Rabbit Clinical Pathology - AVEPA
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Transcript of Rabbit Clinical Pathology - AVEPA
Rabbit Clinical Pathology
John Chitty BVetMed CertZooMed MRCVS
Anton Vets Andover, Hants SP10 2NJ
What is clinical pathology?
• Pre-mortem changes?
• Blood
• Urine
• Faeces
• Cytology
• Histopathology?
What can clinical pathology do?
• Give you a diagnosis?
• Show you the body’s response?
• Provide further clues?
• ALWAYS TREAT THE PATIENT NOT
THE NUMBERS!
In-house or external laboratory? • Advantages of in-house
– Speed of result
– Clinician consistency
• Advantages of lab – QC
– Technician consistency
– Time?
• Variables – Experience of clinician/ technician
– Interest of clinician/ technician
– Technology
– Sample quality
Essentials in-house?
• A microscope!
• Electrolytes
– Na, K, iCa
– Cl?
• PCV
• Total solids?
• Urinalysis
Bloods
• What can we do? – Haematology
– Biochemistry
– Serology
• The drawbacks – What is normal?
– Diurnal variations
– Stress
– Anaesthetic effects
– Digestion?
Diurnal Rhythm
• Bile acids
• Cholesterol
• Urea
– Both highest evening
• WBC count/ differential
– TWBC – lowest evening
– Lymphocyte – “ “ “ “ “
– Heterophil + eosinophil– opposite
Haematology
• Red Cell Counts/ Morphology
• White Cell counts/ Differential/ Morphology
• EDTA
• Smear
Red Cells
• PCV vs HCT
• Anaemia?
• Pet rabbits often
lower PCV
• Haemoconcentration
>45%
• Anaemia <30%
But rabbit RBC’s have short lifespan..
….therefore often see polychromasia &
anisocytosis and up to 4% reticulocytes
Regenerative vs non-regenerative
• Regenerative
– Blood loss
– Uterine AC/ aneurysm
– Gut loss
– Parasites?
– Wounds?
– Avermectin toxicity
– Lead toxicity
– Haemolysis
• Non-regenerative
– Reduced production
– Toxins?
– CHRONIC DISEASE!!!
– PAIN!!!!
WBC
• Increase rare
– Mild in some
INFLAMMATION!!!!
– Large increases in
lymphosarcoma???
• Reduction common
– Chronic infection
– Toxaemia
– Viral infection
Morphology
• Bands and left shift rare
• Toxicity
• Don’t forget..
– Diurnal variation
– Stress haemogram
Lymphocyte
• Increase
– Viral?
– Lymphoma?
• Reduction-
– Stress
– Infection
– Chronic illness
– Age?
Eosinophilia
• How do you judge
reduction?
• Increase
– Parasites???
– Hypersensitivity????
– Modulate mast cells!
Basophilia
• Often lots
• Consider with eosinophils?
• Both increased – Skin disease
– Purulent infection of certain tissues
• No eosinophilia – Liver disease?
– Hyperlipoproteinaemia
– DM
– Nephrosis
Biochemistries
• Normal?
• Normal variations?
• Sensitivity vs specificity
• DO THEY ACTUALLY HELP?????
• Rabbits get stress hyperglycaemia
• The more severe the gut problem, the
more the pain
• The more the pain, the more the stress
• The more the stress, the higher the
glucose
• ie glucose is a prognostic and diagnostic
indicator
Glucose as a gut prognostic?
• <4 – malnutrition?
• 8-15- normal/ average stress
• 15-20 – monitor!
• 20-25- prob surgical
• >25 – reach for the scalpel!
Levels
Is sodium better?
• Linked?
• How specific are they?
• Effects of sodium on fusus coli?
• Always reassess
• Always radiograph!
Lactate
• Similar levels to other mammals
• Can be measured patientside
• Acid-base?
• Possibility of detecting subclinical resp
disease??
• Relationship to caecotrophy and digestive
variations?
• NOT circadian
Prognostic?
• Persistently low may indicate impaired
caecotrophy?
• Rise of > 1.5mmol/l between 12h post-
arrival and 24-48hr post arrival gives fair
prognosis?
Proteins
• Total vs Albumin vs Globulin
• Breed and gender and age effects?
• Feeding?
• How is it measured?
• A:G ratio? 60:40
Total Protein
• Increase
– Dehydration/
hypovolaemia
– Pregnancy/ breeding
– Chronic disease
– Artefact of difficult
blood take
• Decrease
– Starvation
– Protein loss
– Malnutrition
– Stress
Albumin
• Reduction
– Failure to absorb
– Failure to process
– Increased loss
– Increased breakdown
• Increase
– Dehydration
– Hypovolaemia
Liver
• Enzymes show hepatocellular damage? – ALT/AST/GGT/LDH/ALKP
– Or….
• Bile acids show function changes – Diurnal variation
– Dynamic tests
• Cholesterol – Useful in lipidosis
– Beta-HB
– TG?
Kidneys
• Urea – Pre-renal effects
– Post-renal effects
– Diet
– Diurnal
• Creatinine – Sensitive?
• Amylase
• GGT
• Phosphate
Electrolytes
• Calcium
– Total vs ionised
– Consider with phosphate?
• Potassium
• Sodium
• Chloride
• Consider as essential in considering weak/
collapsed rabbit and in deciding fluids
Potassium
• Low
– Anorexia
– Alkalosis
– Losses – eg saliva
– RF
– Diarrhoea
– Artefact
• High Pr/ lipaemia
– FLOPPY RABBIT
SYNDROME??
• High
– RF
– Post-renal
– Acidosis
– Artefact
• haemolysis
Serology
• Serology gives diagnosis?
• Serology shows exposure?
• Serology increases index of suspicion?
Treponema
• 25% positive
• Lesions before
antibody?
• Antibody may persist
• Antibody may decline
post-therapy
• Adjunct to other
diagnostic measures?
• Use as screening?
Pasteurella
• What is the point of
serological testing
against a normal
commensal?
• What will you do if
you get a positive?
• Is it worth screening?
E cuniculi
• Difficult diagnosis – can serology help?
• Rabbit titres fluctuate NOT necessarily rise
• Methodology varies
• Sensitivity varies
• Immune response varies
• Detectable antibody 3-4 weeks post-infection
• High levels 6-9 week post-infection
• Signs linked to cellular rupture and immune reaction
So....
• IgG & IgM negative
• IgG pos & IgM neg
• IgG neg & IgM pos
• IgG & IgM pos
• Rule-out
• Should be
background
• V recent infection
• Should be diagnostic?
E cuniculi diagnosis
• Signs
• Rule-out
• Is it concurrent?
• Response to therapy?
• Serology?
• PCR?
– Urine – spores shed 1-3 mth post-infection
– CSF/ other tissues
– Effect of recrudescence????
Urine
• Gross appearance
helpful?
• Crystals?
– Remember pH
• Collection method
• Bacteriology?
• Cytology?
Bacteriology/ sensitivity
• Likely to find pathogens?
• Likely to find commensals?
• Likely to get contamination?
• Likely to find anything?
• Aerobic vs anaerobic
• Significance of results?
Bacteriology/ sensitivity:
should you do it?
• Consider in:
– Antibiotic “failure”
– Colony “outbreaks”
• How?
Antibiotic Failure
• Consider
– Dose rate
– Penetration of drug
– Drug activity
– Failure of culture/ sensitivity
– Underlying causes
– Chronicity
Culturing Pasteurella
• In healthy rabbit
– No significance
– DO NOT use
prophylactic antibiotic
– Consider other rabbits
• Diseased rabbit
– Young or in colony
• May be significant
• Consider health status
of others
– Older or individual
rabbit
• Significant?
• Consider underlying
causes
Cytology
• Quick
• Simple
• Cheap
• Shows cellular reaction to organisms
• More sensitive than bacteriology?
• Can you base therapy on it?