Jean-Pierre Braun

The preanalytic phase in veterinary clinical pathology.

This article presents the general causes of preanalytic variability with a few examples showing specialists and practitioners that special and improved care should be given to this too often neglected phase. The preanalytic phase of clinical pathology includes all the steps from specimen collection to analysis. It is the phase where most laboratory errors occur in human, and probably also in veterinary clinical pathology. Numerous causes may affect the validity of the results, including technical factors, such as the choice of anticoagulant, the blood vessel sampled, and the duration and conditions of specimen handling. While the latter factors can be defined, influence of biologic and physiologic factors such as feeding and fasting, stress, and biologic and endocrine rhythms can often not be controlled. Nevertheless, as many factors as possible should at least be documented. The importance of the preanalytic phase is often not given the necessary attention, although the validity of the results and consequent clinical decision making and medical management of animal patients would likely be improved if the quality of specimens submitted to the laboratory was optimized.

Effects of intravenous, low-dose ketamine-diazepam sedation on the results of hematologic, plasma biochemical, and coagulation analyses in cats

OBJECTIVEnTo evaluate the effects of an IV, low-dose ketamine-diazepam combination used for short-duration chemical restraint on the results of clinicopathologic testing in cats and to assess its practicality and tolerance.nnnDESIGNnProspective case series.nnnANIMALSn42 client-owned cats of various breeds, ages, and health status.nnnPROCEDURESnBlood samples were obtained just prior to and just after IV injection of ketamine chlorhydrate (10 mg) and diazepam (0.5 mg). A CBC, plasma biochemistry panel, and coagulation profile were performed on each sample (ie, before and after chemical restraint). Practicality of the procedure was assessed, and cats were monitored for immediate and delayed effects.nnnRESULTSnSignificant changes were observed for most of the analytes tested. However, the magnitude of the observed changes was notably low and likely not of clinical relevance. The chemical-restraint procedure appeared effective, safe, and well tolerated.nnnCONCLUSIONS AND CLINICAL RELEVANCEnThe IV, low-dose ketamine-diazepam combination used for short-duration chemical restraint in the present study may be suitable to assist physical restraint for blood sampling for assessment of hematologic, serum biochemical, and coagulation parameters in cats.

Canine Reference Intervals for Coagulation Markers Using the STA Satellite® and the STA-R Evolution® Analyzers

The aim of the current study was to determine canine reference intervals for prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, and antithrombin (AT) according to international recommendations. The STA Satellite® coefficients of variation of within-laboratory imprecision were 3.9%, 1.3%, 6.9%, and 5.1% for PT, APTT, fibrinogen, and AT, respectively. At 4°C, citrated specimens were stable up to 8 hr for whole blood and 36 hr for plasma, except for APTT, which increased slightly (<1 sec). Nonparametric reference intervals determined in citrated plasma from 139 healthy fasting purebred dogs were 6.9–8.8 sec, 13.1–17.2 sec, 1.24–4.30 g/l, and 104–188% for PT, APTT, fibrinogen, and AT, respectively. Based on Passing–Bablok comparison between STA Satellite and STA-R Evolution® using 60 frozen specimens from a canine plasma bank, the corresponding reference intervals were transferred to the STA-R Evolution: 7.1–9.2 sec, 12.9–17.3 sec, 1.20–4.43 g/l, and 94–159% for PT, APTT, fibrinogen, and AT, respectively.

Changes in hematology measurements in healthy and diseased dog blood stored at room temperature for 24 and 48 hours using the XT‐2000iV analyzer

BACKGROUNDnChanges in canine hematology measurements may occur when analyses are delayed due to shipment of specimens to a laboratory.nnnOBJECTIVEnThe purpose of this study was to report changes in hematologic variables in healthy and diseased canine blood measured with a Sysmex XT-2000iV during storage at room temperature for 24 and 48 hours.nnnMETHODSnEDTA-K3 blood samples from 42 healthy and diseased dogs were measured on a Sysmex XT-2000iV analyzer within one hour of sampling, and after storage for 24 and 48 hours at room temperature in the dark.nnnRESULTSnStorage caused little or no change in RBC count, HGB concentration and MCH, while there was a moderate increase in HCT, MCV and reticulocytes count, and a moderate decrease in MCHC. Decreased platelet counts by impedance (PLT-I) and optical (PLT-O) measurements were associated with increased mean platelet volume (MPV), platelet-large cell ratio (P-LCR) and platelet distribution width (PDW), including a right shift in the platelet histogram and a dispersion of the platelet dot plot on the scattergram. The total and differential WBC count remained stable except for decreased monocyte counts. In the scatterplots, monocytes shifted into the lymphocyte population after 24 hours, and neutrophil population shifted to the right appearing in the eosinophil gate at 48 hours of storage. The disease status had only a small effect on storage-induced changes, and observed changes had no consequences for clinical decisions.nnnCONCLUSIONSnBlood storage at room temperature was accompanied by moderate variations in some hematologic variables, awareness of which helps in avoiding misinterpretations.

Validation of the Medonic CA620/530 Vet 20-μ1 Microcapillary Sampler System for Hematology Testing of Feline Blood

The aim of the current study was to compare feline hematologic variables in blood collected in microcapillary tubes (20 μl) and conventional blood tubes with the Medonic CA620/530 Vet in-house hematologic analyzer. A comparison of results obtained in 60 cats presented at the clinics of the veterinary school showed that the correlations between the 2 methods were 0.97 for white blood cell, 0.95 for red blood cell, and 0.93 for platelet counts; 0.92 for hemoglobin concentration; and 0.99 for mean corpuscular volume. No clinically relevant differences between the 2 blood sampling techniques were observed for any variable, which suggests that both techniques are interchangeable in cats. Moreover, microcapillary tubes would allow easier repeated sampling in the same cat and would likely be useful in other small species.

Characterization of proteinuria in dogue de Bordeaux dogs, a breed predisposed to a familial glomerulonephropathy: a retrospective study

Dogue de Bordeaux dog has been reported to be predisposed to a familial glomerulonephropathy that displays some morphological modifications reported in focal and segmental glomerulosclerosis. Prevalence of quantitatively abnormal renal proteinuria was recently reported to be 33% in this breed. The nature of the proteinuria was assessed by sodium dodecyl sulfate-agarose gel electrophoresis and determinations of urinary markers (urinary retinol-binding protein, urinary N-acetyl-β-glucosaminidase, urinary albumin and urinary immunoglobulin G) on stored specimens. Diagnostic performances of sodium dodecyl sulfate-agarose gel electrophoresis to identify dogs with elevated urinary biomarkers were assessed. Samples from 102 adult Dogue de Bordeaux dogs (47 non-proteinuric [urine protein-to-creatinine ratio≤0.2], 20 borderline-proteinuric [0.2< urine protein-to-creatinine ratio ≤0.5] and 35 proteinuric dogs [urine protein-to-creatinine ratio >0.5]) were used, of which 2 were suffering from familial glomerulonephropathy. The electrophoretic protein patterns, for all but one proteinuric dog, were indicative of a glomerular origin and, in all dogs, the urinary albumin concentration related to creatinine concentration and the urinary immunoglobulin G concentration related to creatinine concentration were above the upper limit of the reference interval established for the breed. Sensitivity and specificity of sodium dodecyl sulfate-agarose gel electrophoresis identifying dogs with elevated urinary albumin concentration were 94% and 92%, respectively, while diagnostic performance of sodium dodecyl sulfate-agarose gel electrophoresis in detecting dogs with elevated urinary immunoglobulin G concentration yielded sensitivity and specificity of 90% and 74%, respectively. These results suggest that all proteinuric and some borderline-proteinuric Dogue de Bordeaux dogs likely have underlying glomerular lesions and that sodium dodecyl sulfate-agarose gel electrophoresis and urinary markers might be useful to screen dogs with borderline-proteinuria. Additional investigations are warranted to assess if these findings are related to the familial glomerulonephropathy.

Validation of Preexisting Reference Intervals: Can the Procedure be Applied to Canine Hemostasis?

The de novo establishment of reference intervals (RIs) for all variables is beyond the capabilities of many small laboratories. Thus, recent international recommendations propose procedures to adopt RIs established by “donor” laboratories after validation in “receiving” laboratories. The objective of the current study was to use recently published RIs of canine hemostasis tests as possible donor values and evaluate the validation procedure with randomized sets of values obtained in another study of canine RI determination of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, and antithrombin (AT). The preanalytical, analytical, and demographic conditions of the donor and receiving laboratories were first compared. To represent new reference individuals, 25 validation sample sets of 20 results of the receiving laboratory were randomly selected for each variable and compared with the RI of the donor laboratory. Validation was rejected in all cases for APTT and AT. Donor RI could be validated in 14 of 25 cases for fibrinogen and in 4 of 25 cases for PT. When preanalytical and analytical differences existed between donor and receiving laboratories, validation procedures consistently rejected preexisting RI. When the differences are smaller, the variability of the results obtained in the validation sample sets tested may be responsible for validations or rejections, which can lead to further misinterpretations of results from patients. Validation of a preexisting reference interval is certainly an interesting option for small laboratories, but progressive determination of the laboratorys own reference interval is probably a better long-term solution.

Effects of storage conditions on results for quantitative and qualitative evaluation of proteins in canine urine

OBJECTIVE To investigate effects of storage conditions on the canine urine protein-to-creatinine ratio (UPC) and on SDS-agarose gel electrophoresis (AGE) of urinary proteins. SAMPLE Urine specimens from 20 proteinuric (UPC > 0.5) and 20 nonproteinuric (UPC ≤ 0.2) dogs. PROCEDURES UPC and SDS-AGE were performed on urine specimens stored at room temperature (20°C) and 4°C for up to 5 days and at -20° and -80°C for up to 360 days; some specimens were subjected to 3 freeze-thaw cycles. Results were compared with those obtained for fresh urine specimens. RESULTS UPC was not affected by storage at room temperature or by freezing. A decrease in UPC was observed for specimens from nonproteinuric dogs after 5 days at 4°C (10%) and from both groups after 90 days at -20° and -80°C (≤ 20% and ≤ 15%, respectively). The SDS-AGE profiles revealed no visual changes regardless of duration of storage for specimens stored at room temperature, 4°C, and -80°C, except for 1 profile after 360 days at -80°C. Repeated freeze-thaw cycles did not affect SDS-AGE profiles. Appearance or strengthening of high-molecular-weight bands that could alter interpretation was evident in SDS-AGE profiles after storage at -20°C for ≥ 15 days (31/40 dogs). CONCLUSIONS AND CLINICAL RELEVANCE Storage of urine at -20° or -80°C for up to 1 year influenced the UPC without affecting clinical interpretation. Storage of urine specimens at -20°C impaired visual analysis of SDS-AGE. When SDS-AGE cannot be performed on fresh or recently refrigerated urine specimens, storage at -80°C is recommended.

Comparison of feline serum amyloid A (SAA) measurements assessed by a point-of-care test analyzer to a validated immunoturbidimetric method

Serum amyloid A (SAA) is one of the most important acute phase proteins in cats and increases rapidly and significantly after an inflammatory stimulus. The objective of this study was to compare measurements of SAA concentration in feline blood specimens using the point-of-care Eurolyser Solo Analyzer (SOLO) with results of a validated immunoturbidimetric test. This prospective study was conducted between March 2014 and June 2015 at a university teaching hospital. Blood specimens were collected from a total of 61 cats including 45 client-owned cats with inflammatory diseases presenting to the emergency and critical care service and 16 client-owned healthy cats. Before SAA measurement, the blood was centrifuged and stored at −u200980xa0°C (−u2009112xa0°F). The Eiken assay immunoturbidimetric method (EKITM) which uses latex sensitized anti-human SAA antibodies served as reference SAA test. Serum amyloid A measurements with the EKITM were performed in a reference laboratory. Serum amyloid A measurements with the SOLO were performed in an emergency laboratory. Thirty-six and 18 results were out of the analytical range with the EKITM and the SOLO, respectively. The correlation between the two methods was high (ru2009=u20090.87) and there was an intense mostly proportional bias, with results being approximately 2 times lower with the SOLO than the reference test. This study showed that the SOLO reliably and rapidly measures SAA in feline blood specimens; however, a “de novo” reference interval should be determined for proper interpretation of the results.

Evaluation of CTAD (citrate–theophylline–adenosine–dipyridamole) as a universal anticoagulant in dogs

CTAD (citrate–theophylline–adenosine–dipyridamole) has been shown to be an almost universal anticoagulant in human and feline medicine, allowing most hematology, coagulation, and biochemical analyses. Forty canine blood specimens were collected in CTAD, EDTA, heparin, and citrate for hematology, biochemistry, and coagulation analyses. CTAD partially limited platelet aggregation observed in EDTA blood smears. CTAD specimens gave similar and well-correlated results for most variables of a complete blood cell count, except for mean corpuscular volume, which was moderately higher, and mean corpuscular hemoglobin concentration, which was moderately lower in CTAD than in EDTA; reticulocyte and platelet indexes were poorly correlated. CTAD plasma gave similar results to citrate for fibrinogen, antithrombin, and D-dimers, and relatively similar results for prothrombin time, but activated partial thromboplastin time was poorly correlated. Triglycerides, cholesterol, glucose, total proteins, phosphate, iron, alanine aminotransferase, γ-glutamyl transferase, and lipase were similar and well correlated in CTAD and heparin plasmas. Urea, creatinine, albumin, alkaline phosphatase, amylase, and aspartate aminotransferase showed moderate-to-marked bias, but these variables could be measured in CTAD plasma if new reference intervals were determined. Creatine kinase activity, potassium, chloride, and total carbon dioxide measurements are not recommended in CTAD plasma. CTAD is a prospective candidate as an almost universal anticoagulant for routine hematology, some plasma coagulation, and many biochemistry variables in dogs. Definitive recommendations will require study of abnormal canine blood specimens.