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

2. “Ryan” 7.5 years old Neutered male Labrador Retriever Presented with clinical history of recent (several days) onset lethargy and depression

3. “Ryan” - 7.5 Year-old, Labrador Retriever WBC=88.43 K/  LHIGH(5.50 – 16.90) LYM=9.45 K/  LHIGH(0.70 – 4.90) MONO=5.82 K/  LHIGH(0.10 – 1.40) NEU=70.34 K/  LHIGH(2.00 – 12.00) EOS=2.34 K/  LHIGH(0.10 – 1.49) BASO=0.48 K/  LHIGH(0.00 – 0.10) %LYM=10.7% %MONO=6.6% %NEU=79.5% %EOS=2.7% %BASO=0.5% HCT=19.8%LOW(37.0– 55.0) RBC=2.58M/  LLOW( 5.50 – 8.50 ) HGB=9.3g/dLLOW( 12.0 – 18.0 ) RETIC=145.6K/  L %RETIC=5.6% MCV=76.8fLHIGH( 60.0 – 72.0 ) RDW=22.2%HIGH( 14.7 – 17.9) MCHC=47.0g/dLHIGH( 31.0 – 37.0 ) MCH=36.03pgHIGH(19.50 – 24.50) PLT=747 K/  LHIGH(175 – 500) MPV=19.62fL PCT=1.5% PDW=30.3% Differential algorithm issues. Confirm with blood smear

4. “Ryan” - 7.5 Year-old, Labrador Retriever Erythron HCT=19.8%LOW( 37.0 – 55.0 ) RBC=2.58M/  LLOW( 5.50 – 8.50 ) HGB=9.3g/dLLOW( 12.0 – 18.0 ) RETIC=145.6K/  L %RETIC=5.6% MCV=76.8fLHIGH( 60.0 – 72.0 ) RDW=22.2%HIGH( 14.7 – 17.9) MCHC=47.0g/dLHIGH( 31.0 – 37.0 ) MCH=36.03pgHIGH(19.50 – 24.50)

5. “Ryan” - 7.5 Year-old, Labrador Retriever Erythron HCT=19.8%LOW( 37.0 – 55.0 ) RBC=2.58M/  LLOW( 5.50 – 8.50 ) HGB=9.3g/dLLOW( 12.0 – 18.0 ) Anemia Moderately severe

6. “Ryan” - 7.5 Year-old, Labrador Retriever Erythron HCT=19.8%LOW( 37.0 – 55.0 ) RBC=2.58M/  LLOW( 5.50 – 8.50 ) HGB=9.3g/dLLOW( 12.0 – 18.0 ) RETIC=145.6K/  L %RETIC=5.6% Anemia Moderately severe, regenerative

7. “Ryan” - 7.5 Year-old, Labrador Retriever Erythron HCT=19.8%LOW( 37.0 – 55.0 ) RBC=2.58M/  LLOW( 5.50 – 8.50 ) HGB=9.3g/dLLOW( 12.0 – 18.0 ) RETIC=145.6K/  L %RETIC=5.6% MCV=76.8fLHIGH( 60.0 – 72.0 ) RDW=22.2%HIGH( 14.7 – 17.9) MCHC=47.0g/dLHIGH( 31.0 – 37.0 ) MCH=36.03pgHIGH(19.50 – 24.50) Anemia Moderately severe, regenerative, macrocytic and “hyperchromic” with moderate anisocytosis

8. Erythron – Data Interpretation Anemia Moderately severe Macrocytic (  MCV) “Hyperchromic” (  MCHC) – hemolytic specimen Regenerative (  Reticulocyte Count) Moderate anisocytosis (  RDW)

9. Erythron – Blood Film

11. Agglutination Rouleaux

12. Saline Agglutination Test Saline Solution Agglutination Rouleaux

13. Erythron – Blood Film

15. Erythron – Blood Film Interpretation Anemia Moderately severe Regenerative Polychromasia Anisocytosis Immune mediated extravascular hemolysis Spherocytosis Suggestion of autoagglutination –Requires saline dilution confirmation

16. “Ryan” - 7.5 Year-old, Labrador Retriever Leukon WBC=88.43K/  LHIGH( 5.50 – 16.90 ) LYM=9.45K/  LHIGH( 0.70 – 4.90 ) MONO=5.82K/  LHIGH( 0.10 – 1.40 ) NEU=70.34K/  LHIGH( 3.00 – 12.00) EOS=2.34K/  LHIGH( 0.10 – 1.49 ) BASO=0.48K/  LHIGH( 0.00 – 0.10 ) %LYM=10.7% %MONO=6.6% %NEU=79.5% %EOS=2.7% %BASO=0.5% Differential algorithm issues. Confirm with blood smear.

17. “Ryan” - 7.5 Year-old, Labrador Retriever Leukon WBC=88.43K/  LHIGH( 5.50 – 16.90 ) Leukocytosis Marked

18. “Ryan” - 7.5 Year-old, Labrador Retriever Leukon WBC=88.43K/  LHIGH( 5.50 – 16.90 ) LYM=9.45K/  LHIGH( 0.70 – 4.90 ) MONO=5.82K/  LHIGH( 0.10 – 1.40 ) NEU=70.34K/  LHIGH( 3.00 – 12.00) EOS=2.34K/  LHIGH( 0.10 – 1.49 ) BASO=0.48K/  LHIGH( 0.00 – 0.10 ) %LYM=10.7% %MONO=6.6% %NEU=79.5% %EOS=2.7% %BASO=0.5% Differential algorithm issues. Confirm with blood smear. Leukocytosis Marked with increases in all leukocyte forms

19. Leukon – Blood Film

24. Leukogram Interpretation Marked leukocytosis Increases in all leukocyte forms Marked neutrophilia with possible slight left shift Inflammation with evidence of systemic antigenic stimulation (lymphocytosis) and tissue demand for macrophages (monocytosis)

25. “Ryan” - 7.5 Year-old, Labrador Retriever Thrombon PLT=747 K/  LHIGH( 175 – 500 ) Thrombocytosis Mild

26. “Ryan” - 7.5 Year-old, Labrador Retriever Thrombon PLT=747 K/  LHIGH( 175 – 500 ) MPV=19.62fL Thrombocytosis Mild with enlarged platelets

27. “Ryan” - 7.5 Year-old, Labrador Retriever Thrombon PLT=747 K/  LHIGH( 175 – 500 ) MPV=19.62fL PCT=1.5% PDW=30.3% Thrombocytosis Mild with enlarged platelets and variably-sized platelets

28. Thrombon

29. Thrombon - Interpretation Mild thrombocytosis Clumped platelets at feathered edge Probable underestimation of numbers Enlarged and variably-sized platelets Suggesting bone marrow response to a peripheral demand

30. “Ryan” - 7.5 Year-old, Labrador Retriever WBC=88.43 K/  LHIGH(5.50 – 16.90) LYM=9.45 K/  LHIGH(0.70 – 4.90) MONO=5.82 K/  LHIGH(0.10 – 1.40) NEU=70.34 K/  LHIGH(2.00 – 12.00) EOS=2.34 K/  LHIGH(0.10 – 1.49) BASO=0.48 K/  LHIGH(0.00 – 0.10) %LYM=10.7% %MONO=6.6% %NEU=79.5% %EOS=2.7% %BASO=0.5% HCT=19.8%LOW(37.0– 55.0) RBC=2.58M/  LLOW( 5.50 – 8.50 ) HGB=9.3g/dLLOW( 12.0 – 18.0 ) RETIC=145.6K/  L %RETIC=5.6% MCV=76.8fLHIGH( 60.0 – 72.0 ) RDW=22.2%HIGH( 14.7 – 17.9) MCHC=47.0g/dLHIGH( 31.0 – 37.0 ) MCH=36.03pgHIGH(19.50 – 24.50) PLT=747 K/  LHIGH(175 – 500) MPV=19.62fL PCT=1.5% PDW=30.3% Differential algorithm issues. Confirm with blood smear