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