veterinary clinical pathology

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You know how much I love interesting pathologies… so naturally I had to share these photos with you guys!

This is a conjoined bat that was either stillborn or died at birth (as evidenced by the attached placenta)! They were discovered in southeastern Brazil in 2001 and researchers believe the twins are Neotropical fruit bats (Artibeus).

These photos were taken by Nadja L. Pinheiro, from Área de Embriologia, Universidade Federal Rural do Rio de Janeiro.

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THROMBOCYTOPENIA

Thrombocytopenia is characterised by a low platelet count within the blood. Platelets are manufactured within the Bone Marrow are essential for maintaining haemostasis or in more simpler terms the bodies ability to clot and protect itself from haemorrhage. Thrombocytopenia can be a life threatening condition if not addressed.

WHAT CAUSES THROMBOCYTOPENIA?

 There is no breed, age or sex prevalence concerning this condition. There are five main types of cause:

1) Decreased production of platelets -  This can be caused by types of medication such as oestrogen meds or chloramphenicol. However, the most common cause is aplastic anaemia which occurs when there is a failure in the bone marrow or when the patient is suffering from Leukaemia. Cancer patients undergoing chemotherapy and radiation can also suffer from this type of thrombocytopenia. 

2) Increased blood clotting - Increased blood clotting can be caused by several conditions such as Disseminated Intravascular Coagulation where blood clots form in small blood vessels resulting in poor tissue perfusion and ultimately organ damage. Endotoxic shock can also cause this as well and vasculitis and certain types of cancer i.e Haemangiosarcoma.

3) Destruction of platelets - This is usually caused by autoimmune disease, where the bodies own immune system attacks and destroys its own platelets.This type of condition is more common in dogs and rarely seen in cats. Platelets can also be prematurely destroyed if the patient is suffering from diseases such as Ehrlichiosis and Babesiosis caused by infected tick bites and Heartworm. 

4) Sequestration (The removal of platelets from circulation) - Splenomegaly or a splenic torsion can cause the spleen to function abnormally and in some cases collect and retain up to 90% of the total platelet volume.

5) Haemorrhage due to trauma

WHAT ARE THE CLINICAL SIGNS?

  • Pyrexia
  • Lethargy and appetite loss
  • Heart Murmur
  • Haematuria
  • Excessive coughing
  • Epistaxsis
  • Collapse
  • Petechiae - pinpoint haemorrhages usually seen on the mucus membranes
  • Bruising easily
  • Melena or fresh blood in stools

HOW DO YOU DIAGNOSE THROMBOCYTOPENIA?

Taking a full clinical history to rule out a recent trauma is important as they will enable the clinician to rule out internal haemorrhage due to trauma, in addition information can be gathered to access whether the patient could be suffering from any infectious disease or have contracted any disease such as Babesiosis.Full blood analysis to include biochemistry, haematology and coagulation times should be carried out, in addition to this a 4DX profile testing for 6 vector-bourne diseases is recommended. Radiographs and Abdominal ultrasound can rule our internal haemorrhage and allow for a cancer screen. Additionally a bone marrow aspirate can be carried out. 

WHAT TREATMENT IS AVAILABLE?

In severe cases a blood transfusion is recommended, however in the UK the only source of platelets is from a whole blood transfusion. This must be carried out within four hours of collection and only when the platelet count is very low and bleeding into areas such as the respiratory system is evident. This is a salvage procedure and unfortunately very rarely makes a difference in severely thrombocytopenia patients due to the lack of active platelets in one unit of whole blood. 

In patients suffering from immune mediated thrombocytopenia, steroids or other immunosuppressing drugs are used and often these can successfully control the condition, although relapses are common. 

NURSING CONSIDERATIONS

  • Careful handling and minimal restraint
  • No neck leads to prevent pulling and avoidable bruising around the neck
  • No jugular/arterial blood sampling to prevent haemorrhage
  • Padded kennel again to prevent bruising from laying on hard floor
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Three skin masses present on a 15 year-old, female-spayed, Domestic Short Hair.  The kitty cat’s owner recently felt 3 small, firm masses on the patient’s left forelimb.  The masses were about 1cm apart and non-painful on manipulation.  Aspirates from all three lesions showed…

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Copious amounts of these round cells!  Most of these bad boys contain discrete, purple (or metachromatic!) granules.  Any idea what these cells are…..?  These are mast cells!  Making this a mast cell tumor, sometimes called a mastocytoma.  These cells will often ‘pop’ when cytology slides are made, releasing the granules into the background (see all the free granules in the bottom picture?)

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Cytologic diagnosis:  Mast cell tumor.  Feline mast cell tumors are typically low-grade in behavior - meaning they grow locally but rarely spread to other parts of the body.  In this case, the patient could be facing a more high grade tumor as she has multiple skin tumors simultaneously.  The presence of multiple cutaneous mast cell tumors in a cat is no bueno - many of these cats actually have disseminated disease.  In cats, disseminated mast cell disease will often shore up in the spleen.  No word yet on this patient’s next move, although I suspect these masses will be removed and a hunt will begin for internal tumors.  

The Herbs that Herbalists Take

By Matthew Hamm

In the ever-growing market of herbal medicine, it’s getting more difficult to decide what herbs to buy. When companies come out with new products that seem better than other brands, how does the consumer decide which product is best? For the average herbal consumer, the world of herbal medicine is made even more confusing by the constant release of contradicting studies, along with the addling advice of know-it-all friends. We asked some leading herbal professionals what herbs they take, how they take them, and their tips on choosing what’s best for you.

Herbs in Teas, Cooking and Tinctures

Randy Kidd, D.V.M., believes in the power of herbs. Kidd, author of the “Pet corner” column in Herbs for Health, holds doctorates in veterinary medicine and veterinary and clinical pathology, and practices holistic veterinary medicine. He takes an experimental approach when using different herbs.

“I take one week a month to really learn one herb—I try to use it in everything,” he says. “I take it at various times of the day in varying amounts. The idea is to see how this one herb affects me individually.”

Kidd does not take his herbs in capsule or tablet form because he doesn’t feel that pill forms take full advantage of an herb’s potential. Most of the herbs Kidd uses are in teas and in his cooking. The most common herbs in his teas include licorice root (Glycyrrhiza glabra), hawthorn (Crataegus spp.), burdock root (Arctium lappa), nettle (Urtica dioica), and echinacea (Echinacea spp.). Kidd enjoys cooking with garlic (Allium sativum), turmeric (Curcuma longa), sage (Salvia officinalis), and oregano (Origanum vulgare).

Kidd buys most of his herbs in bulk from Frontier Herbs, a company located in Norway, Iowa, because nearly all of their products are organically certified and he feels that Frontier has the best quality control in the country. He is currently test- growing several culinary and medicinal herbs to see what grows best in his soil and climate. Kidd is attempting to organically certify his thirty-acre farm and in the future wants to develop his own line of herbal products.

Some people need herbs to help their bodies keep up with their busy schedules. Mindy Green, an herbalist, aromatherapist, writer, and esthetician consults for companies in the natural products industry as well as directing education programs at the Herb Research Foundation in Boulder, Colorado. She takes herbs to promote her own good health.

“I like to use herbs preventively, supporting the body before it creates a specific condition,” she says. Green home-grows her own nettles and eats them as a steamed green or dries them for soup in the winter. Green also has a daily habit of drinking 1 quart of her special bone-building and osteoporosis-preventing tea blend. Her recipe consists of equal parts of nettle, oatstraw (Avena sativa), horsetail (Equisetum arvense), alfalfa (Medicago sativa), and red clover (Trifolium pratense). She uses ¼ cup of the dry herbal mixture to 1 quart of water, steeps the tea for one hour, and drinks the mixture throughout the day. For premade products, Green uses Herb Pharm’s Super Echinacea tincture or tablets and Sambucol elderberry (Sambucus nigra) extract from Nature’s Way for colds and the flu.

Keep reading

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The first photo shows a large splenic tumor in a retriever mix, consistent with a hemangiosarcoma.  The second photo shows metastasis to the liver.  The dog also exhibited hemoabdomen, or profuse bleeding into the abdomen, which is also consistent with a hemangiosarcoma, a tumor of blood vessels.  Impression smears of a cut tumor nodule are photographed below, showing large cells of irregular size and shape, and one cell with two nuclei.  Dividing cells and atypia are two signs of malignancy.  The dog was euthanized after profound anemia occurred, and necropsy discovered the above findings.

HYPOADRENOCORTICISM - Addison’s Disease

Addison’s disease is caused when the adrenal glands fail to produce an adequate quality of natural steroid. There are two reasons this condition can occur: 

  1. Immune Destruction of the Adrenal Gland
  2. Consequence of long term Cushing’s treatment

Patients often present in collapse as a result of:

  • Hyponatraemia (Low Sodium)
  • Hyperkalaemia (High Potassium) *LIFE THREATENING*
  • Dehydration

CLINICAL SIGNS:

Clinical signs often wax and wane and are signs which can be associated with may different conditions therefore as addison’s is reasonably uncommon it is often overlooked, until the patient presents in a addisonian crisis.

  • Anorexia
  • Vomiting
  • Haemorrhagic Diahorrea
  • Hypotension
  • Weakness
  • Bradycardia
  • Collapse

DIAGNOSIS:

  1. Haematology and Biochemistry (To access the sodium:potassium ratio)
  2. ACTH Stimulation Test
  3. Echocardiogram

TREATMENT:

When presented as a emergency, the first port of call is to provide intravenous fluid therapy at shock rates to reduce the levels of Potassium in the body and rehydrate the patient. Intravenous Steroids should be also be administered.

In a stable patient Glucocorticoids (Prednisolone) and Mineralocorticoids (Fludrocortisone Acetate) are prescribed. Regular blood testing is recommended to observe the sodium:potassium ratio.

NURSING CARE:

  • Monitor Vital Signs (Temperature is important if the animal is in crisis)
  • Monitor IVFT
  • Encourage the Patient to eat
  • Ensure Water is freely available
  • Provide frequent opportunities to urinate/defecate. 
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SLIDE AGGLUTINATION TEST

What is this test you for?

The Slide Agglutination Test is used as a quick indicator as to whether a patient is suffering from Immune-Mediated Haemolytic Anaemia. 

How do i carry out this test?

1) Collect a blood sample in a EDTA tube

2) Place one drop of the blood onto a microscope slide followed by either 1-2 drops of saline for a dog or 3-4 drops for cat.

3) Rock the slide backwards and forwards several times

4) First observe with the naked eye, this is to examine for any macro-agglutination (See the slide on the right in the picture).  

5) Then place a cover slip over the sample and examine under the microscope, this will show any micro-agglutination (See bottom picture). 

What should i look for when carrying out this test?

True Agglutination an indication of IMHA when looked at under the microscope looks like a cluster of grapes and usually consists of more than 4 RBC’s. 

Sometimes Rouleaux formation can occur, this is where RBC’s appear stacked on top of each other like coins. This is not an indication of IMHA. If this formation is apparent extra saline can be added to disperse the stacks, this will not affect true agglutination.

Can i use this test to 100% confirm a diagnosis of IMHA?

No, agglutination only occurs when there are high antibody levels, therefore a negative slide agglutinations does not rule out IMHA.

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Urine Sediment Examination

Microscopic examination of urine sediment should be routine when examining urine for abnormalities. 

Equipment List:

  • Fresh Urine Sample
  • Standard Microscope
  • x2 Glass Slides
  • x2 Slide Covers
  • x2 Bullet Tubes
  • Centrifuge
  • Pipettes
  • Sedi-Stain

Step One: Suck 3-5ml of fresh Urine up into a syringe and place into a conical tube. Repeat this, so you have two tube of urine to test.

The sample needs to be as fresh as possible to ensure that there has been no deterioration of any cells present and that additional urinary crystals have not formed. 

Step Two: Place the tubes in the centrifuge, opposite each other to ensure the centrifuge is balanced. The sample should be spun at 1200rpm for 3mins.

Do not spin the urine for any longer that 3 mins, as excessive spinning will damage any cells present in the urine.

Step Three: Once spun down, using a pipette remove and discard most of the supernatant leaving the sediment and a small amount of urine in the bottom of each tube.

Step Four: Secure the lid and flick the bottom of the tube to re-suspends the sediment in the small amount of remaining urine. 

By re-suspending the sediment in the urine, a smoother smear will be created when placed on the slide.

Step Five: In ONE of the tubes add 1 drop of sedi-stain and flick the tube a couple of times.

In your practical exams they will ask you to make one plain slide and one stained slide, however in actually practice it is vets preference.

Step Six: Grab your slides and place one drop of plain sediment on one slide and one drop of stained sediment on the other. Carefully cover each drop with a slide cover. 

Slide covers are extremely important as they protect the microscope lens from coming into actually contact with the lens and damages them.

Step Seven: Place under the microscope and examine with the x10 and x40 objective lens.

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SYRINGOMYELIA

This is a neurological condition in which fluid fluid cavities form within the spinal cord. Syringomyelia is a inherited condition which affects certain breeds, most commonly the King Charles Cavalier Spaniel and the Griffons Bruxellois. The incidences of the condition are also on the rise in some toy breeds such as the Pomeranian, Chihuahua and Maltese. 

Why does this condition happen?

These fluid filled cavities (also known as Syrinx’s) develop due to congenital abnormalities such as malformation of the skull and the way it connects to the cervical vertebrae. This causes overcrowding of the back of brain causing the cerebral spinal fluid (CSF) to be forced down the centre of the spinal cord, thus causing the tissue to become distended and cavities to form.

What symptoms should I look out for?

Clinical signs can be different from dog to dog and the degree/size of syrinx has no effect on the severity of symptoms expressed. This means that a patient with only  a slight syrinx could show the same symptoms as a dog with several fluid filled cavities within the spine. 

King Charles Cavalier tend to show symptoms between the ages of 6mths to 3years, however it is important to note that some dogs with the condition do not show clinical signs. 

Clinical signs:

  • Intermittent Neck/Back Pain - May become reluctant to jump and climb, or yelp during exercise.
  • Hyperaesthesia - “Pins and Needles”
  • Phantom Scratching - Compulsive scratching of the shoulder/neck/back of head region although the foot doesn’t make any contact with the skin.
  • Weak or Wobbly Gait- When the nerves within the spinal cord become effected.

How do Vet diagnosis the condition?

Referral for a MRI scan of the brain and spinal cord under General Anaesthetic is almost always necessary. 

How do Vets treat Syringomyelia?

  1. Medical Therapy - Gabapentin, Steroids and Anti-inflammatory drugs are often prescribe to help deal with episodes of pain while diuretics are given to reduce the production of CSF. 
  2. Surgical Treatment - The main aims of surgery are to improve the shape of the back of the skull thus reducing the crowding and reducing the flow of CSF down the spinal cord.

The BVA and Kennel Club management committee have given the go-ahead for a scheme to screen potential breeding stock for conditions such as Syringomyelia and Skull misinformation in the most commonly affected breeds.

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DIAPHRAGMATIC HERNIA

The diaphragm is a large muscle which forms a barrier between the thoracic cavity containing the heart and lungs and the abdominal cavity containing many of the vital organs and structures. It is essential for efficient respiration.

THE TWO TYPES OF DIAPHRAGMATIC HERNIA

Acquired 

An acquired diaphragmatic hernia occurs when the diaphragm ruptures usually due to some kind of blunt trauma (cats falling out of trees or off of fences and dogs involved int RTCs) to the abdomen. The force of the blow against the abdomen forces the abdominal organs up onto the diaphragm causing it to tear or rupture. Once a rupture has occurred the structures such as the intestines, liver and stomach can freely move up into the thoracic cavity compressing the lungs and causing difficulty in breathing.

Congenital

An congenital diaphragmatic hernia occurs not from trauma but from the muscle failing to form correctly during development. These are very rare but from recorded cases it can be seen that Weinmerarner’s and German Shepard’s have a prevalence.

CLINICAL SIGNS

  • Dyspnoea (Difficulty in breathing)
  • Cyanosis (Blue tinge to the Mucus Membranes)
  • Extreme Pain Symptoms (In cases involving strangulated gut)
  • Vomiting
  • Diahorrea 
  • Anorexia

DIAGNOSIS AND TREATMENT

Immediate X-rays of the abdominal and thoracic cavities are needed to diagnose an diaphragmatic hernia. The patient is likely to be in shock therefore stabilisation with IVFT, pain relief and oxygen therapy should be administer to ensure the patient is supported enough for surgical intervention, the only effective treatment option. 

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Cervical mass in a 11 year-old, male-castrated, black Labrador Retriever.  For the past two weeks the patient has been intermittently coughing, especially after voraciously eating his  kibbles.  He is described as healthy otherwise.  On physical examination his primary care veterinarian palpated a very large, 10cm firm mass in his ventral neck.  We got the aspirate samples of the mass and found….

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…and found numerous apparently cohesive clusters of these mononuclear cells.  Their cohesive nature is typical of an epithelial population.  The cells look relatively bland - that is, they all appear very similar to their neighbor.  Such monomorphism suggests a more benign process…but we’ll come back to that interpretation!  Additionally, few clusters were associated with this brilliant magenta extracellular material - could be matrix, secretory product, or colloid.  What tumor type do think this is?!

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Cytologic diagnosis: Neuroendocrine epithelial tumor.  Based upon the mass location, this is consistent with a Thyroid tumor.  Although the population looks relatively benign cytologically, canine thyroid tumors are usually aggressive adenocarcinomas.  Conversely, kitty thyroid tumors are usually benign and equine tumors a 50-50 shot on benign versus malignant.  No word yet on what therapy the owner has elected to pursue - but the prognosis is sadly grave :-(

On an aside, other neuroendocrine origin tumors (like insulin secreting pancreatic tumors or some adrenal tumors) have a very similar cytologic appearance. 

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So very sorry for my protracted absence from the Tumblr community.  Life has been crazy lately…but things are finally settling down. So let the cytology awesomeness begin again!

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Lymph node aspirate from a 10 year-old, male-castrated, German Shepherd Dog.  The patient had a recent onset of lethargy and anorexia.  On examination the patient had significantly enlarged peripheral lymph nodes.  In addition, spleen and liver enlargement were suspected on abdominal palpation.  Aspirates of the lymph node were acquired and this is what we say…

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The samples were wall-to-wall lymphoblasts.  In a normal lymph node you should have 90%+ small mature lymphocytes…in this case I only found about a dozen on the entire slide.  Interestingly enough the lymphoblasts also contained these angular, white inclusions.  Any guess what these could be???  Based upon some special stains, we suspect they are accumulations of antibody!  Crazy to see them this angular though!

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Cytologic diagnosis: Lymphosarcoma.  We even went a little further with this case and found it is a B-lymphocyte tumor.  Which completely fits with the antibody inclusions.  Recall that normal B-cells have the potential to become plasma cells, which make the antibody that so preciously protect us from microbes!  We also found these nasty blasties in the spleen, liver, and circulating in blood.  Thankfully the patient has responded well to chemotherapy thus far.