
18.69 K/L
LYM
=
3.00 K/L
MONO =
2.73 K/L
NEU
=
12.24 K/L
EOS
=
0.62 K/L
BASO =
0.11 K/L
%LYM =
16.0 %
%MONO =
14.6 %
%NEU =
65.5 %
%EOS =
3.3 %
%BASO =
0.6 %
Differential algorithm issues.
HIGH
(
(
(
(
(
(
HIGH
HIGH
HIGH

5.50 – 16.90 )
0.70 – 4.90 )
0.10 – 1.40 )
2.00 – 12.00 )
0.10 – 1.49 )
0.00 – 0.10 )
Mild leukocytosis


Minimal neutrophilia
Mild monocytosis
Confirm with blood smear.

Minimal basophilia
Leukogram Interpretation

Mild leukocytosis
Minimal neutrophilia
 Potential “normal” for this animal
 Potential physiologic (epinephrine)
 Potential minimal to mild inflammation
 Mild monocytosis
 Inflammation associated with tissue demand for
macrophages
 Minimal basophilia
 Insignificant

11 year-old, intact male Beagle
Thrombon
PLT
MPV
PCT
PDW
=
=
=
=
156 K/L
29.38 fL
0.5 %
19.8 %
LOW
( 175 – 500 )
11 year-old, intact male Beagle
Thrombon
PLT

=
156 K/L
LOW
Thrombocytopenia

Mild
( 175 – 500 )
11 year-old, intact male Beagle
Thrombon
PLT
MPV
PCT
PDW

=
=
=
=
156 K/L
29.38 fL
0.5 %
19.8 %
LOW
( 175 – 500 )
Thrombocytopenia

Mild with enlarged platelets
11 year-old, intact male Beagle
Thrombon
PLT
MPV
PCT
PDW

=
=
=
=
156 K/L
29.38 fL
0.5 %
19.8 %
LOW
( 175 – 500 )
Thrombocytopenia

Mild with enlarged platelets and variably-sized platelets
Thrombon Interpretation

Mild thrombocytopenia
Probable bone marrow response to peripheral demand
for platelets
 Enlarged platelets
 Variably-sized platelets
 Potential mechanism of thrombocytopenia
 Peripheral blood consumption
 Peripheral blood destruction

11 year-old, intact male Beagle
WBC
LYM
MONO
NEU
EOS
BASO
%LYM
%MONO
%NEU
%EOS
%BASO
HCT
RBC
HGB
RETIC
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
18.69
3.00
2.73
12.24
0.62
0.11
16.0
14.6
65.5
3.3
0.6
52.5
7.80
19.5
38.9
K/L
K/L
K/L
K/L
K/L
K/L
%
%
%
%
%
%
M/L
g/dL
K/L
HIGH
HIGH
HIGH
HIGH
(
(
(
(
(
(
5.50
0.70
0.10
2.00
0.10
0.00
-
16.90
4.90
1.40
12.00
1.49
0.10
)
)
)
)
)
)
Confirm with blood smear
HIGH
( 37.0
( 5.50
( 12.0
%RETIC =
0.5
%
MCV
=
67.3
fL
( 60.0
RDW
=
15.5
%
( 14.7
MCHC
=
37.2
g/dL
HIGH
( 31.0
MCH
=
25.03
pg
HIGH
( 19.50
PLT
=
156.
K/L
LOW
( 175
MPV
=
29.38
fL
PCT
=
0.5
%
PDW
=
19.8
%
Differential algorithm issues. Confirm with blood smear.
–
–
–
55.0 )
8.50 )
18.0 )
–
72.0 )
–
17.9 )
–
37.0 )
– 24.50 )
500 )
11 year-old, intact male Beagle
Leukon
WBC
=
18.69 K/L HIGH
( 5.50 – 16.90 )
LYM
=
3.00 K/L
( 0.70 – 4.90 )
MONO =
2.73 K/L HIGH
( 0.10 – 1.40 )
NEU
=
12.24 K/L HIGH
( 2.00 – 12.00 )
EOS
=
0.62 K/L
( 0.10 – 1.49 )
BASO =
0.11 K/L HIGH
( 0.00 – 0.10 )
%LYM =
16.0 %
%MONO =
14.6 %
 Mild leukocytosis
%NEU =
65.5 %
 Minimal neutrophilia
%EOS =
3.3 %
 Mild monocytosis
%BASO =
0.6 %
Differential algorithm issues. Confirm with blood smear.

Minimal basophilia
Leukon – Peripheral Blood Film Review
Leukon – Peripheral Blood Film Review
Leukon – Peripheral Blood Film Review
Leukon – Peripheral Blood Film Review
Leukon – Peripheral Blood Film Review
Leukon – Peripheral Blood Film Review
Leukon – Peripheral Blood Film Review
Leukon – Peripheral Blood Film Review
Leukon – Peripheral Blood Film Review
Eosinophil
Basophil
Monocyte
Leukogram Interpretation

Mild leukocytosis
Probable normal neutrophil number
 Prominent mastocythemia
 Morphologically atypical mast cells suggesting a
neoplastic process
 Other leukocytes likely in normal numbers

11 year-old, intact male Beagle
Thrombon
PLT
MPV
PCT
PDW

=
=
=
=
156 K/L
29.38 fL
0.5 %
19.8 %
LOW
( 175 – 500 )
Thrombocytopenia

Mild with enlarged platelets and variably-sized platelets
Thrombon - Peripheral Blood Film Review
Thrombon Interpretation

Mild thrombocytopenia
Probable bone marrow response to peripheral demand
for platelets
 Enlarged platelets
 Variably-sized platelets
 Potential mechanism of thrombocytopenia
 Peripheral blood consumption
 Peripheral blood destruction


Comments following blood film review

Interpretation above confirmed
11 year-old, intact male Beagle
WBC
LYM
MONO
NEU
EOS
BASO
%LYM
%MONO
%NEU
%EOS
%BASO
HCT
RBC
HGB
RETIC
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
18.69
3.00
2.73
12.24
0.62
0.11
16.0
14.6
65.5
3.3
0.6
52.5
7.80
19.5
38.9
K/L
K/L
K/L
K/L
K/L
K/L
%
%
%
%
%
%
M/L
g/dL
K/L
HIGH
HIGH
(
(
(
(
(
(
5.50
0.70
0.10
2.00
0.10
0.00
-
HIGH
( 37.0
( 5.50
( 12.0
–
–
–
HIGH
HIGH
%RETIC =
0.5
%
MCV
=
67.3
fL
( 60.0
RDW
=
15.5
%
( 14.7
MCHC
=
37.2
g/dL
HIGH
( 31.0
MCH
=
25.03
pg
HIGH
( 19.50
PLT
=
156.
K/L
LOW
( 175
MPV
=
29.38
fL
PCT
=
0.5
%
PDW
=
19.8
%
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 )