1. IDEXX LaserCyteTM

2. LaserCyte™ Parameters
Medical Reasons
The “What” and “So What”
Summary

3. LaserCyte™ Parameters
Red blood Cells
White blood Cell
Platlets

4. Red Blood Cells Is there evidence of anemia?
Regenerative or nonregenerative with reticulocyte count
Is there evidence of dehydration?
Polycythemia

5. Red Blood Cells HCT (Hematocrit) RBC (Red Blood Cell Count)
Percentage of the red cell population relative to the total volume of blood
It is a calculation by the LaserCyte
40 – 59% dogs; 29 – 50% cats
Used to diagnose anemia or polycythemia
RBC (Red Blood Cell Count)
Actual number of RBCs in a given quantity of blood
Average is X 106 μL for dogs or X 106 μL for cats

6. Red Blood Cells HGB (Hemoglobin)
A measurement of the oxygen carrying capacity of the red blood cells
The LaserCyte uses four LEDs and photodetectors that measure Hgb concentration by at least three different wavelengths of light and two different aspirates, unlysed and lysed.
The advantages (benefits) of CR are three fold. 1 – interpretation, 2 – cost effectiveness and convenience 3 – telemedicine.
Interpretation advantages include:
Superior dynamic range and contrast resolution – relate to the techniques you use for a DP navicular series. Most often you take two different techniques – one for highlighting the navicular bone and another technique for enhancing the edge of P3 and the hoof wall. With CR, and because you are in control of the contrast, shoot one technique and move your mouse to change contrast an brightness to see different densities.
The ability to zoom in and magnify suspect areas is significantly of interest in radiographic interpretation. We’ll demonstrate the power of the CR system in this area, but you should imagine 2X or 6X the size of the image are you may be looking for changes in.
Wouldn’t it be nice to send your farrier off with a formula and a picture? Because the image is digital and the software will allow, you can annotate or measure, even with a protractor! Clients or farriers alike may enjoy a printed souvenir.
Cost effectiveness – we will discuss the economics later in the presention, however I want to lay out the basic advantages:
One of the most important cost effective measurements is re-takes. Anyone ever ask the tech to make the image darker or lighter? Anyone get back to the clinic from the field and develop the film and find the technique off? …But accept it anyway because it’s too much hassle to go back to the farm? Come on, be honest…I’ve been there…
No need for darkroom – convert or remodel?
No chemical processor needed – monthly maintenance fees?
Film availability/quality – storage/temperature – no problem.
Where’s the file? No worry about archiving and retrieving.
Print – excellent quality without light box – great souvenirs.
Saves space from filing and the actual darkroom square footage.
Telemecicine
Once digital…you can print, , send for consultation or reference.
Cardiopet/Radiopet is an IDEXX subsidiary and has eight veterinary radiologists available for consultation in radiography, ultrasonography, and cardiology. Please see information in the back of the room.
Let’s look at a .jpg image – printable and easily ed…

7. Red Blood Cells # Retics % Retics
A retic count offers a quick and easy assessment of an anemia state. A count, unlike a percentage is not affected by dehydration.
# Retics
The number of reticulocytes is a definitive indicator to distinguish between regenerative and non-regenerative anemias.
The LaserCyte gives aggregate retics in the cat
A retic count above 60,000 μL in cats and 80,000 μL in dogs in considered a regenerative anemia
% Retics
Percentage of reticulocytes in a given quantity of blood
Average is 0.0 – 1.5% for dogs or 0.0 – 0.4% for cats
The advantages (benefits) of CR are three fold. 1 – interpretation, 2 – cost effectiveness and convenience 3 – telemedicine.
Interpretation advantages include:
Superior dynamic range and contrast resolution – relate to the techniques you use for a DP navicular series. Most often you take two different techniques – one for highlighting the navicular bone and another technique for enhancing the edge of P3 and the hoof wall. With CR, and because you are in control of the contrast, shoot one technique and move your mouse to change contrast an brightness to see different densities.
The ability to zoom in and magnify suspect areas is significantly of interest in radiographic interpretation. We’ll demonstrate the power of the CR system in this area, but you should imagine 2X or 6X the size of the image are you may be looking for changes in.
Wouldn’t it be nice to send your farrier off with a formula and a picture? Because the image is digital and the software will allow, you can annotate or measure, even with a protractor! Clients or farriers alike may enjoy a printed souvenir.
Cost effectiveness – we will discuss the economics later in the presention, however I want to lay out the basic advantages:
One of the most important cost effective measurements is re-takes. Anyone ever ask the tech to make the image darker or lighter? Anyone get back to the clinic from the field and develop the film and find the technique off? …But accept it anyway because it’s too much hassle to go back to the farm? Come on, be honest…I’ve been there…
No need for darkroom – convert or remodel?
No chemical processor needed – monthly maintenance fees?
Film availability/quality – storage/temperature – no problem.
Where’s the file? No worry about archiving and retrieving.
Print – excellent quality without light box – great souvenirs.
Saves space from filing and the actual darkroom square footage.
Telemecicine
Once digital…you can print, , send for consultation or reference.
Cardiopet/Radiopet is an IDEXX subsidiary and has eight veterinary radiologists available for consultation in radiography, ultrasonography, and cardiology. Please see information in the back of the room.
Let’s look at a .jpg image – printable and easily ed…

8. Red Blood Cells RDW (Red Cell Distribution Width)
MCV (Mean Corpuscular Volume)
The mean volume of all the RBCs counted in the sample
Smaller than normal is microcytic larger is macrocytic
Used to indicate spherocytes, anisocytosis, or schistocytes all of which must be confirmed with a morphology exam
RDW (Red Cell Distribution Width)
Measurement of the variation of size with in the RBC population. Given as a percentage
Used to indicate anisocytosis, also used by impedance analyzer users to indicate the presence of retics with MCV

9. Red Blood Cells MCHC (Mean Corpuscular Hemoglobin Conc)
The mean concentration of hemoglobin in the red cell
Calculated by dividing the hemoglobin by the hematocrit and expressing the answer as a percentage
Important in classifying anemias
Normal ranges are 30.0 – 36.9%
MCH (Mean Corpuscular Hemoglobin)
Mean mass of hemoglobin in each RBC
Calculated by dividing the hemoglobin by the number of RBCs

10. White blood cell data answers
Is there evidence of inflammation?
Acute, chronic or overwhelming
Is there evidence of stress or excitement?
High levels of glucocorticoids cause mild neutrophilia, lymphopenia and eosinophilia
Is there a demand for phagocytosis or evidence of tissue necrosis?
Elevated monocytosis is almost always seen in chronic inflammation

11. White Blood Cells WBC (White Blood Cell Count)
Total count of all White blood cells
Reported as X 103 μL
Indicator of infection (not diagnostic alone)

12. White Blood Cells Monocytes Lymphocytes
White blood cell that produces antibodies
20 – 30% of WBC population
Lymphocytosis: Prolonged illness, chronic inflammation,
Lymphopenia: Acute inflammation, viral infection, stress, steroid therapy
Monocytes
Reported as X 103 μL
Indicator of infection (not diagnostic alone)

13. White Blood Cells Eosinophils Neutrophils Most common leukocyte
Two classifications: Banded and Segmented
Engulf disease causing bacteria, viruses, and particles (phagocytosis)
Eosinophils
Involved in allergies and parasitic infection
Usually only in circulation for about 30 min
.1 – 1.5 X 103 μL normal range

14. White Blood Cells Basophils
Having the basophil # and % aids in identifying
Systemic hypersensitivity
Acute allergic reactions
Mast cell sarcomas

15. The Medical Reasons White Blood Cells WBC NEUTS EOS LYMPHS MONOS
Acute Inflammation
Increased
Increased
Variable
Decreased
variable
Chronic Inflammation
Increased/ no change
Increased/ no change
Variable
Increased/ no change
Increased
With a WBC count alone you can’t diagnose any of these conditions. There is a WBC increase is all. Only with a diff can you tell on from the other.
Parasites
Increased/ Variable
Decreased/ no change
Increased
Variable
Increased/ no change
Stress Leukogram
Increased
Increased
Decreased/ no change
Decreased
Increased/ no change

16. Is it a stress leukogram or inflammation?
Parameters
Stress
Inflammation
WBC Count
High
High
Neutrophils
High
High
Lymphocytes
Low
Normal
Eosinophils
Low
Normal
Monocytes
Slightly high
Slightly high

17. 3-part versus 5-part differential
Elevated neutrophils
Inflammation No
Yes
Infection No
Yes
Stress No
Yes
Excitement No
Yes
Steroid therapy No
Yes
Decreased neutrophils
Parvo No
Yes
Erhlichiosis No
Yes
Overwhelming infection No
Yes
FIV No
Yes

18. 3-part versus 5-part differential
Elevated basophils and eosinophils
3-part
5-part
Parasites No
Yes
Allergies No
Yes
Mast cell tumors No
Yes
Heartworm No
Yes
Addison’s disease No
Yes
Parvo No
Yes
Stress No
Yes
Distemper No
Yes No
Yes
Cushing’s syndrome

19. Platelet data answers
Is there evidence of autoimmune disorders, occult infections or inflammation?
Suspected coagulopathies?

20. With LaserCyte®, your platelet information increases**
PLT
Involved in clotting
PLT is a platelet count
Thrombocytopenia can be seen in Ehrlichia, FIV, FELV
MPV
MPV (mean platelet volume) aids in the identification of what may be causing a severe thrombocytopenia
PDW
PDW (platelet distribution width) is an objective measure of the degree of variability in the size of platelets and can indicate bone marrow response
**Absolute count—Available using the LaserCyte analyzer.

21. The CBC is a time-sensitive test
Hematology samples are composed of living cells and should be analyzed as soon as possible:
To prevent cell distortions due to shipment or storage
To prevent artifacts created by long-term exposure to EDTA

22. Blood cells continue to develop and change
Samples should be processed within three hours to avoid artificially increased Hct and MCV, and decreased MCHC
Platelet counts should be performed within one hour after collection
Red cells crenate, reticulocytes mature, and lymphocytes’ nuclei become distorted
Rebar A, et al. Guide to Hematology in Dogs and Cats. Jackson, WY: Teton New Media; 2002:11.

23. Which system is ideally suited for your needs?
LaserCyte
QBC VetAutoread™
Lab
Impedence
RBC Count
Yes
---
Yes
Yes
PCV/Hct
Yes
Yes
Yes
Yes
Hgb
Yes
Yes
Yes
Yes
Reticulocytes
Yes
% only
Request
---
MCV
Yes
---
Yes
Yes
MCHC
Yes
Yes
Yes
Yes
RDW
Yes
---
Yes
Yes

24. Which system is ideally suited for your needs?
LaserCyte
QBC VetAutoread™
Lab
Impedence
WBC Count
Yes, corrected for nRBC
Not corrected for nRBC
Yes, corrected for nRBC
nRBCs misclassified
Lymphocytes
Yes, absolute count and %
Grouped with monocytes
Yes, absolute count and %
Small-sized cells number and %
Monocytes
Yes, absolute count and %
Grouped with lymphocytes
Yes, absolute count and %
Middle-sized cells number and %
Neutrophils
Yes, absolute count and %
---
Yes, absolute count and %
---

25. Which system is ideally suited for your needs?
LaserCyte
QBC VetAutoread™
Lab
Impedence
Eosinophils
Yes, absolute count and %
Elevated canine and bovine
Yes, bsolute count and %
---
Basophils
Yes, absolute count and %
Yes
Yes, bsolute count and %
---
Platelet Count
Yes, optical signature,clump s do not interfere with WBC count
Yes, good correlation with clumped platelet samples
Not always, usually reports broad categories (i.e., adequate)
Yes, size only, clumps may go uncounted or misidentified as WBCs
MPV
Yes, absolute count
---
Yes
Yes
PDW
Yes, absolute count
---
Yes
Yes

26. The Doctor’s view
“I have a QBC VetAutoread that is nearly paid off, why should I go in debt again for a new one”
The QBC Vet AutoRead is and was a good in-clinic system. However, as with anything the advances in technology now make it affordable and possible to practice the best medicine available right in your clinic. …
A five part differential is a must for diagnosing many very common diseases or states.
allergies, parasitic infection, chronic inflammation, stress, feline asthma, systemic toxemia, and more.

27. The Doctor’s view
“I let my lab deal with the equipment cost and maintenance, they get me the results I need in plenty of time”
As discussed, a CBC is a time sensitive test. Platelets clump, red cells change shape and size, bands change to segs, lymphocytes, neutrophils, and eosinophils can change size, etc.
This immediate information is critical in many cases.
Not only does the cells change, the animals condition changes between draw and results from the lab

28. The Doctor’s view
“Other in-clinic analyzer’s are just as good, and cost about $5k to $8k less”
Laser Flow Cytometry is the standard in automated hematology.
Other in-clinic analyzers interrogate cells based on size only. This can cause erroneous results in the case of artifacts, nRBCs, reticulocytes, and more.

29. Summary (1 of 3)
You need to show a Dr. why the LaserCyte® is a good investment medically.
Increased ability to diagnose common problems
Immediate results mean immediate treatment and decreased effects from artifacts

30. Summary (2 of 3)
The LaserCyte® is not meant to “replace” the reference lab, it is meant to give the Dr. reference lab results for their in-clinic testing needs.
Do not try to compare to ref lab prices or say that they can now make more $ by doing test in-house.
They will however, increase their testing volume by having ref lab accuracy immediately available.

31. Summary (3 of 3)
Do not try to sell the LaserCyteTM on price or testing volume.
If the Dr. is already doing in-clinic testing, the LaserCyteTM will not make them more money right away, it will give them the ability to make more accurate and rapid diagnosis.
If the Dr. is using the reference lab, the LaserCyteTM will be more expensive to use, but he will do more testing if he/she has the availability to do so.