1. Dog with Icterus Dennis B. DeNicola, DVM, PhD, DACVP Chief Veterinary Educator IDEXX Laboratories

2. “Coalie” 5 years old Spayed female Lhasa Apso Presented with clinical history of anorexia, lethargy and icterus

3. “Coalie” - 5 Year-old, Lhasa Apso WBC=72.99 K/  LHIGH(5.50 – 16.90) LYM=2.77 K/  L(0.70 – 4.90) MONO*16.70 K/  LHIGH(0.10 – 1.40) NEU*51.57 K/  LHIGH(2.00 – 12.00) EOS=1.51 K/  LHIGH(0.10 – 1.49) BASO=0.44 K/  LHIGH(0.00 – 0.10) %LYM=3.8% %MONO=22.9% %NEU*70.7% %EOS*2.1% %BASO=0.6% HCT=19.8%LOW(37.0– 55.0) RBC=2.73M/  LLOW( 5.50 – 8.50 ) HGB=5.8g/dLLOW( 12.0 – 18.0 ) RETIC=215.4K/  L %RETIC=7.9% MCV=72.4fLHIGH( 60.0 – 72.0 ) RDW=21.1%HIGH( 14.7 – 17.9) MCHC=29.2g/dLLOW( 31.0 – 37.0 ) MCH=21.10pg(19.50 – 24.50) PLT=83 K/  LLOW(175 – 500) MPV=29.78fL PCT=0.2% PDW=25.3% Differential algorithm issues. Confirm with blood smear

4. “Coalie” - 5 Year-old, Lhasa Apso Erythron HCT=19.8%LOW( 37.0 – 55.0 ) RBC=2.73M/  LLOW( 5.50 – 8.50 ) HGB=5.8g/dLLOW( 12.0 – 18.0 ) RETIC=215.4K/  L %RETIC=7.9% MCV=72.4fLHIGH( 60.0 – 72.0 ) RDW=21.1%HIGH( 14.7 – 17.9) MCHC=29.2g/dLLOW( 31.0 – 37.0 ) MCH=21.10pg(19.50 – 24.50)

5. “Coalie” - 5 Year-old, Lhasa Apso Erythron HCT=19.8%LOW( 37.0 – 55.0 ) RBC=2.73M/  LLOW( 5.50 – 8.50 ) HGB=5.8g/dLLOW( 12.0 – 18.0 )

6. “Coalie” - 5 Year-old, Lhasa Apso Erythron HCT=19.8%LOW( 37.0 – 55.0 ) RBC=2.73M/  LLOW( 5.50 – 8.50 ) HGB=5.8g/dLLOW( 12.0 – 18.0 ) Anemia Moderately severe

7. “Coalie” - 5 Year-old, Lhasa Apso Erythron HCT=19.8%LOW( 37.0 – 55.0 ) RBC=2.73M/  LLOW( 5.50 – 8.50 ) HGB=5.8g/dLLOW( 12.0 – 18.0 ) RETIC=215.4K/  L %RETIC=7.9% Anemia Moderately severe, regenerative

8. “Coalie” - 5 Year-old, Lhasa Apso Erythron HCT=19.8%LOW( 37.0 – 55.0 ) RBC=2.73M/  LLOW( 5.50 – 8.50 ) HGB=5.8g/dLLOW( 12.0 – 18.0 ) RETIC=215.4K/  L %RETIC=7.9% MCV=72.4fLHIGH( 60.0 – 72.0 ) RDW=21.1%HIGH( 14.7 – 17.9) MCHC=29.2g/dLLOW( 31.0 – 37.0 ) MCH=21.10pg(19.50 – 24.50) Anemia Moderately severe, regenerative, macrocytic and hypochromic with moderate anisocytosis

9. Erythron – Data Interpretation Anemia Moderately severe Macrocytic (increased MCV) Hypochromic (decreased MCHC) Regenerative (increased Reticulocyte Count) Moderate anisocytosis (increased RDW)

10. Erythron – Data Interpretation Anemia Moderately severe Macrocytic (increased MCV) Hypochromic (decreased MCHC) Regenerative (increased Reticulocyte Count) Moderate anisocytosis (increased RDW) No significant morphologic features to help identify underlying etiopathogenesis

11. Erythron – Data Interpretation Anemia Moderately severe Macrocytic (increased MCV) Hypochromic (decreased MCHC) Regenerative (increased Reticulocyte Count) Moderate anisocytosis (increased RDW) No significant morphologic features to help identify underlying etiopathogenesis Additional clinical information – recent bleeding into gastrointestinal tract

12. “Coalie” - 5 Year-old, Lhasa Apso Leukon WBC=72.99K/  LHIGH( 5.50 – 16.90 ) LYM=2.77K/  L( 0.70 – 4.90 ) MONO*16.70K/  LHIGH( 0.10 – 1.40 ) NEU*51.57K/  LHIGH( 3.00 – 12.00) EOS*1.51K/  LHIGH( 0.10 – 1.49 ) BASO*0.44K/  LHIGH( 0.00 – 0.10 ) %LYM=3.8% %MONO*22.9% %NEU*70.7% %EOS*2.1% %BASO*0.6% Differential algorithm issues. Confirm with blood smear.

13. “Coalie” - 5 Year-old, Lhasa Apso Leukon WBC=72.99K/  LHIGH( 5.50 – 16.90 )

14. “Coalie” - 5 Year-old, Lhasa Apso Leukon WBC=72.99K/  LHIGH( 5.50 – 16.90 ) Leukocytosis Marked

15. “Coalie” - 5 Year-old, Lhasa Apso Leukon WBC=72.99K/  LHIGH( 5.50 – 16.90 ) LYM=2.77K/  L( 0.70 – 4.90 ) MONO*16.70K/  LHIGH( 0.10 – 1.40 ) NEU*51.57K/  LHIGH( 3.00 – 12.00) EOS*1.51K/  LHIGH( 0.10 – 1.49 ) BASO*0.44K/  LHIGH( 0.00 – 0.10 ) %LYM=3.8% %MONO*22.9% %NEU*70.7% %EOS*2.1% %BASO*0.6%

16. “Coalie” - 5 Year-old, Lhasa Apso Leukon WBC=72.99K/  LHIGH( 5.50 – 16.90 ) LYM=2.77K/  L( 0.70 – 4.90 ) MONO*16.70K/  LHIGH( 0.10 – 1.40 ) NEU*51.57K/  LHIGH( 3.00 – 12.00) EOS*1.51K/  LHIGH( 0.10 – 1.49 ) BASO*0.44K/  LHIGH( 0.00 – 0.10 ) %LYM=3.8% %MONO*22.9% %NEU*70.7% %EOS*2.1% %BASO*0.6% Leukocytosis Marked with neutrophilia, monocytosis, eosinophilia and basophilia Normal lymphocytes

17. Leukogram Interpretation Marked leukocytosis Neutrophilia, Monocytosis, Eosinophilia, Basophilia Inflammation with prominent tissue demand for macrophages Potential relatively established inflammation since no obvious lymphocytopenia (“glucocorticoid influence”)

18. Erythron – Blood Film

26. Leukogram Interpretation Marked leukocytosis Neutrophilia, Monocytosis Mild neutrophil toxicity Inflammation with prominent tissue demand for macrophages Potential relatively established inflammation since no obvious lymphocytopenia (“glucocorticoid influence”)

27. “Coalie” - 5 Year-old, Lhasa Apso Thrombon PLT=83 K/  LLOW( 175 – 500 ) Thrombocytopenia Moderate

28. “Coalie” - 5 Year-old, Lhasa Apso Thrombon PLT=83 K/  LLOW( 175 – 500 ) MPV=29.78fL Thrombocytopenia Moderate with enlarged platelets

29. “Coalie” - 5 Year-old, Lhasa Apso Thrombon PLT=83 K/  LLOW( 175 – 500 ) MPV=29.78fL PCT=0.2% PDW=25.3% Thrombocytopenia Moderate with enlarged platelets and variably-sized platelets

30. Erythron – Blood Film

31. Thrombon - Interpretation Moderate thrombocytopenia Clumped platelets at feathered edge Possible underestimation of numbers Enlarged and variably-sized platelets Suggesting bone marrow response to a peripheral demand –Peripheral consumption (Inflammation, DIC, etc.) –Peripheral destruction

32. “Coalie” - 5 Year-old, Lhasa Apso WBC=72.99 K/  LHIGH(5.50 – 16.90) LYM=2.77 K/  L(0.70 – 4.90) MONO*16.70 K/  LHIGH(0.10 – 1.40) NEU*51.57 K/  LHIGH(2.00 – 12.00) EOS=1.51 K/  LHIGH(0.10 – 1.49) BASO=0.44 K/  LHIGH(0.00 – 0.10) %LYM=3.8% %MONO=22.9% %NEU*70.7% %EOS*2.1% %BASO=0.6% HCT=19.8%LOW(37.0– 55.0) RBC=2.73M/  LLOW( 5.50 – 8.50 ) HGB=5.8g/dLLOW( 12.0 – 18.0 ) RETIC=215.4K/  L %RETIC=7.9% MCV=72.4fLHIGH( 60.0 – 72.0 ) RDW=21.1%HIGH( 14.7 – 17.9) MCHC=29.2g/dLLOW( 31.0 – 37.0 ) MCH=21.10pg(19.50 – 24.50) PLT=83 K/  LLOW(175 – 500) MPV=29.78fL PCT=0.2% PDW=25.3% Differential algorithm issues. Confirm with blood smear