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Dog with Lethargy and Depression
Dennis B. DeNicola, DVM, PhD, DACVPChief Veterinary Educator
IDEXX Laboratories
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“Ryan”7.5 years oldNeutered maleLabrador Retriever
Presented with clinical history of recent (several days) onset lethargy and depression
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“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
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“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)
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“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
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“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
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“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
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Erythron – Data InterpretationAnemia
Moderately severeMacrocytic (MCV) “Hyperchromic” (MCHC) – hemolytic specimenRegenerative (Reticulocyte Count)Moderate anisocytosis (RDW)
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Erythron – Blood Film
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Erythron – Blood Film
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Erythron – Blood Film
Agglutination
Rouleaux
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Saline Agglutination Test
Saline Solution
Agglutination Rouleaux
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Erythron – Blood Film
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Erythron – Blood Film
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Erythron – Blood Film InterpretationAnemia
Moderately severeRegenerative
PolychromasiaAnisocytosis
Immune mediated extravascular hemolysisSpherocytosisSuggestion of autoagglutination
– Requires saline dilution confirmation
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“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.
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“Ryan” - 7.5 Year-old, Labrador RetrieverLeukonWBC = 88.43 K/L HIGH ( 5.50 – 16.90 )
LeukocytosisMarked
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“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
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Leukon – Blood Film
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Leukon – Blood Film
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Leukon – Blood Film
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Leukon – Blood Film
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Leukon – Blood Film
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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)
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“Ryan” - 7.5 Year-old, Labrador RetrieverThrombonPLT = 747 K/L HIGH ( 175 – 500 )
ThrombocytosisMild
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“Ryan” - 7.5 Year-old, Labrador RetrieverThrombonPLT = 747 K/L HIGH ( 175 – 500 ) MPV = 19.62 fL
ThrombocytosisMild with enlarged platelets
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“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
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Thrombon
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Thrombon - InterpretationMild thrombocytosis
Clumped platelets at feathered edgeProbable underestimation of numbers
Enlarged and variably-sized plateletsSuggesting bone marrow response to a peripheral
demand
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“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