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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