Detection of frequent neutrophil misclassification by the ProCyte Dx in sick dogs and how to avoid it.

OBJECTIVES: A common and severe error in identifying neutrophils in feline blood samples by the IDEXX ProCyte Dx haematology analyser (ProCyte) has been reported. The hypothesis was that the same or similar error would be identified during analysis of canine blood samples and that white blood cell dot plot evaluation would be critical to detect and avoid erroneous results. MATERIALS AND METHODS: Eighty-six canine blood samples collected for clinical diagnosis of hospital patients were evaluated. Differential leukocyte counts were determined by the ProCyte Dx, ADVIA 2120 and manual methods. ProCyte neutrophil percentage results were considered unacceptable if the result was 15% different than percentage results from both ADVIA 2120 and manual counts. ProCyte WBC dot plots and instrument flags were evaluated for correctness. RESULTS: The ProCyte neutrophil counts were unacceptably lower than the ADVIA 2120 and manual neutrophil counts in 13 samples (15% of 86 samples). Neutrophils misclassified by the instrument were erroneously classified as monocytes and/or lymphocytes. All these samples were from patients with systemic inflammation. The error could be eliminated by rejecting results from samples with incorrect separation of cell clusters in the ProCyte WBC dot plots. CLINICAL SIGNIFICANCE: The ProCyte neutrophil count error with canine blood samples is common, severe and might affect clinical decisions. Operators of the instrument must evaluate white blood cell dot plots for correctness to avoid the error.

Feline Differential Leukocyte Count with ProCyte Dx: Frequency and Severity of a Neutrophil-Lymphocyte Error and How to Avoid It.

BACKGROUND: Erroneous neutrophil and lymphocyte counts from analysis of feline blood samples were transferred directly into the hospital information system from the ProCyte Dx hematology instrument in our after-hours laboratory. Errors usually were not detected by the users. HYPOTHESIS/OBJECTIVES: To quantify the frequency and severity of errors associated with the ProCyte Dx analyzer and to identify methods to avoid the errors. ANIMALS: One-hundred six EDTA blood samples routinely submitted from feline hospital patients were analyzed. METHODS: ProCyte differential leukocyte counts were compared to 2 reference methods: Advia 2120 hematology instrument and manual enumeration. Limits for unacceptable deviation from the reference methods were defined as 18 for % lymphocytes and 23 for % neutrophils. RESULTS: Fourteen of 106 samples had unacceptable errors for both lymphocytes and neutrophils compared to both reference methods. Median % lymphocytes in those 14 samples were 11.2, 15.0, and 53.0% for Advia, manual, and ProCyte, respectively. Median % neutrophils were 85.4, 81.5, and 34.2% for Advia, manual, and ProCyte, respectively. All errors were avoided by rejecting automated ProCyte differential leukocyte results whenever the dot plot appeared clearly incorrect, but only 9 of these 14 samples had a ProCyte WBC distribution error flag. CONCLUSIONS AND CLINICAL IMPORTANCE: Results reported by ProCyte had markedly falsely increased lymphocyte and decreased neutrophil counts in 13% of feline patient samples. Users must reject automated differential leukocyte count results when the WBC dot plot appears overtly incorrect. Rejection based only on ProCyte WBC error flag was insufficient.

Comparison of specific gravity analysis of feline and canine urine, using five refractometers, to pycnometric analysis and total solids by drying.

AIMS: To compare the performance of five refractometers for determination of urine specific gravity in cats and dogs, with reference to weight of total solids and pycnometer analysis. METHODS: Urine samples from 27 cats and 31 dogs submitted for routine urinalysis were included. Urine specific gravity was determined with five refractometers. Four were optical, hand-held refractometers with a temperature compensation method and one was a digital model. Urine was dried to determine the precise weight of total solids. The total solids (g/L) were converted to an estimated specific gravity by division with 2.33. Urine specific gravity of four feline and seven canine samples were analysed with a pycnometer. Limits of agreement analysis was used to evaluate the agreement between specific gravity (analysed as specific gravity minus 1) measured by the refractometers and estimated from dried total solids, or pycnometer results. RESULTS: The five refractometers reported clearly different results from each other. Proportional negative bias was noted for refractometer results compared to estimated specific gravity from total solids and a constant negative bias compared to pycnometer results. The two refractometers designed for cat urine reported similar and lowest specific gravity results with a mean negative bias of 0.007 and 0.008 units compared to estimated specific gravity from total solids, and a mean negative bias of 0.006 units compared to pycnometer results. CONCLUSIONS: Refractometer results did not increase consistently with increasing urine specific gravity compared to reference methods or to other refractometers. Two feline refractometers reported consistently lower specific gravity results than reference methods and other refractometers. CLINICAL RELEVANCE: Because of this imprecision, veterinarians should not use precise cut off values such as 1.030 or 1.035 for evaluation of renal concentrating ability in dogs and cats. Veterinarians should consider the variability of refractometric specific gravity results in their clinical assessment. Two feline refractometers appeared to report falsely low specific gravity results.

Relationship among insulin resistance, growth hormone, and insulin-like growth factor I concentrations in diestrous Swedish Elkhounds.

BACKGROUND: In the dog, the normal estrous cycle includes a prolonged luteal phase. Progesterone stimulates local canine mammary growth hormone (GH) production, which may act systemically and contribute to insulin resistance. Swedish Elkhounds are predisposed to progesterone-related diabetes mellitus, and the relationship among insulin resistance, GH, and insulin-like growth factor I (IGF-I) is of particular interest. OBJECTIVE: To study insulin resistance in relation to GH and IGF-I in nondiabetic Swedish Elkhounds during diestrus. We also assessed whether alterations in these hormones could predict diestrus-linked diseases and all-cause mortality. ANIMALS: Eighty-four privately owned female intact Swedish Elkhounds >4 years of age. METHODS: Blood sampling and clinical examination during luteal phase, with a follow-up questionnaire after 20 months. Insulin resistance was calculated by homeostasis model assessment (HOMA-IR). RESULTS: In multivariable regression analysis, GH was positively associated with HOMA-IR (P = .009). An increase in GH of 1 ng/mL was associated with a 12.7% increase in HOMA-IR. Moreover, C-peptide was positively associated with IGF-I (P = .04), and an increase in C-peptide of 0.1 ng/mL was associated with a 6.9% increase in IGF-I. Structural equation modeling supported these results. Twenty-three animals were found to have previously unrecognized mammary masses and had higher GH (P < .0001) and IGF-I (P = .007) than dogs without mammary masses (n = 61). There was no association between high GH and IGF-I concentrations at sampling and future mammary masses. CONCLUSION: We showed that GH was strongly associated with insulin resistance in older Swedish Elkhounds during diestrus.

Serum serotonin concentration is associated with severity of myxomatous mitral valve disease in dogs.

BACKGROUND: The neurotransmitter serotonin (5-hydroxytryptamine, 5-HT) has recently been suggested to play a role in the development of naturally acquired myxomatous mitral valve disease (MMVD) in dogs. AIM: To investigate the association between serum 5-HT concentration and MMVD severity in dogs, and to assess potential associations between serum 5-HT concentrations and dog characteristics, echocardiographic variables, heart rate, systolic blood pressure, presence of macrothrombocytosis, and plateletcrit. ANIMALS: A total of 120 client-owned dogs. MATERIAL AND METHODS: Dogs were prospectively recruited and were classified by standard echocardiography into healthy (dogs of breeds predisposed to MMVD, but without echocardiographic evidence of the disease), mild, moderate, or severe MMVD groups. Serum 5-HT concentrations were analyzed using an ELISA. RESULTS: Dogs with severe MMVD had lower serum 5-HT concentrations than healthy dogs (P = .0025) and dogs with mild MMVD (P = .0011). Unilinear and multiple regression analyses showed that serum 5-HT concentrations decreased with increasing left atrial to aortic root ratio (LA/Ao), were higher in Cavalier King Charles Spaniel (CKCS) dogs compared to dogs of other breeds, and were higher in female dogs than in male dogs. The LA/Ao was the variable most strongly associated with serum 5-HT concentration. CONCLUSIONS AND CLINICAL IMPORTANCE: The finding of higher serum 5-HT concentrations in dogs of breeds predisposed to the early onset of MMVD (CKCS) and dogs with mild MMVD suggests that alterations in 5-HT signaling might play a role in progression of early stages of MMVD.

Canine herpesvirus during pregnancy and non-pregnant luteal phase.

Canine herpesvirus (CHV) is a widespread infection among dogs that typically get latently infected after exposure and can reactivate the infection after stress. The aim of the present study was to study the effects of latent CHV infection during pregnancy on pregnancy outcome, and to study if there are signs of genital viral reactivation during pregnancy or during non-pregnant luteal phase. Twelve mated bitches and eight control bitches were followed and sampled regularly during pregnancy or non-pregnant luteal phase. Blood samples were taken for antibody analysis and vaginal swabs for real-time PCR analysis. Three of the pregnant bitches were vaccinated against CHV during pregnancy. All bitches had antibodies to CHV. Two pregnant bitches that were not vaccinated had a twofold or larger increase in CHV titre, with no negative effects detected on pregnancy. Higher titres were not associated with smaller litters or with vaccination. There was no consistent variation in antibody titres due to pregnancy or non-pregnant luteal phase. Vaginal excretion of CHV was not detected from any of the bitches.

Expression of four canine leukocyte adhesion factors in fresh and stored whole blood samples evaluated using a no-lyse, no-wash method.

Expression of four leukocyte adhesion factors on canine leukocytes was studied by flow cytometry using a no-lyse, no-wash method. The effect of fixation and storage for up to 14 days in 1% paraformaldehyde on labelled samples and within assay variation was evaluated. Monoclonal antibodies directed to monocyte marker CD14, and to adhesion molecules CD11a, CD18, CD32 and CD49d were used. Cell surface marker, cell population, time, and the interactions between time and cell marker significantly affected expression of cell adhesion factors. For CD18, there was a significant difference in mean fluorescence intensity (MFI) between fresh and stored samples (P<0.001), but no significant difference between stored samples. The MFIs of CD11a and CD49d were not significantly affected by fixation and storage. The CVs differed significantly depending on cell marker (P<0.001) and cell population (P=0.005). Fixation and storage did not significantly affect the CV. In conclusion, a no-lyse, no-wash method can be applied to canine leukocytes. The effect of fixation and storage on the resulting MFI differs between monoclonal antibodies, and should be evaluated for each antibody before use. The coefficient of variation was generally acceptable, and high CVs were related to a low MFIs or low numbers of analysed cells.

Clinical alterations and mRNA levels of IL-4 and IL-5 in bronchoalveolar cells of horses with transient pulmonary eosinophilia.

The aim of this study was to assess clinical signs and altered pulmonary cell expression of cytokines related to eosinophil kinetics in horses with pulmonary eosinophilia. Pulmonary eosinophilia was detected by bronchoalveolar lavage (BAL) in a group of standardbreds in training. Horses had detailed clinical examination, bronchoscopy, endobronchial biopsy and BAL on three occasions at approximately 6 month intervals. During the second sampling period BAL eosinophils were significantly elevated (p>0.010), with five horses having from 5% to 37% eosinophils in BAL. Neither detailed clinical examination parameters nor gene expression of IL-4 and IL-5 mRNA (real-time-PCR) were associated with BAL eosinophilia. Pulmonary eosinophilia abated without treatment apart from deworming. It appears that pronounced lung eosinophilia in horses can be transient, abate without specific treatment, and in this instance, lack correlation to upregulation of expression of either IL-4 or IL-5.

Diseases associated with pronounced eosinophilia: a study of 105 dogs in Sweden.

Records of 105 dogs with pronounced eosinophilia (>2.2 x 10(9) eosinophils/litre) were evaluated in a retrospective study to determine diseases associated with the abnormality in dogs in Sweden. Inflammatory disease in organs with large epithelial surfaces, such as the gut, lungs or skin, was found in 36 per cent of the dogs. A further one-quarter of the 105 cases were placed in the 'miscellaneous' category, which comprised various diseases found at low frequency. The most well defined diagnosis was pulmonary infiltrates with eosinophils in 12 per cent of the dogs. A further 11 per cent had parasitic disease caused by either sarcoptic mange or nasal mite. No atopic dog was found and rottweilers were over-represented in most disease groups. Pronounced eosinophilia, in many cases transient, seems to be associated with a variety of disorders in dogs. In the present study, rottweilers appeared to be more prone to a high eosinophil response than other breeds.

Detection of granulocytic Ehrlichia species DNA by PCR in persistently infected dogs.

Three female beagle dogs inoculated with granulocytic Ehrlichia species were monitored for four to six months to determine whether there was evidence that the organisms persisted. The dogs were inoculated intravenously with blood containing an Ehrlichia species closely related to Ehrlichia equi and Ehrlichia phagocytophila, and identical to the human granulocytic ehrlichiosis agent with respect to its 16S rRNA gene sequence. The clinical signs were evaluated, and blood samples were collected for haematology, serum biochemistry and serology. Ehrlichial inclusions in the blood were monitored by microscopy, and ehrlichial DNA was detected by the polymerase chain reaction (PCR). Two of the dogs were injected with prednisolone on days 54 to 56 and days 152 to 154 after infection, and the other was injected with prednisolone on days 95 to 97 after infection. The dogs were euthanased and examined postmortem. Ehrlichial inclusions were demonstrated in the neutrophils and seroconversion occurred shortly after inoculation. Two of the dogs developed acute disease with rectal temperatures above 39.0 degrees C, after which no further clinical signs were observed. The administration of corticosteroids seemed to facilitate the detection of ehrlichial inclusions. Ehrlichial DNA was detected intermittently by PCR in blood samples from two of the dogs throughout the study. Persistent infection was demonstrated up to five-and-a-half months after inoculation.

Granulocyte function in dogs experimentally infected with a Swedish granulocytic Ehrlichia species.

Granulocyte function was studied in six dogs inoculated with a Swedish granulocytic Ehrlichia species and in four control dogs. Whole blood chemiluminescence (CL) was enhanced in the dogs with granulocytic ehrlichiosis. Both CL after stimulation with zymosan and spontaneous CL was significantly increased at peak of infection compared with pre-infection levels. Ingestion of FITC-labelled serum-opsonized yeast cells was high and stable in both groups. The ingestion was lower when the yeast cells were opsonized with anti-yeast IgG. However, there was no difference between groups. The labelling intensity of anti-human CD11b, CD18 and CD32 mAb on the granulocytes in dogs with ehrlichiosis was similar to that in control dogs. The opsonic activity in serum collected at the peak of infection was not different from serum drawn prior to inoculation. Opsonic activity was investigated both by yeast cell ingestion and by chemiluminescence after stimulation with zymosan. The serum from infected dogs enhanced the respiratory burst without stimulation with zymosan of leukocytes from healthy dogs. This suggests that serum at the peak of infection contains granulocyte activators. In this study we found normal phagocytosis together with evidence of enhanced oxidative metabolism in the granulocytes from dogs with granulocytic ehrlichiosis.

Early manifestations of granulocytic ehrlichiosis in dogs inoculated experimentally with a Swedish Ehrlichia species isolate.

Seven beagles were inoculated experimentally with a Swedish canine Ehrlichia species isolate to study its pathogenicity. With respect to the 16S rRNA gene sequence, the isolate was identical to the human granulocytic ehrlichiosis (HGE) agent and closely related to both Ehrlichia equi and E phagocytophila. After an incubation period of four to 11 days, the most prominent clinical signs were high fever for two to five days and depression. All the dogs developed profound thrombocytopenia, moderate leukopenia and a strong serological antibody response. Ehrlichial inclusions were detected in blood neutrophils from four to 14 days after inoculation for four to eight days. Ehrlichial DNA could be detected by polymerase chain reaction during the parasitaemic stage and a few days before and after microscopic inclusions were visible. Postmortem, the dogs showed reactive splenic hyperplasia and non-specific mononuclear reactive hepatitis.

Experimental infection of dogs with the nasal mite Pneumonyssoides caninum.

A successful experimental transmission of the canine nasal mite, Pneumonyssoides caninum, is described. Some 11 weeks after repeated systemic ivermectin treatment, four Beagles were inoculated via the right nostril with 20 P. caninum mites of different sexes and life stages, obtained at the necropsy of an infected dog. The inoculated dogs and a matching uninoculated control were observed for clinical signs for 14 weeks and then euthanised. Vague upper respiratory signs and a transient minor increase in the number of eosinophils in peripheral blood were recorded in the inoculated dogs. At necropsy 4-12 P. caninum mites were found in the nasal cavities and sinuses of the inoculated dogs, but none in the control. In three out of the four infected dogs mites were found in both the right and left nasal cavities and sinuses of the skull. Since in no case more mites than the number used for inoculation were detected it is not clear if the mites managed to reproduce in the dogs. Inflammatory lesions were seen most consistently in the olfactory mucosa, respiratory mucosa and tonsils, and growth of opportunistic bacteria was observed in the tonsils of the infected dogs. The inflammatory lesions seen in the olfactory mucosa may explain why dogs infected with P. caninum sometimes appear to suffer from impaired scenting ability.

Expression of adhesion and Fcgamma-receptors on canine blood eosinophils and neutrophils studied by anti-human monoclonal antibodies.

Commercially available anti-human monoclonal antibodies were tested as markers of adhesion receptors and Fcgamma-receptors on canine neutrophils and eosinophils. Purified populations of eosinophils and neutrophils were incubated with selected monoclonal antibodies and binding was measured by flow cytometry. Most of the anti-human monoclonal antibodies used in this study crossreacted with canine granulocytes and many showed expression similar to that of human granulocytes. The results suggest that the adhesion and Fcgamma-receptors are well conserved among species. Canine eosinophils and neutrophils were simultaneously purified by a two-layer Percoll density gradient centrifugation. The purity of the neutrophil fraction was > or = 97% after lysis of the erythrocytes. In the eosinophil fraction, 27-92% were eosinophils (mean 60%). After purification, the neutrophils and eosinophils were incubated with selected monoclonal antibodies and analysed by flow cytometry. Human anti-CD11b and CD18 antibodies bound intensely to both canine eosinophils and neutrophils. Canine neutrophils did label with anti-CD29, but eosinophils did not. Anti-CD49d bound weakly to both eosinophils and neutrophils. Both anti-CD16 and anti-CD32antibodies labelled neutrophils, but not eosinophils. There was no binding of anti-CD9 to canine neutrophils and the binding of anti-CD9 to canine eosinophils varied between dogs.

Diurnal variation of canine blood leukocyte counts.

A diurnal variation was detected in the numbers of total leukocytes, neutrophils, lymphocytes and eosinophils in the blood of 19 dogs (10 beagles and nine German shepherds). Blood samples were collected every fourth hour for 24 hours and once a day for 7 days. The neutrophil count increased during the day and reached its maximum in the late afternoon. The lymphocyte count had its maximum values in the late evening and its minimum values in the early morning. The eosinophil numbers were low around noon, increased during the afternoon and reached their maximum numbers in the late evening. Leukocyte numbers had statistically significant diurnal variation, so in designing research protocols with repeated blood sampling and closely controlled factors it may be important to take blood samples at the same time every day. The mild normal leukocyte changes during the day are not likely to confuse interpretation of clinical cases where patient results are compared with wide reference ranges.