July 2006 Issue

Featured Case Study:
One-year-old mixed-breed dog, Heraios, is feverish and lethargic, with dark-colored urine—what’s the diagnosis? by Martina Becker, DVM, Giessen, Germany

Announcing no slide warm-up on the VetTest® Chemistry Analyzer—just 8 minutes to results!

• Oral Disease Prevalence Study
• CAPC recommends Giardia test
• No cross-reactivity was detected with the SNAP® Parvo Test

Sample Preparation Poster—The VetStat® Electrolyte and Blood Gas Analyzer Sample Collection and Preparation Poster

Training Opportunities: Check out the CE credit-approved Webinars, seminars, and lunch-and-learns available this month from IDEXX

Practice Management: Use dental reminders to ensure procedures get scheduled, by Wendy S. Myers

Interactive Challenge: Now earn FREE CE credit! Identify the primary nucleated cell type and suggest a possible cause for the process from this nasal swab from a dog.

Featured case study: One-year-old male mixed-breed dog, Heraios
by Martina Becker, DVM, Giessen, Germany

Physical exam
Heraios presented in moderately reduced general body condition. His attitude was subdued.

Differential Diagnoses
Heraios was referred with a diagnosis of intravascular hemolytic anemia. The primary differential diagnosis list includes immune-mediated hemolytic anemia with or without a potential underlying infectious agent.

Plan
A complete blood count (CBC), including a detailed microscopic review of the peripheral blood film, complete chemistry profile and urinalysis were requested to better characterize the anemia, as well as investigate for any significant systemic effects associated with the presenting primary anemia. Because of the recent history of travel to Spain, serologic investigation into possible Babesia infection was requested also.

Day 1

Laboratory Data

Erythron—There is a moderate-to-severe anemia that is characterized as macrocytic, normocytic and normochromic. The degree of polychromasia present supports regenerative anemia. The prominent spherocytosis in this case is strongly supportive of an extravascular immune-mediated hemolytic mechanism for this anemia. Specific underlying etiopathogenesis is not identified. The presence of macrocytic- and hypochromic-appearing erythrocytes in the background suggest a potential complicating chronic blood loss/iron deficiency.

Leukon—There is a marked leukocytosis characterized by a marked neutrophilia with a left shift and a monocytosis. Findings are consistent with an inflammatory process and, because of the degree of neutrophilia, would be commonly classified as a leukamoid reaction.

Thrombon—There is a mild thrombocytopenia, and the presence of enlarged platelets is supportive of an increased rate of thrombopoiesis in the bone marrow in response to a peripheral demand for platelets. Peripheral destruction, such as immune-mediated destruction, or peripheral consumption, such as utilization in coagulation, should be strongly considered.

Liver panel—There is a mild increase in ALT supportive of mild hepatocellular injury, which may merely be a result of the hypoxia associated with the anemia present. ALKP is moderately increased either due to an increase in the hepatic (cholestasis) or steroid-induced isozyme or a combination of the two. The slight increase in total serum bilirubin and cholesterol, as well as the bilirubinuria, are supportive of cholestasis. Based upon the hematology changes noted, the process has been present for a significant enough amount of time for both of these causes of the ALKP increase to have occurred due to hypoxic insult and a sustained endogenous glucocorticoid influence.

Kidney panel—There is a minimal and insignificant increase in urea nitrogen. Decreased glomerular filtration rate (GFR) is not supported in light of the normal creatinine value. The probable effect of a recent protein diet must be considered to help explain this finding.

Potassium—There is a minimal and insignificant decrease in potassium.

Final Diagnosis
Idiopathic immune-mediated hemolytic anemia
Inflammation—Leukamoid reaction

Therapeutic plan

Clinical case outcome
After five days of hospitalization, Heraios was in good general condition and was sent home. At the time of release, the leukocytosis was much less marked than at the time of presentation. His hematocrit increased steadily during the hospitalization period. Two months after the initial presentation, Heraios developed a severe immune-mediated thrombocytopenia. Platelet numbers returned to within reference interval limits with prednisolone treatment. Two months after the thrombocytopenia episode, Heraios had all hematology values within reference interval limits and was no longer receiving prednisolone. A mechanism for the finding of macrocytic- and hypochromic-appearing erythrocytes in circulation at the time of presentation was not identified.

The recommendations contained in Diagnostic Edge educational materials are intended to provide general guidance only. As with any diagnosis or treatment, you should use clinical discretion with each patient based on a complete evaluation of the patient, including history, physical presentation and complete laboratory data. With respect to any drug therapy or monitoring program, you should refer to product inserts for a complete description of dosages, indications, interactions and cautions.

We want to hear from you: E-mail us at diagnosticedge@idexx.com.

• Let us know what you think about this case.
• Do you have a case that you would like to submit?

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Announcing no slide warm-up on the VetTest® Chemistry Analyzer—just 8 minutes to results!

When you upgrade to VetTest® software version 8.08 (released in July), you do not need to bring the slides to room temperature before using them on your VetTest analyzer. After removing the slides from the freezer or the refrigerator, you can insert them directly into the analyzer.

Your VetTest analyzer offers you:

• Convenience—Run tests quickly in-house for results during your patients’ visits.
• Flexibility—Run only the slides you need—and now you can use slides right out of the freezer; no warm-up time necessary with software version 8.08!
• Speed—The VetTest analyzer and the StatSpin® centrifuge offer you results in just eight minutes when you use plasma.

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Oral Disease Prevalence Study

A recent nationwide study (895 KB) by Jan Bellows, DVM, DAVDC, DABVP, and IDEXX Laboratories has shown that one in every seven cats with oral disease also has FIV and/or FeLV.

Results

• A total of 8,982 orally diseased cats were screened. Presenting cases included cats with plaque, calculus, gingivitis, periodontal disease, feline odontoclastic resorption lesions, gingivostomatitis and other oral diseases as defined by the practitioner.¹
• Of 8,982 cats tested, 1,276 were retrovirus-positive, a 14.2% prevalence (Figure 1).¹
• Cats with gingivitis and stomatitis exhibited 14.3% and 23.9% prevalence of retroviral infection, respectively (Figure 2).¹

Read more (895 KB)

No cross-reactivity was detected with the SNAP® Parvo Test

Parvo vaccine cross-reactivity in dogs—In a study of 64 dogs vaccinated with six different modified live CPV-2 vaccines, the SNAP® Parvovirus Antigen Test did not detect CPV-2 in their feces.²

A population of 64 beagles with low or no antibody to canine parvovirus-2 (CPV-2) were vaccinated with one of five different combination vaccines (Duramune Max 5®, Ft. Dodge Animal Health; Progard 5, Intervet; Vangard Plus 5L®, Pfizer Animal Health; Recombitek C4®, Merial; and Galaxy DA2PPv®, Schering Plough Animal Health) or one monovalent product (NeoPar® NEOTECH LLC) containing modified live CPV-2 vaccine. Fecal samples were collected on day 0 and on one or more of the following days: 3, 4, 5, 6 and 7 post-vaccination. All samples were tested for CPV-2 using the SNAP® Parvo Test. No cross-reactivity was detected.

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Download the VetStat® Electrolyte and Blood Gas Analyzer Sample Collection and Preparation Poster

The VetStat Electrolyte and Blood Gas Analyzer is designed to analyze whole-blood, serum or plasma samples. To ensure maximum accuracy, it’s important that you always prepare the sample properly when analyzing electrolyte and blood gas parameters.

Now available, the VetStat® sample collection and preparation poster, is a quick and easy reference to preparing your whole-blood, plasma or serum samples for effortless use with the analyzer. (265 KB)

If you would like a copy of the VetStat sample preparation poster for your practice, call IDEXX Customer Support at 1-800-248-2483.

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Education and Events

We offer a variety of training events about emerging trends and best practices in veterinary diagnostics in a forum designed to involve, educate and motivate you and your staff. Here are some of the upcoming educational events.
See a full listing.

Webinars

• The Most Commonly Misdiagnosed Diseases in Veterinary Medicine
  Fred Metzger, DVM, DABVP, and Peter Kintzer, DACIVM

Seminars

• Diagnosing Canine Pancreatitis
  Jörg Steiner, med.vet., Dr.med.vet., PhD, DACVIM-SA, DECVIM-CA

Lunch-and-Learn at CVC

• Tick-Borne Diseases: Lyme Disease, Anaplasmosis and Co-infection
  Rick Alleman, DVM, PhD, DABVP, DACVP and Matt Eberts, DVM

Visit the education and events calendar, click the date to view the details, fill out and submit the form to register.

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Dental recommended reminders ensure procedures get scheduled
by Wendy S. Myers

A client with a 10-year-old cat named Cosmo visits your hospital for a wellness exam. The doctor diagnoses grade 3 dental disease and recommends a professional dental cleaning and preanesthetic testing. The client forgets to schedule the dental cleaning at checkout, yet the doctor assumes the procedure was scheduled as she steps into the next exam room. Will another year pass before you see Cosmo again? The dental disease—and Cosmo’s health—will worsen because the recommendation did not receive follow-up.

To make sure what gets recommended actually gets scheduled, create a “dental recommended” callback or reminder code in your veterinary software. On your travel sheet, have a section of common recommendations that need follow-up for the doctor and/or technician to circle. In this scenario, the doctor would circle “dental recommended” so the receptionist knows to schedule the procedure at checkout. If the appointment is not made, the receptionist enters the “dental recommended” code, which generates a two-week callback and/or reminder postcard.

A technician or receptionist would call the client two weeks later, saying, “The doctor asked me to call you about scheduling Cosmo’s dental cleaning so we can treat and slow the progression of his dental disease. When would be a convenient time for you to schedule Cosmo’s dental cleaning? I have an opening on Friday or Monday… which best fits your schedule?” Always direct the client to a specific appointment date because you’ll increase the likelihood she will say yes.

To significantly increase compliance, use this technique for any recommendation that requires follow-up, such as “weight loss recommended,” “senior bloodwork recommended” or “medication monitoring recommended.” Don’t be shy about calling clients for needed medical services. The AAHA 2003 study, “The Path to High-Quality Care,” found 78% of clients surveyed wanted to be called about overdue vaccines and medication, but only 52% actually received a call. Be a pet advocate and remind clients of doctors’ recommendations. You’ll improve the health of your patients and your practice!

Wendy S. Myers owns Communication Solutions for Veterinarians in Denver, Colorado, and provides consulting services on client service, marketing and hospital management. She is the author of two books and four videos. You can reach her at 1-720-344-2347 or visit www.mycommunicationsolutions.com.

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NOW with FREE CE Credit!

Can you identify the primary nucleated cell type and suggest a possible cause for the process from this nasal swab from a dog (Wright’s stain)?

Step up to take the Interactive Challenge—and now you can step up your CE credits, too! Earn a half-hour of FREE CE credit for each month’s challenge.

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Figure 1: Nasal swab from a dog, Wright’s stain, 50x objective field of view

Figure 2: Nasal swab from a dog, Wright’s stain, 100x objective field of view

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Thanks for taking the Diagnostic Edge Interactive Challenge!

*Each interactive challenge meets the requirements for 0.5 hours of continuing education credit in jurisdictions that recognize AAVSB’s RACE approval; however, participants should be aware that some boards have limitations on the number of hours accepted in certain categories and/or restrictions on certain methods of delivery of continuing education.

AAVSB Provider Number 106

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