Canine reference intervals for the Sysmex XT-2000iV hematology analyzer

The Immature Reticulocyte Fraction (IRF) in the Sysmex XN-1000V Analyzer Can Differentiate between Causes of Regenerative and Non-Regenerative Anemia in Dogs and Cats

The Sysmex XN-1000V analyzer can identify those reticulocytes with high RNA content and fluorescence, providing the immature reticulocyte fraction (IRF). While this parameter has been used in human medicine to identify the cause of anemia, few studies have focused on its use in veterinary medicine. In this study, we determined the IRF and related reticulocyte parameters in a large population of non-anemic and anemic dogs and cats (subclassified depending on the origin of their anemia). The IRF was significantly higher in hemolytic anemias compared to hemorrhagic ones in both species. Moreover, the IRF was significantly lower in dogs and cats with bone marrow failure than in other non-regenerative anemias and in both groups compared to pre-regenerative anemias. The accurate cut-off values for the differential in regenerative anemias and reference ranges for both species using the Sysmex XN-1000V are also reported. The measurement of the IRF in this analyzer can help clinicians to further classify the type of anemia in both species.

Effect of storage on the nitro blue tetrazolium reduction test in dog blood samples

INTRODUCTION

The nitro blue tetrazolium (NBT) reduction test (NBTT) has been used for measuring the metabolic activity of phagocytes of mammals. Activated neutrophils transform NBT into formazan in the cytoplasm. The NBTT can detect the activation of neutrophils in peripheral blood and is used to assess neutrophil function in dogs. However, the NBTT is not used frequently in the clinical setting, as samples should be processed after blood collection.

OBJECTIVE

The aim of this study was to evaluate the effect of storage on NBTT in dog blood samples.

MATERIALS AND METHODS

Residual EDTA blood samples from 22 dogs were included of different ages, breeds, and sex. The buffy coat layer was separated from the blood and incubated with 0.1% NBT. The NBTT was performed at 0, 24, 48, and 72 h after the collection of blood. Blood samples were stored at 4°C until the tests were performed. Blood smears were evaluated by light microscopy, and the NBT reduction rate was reported, which represents the percentage of activated neutrophils. The NBT reduction rate was calculated after counting 300 neutrophils in each slide.

RESULTS

The means of NBTT in dog blood samples at 0, 24, 48, and 72 h were 8.3%, 8.5%, 8.7%, and 7.8%, respectively. No significant differences were observed between time points.

CONCLUSIONS

This study showed that the NBTT can be performed up to 72 h after the collection of canine blood if correctly refrigerated at 4°C. This finding supports the performance of the NBTT in the clinical setting.

Reference intervals for reticulocyte indices, immature reticulocyte fraction, and the percentage of hypochromic red blood cells in adult large breed dogs using the ADVIA 2120 hematology analyzer

Reticulocyte indices are used to characterize anemia, including the identification of regeneration. In people, the immature reticulocyte fraction (IRF), percentage of hypochromic red blood cells (%HYPO-RBC), and other reticulocyte indices have been used as earlier indicators of erythropoiesis and as valuable monitoring tools in the assessment of various therapies. The reference intervals (RI) of the IRF and %HYPO-RBC have not been reported in dogs. The objective of this study was to establish RIs for novel variables (IRF, %HYPO-RBC, and CH-delta) and assess RIs for more commonly reported reticulocyte indices in healthy dogs. RIs were calculated from blood results retrospectively collected from 106 client-owned healthy dogs at the time of induction into a blood donor program using the ADVIA 2120 hematology analyzer (Siemens Healthcare Diagnostics). For the calculation of RIs, appropriate tests were applied for outlier detection and normality assessment. For variables normally distributed, RIs and their respective 90% confidence intervals (CIs) were calculated using parametric methods, while for variables not normally distributed, robust methods were used and bootstrapping for calculating the 90% CIs. The following RIs were established: reticulocyte hemoglobin content (CHr) 24.5-28 pg, mean reticulocyte volume (MCVr) 85.9-99.3 fL, mean corpuscular hemoglobin concentration of reticulocytes (CHCMr) 271.0-306.3 g/L, IRF 10.4%-43.5%, CH-delta 0.5-4.3 pg, and percentage of hypochromic red blood cells (%HYPO-RBC) 0.10%-0.80%. The results of this study provide RIs for novel reticulocyte variables. Further studies are required to determine the clinical utility of IRF, %HYPO-RBC, and CH delta as early indicators of erythropoietic activity in canine patients.

A blinded, randomized and controlled multicenter clinical trial to assess the efficacy and safety of Leisguard® as an immunotherapeutic treatment for healthy Leishmania infantum-seropositive dogs

BACKGROUND

Domperidone (Leisguard®) is an immunomodulatory drug used as a preventive measure in healthy dogs. However, no studies have been published in healthy Leishmania infantum-seropositive dogs. The aim of this study was to evaluate the clinical efficacy and safety of domperidone as immunotherapy in Leishmania-seropositive healthy dogs.

METHODS

Sixty-seven dogs were treated with domperidone at 0.5 mg/kg and 44 dogs received placebo, once daily for 4 consecutive weeks. Monthly treatments were repeated every 4 months until the end of the 1-year follow-up period. Veterinary examinations were performed on days 0, 30, 120, 150, 240, 270 and 360. Samples of blood and urine were collected on days 0, 120, 240 and 360 for routine laboratory tests and quantitative in-house ELISA for the detection of L. infantum-specific antibodies. Furthermore, Leishmania real-time PCR and IFN-γ ELISA were performed at day 0 and the end of the study. Dogs that developed disease were withdrawn from the study and classified as sick dogs. Adverse drug reactions were reported.

RESULTS

Thirty dogs developed disease during the follow-up period: 13/67 (19.4%) in the group treated with domperidone and 17/44 (38.6%) in the placebo-treated group (P = 0.03). Low-seropositive dogs treated with domperidone (4/40, 9.1%) were significantly less likely to develop disease compared to low-seropositive dogs treated with placebo (7/24, 29.2%; P = 0.04), while no differences were found between domperidone (9/23, 39.1%) and placebo (10/20, 50%) in medium- to high-seropositive dogs. At the end of the study, a higher proportion of Leishmania PCR-positive dogs was observed in the placebo-treated group (16/33, 48.5%) compared to the domperidone group (13/51, 25.5%; P = 0.04). Furthermore, low-seropositive dogs treated with domperidone with an increase of IFN-γ concentration presented a higher increase than those treated with placebo at the end of the study. Four dogs treated with domperidone presented self-limiting diarrhea.

CONCLUSIONS

Healthy dogs with low L. infantum antibody levels treated with domperidone were less likely to develop disease compared to placebo-treated dogs. Furthermore, domperidone presented a good safety profile.

Evaluation of red blood cell distribution width, neutrophil-to-lymphocyte ratio, and other hematologic parameters in canine acute pancreatitis

OBJECTIVE

To determine if RBC distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and other hematological parameters are associated with increased odds of in-hospital mortality, increased length of hospitalization (LOH), or disease severity as measured by the Canine Acute Pancreatitis Severity (CAPS) score in dogs with acute pancreatitis (AP).

DESIGN

Retrospective, multicenter study from January 2016 to August 2020.

SETTING

Four private emergency and specialty referral centers.

ANIMALS

On initial case search, 118 client-owned dogs were identified with a clinical diagnosis of AP. Out of these cases, 114 dogs met inclusion criteria, defined as sudden onset of ≥2 compatible clinic signs (lethargy, anorexia, vomiting, or abdominal pain), a specific canine pancreatic lipase concentration >400 μg/L, hospital admission, as well as CBC and serum biochemistry run within 48 hours of initial hospitalization. Disease severity was calculated and measured using the CAPS score, in addition to LOH and in-hospital mortality.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Clinical endpoints were in-hospital mortality, LOH, and disease severity, as evaluated by the CAPS score. Overall in-hospital mortality was 36.8%. NLR was significantly associated with survival, with a higher percentage being associated with an increased likelihood of nonsurvival (odds ratio: 1.1, 95% confidence interval: 1.0-1.2; P = 0.006, adjusted P = 0.04). Increased NLR was found to be significantly associated with a longer LOH based on the unadjusted P-value (P = 0.02) but was not statistically significant based on a P-value adjusted for multiple comparisons (P = 0.12). No significant associations were noted when RDW, platelet-to-lymphocyte ratio, WBC count, mean platelet volume, RDW-to-platelet ratio, or RDW-to-total serum calcium ratio was evaluated against outcome measures.

CONCLUSIONS

This study retrospectively evaluated the prognostic utility of several readily available hematological parameters in dogs hospitalized for AP. Dogs with an increased NLR may have a higher risk of in-hospital mortality and increased LOH, although future prospective studies are necessary to confirm these findings.

Performance of the Sysmex XN-V hematology analyzer in determining the immature platelet fraction in dogs: A preliminary study and reference values

BACKGROUND

Immature platelets (IPs) are newly formed platelets released into circulation that have been demonstrated as good markers of thrombopoiesis. Although many flow cytometric and fully automated-based methods are available, the latest Sysmex XN-V hematology analyzer for veterinary use is equipped with a specific fluorescent platelet channel (PLT-F) that detects platelets using a platelet-specific dye.

OBJECTIVES

The aims of this study were to evaluate the performance of the Sysmex XSN-1000 V in determining the IPF (immature platelet fraction) and other selected PLT-F channel parameters and to propose IPF reference intervals (RIs) for canine blood samples.

METHODS

Canine EDTA blood samples were analyzed on the Sysmex XN-1000 V to assess linearity, imprecision, carryover, stability, and the effect of platelet clumping on selected platelet parameters from the PLT-F channel. We also reported the de novo generated RIs for the IPF in dogs.

RESULTS

Imprecision was acceptable (CV <10%) for all parameters except for the absolute IPF values (IPF#), in which the reproducibility was 12.15% for the normal-low concentration samples. Linearity and carryover were excellent for all variables. Relative IPF values (IPF %) and IPF# remained stable for both storage conditions for up to 48 hours; however, a nonsignificant progressive increase in these parameters was observed from 12 hours at 4°C. We observed a statistical increase in IPF% and IPF# and a statistically significant decrease in PLT-F counts after intentional in vitro platelet aggregation. RIs were generated for all reference samples (n = 69) and for samples with (n = 25) or without (n = 44) platelet clumps.

CONCLUSIONS

The performance of the new PLT-F channel-derived variables for dogs was excellent. Specific RIs for IPF should be used when platelet aggregates are present.

Signalment, Immunological and Parasitological Status and Clinicopathological Findings of Leishmania-Seropositive Apparently Healthy Dogs

Canine leishmaniosis caused by Leishmania infantum is a disease with a wide range of clinical manifestations. Epidemiological serosurveys performed in Europe often lack a thorough assessment of clinical health status of studied dogs. The aim of this study was to evaluate signalment, immunological and parasitological status and clinicopathological findings of L. infantum-seropositive apparently healthy dogs (n = 212) living in endemic areas. Routine laboratory tests, endpoint in-house ELISA to quantify the anti-Leishmania antibodies, blood Leishmania qPCR and IFN-γ ELISA were performed. All dogs enrolled were L. infantum-seropositive and were classified as healthy (n = 105) or sick (n = 107) according to LeishVet guidelines. The sick group presented a higher proportion of medium to high antibody levels and positive qPCR and lower IFN-γ concentration compared to the healthy group. Sick dogs were mostly classified in LeishVet stage IIa. Biochemical alterations (98%) were the most common clinicopathological findings, with fewer urinary tract (46%) and hematological (40%) alterations. Apparently healthy L. infantum-seropositive dogs can be classified between truly healthy dogs and sick dogs with clinicopathological findings. Sick dogs presented medium to high seropositivity and parasitemia and low IFN-γ concentrations, and their most common clinicopathological abnormalities were serum protein alterations followed by proteinuria and lymphopenia.

Stomatocytosis in a Beagle and Australian Cattle Dog

BACKGROUND

Canine stomatocytosis is a well-recognized rare erythrocyte disorder characterized by nonsyndromic forms with selective erythroid involvement, syndromic forms with extra-hematologic disease, and acquired forms.

OBJECTIVES

We describe serial clinicopathologic changes in two dogs with stomatocytosis of breeds that are different from those previously reported.

METHODS

Blood samples were obtained from a 12-year-old female neutered Australian Cattle Dog and a 12-year-old male neutered Beagle for hematologic and biochemical analyses, including a morphologic examination of peripheral blood films. Serial clinicopathologic data were reviewed, including CBCs performed by the referring veterinary surgeons.

RESULTS

Serial CBC data in both cases reported a variable decrease in RBC numbers commonly associated with a normal hematocrit, macrocytosis, hypochromasia, changes in red cell distribution width parameters including marked histogram abnormalities in volume distribution of the RBC population, and mildly increased or normal reticulocyte counts. Morphologic examination of peripheral blood films identified variable numbers of stomatocytes, knizocytes (Case 1, Day 1, Day 4), mild anisocytosis, mild macrocytosis, and mild polychromasia.

CONCLUSIONS

In both cases, the changes exhibited in the erythrogram raise suspicion for an RBC membrane disorder with cell volume dysregulation and stomatocytosis, although they did not appear to cause clinically relevant hemolysis.

Validation of the Sysmex XN-V hematology analyzer for canine specimens

Background

The Sysmex XN‐V is derived from the new Sysmex XN series of human hematology analyzers. The main changes from the previously validated XT‐2000iV analyzer include an optic‐fluorescent analysis for platelets and nucleated RBC count.

Objective

We aimed to validate the Sysmex XN‐V for canine blood according to American College for Veterinary Clinical Pathology and International Council for Standardization in Hematology recommendations.

Materials and Methods

Canine EDTA blood specimens and quality control material were analyzed on the Sysmex XN‐V to evaluate imprecision, bias, linearity, a comparison with the XT‐2000iV analyzer, interference effects, carry‐over, and stability. We also verified previously established Sysmex XT‐2000iV reference intervals (RIs).

Results

Imprecision and bias were low (<5%) for most variables. Observed total error was lower than allowable total error for most measured variables except lymphocytes and monocytes. Visually determined linearity was excellent for all variables, except for lymphocytes. The correlation between the XN‐V and XT‐2000iV analyzers was high (>0.93) for all variables except MCHC and reticulocyte indices. Correlations between the Sysmex XN‐V and manual differential counts were good for neutrophils and eosinophils, acceptable for lymphocytes, and fair for monocytes. Hemolysis, lipemia, and to a lesser extent icterus, had significant effects on measured hemoglobin concentration and associated variables. Carry‐over was not visually observed for any variable. Changes in the Sysmex XN‐V measurements after storage at 4℃ and 24℃ were similar to those described for the Sysmex XT‐2000iV analyzer. The previously established Sysmex XT‐2000iV RIs can be used to interpret results from the Sysmex XN‐V analyzer for most variables except red blood cell distribution width and mean platelet volume.

Conclusions

The performance of the Sysmex XN‐V analyzer was excellent and compared favorably with the Sysmex XT‐2000iV analyzer.

Haematology and blood chemistry in free-ranging quokkas (Setonix brachyurus): Reference intervals and assessing the effects of site, sampling time, and infectious agents

Quokkas (Setonix brachyurus) are small macropodid marsupials from Western Australia, which are identified as of conservation concern. Studies on their blood analytes exist but involve small sample sizes and are associated with very little information concerning the health of the animals. Blood was collected from free-ranging quokkas from Rottnest Island (n = 113) and mainland (n = 37) Western Australia, between September 2010 and December 2011, to establish haematology and blood chemistry reference intervals. Differences in haematology and blood chemistry between sites (Rottnest Island v mainland) were significant for haematology (HMT, p = 0.003), blood chemistry (BLC, p = 0.001) and peripheral blood cell morphology (PBCM, p = 0.001). Except for alkaline phosphatase, all blood chemistry analytes were higher in mainland animals. There were also differences with time of year in HMT (p = 0.001), BLC (p = 0.001) and PBCM (p = 0.001) for Rottnest Island quokkas. A small sample of captive animals (n = 8) were opportunistically sampled for plasma concentrations of vitamin E and were found to be deficient compared with wild-caught animals. Fifty-eight of the 150 quokkas were also tested for the presence of Salmonella, microfilariae, Macropodid herpesvirus-6, Theileria spp., Babesia spp., trypanosomes, Cryptococcus spp. and other saprophytic fungi. All eight infectious agents were detected in this study. Infectious agents were detected in 24 of these 58 quokkas (41%), with more than one infectious agent detected for all 24 individuals. Salmonella were detected concurrently with microfilariae in 8 of these 24 quokkas, and this mixed infection was associated with lower values across all haematological analytes, with Salmonella having the greater involvement in the decreased haematological values (p < 0.05). There was no evidence for an effect of sex on HMT, BLC and PBCM. Our data provide important haematological and blood chemistry reference intervals for free-ranging quokkas. We applied novel methods of analyses to HMT and BLC that can be used more broadly, aiding identification of potential disease in wildlife.

Hematological and Biochemical Reference Intervals for 5 Adult Hunting Dog Breeds Using a Blood Donor Database

Simple Summary

Hematological and biochemical profiles are essential in the diagnosis and monitoring of disease in veterinary medicine, requiring optimal Reference Intervals (RIs) for accurate interpretation. The aim of this study is to determine hematobiochemical RIs for 5 hunting dog breeds from a blood donor database and to compare them with laboratory established and published RIs to identify possible breed and attitude-related differences. A total of 445 healthy adult hunting dogs (156 Ariégeois, A; 52 Bleu de Gascogne, B; 64 Bracco italiano, C; 123 Segugio italiano, D; 50 Briquet Griffon Vandeen, E) were included in the study. Significant differences in 12 hematologic and serum biochemical analytes, for which a breed-specific variation appears to be the most plausible explanation, were detected, and new RIs for these parameters are provided.

Abstract

Numerous studies have shown the importance of breed-related differences between hematological and biochemical results in veterinary medicine. The aim of this study is to determine hematologic and biochemical Reference Intervals (RIs) for 5 hunting dog breeds from a blood donor database, adopting an indirect sampling method, and to compare them with laboratory established and published RIs to identify possible breed and attitude-related differences. The study analyzed the blood parameters of 445 adults (222 females and 223 male, with age ranging from 2 to 8 years, mean age 5.3 years), client-owned, clinically healthy blood donor dogs of 5 breeds: 156 Ariégeois, 52 Bleu de Gascogne, 64 Bracco italiano, 123 Segugio italiano, and 50 Briquet Griffon Vandeen. Statistical analysis was performed as recommended by the American Society of Veterinary Clinical Pathology (ASVCP) guidelines. RIs for red blood cells (RBC), hematocrit (HCT), hemoglobin (HB), main corpuscular volume (MCV), main corpuscular hemoglobin (MCH), main corpuscular hemoglobin concentration (MCHC), red distribution widht (RDW), white blood cells (WBC), and differential leukocytes count, PLT, Albumin, Total Protein, Urea, Creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) for each of the 5 breeds were performed, and significant differences with the established RIs were detected. We found significant differences in 12 hematologic and serum biochemical analytes for which a breed-specific variation appears to be the most plausible explanation. New RIs for HCT, MCH, MCHC, RDW, PLT, Monocytes, Eosinophils, Albumin, Urea, Creatinine, AST, and ALT are provided for at least 1 breed. Breed-specific RIs for adult hunting dogs will help avoid misinterpretation of laboratory results in these breeds.

Development and validation of a novel clinical scoring system for short-term prediction of death in dogs with acute pancreatitis

Background

Acute pancreatitis (AP) is associated with a high death rate in dogs, but accurate predictors of early death are still lacking.

Objectives

To develop a scoring system for prediction of short‐term case fatality in dogs with AP.

Animals

One hundred sixty‐nine dogs with AP including 138 dogs in the training cohort and 31 dogs in the validation cohort.

Methods

Multicenter, retrospective cohort study. Survival analysis was used to assess the associations with short‐term death (within 30 days after admission). Independent predictors of death were identified by a stepwise selection method and used for the score calculation.

Results

Death rate within 30 days after admission was 33% in the training cohort. Four independent risk factors for short‐term death were identified in the training cohort: presence of systemic inflammatory response syndrome, coagulation disorders, increased creatinine and ionized hypocalcemia. Canine Acute Pancreatitis Severity (CAPS) score was developed to predict short‐term death, integrating these 4 factors in a weighted way. A simplified version of CAPS score (sCAPS) including respiratory rate instead of SIRS was also assessed. The area under the receiver‐operating characteristic curve (AUC) of CAPS and sCAPS scores was 0.92 in the training cohort with an optimal cutoff of 11 (sensitivity, 89%; specificity, 90%) and 6 (sensitivity, 96%; specificity, 77%), respectively. CAPS and sCAPS score were validated in the validation cohort with respective AUC of 0.91 and 0.96.

Conclusions and Clinical Importance

We propose 2 scoring systems that allow early and accurate prediction of short‐term death in dogs with AP.

Hematology reference intervals for adult cows in France using the Sysmex XT-2000iV analyzer

In order to develop bovine hematology reference intervals (RIs) in accordance with new international recommendations, we analyzed 156 blood specimens of healthy adult dairy and beef cows from 32 farms with a Sysmex XT-2000iV analyzer, and by manual scoring of platelet clumps and white blood cell (WBC) differential. We established RIs by the nonparametric method, and examined effects of age, production type (beef vs. dairy), and stage of lactation. RIs could not be determined for platelet count and indices because clumps were observed in 80% of specimens. Optical and impedance red blood cell (RBC) counts were similar, although statistically different. RIs for analyzer and manual WBC differentials were not different except for lymphocyte concentration, the subpopulations of which were counted manually. Hematocrit was higher in beef than dairy cattle, and hemoglobin was lower in early lactation. Increases in RBC count, mean corpuscular volume, mean corpuscular hemoglobin, and RBC distribution width were noted with increasing age, along with decreases in WBC count, neutrophils, and lymphocytes. Most RIs in our study, with the exception of neutrophils, were similar to those previously reported using a flow cytometry analyzer.

Analytical variability of estimated platelet counts on canine blood smears

BACKGROUND

The analytical variability of estimated platelet counts in dogs has not been reported.

OBJECTIVES

The purpose of this study was to assess the magnitude of analytical imprecision of platelet estimates and the possible impact of this imprecision on clinical decisions.

METHODS

Three independent observers counted the number of platelets in 3 different areas (LE = lateral edge; CM = central monolayer; FE = feathered edge) of 30 canine blood smears with different instrumental platelet counts. The coefficient of variation (CV) for each observer was calculated in different areas of each smear (intra-observer variability), among different regions of each smear (inter-area variability), and among different observers in each area (inter-observer variability). The influence of these variabilities on the classification of platelet estimates as adequate, increased, or decreased was also assessed.

RESULTS

The CVs recorded in the different areas by each observer ranged from 8% to 88% and were negatively correlated (P < .001, r = -.65) with the mean number of platelets per field. The mean platelet number was significantly lower in the FE and significantly higher in the CM compared with the LE, but the magnitude of this difference varied with the operators. The concordance among operators regarding platelet estimates was fair (k = 0.36) to substantial (k = 0.71) depending on the area. The overall inter-area concordance was moderate (k = 0.59).

CONCLUSIONS

Platelet estimates suffer from high variability that could lead to patient misclassification. Therefore, guidelines to standardize the platelet estimate are needed.

White blood cell differentials in dogs with congestive heart failure (CHF) in comparison to those in dogs without cardiac disease

OBJECTIVES

To determine if dogs with congestive heart failure have different white blood cell differential cell counts than dogs without cardiac disease.

MATERIALS AND METHODS

In total, 72 dogs with congestive heart failure and 143 controls were included in this retrospective study. Signalment, white blood cell differential counts and echocardiography data were retrieved. Basic statistical analysis was performed on white blood cell differential counts, and principal component analysis was used to compare these counts between cases and controls, with age, gender and case/control status as supplementary variables. Cases and controls were compared with binary logistic regression for the principal components identified and individual white blood cell differential counts. Principal component analysis of cases alone was conducted with age, gender, weight and mitral E wave:isovolumic relaxation time as supplementary variables. Linear regression analysis was used to explore the association between mitral E wave:isovolumic relaxation time and the principal components, weight, gender, age and diagnosis (mitral valve disease or dilated cardiomyopathy).

RESULTS

Among cases and controls, the largest variance in data (component 1) was associated with neutrophils, band neutrophils, monocytes and case status (P<0·01). The odds of an individual being a case increased 2·5-fold (95% confidence interval: 1·4 to 4·4) for each unit increase in component 1. Among the cases, mitral E wave:isovolumic relaxation time was associated with neutrophil count and case/control category.

CLINICAL SIGNIFICANCE

Dogs with congestive heart failure had a statistically significant increase in neutrophils, band neutrophils and monocytes in comparison with those without cardiac disease but the cell counts remained within normal reference intervals.

Evaluation of CTAD (citrate-theophylline-adenosine-dipyridamole) as a universal anticoagulant in dogs

CTAD (citrate-theophylline-adenosine-dipyridamole) has been shown to be an almost universal anticoagulant in human and feline medicine, allowing most hematology, coagulation, and biochemical analyses. Forty canine blood specimens were collected in CTAD, EDTA, heparin, and citrate for hematology, biochemistry, and coagulation analyses. CTAD partially limited platelet aggregation observed in EDTA blood smears. CTAD specimens gave similar and well-correlated results for most variables of a complete blood cell count, except for mean corpuscular volume, which was moderately higher, and mean corpuscular hemoglobin concentration, which was moderately lower in CTAD than in EDTA; reticulocyte and platelet indexes were poorly correlated. CTAD plasma gave similar results to citrate for fibrinogen, antithrombin, and D-dimers, and relatively similar results for prothrombin time, but activated partial thromboplastin time was poorly correlated. Triglycerides, cholesterol, glucose, total proteins, phosphate, iron, alanine aminotransferase, γ-glutamyl transferase, and lipase were similar and well correlated in CTAD and heparin plasmas. Urea, creatinine, albumin, alkaline phosphatase, amylase, and aspartate aminotransferase showed moderate-to-marked bias, but these variables could be measured in CTAD plasma if new reference intervals were determined. Creatine kinase activity, potassium, chloride, and total carbon dioxide measurements are not recommended in CTAD plasma. CTAD is a prospective candidate as an almost universal anticoagulant for routine hematology, some plasma coagulation, and many biochemistry variables in dogs. Definitive recommendations will require study of abnormal canine blood specimens.

Sensitivity and specificity of manual and automated measurements of reticulocyte parameters for classification of anemia in dogs: 174 cases (1993-2013)

OBJECTIVE To assess sensitivity and specificity of manual and automated measurements of reticulocyte percentage, number, and production index for classification of anemia in dogs. DESIGN Retrospective case series SAMPLE 174 blood smears from client-owned dogs with anemia collected between 1993 and 2013 for which reticulocyte parameters were determined manually (nonregenerative anemia, 22; preregenerative anemia, 23; regenerative anemia, 28) or with an automated laser-based counter (nonregenerative anemia, 66; preregenerative anemia, 17; regenerative anemia, 18). PROCEDURES Diagnostic performance was evaluated with receiver operating characteristic (ROC) curves by considering preregenerative anemia as nonregenerative or regenerative. Sensitivity, specificity, and positive likelihood ratio were calculated by use of cutoffs determined from ROC curves or published reference limits. RESULTS Considering preregenerative anemia as non regenerative, areas under the curve (AUCs) for reticulocyte percentage, number, and production index were 97%, 93%, and 91% for manual counting and 93%, 90%, and 93% for automated counting. Sensitivity, specificity, and positive likelihood ratio were 82% to 86%, 82% to 87%, and 4.6 to 6.4, respectively. Considering preregenerative anemia as regenerative, AUCs were 77%, 82%, and 80% for manual counting and 81%, 82%, and 92% for automated counting. Sensitivity, specificity, and positive likelihood ratio were 72% to 74%, 76 to 87%, and 2.7 to 6.2, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Whereas all reticulocyte parameters identified regeneration in anemic dogs, the performance of specific parameters was dependent on the method used. Findings suggested that lower cutoffs than published reference limits are preferred for reticulocyte number and production index and higher cutoffs are preferred for reticulocyte percentage. Reticulocyte production index may be useful when the pretest probability of regeneration is moderate.

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.

A mycobacterial coinfection in a dog suspected on blood smear

A 4-year-old neutered female crossbred Shepherd was referred for a history of 10 days of anorexia, polyuria, polydipsia, polyadenomegaly, and diarrhea. On physical examination, the dog appeared quiet, responsive, and apyretic, with generalized and severe lymphadenomegaly. Hematologic abnormalities included neutrophilic leukocytosis with left shift, and lymphopenia. Blood smears revealed intracytoplasmic bacilli negatively stained with May-Grünwald-Giemsa in neutrophils and monocytes. Lymph node smears revealed pyogranulomatous adenitis with calcified deposits and many negative-staining rod structures, both within the cytoplasm of neutrophils and macrophages, and free in the background. An acid-fast stain (Ziehl-Neelsen) confirmed the diagnosis of mycobacterial infection. The dog was euthanized for public health and ethical reasons, and the postmortem examination revealed severe and generalized granulomatous and necrotizing lymphadenitis, panniculitis, and hepatitis, and infiltration of epithelioid macrophages in the lungs, colon, and spleen. Numerous acid-fast bacilli, consistent with mycobacterial infection, were observed both in the cytoplasm of epithelioid macrophages and giant cells, and free in the background. Mycobacterium bovis was first confirmed by conventional PCR of organ extracts. Mycobacterium avium was detected in a culture of the same organs. Further PCR amplifications and sequencing revealed a coinfection with 2 different species of mycobacterium, one belonging to the Mycobacterium avium complex and the other to the Mycobacterium tuberculosis complex.

The preanalytic phase in veterinary clinical pathology

This article presents the general causes of preanalytic variability with a few examples showing specialists and practitioners that special and improved care should be given to this too often neglected phase. The preanalytic phase of clinical pathology includes all the steps from specimen collection to analysis. It is the phase where most laboratory errors occur in human, and probably also in veterinary clinical pathology. Numerous causes may affect the validity of the results, including technical factors, such as the choice of anticoagulant, the blood vessel sampled, and the duration and conditions of specimen handling. While the latter factors can be defined, influence of biologic and physiologic factors such as feeding and fasting, stress, and biologic and endocrine rhythms can often not be controlled. Nevertheless, as many factors as possible should at least be documented. The importance of the preanalytic phase is often not given the necessary attention, although the validity of the results and consequent clinical decision making and medical management of animal patients would likely be improved if the quality of specimens submitted to the laboratory was optimized.

Breed-specific hematologic reference intervals in healthy adult Dogues de Bordeaux

BACKGROUND

There is an increasing interest for breed-specific reference intervals in veterinary medicine. In a previous study, breed-specific biochemical reference intervals (RIs) have been established for Dogues de Bordeaux (DDBs). This breed is predisposed to familial juvenile glomerulonephropathy and hypothyroidism, and would benefit from hematologic RI.

OBJECTIVE

The purpose was de novo establishment of breed-specific hematologic RIs for the DDB in accordance with the International Federation of Clinical Chemistry and Clinical and Laboratory Standards Institute guidelines.

METHODS

One hundred and twenty DDBs from France and Belgium were recruited. CBCs were determined with the Sysmex XT-2000iV analyzer within 12 hours of blood collection. RIs were determined using the nonparametric method. Effects of sex, age, and face mask color were studied.

RESULTS

RIs were determined in 58 healthy dogs. DDBs had higher RIs for HGB, HCT, MCV, MCHC, and mean platelet volume, and lower RIs for reticulocytes counts, platelets by impedance (PLT-I) and optical count (PLT-O), and plateletcrit when compared with generic canine RIs. Age significantly affected RIs for HGB, HCT, MCHC, WBC, neutrophil, lymphocyte, and monocyte counts.

CONCLUSION

The generic canine RIs established in the same laboratory with analogous preanalytical and analytical variations did not differ significantly from breed-specific RIs, and thus have no significant impact on clinical decision making; however, breed-specific RIs are advised for some RBC and all platelet-related variables to avoid erroneous suspicion of polycythemia and thrombocytopenia when using general canine RIs for evaluation of DDB.

The theory of reference values: an unfinished symphony

The history of the theory of reference values can be written as an unfinished symphony. The first movement, allegro con fuoco, played from 1960 to 1980: a mix of themes devoted to the study of biological variability (intra-, inter-individual, short- and long-term), preanalytical conditions, standardization of analytical methods, quality control, statistical tools for deriving reference limits, all of them complex variations developed on a central melody: the new concept of reference values that would replace the notion of normality whose definition was unclear. Additional contributions (multivariate reference values, use of reference limits from broad sets of patient data, drug interferences) conclude the movement on the variability of laboratory tests. The second movement, adagio, from 1980 to 2000, slowly develops and implements initial works. International and national recommendations were published by the IFCC-LM (International Federation of Clinical Chemistry and Laboratory Medicine) and scientific societies [French (SFBC), Spanish (SEQC), Scandinavian societies…]. Reference values are now topics of many textbooks and of several congresses, workshops, and round tables that are organized all over the world. Nowadays, reference values are part of current practice in all clinical laboratories, but not without difficulties, particularly for some laboratories to produce their own reference values and the unsuitability of the concept with respect to new technologies such as HPLC, GCMS, and PCR assays. Clinicians through consensus groups and practice guidelines have introduced their own tools, the decision limits, likelihood ratios and Reference Change Value (RCV), creating confusion among laboratorians and clinicians in substituting reference values and decision limits in laboratory reports. The rapid development of personalized medicine will eventually call for the use of individual reference values. The beginning of the second millennium is played allegro ma non-troppo from 2000 to 2012: the theory of reference values is back into fashion. The need to revise the concept is emerging. The manufacturers make a friendly pressure to facilitate the integration of Reference Intervals (RIs) in their technical documentation. Laboratorians are anxiously awaiting the solutions for what to do. The IFCC-LM creates Reference Intervals and Decision Limits Committee (C-RIDL) in 2005. Simultaneously, a joint working group IFCC-CLSI is created on the same topic. In 2008 the initial recommendations of IFCC-LM are revised and new guidelines are published by the Clinical and Laboratory Standards Institute (CLSI C28-A3). Fundamentals of the theory of reference values are not changed, but new avenues are explored: RIs transference, multicenter reference intervals, and a robust method for deriving RIs from small number of subjects. Concomitantly, other statistical methods are published such as bootstraps calculation and partitioning procedures. An alternative to recruiting healthy subjects proposes the use of biobanks conditional to the availability of controlled preanalytical conditions and of bioclinical data. The scope is also widening to include veterinary biology! During the early 2000s, several groups proposed the concept of 'Universal RIs' or 'Global RIs'. Still controversial, their applications await further investigations. The fourth movement, finale: beyond the methodological issues (statistical and analytical essentially), important questions remain unanswered. Do RIs intervene appropriately in medical decision-making? Are RIs really useful to the clinicians? Are evidence-based decision limits more appropriate? It should be appreciated that many laboratory tests represent a continuum that weakens the relevance of RIs. In addition, the boundaries between healthy and pathological states are shady areas influenced by many biological factors. In such a case the use of a single threshold is questionable. Wherever it will apply, individual reference values and reference change values have their place. A variation on an old theme! It is strange that in the period of personalized medicine (that is more stratified medicine), the concept of reference values which is based on stratification of homogeneous subgroups of healthy people could not be discussed and developed in conjunction with the stratification of sick patients. That is our message for the celebration of the 50th anniversary of Clinical Chemistry and Laboratory Medicine. Prospects are broad, enthusiasm is not lacking: much remains to be done, good luck for the new generations!

Changes in hematology measurements in healthy and diseased dog blood stored at room temperature for 24 and 48 hours using the XT-2000iV analyzer

BACKGROUND

Changes in canine hematology measurements may occur when analyses are delayed due to shipment of specimens to a laboratory.

OBJECTIVE

The purpose of this study was to report changes in hematologic variables in healthy and diseased canine blood measured with a Sysmex XT-2000iV during storage at room temperature for 24 and 48 hours.

METHODS

EDTA-K3 blood samples from 42 healthy and diseased dogs were measured on a Sysmex XT-2000iV analyzer within one hour of sampling, and after storage for 24 and 48 hours at room temperature in the dark.

RESULTS

Storage caused little or no change in RBC count, HGB concentration and MCH, while there was a moderate increase in HCT, MCV and reticulocytes count, and a moderate decrease in MCHC. Decreased platelet counts by impedance (PLT-I) and optical (PLT-O) measurements were associated with increased mean platelet volume (MPV), platelet-large cell ratio (P-LCR) and platelet distribution width (PDW), including a right shift in the platelet histogram and a dispersion of the platelet dot plot on the scattergram. The total and differential WBC count remained stable except for decreased monocyte counts. In the scatterplots, monocytes shifted into the lymphocyte population after 24 hours, and neutrophil population shifted to the right appearing in the eosinophil gate at 48 hours of storage. The disease status had only a small effect on storage-induced changes, and observed changes had no consequences for clinical decisions.

CONCLUSIONS

Blood storage at room temperature was accompanied by moderate variations in some hematologic variables, awareness of which helps in avoiding misinterpretations.

Breed-specific hematological phenotypes in the dog: a natural resource for the genetic dissection of hematological parameters in a mammalian species

Remarkably little has been published on hematological phenotypes of the domestic dog, the most polymorphic species on the planet. Information on the signalment and complete blood cell count of all dogs with normal red and white blood cell parameters judged by existing reference intervals was extracted from a veterinary database. Normal hematological profiles were available for 6046 dogs, 5447 of which also had machine platelet concentrations within the reference interval. Seventy-five pure breeds plus a mixed breed control group were represented by 10 or more dogs. All measured parameters except mean corpuscular hemoglobin concentration (MCHC) varied with age. Concentrations of white blood cells (WBCs), neutrophils, monocytes, lymphocytes, eosinophils and platelets, but not red blood cell parameters, all varied with sex. Neutering status had an impact on hemoglobin concentration, mean corpuscular hemoglobin (MCH), MCHC, and concentrations of WBCs, neutrophils, monocytes, lymphocytes and platelets. Principal component analysis of hematological data revealed 37 pure breeds with distinctive phenotypes. Furthermore, all hematological parameters except MCHC showed significant differences between specific individual breeds and the mixed breed group. Twenty-nine breeds had distinctive phenotypes when assessed in this way, of which 19 had already been identified by principal component analysis. Tentative breed-specific reference intervals were generated for breeds with a distinctive phenotype identified by comparative analysis. This study represents the first large-scale analysis of hematological phenotypes in the dog and underlines the important potential of this species in the elucidation of genetic determinants of hematological traits, triangulating phenotype, breed and genetic predisposition.

Feline reference intervals for the Sysmex XT-2000iV and the ProCyte DX haematology analysers in EDTA and CTAD blood specimens

Laser-based haematology analysers are routinely used in veterinary clinical pathology laboratories, and are available to practitioners. However, feline haematological reference intervals (RIs) determined according to international recommendations are, to our knowledge, not available. Furthermore, platelet count RI is difficult to establish in cats because of the frequent occurrence of platelet aggregation in blood specimens. The purpose of this study was to establish feline haematological RIs with the Sysmex XT-2000iV and ProCyte DX analysers, in ethylenediamine tetra-acetic acid (EDTA) and in citrate, theophylline, adenosine and dipyridamole (CTAD), which is a combination of anticoagulants limiting platelet aggregation. Blood specimens from 120 healthy cats were analysed in duplicate, and the degree of platelet aggregation was assessed on blood smears. After exclusion of inadequate specimens, 81 sets of results (from 44 males and 37 females, aged from 6 to 116 months) were available for the determination of RIs by the non-parametric method. The effects of the anticoagulant, analyser and aggregation score were assessed. When the aggregation effect was significant, the RIs were determined using the subgroup of blood specimens with no or little aggregation. The effects of sex, age and weight were also investigated, but were moderate. The different RIs obtained with the Sysmex XT-2000iV and ProCyte DX analysers, and the two anticoagulants, were very similar to previous RIs established in EDTA with the ADVIA 120, another laser-based analyser, except for the platelet count in CTAD specimens. Its lower reference limit was higher in CTAD vs EDTA specimens, which confirms the interest in this anticoagulant in cats.

Haematological and biochemical reference intervals of four feline breeds

Many feline breeds have been generated from a small number of ancestors. Thus, breed-specific peculiarities can be expected, which could include haematological and biochemical measurements. Despite this, there are only a few reports on breed-specific reference intervals (RI). This information is essential in routine practice where results from individual patients are usually compared with an RI. The aim was to compare haematological and biochemical data from clinically healthy Abyssinian, Holy Birman, Norwegian Forest and Siberian cats with published RIs to assess whether the published RIs are acceptable in these breeds. Comparison with established RIs using guidelines from the National Committee for Clinical Laboratory Standards and the American Society of Veterinary Clinical Pathology, revealed a number of breed-related clinicopathological differences. New RIs were established, but in most cases the new RIs overlapped with published RIs, and the use of the breed-specific data would minimally affect the clinical interpretation of laboratory results. Important differences that could result in misinterpretation of laboratory results were as follows: microcytosis and high α2-globulin concentrations in Abyssinian cats; high serum creatinine, α2-globulin and glucose concentrations in Holy Birman cats; high serum alkaline phosphatase activity and calcium and phosphate concentration in Norwegian Forest cats; low β2-globulin and γ-globulin concentrations in Norwegian Forest and Siberian cats. Breed-specific RIs should be used for these analytes. In addition, care should be taken in interpreting clinicopathological data in purebred cats for which specific RIs have not been established.

Changes in haematology measurements with the Sysmex XT-2000iV during storage of feline blood sampled in EDTA or EDTA plus CTAD

In veterinary medicine a complete blood cell count (CBC) cannot always be performed within 24 h as usually recommended, particularly for specimens shipped to a reference laboratory. This raises the question of the stability of the variables, especially in ethylenediamine tetra-acetic acid (EDTA) feline blood specimens, known to be prone to in vitro platelet aggregation. Citrate, theophylline, adenosine and dipyridamole (CTAD) has been reported to limit platelet aggregation in feline blood specimens. The aim of this study was to measure the stability of the haematological variables and the platelet aggregation score in EDTA and EDTA plus CTAD (EDCT) feline blood specimens during 48 h of storage at room temperature. Forty-six feline EDTA and EDCT blood specimens were analysed with a Sysmex XT-2000iV analyser, and the platelet count and score of platelet aggregation were estimated immediately and after 24 and 48 h of storage. A significant increase in mean corpuscular volume, haematocrit, reticulocyte and eosinophil counts, and a significant decrease in mean corpuscular haemoglobin concentration and monocyte count were observed. Haemoglobin, mean corpuscular haemoglobin, and red blood cell, white blood cell, neutrophil and lymphocyte counts remained stable. Changes in reticulocyte indexes with time (low fluorescence ratio, medium fluorescence ratio, high fluorescence ratio and immature reticulocyte fraction) were not significant. Changes were generally more pronounced in EDTA than in EDCT. Platelet aggregation decreased markedly in initially highly aggregated EDTA specimens, and increased slightly in initially non- or mildly-aggregated EDTA or EDCT specimens. Platelet counts increased and decreased, or remained stable, respectively. CTAD can reduce storage-induced changes of the haematological variables in feline samples, thus improving the reliability of a CBC and limiting clinical misinterpretations.

Cation-leak stomatocytosis in standard schnauzers does not cosegregate with coding mutations in the RhAG, SLC4A1, or GLUT1 genes associated with human disease

Autosomal dominant overhydrated cation-leak stomatocytosis in humans has been associated with missense mutations in the erythroid membrane transport genes AE1, RhAG, and GLUT1. Syndromic stomatocytosis has been reported in three dog breeds, but stomatocytosis in Standard Schnauzers is usually asymptomatic, and is accompanied by minimal if any anemia. We have extended the evaluation of a cohort of schnauzers. We found that low-level stomatocytosis was accompanied by increased MCV and increased red cell Na content, and minimal or no reticulocytosis. Red cells from two affected dogs exhibited increased currents in on-cell patches measured in symmetrical NaCl solutions, but Na,K-ATPase and NKCC-mediated cation flux was minimal. Three novel coding polymorphisms found in canine RhAG cDNA and three novel polymorphisms found in canine SLC4A1 cDNA did not cosegregate with MCV or Na content. The GLUT1 cDNA sequence was normal. We conclude that unlike human overhydrated cation-leak stomatocytosis, stomatocytosis in this cohort of Standard Schnauzers is not caused by mutations in the genes encoding RhAG, SLC4A1, or GLUT1.

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.