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Dog with Icterus

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.

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Dog with Icterus

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  1. Dog with Icterus Dennis B. DeNicola, DVM, PhD, DACVP Chief Veterinary Educator IDEXX Laboratories

  2. “Coalie” • 5 years old • Spayed female • Lhasa Apso • Presented with clinical history of anorexia, lethargy and icterus

  3. “Coalie” - 5 Year-old, Lhasa Apso WBC = 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/LLOW( 175 – 500 ) MPV = 29.78 fL PCT = 0.2 % PDW = 25.3 % Differential algorithm issues. Confirm with blood smear

  4. “Coalie” - 5 Year-old, Lhasa Apso Erythron 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 )

  5. “Coalie” - 5 Year-old, Lhasa Apso Erythron 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 )

  6. “Coalie” - 5 Year-old, Lhasa Apso Erythron 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 ) • Anemia • Moderately severe

  7. “Coalie” - 5 Year-old, Lhasa Apso Erythron 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 % • Anemia • Moderately severe, regenerative

  8. “Coalie” - 5 Year-old, Lhasa Apso Erythron 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 ) • Anemia • Moderately severe, regenerative, macrocytic and hypochromic with moderate anisocytosis

  9. Erythron – Data Interpretation • Anemia • Moderately severe • Macrocytic (increased MCV) • Hypochromic (decreased MCHC) • Regenerative (increased Reticulocyte Count) • Moderate anisocytosis (increased RDW)

  10. Erythron – Data Interpretation • Anemia • Moderately severe • Macrocytic (increased MCV) • Hypochromic (decreased MCHC) • Regenerative (increased Reticulocyte Count) • Moderate anisocytosis (increased RDW) • No significant morphologic features to help identify underlying etiopathogenesis

  11. Erythron – Data Interpretation • Anemia • Moderately severe • Macrocytic (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

  12. “Coalie” - 5 Year-old, Lhasa Apso Leukon WBC = 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.

  13. “Coalie” - 5 Year-old, Lhasa Apso Leukon WBC = 72.99 K/L HIGH ( 5.50 – 16.90 )

  14. “Coalie” - 5 Year-old, Lhasa Apso Leukon WBC = 72.99 K/L HIGH ( 5.50 – 16.90 ) • Leukocytosis • Marked

  15. “Coalie” - 5 Year-old, Lhasa Apso Leukon WBC = 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 %

  16. “Coalie” - 5 Year-old, Lhasa Apso Leukon WBC = 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

  17. Leukogram Interpretation • Marked leukocytosis • Neutrophilia, Monocytosis, Eosinophilia, Basophilia • Inflammation with prominent tissue demand for macrophages • Potential relatively established inflammation since no obvious lymphocytopenia (“glucocorticoid influence”)

  18. Erythron – Blood Film

  19. Erythron – Blood Film

  20. Erythron – Blood Film

  21. Erythron – Blood Film

  22. Erythron – Blood Film

  23. Erythron – Blood Film

  24. Erythron – Blood Film

  25. Erythron – Blood Film

  26. Leukogram Interpretation • Marked leukocytosis • Neutrophilia, Monocytosis • Mild neutrophil toxicity • Inflammation with prominent tissue demand for macrophages • Potential relatively established inflammation since no obvious lymphocytopenia (“glucocorticoid influence”)

  27. “Coalie” - 5 Year-old, Lhasa Apso Thrombon PLT = 83 K/L LOW ( 175 – 500 ) • Thrombocytopenia • Moderate

  28. “Coalie” - 5 Year-old, Lhasa Apso Thrombon PLT = 83 K/L LOW ( 175 – 500 ) MPV = 29.78 fL • Thrombocytopenia • Moderate with enlarged platelets

  29. “Coalie” - 5 Year-old, Lhasa Apso Thrombon PLT = 83 K/L LOW ( 175 – 500 ) MPV = 29.78 fL PCT = 0.2 % PDW = 25.3 % • Thrombocytopenia • Moderate with enlarged platelets and variably-sized platelets

  30. Erythron – Blood Film

  31. Thrombon - Interpretation • Moderate thrombocytopenia • Clumped platelets at feathered edge • Possible underestimation of numbers • Enlarged and variably-sized platelets • Suggesting bone marrow response to a peripheral demand • Peripheral consumption (Inflammation, DIC, etc.) • Peripheral destruction

  32. “Coalie” - 5 Year-old, Lhasa Apso WBC = 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/LLOW( 175 – 500 ) MPV = 29.78 fL PCT = 0.2 % PDW = 25.3 % Differential algorithm issues. Confirm with blood smear

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