Dog with Lethargy and Depression

Dennis B. DeNicola, DVM, PhD, DACVPChief Veterinary Educator

IDEXX Laboratories

“Ryan”7.5 years oldNeutered maleLabrador Retriever

Presented with clinical history of recent (several days) onset lethargy and depression

“Ryan” - 7.5 Year-old, Labrador RetrieverWBC = 88.43 K/L HIGH ( 5.50 – 16.90 )LYM = 9.45 K/L HIGH ( 0.70 – 4.90 )MONO = 5.82 K/L HIGH ( 0.10 – 1.40 )NEU = 70.34 K/L HIGH ( 2.00 – 12.00 )EOS = 2.34 K/L HIGH ( 0.10 – 1.49 )BASO = 0.48 K/L HIGH ( 0.00 – 0.10 )%LYM = 10.7 %%MONO = 6.6 %%NEU = 79.5 %%EOS = 2.7 %%BASO = 0.5 %HCT = 19.8 % LOW ( 37.0 – 55.0 )RBC = 2.58 M/L LOW ( 5.50 – 8.50 )HGB = 9.3 g/dL LOW ( 12.0 – 18.0 )RETIC = 145.6 K/L%RETIC = 5.6 %MCV = 76.8 fL HIGH ( 60.0 – 72.0 )RDW = 22.2 % HIGH ( 14.7 – 17.9 )MCHC = 47.0 g/dL HIGH ( 31.0 – 37.0 )MCH = 36.03 pg HIGH ( 19.50 – 24.50 )PLT = 747 K/L HIGH ( 175 – 500 )MPV = 19.62 fLPCT = 1.5 %PDW = 30.3 %Differential algorithm issues. Confirm with blood smear

“Ryan” - 7.5 Year-old, Labrador RetrieverErythronHCT = 19.8 % LOW ( 37.0 – 55.0 )RBC = 2.58 M/L LOW ( 5.50 – 8.50 )HGB = 9.3 g/dL LOW ( 12.0 – 18.0 )RETIC = 145.6 K/L%RETIC = 5.6 %MCV = 76.8 fL HIGH ( 60.0 – 72.0 )RDW = 22.2 % HIGH ( 14.7 – 17.9 )MCHC = 47.0 g/dL HIGH ( 31.0 – 37.0 )MCH = 36.03 pg HIGH (19.50 – 24.50)

“Ryan” - 7.5 Year-old, Labrador RetrieverErythronHCT = 19.8 % LOW ( 37.0 – 55.0 )RBC = 2.58 M/L LOW ( 5.50 – 8.50 )HGB = 9.3 g/dL LOW ( 12.0 – 18.0 )

AnemiaModerately severe

“Ryan” - 7.5 Year-old, Labrador RetrieverErythronHCT = 19.8 % LOW ( 37.0 – 55.0 )RBC = 2.58 M/L LOW ( 5.50 – 8.50 )HGB = 9.3 g/dL LOW ( 12.0 – 18.0 )RETIC = 145.6 K/L%RETIC = 5.6 %

AnemiaModerately severe, regenerative

“Ryan” - 7.5 Year-old, Labrador RetrieverErythronHCT = 19.8 % LOW ( 37.0 – 55.0 )RBC = 2.58 M/L LOW ( 5.50 – 8.50 )HGB = 9.3 g/dL LOW ( 12.0 – 18.0 )RETIC = 145.6 K/L%RETIC = 5.6 %MCV = 76.8 fL HIGH ( 60.0 – 72.0 )RDW = 22.2 % HIGH ( 14.7 – 17.9 )MCHC = 47.0 g/dL HIGH ( 31.0 – 37.0 )MCH = 36.03 pg HIGH (19.50 – 24.50)

AnemiaModerately severe, regenerative, macrocytic and “hyperchromic” with moderate anisocytosis

Erythron – Data InterpretationAnemia

Moderately severeMacrocytic (MCV) “Hyperchromic” (MCHC) – hemolytic specimenRegenerative (Reticulocyte Count)Moderate anisocytosis (RDW)

Erythron – Blood Film

Erythron – Blood Film

Erythron – Blood Film

Agglutination

Rouleaux

Saline Agglutination Test

Saline Solution

Agglutination Rouleaux

Erythron – Blood Film

Erythron – Blood Film

Erythron – Blood Film InterpretationAnemia

Moderately severeRegenerative

PolychromasiaAnisocytosis

Immune mediated extravascular hemolysisSpherocytosisSuggestion of autoagglutination

– Requires saline dilution confirmation

“Ryan” - 7.5 Year-old, Labrador RetrieverLeukonWBC = 88.43 K/L HIGH ( 5.50 – 16.90 )LYM = 9.45 K/L HIGH ( 0.70 – 4.90 )MONO = 5.82 K/L HIGH ( 0.10 – 1.40 )NEU = 70.34 K/L HIGH ( 3.00 – 12.00 )EOS = 2.34 K/L HIGH ( 0.10 – 1.49 )BASO = 0.48 K/L HIGH ( 0.00 – 0.10 )%LYM = 10.7 %%MONO = 6.6 %%NEU = 79.5 %%EOS = 2.7 %%BASO = 0.5 %Differential algorithm issues. Confirm with blood smear.

“Ryan” - 7.5 Year-old, Labrador RetrieverLeukonWBC = 88.43 K/L HIGH ( 5.50 – 16.90 )

LeukocytosisMarked

“Ryan” - 7.5 Year-old, Labrador RetrieverLeukonWBC = 88.43 K/L HIGH ( 5.50 – 16.90 )LYM = 9.45 K/L HIGH ( 0.70 – 4.90 )MONO = 5.82 K/L HIGH ( 0.10 – 1.40 )NEU = 70.34 K/L HIGH ( 3.00 – 12.00 )EOS = 2.34 K/L HIGH ( 0.10 – 1.49 )BASO = 0.48 K/L HIGH ( 0.00 – 0.10 )%LYM = 10.7 %%MONO = 6.6 %%NEU = 79.5 %%EOS = 2.7 %%BASO = 0.5 %Differential algorithm issues. Confirm with blood smear.

LeukocytosisMarked with increases in all leukocyte forms

Leukon – Blood Film

Leukon – Blood Film

Leukon – Blood Film

Leukon – Blood Film

Leukon – Blood Film

Leukogram InterpretationMarked leukocytosis

Increases in all leukocyte formsMarked neutrophilia with possible slight left shift

Inflammation with evidence of systemic antigenic stimulation (lymphocytosis) and tissue demand for macrophages (monocytosis)

“Ryan” - 7.5 Year-old, Labrador RetrieverThrombonPLT = 747 K/L HIGH ( 175 – 500 )

ThrombocytosisMild

“Ryan” - 7.5 Year-old, Labrador RetrieverThrombonPLT = 747 K/L HIGH ( 175 – 500 ) MPV = 19.62 fL

ThrombocytosisMild with enlarged platelets

“Ryan” - 7.5 Year-old, Labrador RetrieverThrombonPLT = 747 K/L HIGH ( 175 – 500 ) MPV = 19.62 fLPCT = 1.5 %PDW = 30.3 %

ThrombocytosisMild with enlarged platelets and variably-sized platelets

Thrombon

Thrombon - InterpretationMild thrombocytosis

Clumped platelets at feathered edgeProbable underestimation of numbers

Enlarged and variably-sized plateletsSuggesting bone marrow response to a peripheral

demand

“Ryan” - 7.5 Year-old, Labrador RetrieverWBC = 88.43 K/L HIGH ( 5.50 – 16.90 )LYM = 9.45 K/L HIGH ( 0.70 – 4.90 )MONO = 5.82 K/L HIGH ( 0.10 – 1.40 )NEU = 70.34 K/L HIGH ( 2.00 – 12.00 )EOS = 2.34 K/L HIGH ( 0.10 – 1.49 )BASO = 0.48 K/L HIGH ( 0.00 – 0.10 )%LYM = 10.7 %%MONO = 6.6 %%NEU = 79.5 %%EOS = 2.7 %%BASO = 0.5 %HCT = 19.8 % LOW ( 37.0 – 55.0 )RBC = 2.58 M/L LOW ( 5.50 – 8.50 )HGB = 9.3 g/dL LOW ( 12.0 – 18.0 )RETIC = 145.6 K/L%RETIC = 5.6 %MCV = 76.8 fL HIGH ( 60.0 – 72.0 )RDW = 22.2 % HIGH ( 14.7 – 17.9 )MCHC = 47.0 g/dL HIGH ( 31.0 – 37.0 )MCH = 36.03 pg HIGH ( 19.50 – 24.50 )PLT = 747 K/L HIGH ( 175 – 500 )MPV = 19.62 fLPCT = 1.5 %PDW = 30.3 %Differential algorithm issues. Confirm with blood smear