Platelet distribution width and mean platelet volume in the interpretation of thrombocytopenia in dogs

Effects of canine influenza infection and DA2PP vaccination on the development of platelet-associated immunoglobulins and platelet counts in dogs

BACKGROUND

Immune thrombocytopenia (ITP) is commonly associated with platelet-associated immunoglobulins (PAIg). Demonstration of PAIg can help determine etiologies for thrombocytopenia. In humans, ITP and thrombocytopenia have been associated with various vaccinations and influenza infections, respectively.

OBJECTIVES

We aimed to evaluate platelet counts and PAIg in research dogs with H3N2 and in research and client-owned dogs routinely vaccinated for distemper, adenovirus-2, parainfluenza, and parvovirus (DA2PP). The hypotheses were that H3N2 infection but not DA2PP vaccination would decrease platelet counts, and neither would result in the detection of PAIg.

METHODS

Three pilot studies. Platelet counts and PAIg, measured by direct flow cytometry as %IgG, were evaluated in eight research Beagles following experimental infection with H3N2 (experiment 1), nine research Beagles vaccinated for DA2PP (experiment 2), and thirty client-owned dogs vaccinated for DA2PP (experiment 3). All animals were considered healthy at the start of the experiments.

RESULTS

Transient, self-resolving decreases in platelet counts and increases in %IgG occurred following H3N2 infection, and one dog became thrombocytopenic and positive for PAIg. Following DA2PP vaccination, %IgG increased in research and client-owned dogs, but only one dog was considered positive for PAIg with a concurrent increase in platelet count. Mean PAIg increased from baseline in client-owned dogs following vaccination.

CONCLUSIONS

Transient PAIg and thrombocytopenia can occur following H3N2 infection, while routine vaccination for DA2PP in this group of dogs was not associated with the development of thrombocytopenia or clinically relevant formation of PAIg.

Mean Platelet Volume and Platelet Volume Distribution Width in Canine Parvoviral Enteritis

Bacterial translocation from the damaged intestinal tract, reported in canine parvoviral (CPV) enteritis, is thought to be responsible for the systemic inflammatory response resulting from coliform septicemia, which could ultimately progress to septic shock and death. Alterations in platelet indices, specifically mean platelet volume (MPV), is a consistent finding in critically ill people and dogs with and without sepsis. Increased MPV has been reported to be an indirect indicator of platelet activation and of bone marrow response in people and dogs with sepsis. The study aim was to compare admission MPV and platelet volume distribution width (PVDW) in dogs with CPV enteritis to that of healthy aged-matched control dogs. Forty-eight dogs with CPV enteritis and 18 healthy age matched control dogs were included. CPV infection was confirmed with electron microscopy and concurrent blood-borne infections were excluded using PCR. EDTA whole blood samples were analyzed on an automated cell counter, ADVIA 2120, within 30-60 min from collection. There was no significant difference for platelet count between the groups. The MPV for CPV infected dogs (median: 14.0; IQR: 12.2–15.1) was significantly higher compared to controls (11.3; IQR: 10.3–13.1, P = 0.002). The PVDW for CPV infected dogs (66.9; IQR: 64.2–68.8) was significantly higher compared to controls (63.3; IQR: 60.2–65.1, P < 0.001). These findings suggest that significant platelet activation is present in dogs with CPV enteritis which may play a role in the disease outcome, similar to people with sepsis. Further studies are required to investigate the prognosticating ability of MPV in dogs with CPV enteritis.

Detection and dynamics of anti-platelet antibodies in thrombocytopenic dogs with and without idiopathic immune thrombocytopenia

BACKGROUND

Antiplatelet antibodies are detected in multiple diseases including primary immune thrombocytopenia (ITP). Dynamics of how these antibodies change over time in ITP is unknown in dogs.

HYPOTHESIS/OBJECTIVES

Antiplatelet antibodies (APA) will be detected in thrombocytopenic dogs with multiple etiologies and dynamics of APA in dogs with ITP can be used to evaluate response to treatment and relapse. Determine APA at the time of diagnosis in thrombocytopenic dogs and serially in primary ITP dogs.

ANIMALS

Seventy-nine thrombocytopenic dogs and 28 primary ITP dogs.

METHODS

Direct flow cytometry was performed in thrombocytopenic dogs at initial evaluation and serially in suspected primary ITP dogs. In primary ITP dogs, a 2-tailed Fisher's exact test was performed comparing survival to discharge between dogs with and without melena and to relate response to treatment and relapse to changes in APA and platelet count (repeated measures analysis, Spearman correlation).

RESULTS

Twenty percent (16/79) of thrombocytopenic non-ITP dogs with infectious, neoplastic, or other diseases and all primary ITP dogs were positive for APA. Melena at initial evaluation was associated with decreased survival to discharge (odds ratio 0.06; P = .01). Persistence of APA was not associated with response to treatment, but recurrence of antibodies was associated with relapse (odds ratio 205.0; P < .01). There was no difference in percentage of APA or platelet count at initial diagnosis between dogs that did or did not respond to treatment.

CONCLUSIONS AND CLINICAL IMPORTANCE

Serial monitoring of APA in dogs with primary ITP appeared beneficial for determining relapse of disease.

A pilot study evaluating the prognostic utility of platelet indices in dogs with septic peritonitis

OBJECTIVE

To characterize platelet indices at time of diagnosis of septic peritonitis in dogs and to assess the relationship between platelet parameter data and survival to discharge in dogs treated surgically.

DESIGN

Retrospective, observational, descriptive pilot study from 2009 to 2014.

SETTING

University teaching hospital.

ANIMALS

Forty-eight dogs diagnosed with septic peritonitis were included in this study. Thirty-six dogs had surgical source control. Blood samples from 46 healthy control dogs were used for reference interval (RI) generation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Dogs with septic peritonitis had significantly increased mean values for mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) with increased proportions of dogs having values above the RI compared to healthy dogs. A significantly increased proportion of dogs with septic peritonitis had platelet counts above (12.5%) and below (8.3%) the RI, with no significant difference in mean platelet count compared to healthy dogs. No significant differences in the mean platelet count, MPV, PCT, or PDW were found between survivors and nonsurvivors in dogs with surgical source control; however, dogs with MPV values above the RI had significantly increased mortality compared to dogs within the RI (P = 0.025). Values outside the RI for other platelet parameters were not associated with significant differences in mortality.

CONCLUSIONS

Dogs with septic peritonitis have increased frequency of thrombocytosis and thrombocytopenia with increased MPV, PCT, and PDW. An increased MPV may be a useful indicator of increased risk of mortality in dogs treated surgically.

Optimized gating and reference ranges of reticulated platelets in dogs for the Sysmex XT-2000iV

Background

Canine reticulated platelets (r-PLTs) i.e., juvenile PLTs reflecting thrombopoiesis can be measured automatically with the hematology analyzer Sysmex XT-2000iV using manual gating options. However, the impact of interferences on r-PLT measurements performed with the gates published previously (Pankraz et al., Vet Clin Path 38:30–38, 2009; Gelain et al., High fluorescent platelets fraction in macrothrombocytopenic Norfolk terrier, 2010) is largely unknown.

The aim was to compare different published gates for measurement of r-PLTs with the Sysmex XT-2000iV with an own, optimized gate (“Oellers-gate”) and to establish reference intervals (RIs) in > 120 dogs.

Data of 362 measurements of diseased and healthy dogs were analyzed retrospectively. Several gates were applied and RIs for r-PLTs and platelet indices were established for pet dogs and a group of 153 healthy Beagles kept under defined housing conditions. Intra-assay precision (CV) was also assessed.

Results

In 30/362 samples, interferences consistent with small erythrocytes/reticulocytes were seen in the previously published gates but not in the “Oellers-gate”. Good correlation was found between the different gates (r_s: 0.88–1.00). RIs for the “Pankraz-gate”, the “Gelain-gate”, and the “Oellers-gate” were 0.0–1.2, 0.2–3.7 and 0.2–3.9 % respectively. CVs were ranging between 22 and 41 %.

Conclusions

Optimization of previously published gates minimized interferences of small erythrocytes with r-PLT measurements.

Evaluation of platelet distribution width in chronic obstructive pulmonary disease patients with pulmonary embolism

BACKGROUND

Platelets play an important role in the pathogenesis of pulmonary embolism (PE). We aimed to investigate whether there is a correlation between platelet distribution width (PDW) and chronic obstructive pulmonary disease (COPD) patients with PE.

METHODS

We conducted a retrospective study using 126 COPD patients with PE and 51 COPD patients without PE. Blood biomarkers, including PDW and d-dimer, were included. Odds ratios (OR) associated with PDW and interactions with d-dimer, SpO2 were estimated for PE.

RESULTS

PDW was higher in the COPD patients with PE group (p = 0.007). A higher PDW had a significantly increased risk of PE than a lower PDW (adjusted OR 2.724, 95% CI: 1.290-5.753).

CONCLUSION

PDW are elevated in COPD patients with PE and are associated with the risk of PE.

Canine stage 1 periodontal disease: a latent pathology

To evaluate the potential health issues associated with periodontal disease (PD) in dogs, 1004 teeth from 25 dogs were examined. The dogs were randomly selected, aged 2-14 years, and had at least 95% of their teeth at the first PD stage. Significant positive correlations between plaque grade (PG) and gum inflammation, gingival regression, periodontal pocket, age and serum alanine aminotransferase (ALT) activity were identified. In contrast, PG was negatively correlated to total platelet count. Altogether, these findings suggest that prevention and therapy at the first PD stages can have an important impact on the general health condition of dogs.

Generation of functional platelets from canine induced pluripotent stem cells

Thrombocytopenia (TTP) is a blood disease common to canines and human beings. Currently, there is no valid therapy for this disease except blood transfusion. In this study, we report the generation of canine induced pluripotent stem cells (ciPSCs) from canine embryonic fibroblasts, and a novel protocol for creating mature megakaryocytes (MKs) and functional platelets from ciPSCs. The ciPSCs were generated using lentiviral vectors, and differentiated into MKs and platelets on OP9 stromal cells supplemented with growth factors. Our ciPSCs presented in a tightly domed shape and showed expression of a critical pluripotency marker, REX1, and normal karyotype. Additionally, ciPSCs differentiated into cells derived from three germ layers via the formation of an embryoid body. The MKs derived from ciPSCs had hyperploidy and transformed into proplatelets. The proplatelets released platelets early on that expressed specific MK and platelet marker CD41/61. Interestingly, these platelets, when activated with adenosine diphosphate or thrombin, bind to fibrinogen. Moreover, electron microscopy showed that the platelets had the same ultrastructure as peripheral platelets. Thus, we have demonstrated for the first time the generation of ciPSCs that are capable of differentiating into MKs and release functional platelets in vitro. Our system for differentiating ciPSCs into MKs and platelets promises a critical therapy for canine TTP and appears to be extensible in principle to resolve human TTP.

Establishment of canine hematology reference intervals for the Sysmex XT-2000iV hematology analyzer using a blood donor database

BACKGROUND

The Sysmex XT-2000iV is a hematology analyzer that combines impedance and optical techniques and has been previously validated for dogs. Specific reference intervals (RIs) are useful when interpreting results.

OBJECTIVES

The aim of this study was to determine hematologic RIs for the Sysmex XT-2000iV using a large reference population of client-owned clinically healthy blood donor dogs, adopting an indirect sampling method.

METHODS

Dogs were screened for breed, size, health, travel history, and previous blood transfusions, and the quality of blood specimens was also reviewed. Results from specimens that met inclusion criteria were used to determine RIs using a nonparametric method. Specimens from Akitas and sighthounds were excluded from the study.

RESULTS

Of 992 specimens that had been collected from blood donors and analyzed, 297 were initially included in the RI study. An additional 38 specimens were excluded as outliers, and hematologic RIs for the Sysmex XT-2000iV were based on analysis of specimens from 259 clinically healthy dogs. Measurands evaluated had variable distributions, and intervals obtained were generally comparable to previously reported RIs. Differences observed included higher lower and upper reference limits (LRL and URL, respectively) for MCV and lower URL for WBC count. Reticulocyte count and the LRL of the absolute lymphocyte count were also higher than previously reported, and the RI for platelet count was narrower and lower.

CONCLUSIONS

Canine RIs for the Sysmex hematology analyzer were established using an indirect sampling method with reference individuals selected from a large database of client-owned clinically healthy blood donor dogs. For specimens included in this study, time from collection to analysis was similar to what veterinary commercial laboratories experience.