Anaemic dog blood smears - help!!

RE: Anaemic dog blood smears - help!!

Jenny Boyd — Tue, 05 Jul 2016 08:18:54 GMT

I agree with yantha, creat increase likely due to breed,

RE: Anaemic dog blood smears - help!!

mariette asselbergs — Tue, 05 Jul 2016 00:03:33 GMT

To check for Babesia spp it is important to use a drop of periferal blood (an ear vein).

And i would be very careful with preds. We used them to increase Babesia in blood of carriers to make vaccine!

Mariette

RE: Anaemic dog blood smears - help!!

Yantha Smyth — Mon, 04 Jul 2016 23:14:43 GMT

My 2-p-worth is that being a sight hound the WBC count is often below ref range and often the TP a bit low, and creatinine high...so these could be breed-related incidentals. I would second measuring a PCV to confirm the Hct, as that level in a sight hound is very low and would be the main thing to be concerned with. Is it possible the Zn in supplement could be enough to cause haemolysis??

I don't look at enough smears to be any help sorry!

Yantha

RE: Anaemic dog blood smears - help!!

Beats — Mon, 04 Jul 2016 23:11:26 GMT

[quote user="shanley barber"]The smears were made from EDTA blood taken about 30 min after drawing the sample. [/quote]

I aim for 1-5mins as I'm bad enough at interpreting blood smears without extra artifacts from sitting in EDTA potentially adding to my woes. Fine if I know I'll want to look at blood smear in advance, but if only decide after see haematology results I'll sometimes need to rebleed the dog (lets me check that first sample wasn't a freak result due to clot or machine error or something anyway). I may do this purely out of superstition however.

RE: Anaemic dog blood smears - help!!

Beats — Mon, 04 Jul 2016 23:06:35 GMT

[quote user="shanley barber"]His temp is 39.3C.[/quote]

I frequently get patients with 39.3'C with no pathology at all (like routine neuters being admitted), so I call this possibly pyrexic, but given signs pyrexia does seem likely.

[quote user="shanley barber"]I do think that the inclusions that are visible are refractile, so I have mostly ignored them.[/quote]

Cleaning the stain jars, failing that new stain, or rinsing better may prevent these - but if you're comfortable to ignore them then I'm not sure they hamper your interpretation of the rest of slide.

[quote user="shanley barber"] There is no platelet clumping at the feathered edges, and white blood cells are rare; the one neutrophil I saw looked fairly normal. [/quote]

So that's looking like more than 2 cell-lines affected then maybe? I'm thinking bone marrow involvement a realistic possibility.

[quote user="shanley barber"]I'm a bit confused as to why the dog has an increased Creatinine? [/quote]

Ideally check a pre-drip urine sample to ensure is concentrating (SG>1.030) - if so then likely creatinine result due to mild dehydration from illness? At that low level I wouldn't get too hung up on it - I think it's a distraction to the haematology which looks to be most relevant results.

Good luck!

RE: Anaemic dog blood smears - help!!

Michael Woodhouse — Mon, 04 Jul 2016 23:06:33 GMT

In vitro haemolysis will cause raised creatinine, I assume it could also happen in vitro. It would fit with raised bilirubin.

Alternately - could the dog have kidney disease, reduced EPO and be anemic? (I suspect not)

RE: Anaemic dog blood smears - help!!

shanley barber — Mon, 04 Jul 2016 22:58:02 GMT

His temp is 39.3C. I do think that the inclusions that are visible are refractile, so I have mostly ignored them. The smears were made from EDTA blood taken about 30 min after drawing the sample.

There is no platelet clumping at the feathered edges, and white blood cells are rare; the one neutrophil I saw looked fairly normal.

I'm a bit confused as to why the dog has an increased Creatinine?

Thx

RE: Anaemic dog blood smears - help!!

Beats — Mon, 04 Jul 2016 22:18:03 GMT

Hi Shanley,

Not sure this will be of any help, but here are my fellow GP thoughts:

1) If you have facilities to do a manual PCV, not just to confirm actually anemic, but also to give basline for any monitoring.

2) Check manual platelet count: I count plenty in first picture and maybe slightly less than plenty in second picture, so machine reading may be accurate. Look at 10 different random high power fields and count all the platelets in each - on average should get between 5 and 15 per high power field. more importantly, check along the feathered edge of the blood smear under 10x or 40x objective lens to see if there are platelet clumps - if so then you can forget the machine-read thrombocytopenia.

3) I'm not seeing wbcs, so the leukopenia is probably genuine enough.

4) Do a fresh smear, prefarbly on a fresh blood sample collected straight into EDTA and then decent smear made immeidately after mixing as I think quite a few artifacts in those rbcs - could these be from delay in making smear or not rapidly air-drying? (Not criticising, just thinking) If there are areas on the slide where the rbcs look more normal and then areas where they don't that would suggest artifact - genuine changes in rbcs are usually quite evenly distributed throughout slide

5) focus in and out of field on your current slide - i think those coloured bits on erythrocytes look more like bits of stain in which case they'll be refractile and won't just come into sharp focus and out again with the rbcs they are apparently in?

6) Keep 2 x EDTA samples in case you do wish PCR testing prior to giving any doxycycline if you choose to do this.

7) Start on preds 1mg/kg q12hrs (that's what I'd do anyway) +/- doxycycline if you think you're in an area where protozoal infections and the like are a posisbility.

8) Send your samples to external lab

9) If multiple cell lines genuinely affected then consider bone marrow pathology most likely.

10) Get some NEW methylene blue stain for weekends when want to assess if anemia regnerative or not. (next time you're ordering fresh speedy-diff stain or equivalent eg http://www.clin-tech.co.uk/)

11) a baseline cortisol (which should be elevated to >40nmol/L) to rule out addison's never hurts either - take serum sample(s) prior to preds and can keep in fridge/freezer if not wanting to post.How pyrexic is pyrexic?

RE: Anaemic dog blood smears - help!!

shanley barber — Mon, 04 Jul 2016 22:13:31 GMT

Diff quik.

RE: Anaemic dog blood smears - help!!

Michael Woodhouse — Mon, 04 Jul 2016 21:57:06 GMT

Babesia?

If you look in clin path textbooks there's a heap of things that can cause inclusions in erythrocytes.

What is the stain?

RE: Anaemic dog blood smears - help!!

shanley barber — Mon, 04 Jul 2016 21:42:58 GMT

RE: Anaemic dog blood smears - help!!

shanley barber — Mon, 04 Jul 2016 21:41:46 GMT