hours of 8:00 AM–10:00 PM Monday through Friday,

9:00 AM–10:00 PM Saturday and 12:00 PM to 7:00 PM

Sunday.

Your requests for sample pick-up, additional copies of

reports, consultation with specialists, supplies, billing

information etc. will be handled promptly, efficiently

and professionally. This is our promise to you.

Introducing the True North TeamDr. Jim Bilenduke

Burnaby lab: Monday–Friday; Langley lab on Sundays

Dr. Allan Berrington

Langley lab: Monday–Saturday

Dr. Julie Armstrong

Langley lab: Tuesday–Wednesday before 5:30 PM,

Thursday before 2:00 PM

Dr. Sally Lester

Off-site: available by phone on request

Dr. David Gribble

Off-site: available by phone on request

111

DIAGNOSTIC, CLINICAL

AND LAB NEWS SPRING 2013

FROM TRUE NORTH VOLUME 1 No.1

U N D E R T H E S C O P E

Our Promise to YouWe want your True North experiences to be pleasant

and efficient. Our goal, first and foremost is patient

care. This means that we are here to assist you in

caring for your patients and clients. Because our client

services department includes everyone at True North,

when you call either our Langley or Burnaby location,

you will speak with someone who is able and willing

to assist you. You can reach us during the laboratory

Welcome to our Quarterly Newsletter!

1

Our goal is to help keep you up-to-date with current diagnosticinformation, what’s happening at the lab and information on howto trouble shoot common pitfalls. We also will offer clinical updatesfrom conferences and journals, intriguing cases and practice tips,Every team member in the veterinary practice plays an importantrole, so we’ll aim to provide something of interest to everyone.

INSIDETesting forHyperadrenocorticism . . . .2

Practice Tip . . . . . . . . . . . . . . . . . . . .2

Vitamin E and EquineNeuromuscular Disease . .3

Breed-relatedHepatopathies of Dogs . . .4

Not All Molds are Alike . . .5

Red Urine in Rabbits . . . . . . .6

Feline BloodTransfusions . . . . . . . . . . . . . . . . .6

11U N D E R T H E S C O P E | S P R I N G 2 0 1 3 2

D I A G N O S T I C P E A R L S � � �

Similar to feline hyperthyroidism, hyperadrenocorti-

cism (HAC) is being detected earlier in the course of

the disease than was reported 20 or 30 years ago.

Despite the fact that we may be catching it early,

the clinical history and physical examination findings

remain key. It is not uncommon to see only one of

the common clinical signs typically associated with

Cushing’s (e.g., PU/PD or alopecia), versus multiple

clinical signs. Biochemical changes should not be

the sole trigger to pursue additional testing.

Consider Testing When:• Common clinical signs are present. These include

PU/PD, alopecia, a potbelly, thin skin, panting

respiration and weakness.

• Insulin resistance is present and after errors in insulin

administration and issues of comprehension and

compliance, infection or inflammation (e.g., of urinary

tract or pancreas) and neoplasia have been ruled out.

• An adrenal tumour has been identified using

an imaging study.

• Macrotumour signs are noted. These include

a poor appetite, vague behavioural changes, or

neurological indicators.

• Persistent hypertension is detected.

• Calcinosis cutis is present.

Diagnostic TestingIt is important to remember that testing should be

postponed if serious concurrent illness is present.

• Low Dose Dexamethasone Suppression test

(LDDST) is the initial test of choice.

• High Dose Dexamethasone Suppression test

(HDDST) is not a diagnostic test but rather a

differentiation test (see below).

• ACTH Stimulation test is less affected by non-

adrenal illness and is the gold standard for testing

for hypoadrenocorticism or iatrogenic HAC.

• Urine Cortisol: Creatinine Ratio is helpful for ruling

out HAC. Check 2 or 3 morning urine samples. Be

sure to start 48 hours after the last veterinary exam

to minimize the effects of stress.

• Differentiation testing is recommended to deter-

mine whether the tumour is pituitary or adrenal.

Consider endogenous ACTH & HDDST in conjunction

with diagnostic imaging (radiographs, abdominal

ultrasound, MRI or CT).

Practice TipPreparing a fresh blood film before putting the

sample into EDTA takes a little extra time but

is well worth the effort. We make blood films

from every sample submitted but the EDTA

stored blood changes the cells in certain ways.

We want to have fresh films to check:

1) Toxic change is more accurately assessed as

it is affected by aging of the sample.

2) Red blood cell morphology is less likely to be

altered so abnormal shapes are easier to see,

e.g., acanthocytes.

3) Lymphocytes swell over time making nuclear

morphology harder to interpret.

Don’t worry if you don’t feel confident in making

good films: practice makes perfect!

Brief Update on Testing for Canine Hyperadrenocorticism:A Preview to the ACVIM Consensus Statement

Despite the fact wemay be catchingit early, clinicalhistory and physicalexamination findingsremain key.

Technique for a Well-made Blood Smear

To view a video of this procedure click on this link

http://www.youtube.com/watch?v=iA6ce-3sYgk

11U N D E R T H E S C O P E | S P R I N G 2 0 1 3 13

I N S I D E T H E P A D D O C K

Vitamin E is a fat-soluble vitamin with many different

functions and a complex metabolism. It has powerful

antioxidant properties and regulates cellular func-

tions through direct interactions with proteins,

enzymes and membranes. Several neuromuscular

diseases are known to be associated with Vitamin E

deficiency.

1. Equine Motor Neuron Disease- EMND

a) This is a disease of horses over two years of age.

Multifactorial causes contribute to increased

individual sensitivity. High environmental risks

include lack of pasture and/or Vitamin E sup-

plementation for at least 18 months.

b) Clinical signs include muscle fasciculation,

symmetrical sweating, weight loss, muscle

atrophy, a preference to be recumbent, a

“camped under” appearance, and an elevated

tail head.

c) Antemortem diagnosis requires a biopsy of

the tail head muscle (sacrocaudalis dorsalis

medialis muscle).

Vitamin E and EquineNeuromuscular Disease

d) Forty percent of treated cases will recover.

Horses should not be asked to perform while

recovering.

2. Equine Neuroaxonal Dystrophy/Equine Degener-

ative Myeloencephalopathy. NAD/EDM.

a) Typically a disease of young horses, most

often less than a year of age. A genetic predis-

position is recognized. Vitamin E levels are not

consistently low in affected animals.

b) Clinical signs include symmetric ataxia, a base-

wide stance at rest and proprioceptive deficits

of all limbs. The two diseases (NAD and EDM)

are clinically indistinguishable.

c) The diagnosis is made on post mortem as

the two diseases are distinguished based on

histologic lesions.

d) Treatment with Vitamin E once clinical signs

are present does not help. Vitamin E supple-

mentation for foals in at-risk herds can decrease

the severity of the disease.

3. Vitamin E Deficient Myopathy

a) Horses have clinical signs similar to EMND but

tail head muscles are not atrophied. Special

mitochondrial stains are necessary for the

diagnosis. This requires non-formalin fixed

muscle specimens. The University of Minnesota’s

website provides instructions on muscle biopsy

submission: http://www.cvm.umn.edu/umec/

lab/biopsy_instructions/home.html

b) Vitamin E levels are low in muscle yet serum

Vitamin E levels are variable.

c) All horses recover with therapy.

Clinical Pointers• Vitamin E is affected by hemolysis: hemolyzed

samples should not be submitted.

• Samples can be stored vertically for up to 72 hours

in a refrigerator.

• Fasting is not necessary

• Adequate Vitamin E levels are over 2 ug/ml;

marginal Vitamin E levels are between 1.5–2 ug/ml

• Horses with normal values will consistently have

normal results with repeated sampling, therefore,

if normal, retesting is not necessary.

• Deficient horses have a greater daily variation.

Horses with marginal levels should be retested at

least a second time. ...Continued/5

Severalneuromusculardiseases areknown to beassociated withVitamin Edeficiency.

MalteseMaltese with the PSVA/MVD* trait

have now been recognized with

a specific Zone 3 inflammatory

hepatopathy. Inflammation occludes

venules, causes portal hypertension,

secondary ascites and prominent

abdominal veins. A subset of affected

dogs has concurrent IBD. Concurrent

surgical correction is contraindicated

as it is likely to be fatal.

Increased attention should be given to those dogs that have ALT values

over 3x normal. Ultrasound findings suggestive of this condition include

difficulty visualizing hepatic veins, an irregular, nodular hepatic

surface and margins. Biopsy is necessary for diagnosis. This condition

is managed medically.

*PSVA/MVD = portosystemic vascular anomalies/

hepatoportal microvascular dysplasia

11U N D E R T H E S C O P E | S P R I N G 2 0 1 3 14

DalmatiansDalmatians have a familial copper-

associated liver disease similar to

that seen in Bedlington terriers.

ALT elevations are often ten times

normal. A concurrent Fanconi-like

syndrome is possible. The disease

progresses rapidly.

Several Breeds are Predisposed to Liver Disease.Which dogs are at risk?

B R E E D-R E L A T E D H E P A T O P A T H I E S

Labrador RetrieversLabrador Retrievers similarly appear

to have a genetic predisposition to

develop chronic hepatitis. A significant

percentage of affected dogs have

elevated copper levels. ALT levels are

increased and dietary copper likely

plays a role.

Standard PoodlesStandard Poodles appear predisposed

to developing chronic hepatitis.

Currently the cause, clinical manifes-

tations, genetics of transmission,

incidence and appropriate therapy

are unknown. Females appear to be

pre-disposed. Age at presentation is

most often 6–8 years but it is reported

in dogs as young as 3–4 yrs.

On-going research is taking place.

The study end date is July 2013.

If you have a case, contact:

Dr. Allison Bradle,

Department of Clinical Sciences,

Colorado State University

Fort Collins, CO 80523-1678

Email: ambradl@colostate.edu

Tel: 970-297-4017

Scottish TerriersScottish Terriers are thought to have

abnormal steroidogenesis causing

increased ALP levels and a degenerative

vacuolar hepatopathy. Over time, 25%

of affected dogs will progress to severe

liver dysfunction. Hepatocellular

carcinoma has been confirmed in some

cases—possibly linked to chronic

increased androgens. Routine ultra-

sound monitoring is advised to detect transforming hepatic architecture

and the development of ascites and/or portal hypertension.

Presented at ACVIM Forum 2012

15U N D E R T H E S C O P E | S P R I N G 2 0 1 3

A T R U E N O R T H P E R S P E C T I V E

Not All Molds are AlikeRescue of dogs and cats from other areas of North

America and relatively more exotic regions such and

Mexico, Central America, South America and some

of the Caribbean Islands is a common occurrence

these days and many if not most practices have

probably seen these adopted pets.

The “kickoff” for this phenomenon seems to have

been Hurricane Katrina and its devastation of New

Orleans. Some of these pets will bring with them

infections by agents that do not normally occur in

our geographic region: British Columbia and Alberta.

Of particular concern, from a public health point of

view, are the dimorphic fungal agents as they are

capable of causing systemic infection in animals

and people. These include Histoplasma capsulatum,

Blastomyces dermatitidis and Coccidiodes immitis.

These are soil borne fungi with restricted geographic

distribution.

The risk of animal to animal or animal to human

transmission of infection is minimal to nonexistent.

Rarely, cases involving unusual circumstances have

been reported. On the other hand, the mycelial stage

produced in laboratory culture is highly infectious

and very dangerous to laboratory personnel as the

arthroconidia borne by mycelia are very easily

aerosolized. Culture of these organisms should only

be handled by laboratories that are equipped to do so.

The Provincial Laboratory (Animal Health Centre*) in

Abbotsford is the only Class III laboratory in B.C.

capable of handling culture submissions where these

organisms are suspected.

Should you see a patient rescued from a geographic

region where these agents are considered to be

endemic, serologic and/or urine antigen testing are

recommended over culture, at least in the initial

stages of testing.

Samples submitted to True North Veterinary

Diagnostics for culture when one of these agents

is suspected or is a differential will be put on hold

and the clinic will be called.

Please include in the history whether an animal

has been rescued or adopted from, or has traveled

to regions where these agents are endemic, when

requesting fungal or bacterial culture. These fungal

agents are capable of growing on media used for

bacterial culture. If travel history or adoption source

has not been noted in submissions for fungal culture

from the respiratory tract, skin wounds, bone lesions,

joints and organs they will be held until such infor-

mation can be obtained.

Pet rescue broadenszoonotic infectiousdisease considerations.Please help us keepour personnel safe.

Laboratory Diagnosis of Systemic and Deep Tissue Fungal Infection

Geographic distribution of thedimorphic fungal agentsCoccidiodes California and neighbor states

to the east, New Mexico, Mexico

and Texas.

Blastomyces States of the Mississippi, Missouri

and Ohio River valleys, parts of

Ontario, Quebec & Manitoba.

Histoplasma Similar to Blastomyces excepting

Manitoba, areas of Central and

South America.

Please help us keep our personnel safe.

Vitamin E and Equine...from 3

Supplementation Recommendations• The bioavailability of Vitamin E supplements is not

consistent. Water dispersable formulations are

most bioavailable with natural forms being more

bioavailable than synthetic ones. Please see

http://www.cvm.umn.edu/umec/lab/vitE/home.html

for additional information. NRC* requirements are

based on the bioavailability of synthetic products.

• The highest Vitamin E levels are found in fresh

green forage; Vitamin E levels decrease with the

storage and processing of forage.

• The NRC advises 500 IU /day for the average 500

kg horse. The upper safety range is considered

10,000 IU/day for a 500 kg horse. Healthy horses

with a good quality dietary intake should not need

more than 500 IU/day.

• Foals, lactating mares and horses being exercised

heavily have the highest daily requirements.

C.J. Finno and S.J. Valberg. A Comparative Review of Vitamin E andAssociated Equine Disorders. J Vet Intern Med 2012;26:1251-1266

*NRC. National Research Council, (Nutrient Requirements of Horses2007 - available online)

*For more informationon submitting samplesfor culture, contact theProvincial Laboratory(Animal Health Centre)1767 Angus Campbell RoadAbbotsford, BC V3G 2M3

Tel 604 556 3003

BC Toll Free1 800 661 9903

16U N D E R T H E S C O P E | S P R I N G 2 0 1 3

Red Urine in Rabbits…and other Urogenital Matters

Red urine may be caused by the presence of red blood

cells, hemoglobin or porphyrins in rabbits. Porphyrin-

pigmented urine may be dark brown, orange or red.

This is believed to be related to the consumption of

certain plant proteins. It is not harmful to the rabbit

and is usually temporary, lasting 3–4 days.

Hematuria may be secondary to pathology within

the urinary tract. Urinary tract disease is relatively

common in pet rabbits. The calcium metabolism in

rabbits is unique. Renal excretion of calcium is less

than 2% in most mammals whereas in rabbits it is

45–60% causing calciuria. An increased risk of calcium

oxalate and calcium carbonate urolithiasis occurs

especially in rabbits with limited exercise, a diet of

free-fed pellets and an obese body condition.

Intact female rabbits are at risk for a number of repro-

ductive tract diseases. Uterine adenocarcinoma is

the most common neoplasia in older female rabbits.

Frank blood or blood clots are most often associated

with the genital tract.

Langley Lab320–6325 204th StreetLangley, BC V2Y 3B3

Tel 604.539.55501-877.539.5550Fax 1-888.336.9408

Burnaby Lab8626 Commerce CourtBurnaby, BC V5A 4N6

Tel 604.444.44791-877.474.4479Fax 1-888.318.5350

Feline Blood TransfusionsBlood transfusion is a potentially life-saving procedure

that is within the reach of most practitioners. Only

minimal equipment is required: CPD-A1.

Patients for whom transfusion should be considered

are those with:

• Ongoing blood loss with PCV <15%

• Chronic, non-regenerative anemia with PCV <10%

• Acute blood loss associated with signs of

Hypoperfusion with PCV <18%

• Requiring surgery with a PCV <18–20% or

having a total protein/solids <20 mg/dL

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Forward toa Colleague

Your Commentsand Suggestions

• Expected blood loss due to coagulopathy or

rodenticide with PCV 15%

• Tachycardia despite normovolemia with PCV 10–20%

This article reviews the indications, precautions and

procedures in a straight forward manner.

Key PointsUnlike dogs, only type-specific plasma should be

administered to cats as they have antibodies to non-

self blood types within their plasma.

Cats have traditionally been recognized to have three

blood groups: A, B and AB; a newer antibody Mik has

been identified and cats are either positive or negative

for this. As a consequence, all donors and recipients

must be A-B blood typed even for a first transfusion.

Mik is not assessed in blood typing.

Cross-matching is considered the gold standard in

order to detect additional incompatibilities due to the

Mik antibody (any transfusion) or antibodies induced

by exposure to exogenous substances should the

patient require a subsequent transfusion. Steps to

perform cross-matching are outlined in the article

at: Pinker Shade of Pale

The volume of whole blood to be administered can

be calculated using this formula:

Total blood volume (target PCV – current (recipient) PCV)Volume = of patient xdonor PCV[K x weight (kg)]

where K = estimated blood volume of 40–60 ml/kg body weight

Donors must be healthy and retrovirus negative. A

maximum of 10–12 ml/kg can be donated by donor

at one time. Donor care is discussed.

Excerpted and adapted from:Feline Blood Transfusions: A pinker shade of pale

Barfield D, Adamantos A. J Fel Med Surg (2011) 13, 11-23.