IDEXX VetTest® Chemistry Analyser

Featured Case Study

Canine Case Study: 8-year-old cocker spaniel named Bailey

History: Vomiting (acute onset) and severe depression/weakness

Physical examination: Quiet, alert, responsive
Capillary refill time ›2 seconds/minute: dark pink/mildly tacky mucus membranes
Temperature: 102.8°F (39.3°C)
Pulse: 160
Respiratory rate: 34 (shallow breaths)
Moderate to severe dehydration

Eye, ear, nose and throat examination: There are no significant findings.

Heart and lungs: There are no significant abnormalities. No murmurs or arrhythmias were noted.

Gastrointestinal and urogenital systems: There is a history of vomiting not associated with eating. Owner estimates that Bailey has vomited at least 6 to 8 times in the past 24 hours. The abdomen is very painful on palpation and the abdominal wall is tense.

Musculoskeletal, lymphatic and integumentary systems: There are no significant abnormalities.

In-Clinic Laboratory Findings

Haematology
Red Blood Cells—There is a minimal macrocytic, hypochromic and mildly regenerative anemia based upon the finding of a slightly increased absolute reticulocyte count.

White Blood Cells (five-part differential)—There is a mild leukocytosis characterized by a mild neutrophilia, a minimal monocytosis and a lymphocyte count at the low end of the reference range. Quantitative changes are consistent with either simple glucocorticoid influence ("stress") or inflammation with superimposed glucocorticoid influence ("stress"). Peripheral blood-smear evaluation revealed the presence of immature neutrophil forms (bands) in low numbers with moderate toxicity, which supports the second interpretation of an inflammation with superimposed gluococorticoid influence ("stress"). The minimal monocytosis is consistent with either glucocorticoid influence ("stress") or inflammation with a tissue demand for platelets.

Platelets—There is an adequate number of platelets. Potential slight variation in platelet size may be present based upon the finding of a PDW greater than 15–20%.

The figure to the right shows a high magnification field of view of the monolayer region of a peripheral blood smear from Bailey. Note the presence of a band neutrophil form with moderate toxicity characterized by blue-staining cytoplasm, and the presence of several pale blue and irregular-shaped inclusions compatible with Dohle bodies. Also note that there are adequate numbers of platelets, validating the platelet count from the instrument. There is slight variation in size of platelets, suggesting a possible bone marrow response to a peripheral demand for platelets most likely due to consumption or destruction in the peripheral blood.

Chemistry
Primary Pancreas Profile
Lipase—There is a significant increase in lipase (greater than three-fold above the high end of the reference range), which is supportive of active pancreatitis. This is particularly supportive of pancreatitis because of the lack of any obvious evidence of renal disease or specifically, decreased glomerular filtration rate (GFR), which could result in nonspecific increases in lipase.

Amylase—There is no significant abnormality in the amylase value; however, this is often noted in cases of active pancreatitis in the dog.

Secondary Pancreas Profile
ALT—Mild hepatocellular injury is indicated by the mild increase in ALT. Localized hepatocellular injury is possible with localized inflammatory disease.

ALKP and Total Bilirubin—Cholestasis is supported in the finding of an increase in ALKP and total bilirubin. Cholestasis associated with post-hepatic obstructive disease, which is typically transient in nature, is commonly seen with active pancreatitis in the dog because of the inflammatory process located around the common bile duct.

Proteins—There is a slight decrease in total protein, a slight decrease in globulins, and an albumin value in the low end of the reference range. Protein profile changes are most consistent with protein loss. In light of the erythron changes noted above, investigation into possible acute blood loss is recommended or loss of all proteins into the gastrointestinal tract or any possible protein-rich abdominal fluid, such as abdominal fluid (peritonitis), that may be seen with active pancreatitis.

Calcium—There is a slight hypocalcemia; however, this is likely to be an insignificant hypocalcemia in light of the albumin being in the low end of the reference range. Approximately 50% of the total calcium in the serum/plasma is protein-bound. Decreases in albumin result in a subsequent decrease in total calcium. The physiologically significant calcium, ionized calcium, is likely to be within reference range limits. An ionized calcium value should be determined if there are any clinical signs that develop that could be associated with a decrease in ionized calcium.

Glucose—There is a slight hyperglycemia that is most likely associated with the glucocorticoid influence suggested in the leukogram interpretation.

Ultrasound: There is a hypoechoic appearance of the pancreas with a hyperechoic appearance surrounding the pancreas. The pancreas is enlarged and there is an accumulation of fluid.

Diagnosis: Clinical presentation, physical examination findings, laboratory data, and radiographic findings are strongly supportive of acute pancreatitis.

Plan: Fluid therapy, analgesic therapy, nutritional therapy, monitor bloodwork. CPLI (confirmatory test) submitted to IDEXX Reference Laboratories.

Confirmatory test results: CPLI: 270 µg/L (reference range 2.2–102.1 µg/L). Confirmation of initial diagnosis of pancreatitis.

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