HOW DIGITAL CYTOLOGY IS CHANGING THE GAME FOR HEMATOLOGY SCOPIOVET (continued)
5 TAILS FROM THE VETERINARY ER Kavit recalls a recent case example involving a cat where his suspicions were validated by a pathologist’s invaluable input. “We ran a test, and it said, ‘this is a regenerative anemia’ and looking at this cat with chronic liver and kidney disease thinking, ‘you’re doing well to regenerate’, and then what would be the blood loss, what would be the destruction of red blood cells if that were true. The pathologist’s review told a different story, a marked nonregenerative anemia which was much more believable to the case, and so sometimes the path review just rights the wrong, when you see something the machine is telling you and you don’t see why it fits.” Another case helped Kavit believe the machine when the values seemed like a stretch. “We had another case where the lymphocyte count was through the roof, and we thought, ‘it cannot be that high – how can you make so many lymphocytes?!’ The cat went from very healthy to very unhealthy in a matter of a few days. We thought we were dealing with something a lot more acute. As it turned out, from the pathologist’s interpretation, it was a lymphoblastic leukemia, so a genuine lymphocyte disorder. Kate was not surprised. “We’re all familiar with the difference between leukemia types; there’s the kind that has a grim prognosis, and the kind that can be more chronic with longer survival times. On a CBC
Other times it allows you to prevent something becoming an emergency. Having a pathologist look at the actual cells makes a difference.” As a seasoned veterinary clinical pathologist, Dr. Kate Baker, founder of the Veterinary Cytology Schoolhouse, admires how much urgent care practitioners are able to do on the fly. “In the ER, emotions run high, costs are high, there’s significant morbidity, limited time, and it all requires quick decisions,” she said. “The practicality of having someone else to help you is big. The importance of looking at a blood smear is significant; you have to check your automated differential because although they’re great … they’re not perfect. But also – it’s not just confirming what the CBC is telling you, but also expanding upon it. CBCs and blood smears are inherently linked for maximal information. If you’re not using both you’re leaving a huge amount of information on the table.” Kate welcomes the rise in in-house diagnostics, and lauds the role of digital cytology in point of care hematology for its unique value add: “The reason why blood smears became less popular in the first place is because the time delay often rendered the test moot, but now by making the turnaround almost immediate, you’re bringing the value back to blood smears and getting on the right path sooner. That’s why it’s so important to have the technology to get the answer quickly.”
those will often look the same – and so you absolutely have to look at the blood smear, because there are morphological differences that can give clues as to which you’re dealing with. So, while many people do “get by” with the CBC, I must wonder how many scenarios – especially in particularly busy clinics or those with limited funds – are missing out on that vital information by not utilizing the blood smear. 6 CELLMATES The integration of clinical pathology at the point-of-care creates the next evolution for veterinary hematology. (continued)
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