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Dog with Lethargy and Depression

Learn about Ryan, a 7.5-year-old Labrador Retriever, presenting with lethargy, anemia, regenerative macrocytic hyperchromic. This case study covers diagnostic findings and interpretation for anemia, leukocytosis, and thrombocytosis.

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Dog with Lethargy and Depression

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  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/L HIGH ( 5.50 – 16.90 ) LYM = 9.45 K/L HIGH ( 0.70 – 4.90 ) MONO = 5.82 K/L HIGH ( 0.10 – 1.40 ) NEU = 70.34 K/L HIGH ( 2.00 – 12.00 ) EOS = 2.34 K/L HIGH ( 0.10 – 1.49 ) BASO = 0.48 K/L HIGH ( 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 = 2.58 M/L LOW ( 5.50 – 8.50 ) HGB = 9.3 g/dL LOW ( 12.0 – 18.0 ) RETIC = 145.6 K/L %RETIC = 5.6 % MCV = 76.8 fL HIGH ( 60.0 – 72.0 ) RDW = 22.2 % HIGH ( 14.7 – 17.9 ) MCHC = 47.0 g/dL HIGH ( 31.0 – 37.0 ) MCH = 36.03 pg HIGH ( 19.50 – 24.50 ) PLT = 747 K/L HIGH ( 175 – 500 ) MPV = 19.62 fL 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 = 2.58 M/L LOW ( 5.50 – 8.50 ) HGB = 9.3 g/dL LOW ( 12.0 – 18.0 ) RETIC = 145.6 K/L %RETIC = 5.6 % MCV = 76.8 fL HIGH ( 60.0 – 72.0 ) RDW = 22.2 % HIGH ( 14.7 – 17.9 ) MCHC = 47.0 g/dL HIGH ( 31.0 – 37.0 ) MCH = 36.03 pg HIGH (19.50 – 24.50 )

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

  10. Erythron – Blood Film

  11. Erythron – Blood Film Rouleaux Agglutination

  12. Saline Agglutination Test Saline Solution Agglutination Rouleaux

  13. Erythron – Blood Film

  14. 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 = 88.43 K/L HIGH ( 5.50 – 16.90 ) LYM = 9.45 K/L HIGH ( 0.70 – 4.90 ) MONO = 5.82 K/L HIGH ( 0.10 – 1.40 ) NEU = 70.34 K/L HIGH ( 3.00 – 12.00 ) EOS = 2.34 K/L HIGH ( 0.10 – 1.49 ) BASO = 0.48 K/L HIGH ( 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 = 88.43 K/L HIGH ( 5.50 – 16.90 ) • Leukocytosis • Marked

  18. “Ryan” - 7.5 Year-old, Labrador Retriever Leukon WBC = 88.43 K/L HIGH ( 5.50 – 16.90 ) LYM = 9.45 K/L HIGH ( 0.70 – 4.90 ) MONO = 5.82 K/L HIGH ( 0.10 – 1.40 ) NEU = 70.34 K/L HIGH ( 3.00 – 12.00 ) EOS = 2.34 K/L HIGH ( 0.10 – 1.49 ) BASO = 0.48 K/L HIGH ( 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

  20. Leukon – Blood Film

  21. Leukon – Blood Film

  22. Leukon – Blood Film

  23. 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/L HIGH ( 175 – 500 ) • Thrombocytosis • Mild

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

  27. “Ryan” - 7.5 Year-old, Labrador Retriever Thrombon PLT = 747 K/L HIGH ( 175 – 500 ) MPV = 19.62 fL 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/L HIGH ( 5.50 – 16.90 ) LYM = 9.45 K/L HIGH ( 0.70 – 4.90 ) MONO = 5.82 K/L HIGH ( 0.10 – 1.40 ) NEU = 70.34 K/L HIGH ( 2.00 – 12.00 ) EOS = 2.34 K/L HIGH ( 0.10 – 1.49 ) BASO = 0.48 K/L HIGH ( 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 = 2.58 M/L LOW ( 5.50 – 8.50 ) HGB = 9.3 g/dL LOW ( 12.0 – 18.0 ) RETIC = 145.6 K/L %RETIC = 5.6 % MCV = 76.8 fL HIGH ( 60.0 – 72.0 ) RDW = 22.2 % HIGH ( 14.7 – 17.9 ) MCHC = 47.0 g/dL HIGH ( 31.0 – 37.0 ) MCH = 36.03 pg HIGH ( 19.50 – 24.50 ) PLT = 747 K/L HIGH ( 175 – 500 ) MPV = 19.62 fL PCT = 1.5 % PDW = 30.3 % Differential algorithm issues. Confirm with blood smear

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