idexx lasercyte tm
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IDEXX LaserCyte TM. LaserCyte™ Parameters. LaserCyte Parameters Medical Reasons The “What” and “So What” Summary. LaserCyte™ Parameters. Red blood Cells. White blood Cell. Platlets. Red Blood Cells . Is there evidence of anemia? - PowerPoint PPT PresentationTRANSCRIPT
IDEXX LaserCyteTM
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LaserCyte Training
LaserCyte™ Parameters
LaserCyte Parameters Medical ReasonsThe “What” and “So What” Summary
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LaserCyte Training
LaserCyte™ Parameters
White blood Cell
Red blood Cells
Platlets
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LaserCyte Training
Red Blood Cells
• Is there evidence of anemia? Regenerative or nonregenerative with Regenerative or nonregenerative with
reticulocyte countreticulocyte count
• Is there evidence of dehydration? PolycythemiaPolycythemia
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Red Blood Cells
HCT (Hematocrit) Percentage of the red cell population relative Percentage of the red cell population relative
to the total volume of bloodto the total volume of blood It is a calculation by the LaserCyteIt is a calculation by the LaserCyte 40 – 59% dogs; 29 – 50% cats40 – 59% dogs; 29 – 50% cats Used to diagnose anemia or polycythemiaUsed to diagnose anemia or polycythemia
RBC (Red Blood Cell Count) AActual number of RBCs in a given quantity of ctual number of RBCs in a given quantity of
bloodblood Average is 5.9 - 8.6 X 10Average is 5.9 - 8.6 X 1066 μL for dogs or 5 -μL for dogs or 5 -
10 10 X 10X 1066 μL for catsμL for cats
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Red Blood Cells HGB (Hemoglobin)
A measurement of the oxygen carrying capacity of the A measurement of the oxygen carrying capacity of the red blood cellsred blood cells
The LaserCyte uses four LEDs and photodetectors that The LaserCyte uses four LEDs and photodetectors that measure Hgb concentration by at least three different measure Hgb concentration by at least three different wavelengths of light and two different aspirates, unlysed wavelengths of light and two different aspirates, unlysed and lysed.and lysed.
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Red Blood Cells # Retics
The number of reticulocytes is a definitive indicator to The number of reticulocytes is a definitive indicator to distinguish between regenerative and non-regenerative distinguish between regenerative and non-regenerative anemias. anemias.
The LaserCyte gives aggregate retics in the catThe LaserCyte gives aggregate retics in the cat A retic count above 60,000 A retic count above 60,000 μL in cats and 80,000 μL in μL in cats and 80,000 μL in
dogs in considered a regenerative anemiadogs in considered a regenerative anemia % Retics
Percentage of reticulocytes in a given quantity of bloodPercentage of reticulocytes in a given quantity of blood Average is 0.0 – 1.5% Average is 0.0 – 1.5% for dogs or 0.0 – 0.4% for catsfor dogs or 0.0 – 0.4% for cats
A retic count offers a quick and easy assessment of an anemia
state. A count, unlike a percentage is not affected by
dehydration.
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Red Blood Cells MCV (Mean Corpuscular Volume)
The mean volume of all the RBCs counted in the sample The mean volume of all the RBCs counted in the sample Smaller than normal is microcytic larger is macrocyticSmaller than normal is microcytic larger is macrocytic Used to indicate spherocytes, anisocytosis, or schistocytes Used to indicate spherocytes, anisocytosis, or schistocytes
all of which must be confirmed with a morphology examall of which must be confirmed with a morphology exam RDW (Red Cell Distribution Width)
Measurement of the variation of size with in the RBC Measurement of the variation of size with in the RBC population. Given as a percentagepopulation. Given as a percentage
Used to indicate anisocytosis, also used by impedance Used to indicate anisocytosis, also used by impedance analyzer users to indicate the presence of retics with MCVanalyzer users to indicate the presence of retics with MCV
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Red Blood Cells
MCHC (Mean Corpuscular Hemoglobin Conc)
The mean concentration of hemoglobin in the red cellThe mean concentration of hemoglobin in the red cell Calculated by dividing the hemoglobin by the Calculated by dividing the hemoglobin by the
hematocrit and expressing the answer as a percentagehematocrit and expressing the answer as a percentage Important in classifying anemiasImportant in classifying anemias Normal ranges are 30.0 – 36.9%Normal ranges are 30.0 – 36.9%
MCH (Mean Corpuscular Hemoglobin) Mean mass of hemoglobin in each RBCMean mass of hemoglobin in each RBC Calculated by dividing the hemoglobin by the number Calculated by dividing the hemoglobin by the number
of RBCsof RBCs
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White blood cell data answers
• Is there evidence of inflammation? Acute, chronic or overwhelmingAcute, chronic or overwhelming
• Is there evidence of stress or excitement?
High levels of glucocorticoids cause mild High levels of glucocorticoids cause mild neutrophilia, lymphopenia and eosinophilianeutrophilia, lymphopenia and eosinophilia
• Is there a demand for phagocytosis or evidence of tissue necrosis?
Elevated monocytosis is almost always seen Elevated monocytosis is almost always seen in chronic inflammationin chronic inflammation
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White Blood Cells
WBC (White Blood Cell Count) Total count of all White blood cellsTotal count of all White blood cells Reported as X 10Reported as X 1033 μL μL Indicator of infection (not diagnostic alone)Indicator of infection (not diagnostic alone)
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White Blood Cells
Lymphocytes White blood cell that produces antibodiesWhite blood cell that produces antibodies 20 – 30% of WBC population20 – 30% of WBC population Lymphocytosis: Prolonged illness, chronic Lymphocytosis: Prolonged illness, chronic
inflammation,inflammation, Lymphopenia: Acute inflammation, viral infection, Lymphopenia: Acute inflammation, viral infection,
stress, steroid therapystress, steroid therapyMonocytes
Reported as X 10Reported as X 1033 μL μL Indicator of infection (not diagnostic alone)Indicator of infection (not diagnostic alone)
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White Blood Cells
Neutrophils Most common leukocyteMost common leukocyte Two classifications: Banded and SegmentedTwo classifications: Banded and Segmented Engulf disease causing bacteria, viruses, and Engulf disease causing bacteria, viruses, and
particles (phagocytosis)particles (phagocytosis) Eosinophils
Involved in allergies and parasitic infectionInvolved in allergies and parasitic infection Usually only in circulation for about 30 minUsually only in circulation for about 30 min .1 – 1.5 X 10.1 – 1.5 X 1033 μL normal rangeμL normal range
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White Blood Cells
Basophils Having the basophil # and % aids in identifyingHaving the basophil # and % aids in identifying
• Systemic hypersensitivitySystemic hypersensitivity• Acute allergic reactionsAcute allergic reactions• Mast cell sarcomasMast cell sarcomas
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The Medical Reasons
White Blood Cells
Decreased/
no change
Increased
Variable
Variable
EOS
Increased
Decreased/ no
change
Increased/ no
change
Increased
NEUTS
Increased
Increased/
Variable
Increased/ no
change
Increased
WBC
Stress
Leukogram
Parasites
Chronic
Inflammation
Acute
Inflammation
MONOSLYMPHS
Increased/
no change
Decreased
Increased/
no change
Variable
IncreasedIncreased/
no change
variableDecreased
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Is it a stress leukogram or inflammation?
NormalLowEosinophils
Slightly highSlightly highMonocytes
NormalLowLymphocytes
HighHighNeutrophils
HighHighWBC Count
InflammationStressParameters
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3-part versus 5-part differential
YesNo Steroid therapyYesNo ExcitementYesNo StressYesNo InfectionYesNo Inflammation
5-part3-partElevated neutrophils
YesNo Overwhelming infection
YesNo ErhlichiosisYesNo Parvo
Decreased neutrophils
YesNo FIV
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3-part versus 5-part differential
YesNoAddison’s disease
YesNoHeartworm
YesNoMast cell tumors
YesNoAllergies
YesNoParasites
5-part3-partElevated basophils
and eosinophils
YesNoParvo
YesNoStress
YesNoDistemper
YesNoCushing’s syndrome
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Platelet data answers
• Is there evidence of autoimmune disorders, occult infections or inflammation?
• Suspected coagulopathies?
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With LaserCyte®, your platelet information increases**
• PLT• Involved in clottingInvolved in clotting• PLT is a platelet countPLT is a platelet count• Thrombocytopenia can be seen in Ehrlichia, FIV, FELVThrombocytopenia can be seen in Ehrlichia, FIV, FELV
• MPV• MPV (mean platelet volume) aids in the identification of MPV (mean platelet volume) aids in the identification of
what may be causing a severe thrombocytopeniawhat may be causing a severe thrombocytopenia• PDW
• PDW (platelet distribution width) is an objective PDW (platelet distribution width) is an objective measure of the degree of variability in the size of measure of the degree of variability in the size of platelets and can indicate bone marrow responseplatelets and can indicate bone marrow response
**Absolute count—Available using the LaserCyte analyzer.
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The CBC is a time-sensitive test
• Hematology samples are composed of living cells and should be analyzed as soon as possible:
To prevent cell distortions due to To prevent cell distortions due to shipment or storageshipment or storage
To prevent artifacts created by long-term To prevent artifacts created by long-term exposure to EDTAexposure to EDTA
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Blood cells continue to develop and change
• Samples should be processed within three hours to avoid artificially increased Hct and MCV, and decreased MCHC
• Platelet counts should be performed within one hour after collection
• Red cells crenate, reticulocytes mature, and lymphocytes’ nuclei become distorted
Rebar A, et al. Guide to Hematology in Dogs and Cats. Jackson, WY: Teton New Media; 2002:11.
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Which system is ideally suited for your needs?
YesYes---YesRDW
YesYesYesYesMCHC
YesYes---YesMCV
---Request% onlyYesReticulocytes
YesYesYesYesHgb
YesYesYesYesPCV/Hct
YesYes---YesRBC Count
ImpedenceLabQBC
VetAutoread™LaserCyte
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Which system is ideally suited for your needs?
---Yes, absolute count and %---Yes, absolute
count and %Neutrophils
Middle-sized cells number
and %Yes, absolute count and %
Grouped with lymphocytes
Yes, absolute count and %Monocytes
Small-sized cells number
and %Yes, absolute count and %
Grouped with monocytes
Yes, absolute count and %Lymphocytes
nRBCs misclassified
Yes, corrected for nRBC
Not corrected for nRBC
Yes, corrected for nRBCWBC Count
ImpedenceLabQBC
VetAutoread™LaserCyte
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Which system is ideally suited for your needs?
YesYes---Yes, absolute countPDW
YesYes---Yes, absolute countMPV
---Yes, bsolute count and %YesYes, absolute
count and %Basophils
---Yes, bsolute count and %
Elevated canine and bovine
Yes, absolute count and %Eosinophils
Yes, size only, clumps may go uncounted or misidentified as WBCs
Not always, usually reports broad categories (i.e., adequate)
Yes, good correlation with clumped platelet samples
Yes, optical signature,clumps do not interfere with WBC count
Platelet Count
ImpedenceLabQBC
VetAutoread™LaserCyte
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The Doctor’s view
“I have a QBC VetAutoread that is nearly paid off, why should I go in debt again for a new one”
The QBC Vet AutoRead is and was a good in-clinic system. The QBC Vet AutoRead is and was a good in-clinic system. However, as with anything the advances in technology now make However, as with anything the advances in technology now make it affordable and possible to practice the best medicine available it affordable and possible to practice the best medicine available right in your clinic. …right in your clinic. …
A five part differential is a must for diagnosing many very common diseases or states.
allergies, parasitic infection, chronic inflammation, stress, feline asthma, systemic toxemia, and more.
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The Doctor’s view
“I let my lab deal with the equipment cost and maintenance, they get me the results I need in plenty of time”
As discussed, a CBC is a time sensitive test. As discussed, a CBC is a time sensitive test. Platelets clump, red cells change shape and size, Platelets clump, red cells change shape and size, bands change to segs, lymphocytes, neutrophils, bands change to segs, lymphocytes, neutrophils, and eosinophils can change size, etc.and eosinophils can change size, etc.
This immediate information is critical in many This immediate information is critical in many cases.cases.
Not only does the cells change, the animals Not only does the cells change, the animals condition changes between draw and results from condition changes between draw and results from the labthe lab
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The Doctor’s view
“Other in-clinic analyzer’s are just as good, and cost about $5k to $8k less”
Laser Flow Cytometry is the standard in Laser Flow Cytometry is the standard in automated hematology.automated hematology.
Other in-clinic analyzers interrogate cells based on size only. This can cause erroneous results in the case of artifacts, nRBCs, reticulocytes, and more.
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Summary (1 of 3)
You need to show a Dr. why the LaserCyte® is a good investment medically.
Increased ability to diagnose common problems Immediate results mean immediate treatment and decreased
effects from artifacts
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Summary (2 of 3)
The LaserCyte® is not meant to “replace” the reference lab, it is meant to give the Dr. reference lab results for their in-clinic testing needs.
Do not try to compare to ref lab prices or say that they can now make more $ by doing test in-house.
They will however, increase their testing volume by having ref lab accuracy immediately available.
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Summary (3 of 3)
Do not try to sell the LaserCyteTM on price or testing volume.
If the Dr. is already doing in-clinic testing, the LaserCyteTM will not make them more money right away, it will give them the ability to make more accurate and rapid diagnosis.
If the Dr. is using the reference lab, the LaserCyteTM will be more expensive to use, but he will do more testing if he/she has the availability to do so.