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