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 )