#blood work

“Send Me a Copy of the Labs”

When I get lab results I always go over them with the owner. Generally if there isn’t anything concerning I’ll say everything looks good and there is nothing to worry about. If there are abnormalities we discuss what they mean and what the next steps are, if there are any. Most discussions take less than ten minutes and everyone moves on with their day.

More and more often I am asked by owners to send them a copy of their pet’s lab work. Some people just want a copy to keep in their pet’s file at home which is totally fine by me. Other times something worse happens. The lab results are shared with FB groups, forums, human physician friends or even worse… Googled. Then the emails and phone calls start.

There is so much more to diagnostics than just reading the numbers and seeing if they are red or black. What was the test run for? Was the patient fasted? How old is the patient? What species is the patient? What medications are being used? And on and on.

This lab work below is from one such case. I told the owner everything was within normal limits and we would proceed with the spay. I got a frantic phone call asking why I had not let them know their cat had leukemia and was in liver failure. Let’s look it over. Buckle up because this is a long one.

Before we even look at the results we need to look at the chart for information on this patient. In this case it is a four month old, intact female domestic short hair who was not fasted for this sample. This cat has no medical issues and is not taking medications

First of all we look at the CBC. The reticulocyte hemoglobin is the first red finding. What are reticulocytes? They are immature red blood cells. If there are abnormally high numbers of them it can mean the patient is anemic. Looking at the reticulocyte count we can see that it is within the normal range. So what does the reticulocyte hemoglobin mean? Hemoglobin is the protein that allows blood cells to carry oxygen. Indirectly reticulocyte hemoglobin measures the amount of iron available in the body when the cells were produced. The result is 14.9 pg and the normal range is 15.3-22.9 pg. This cat is completely normal on physical exam and has no symptoms of illness. The rest of the RBC parameters are normal and because this is such a minor decrease we don’t really care.

The next abnormality is a slightly increased white blood cell count. That in itself is pretty non-specific so we have to continue on. We see that the lymphocytes are elevated. This can be because of leukemia, infection, antigenic stimulation, stress response, and other things. It’s really common for kittens to have elevated lymphocyte counts. They are getting vaccinated, have epinephrine going through their systems like crazy at the vet, and are getting antigenic stimulation from the environment. I am not excited about this finding and would just move on.

If you read the little blurb under the CBC it says platelet clumping was noted and may affect the platelet count. This is also a normal finding in cats. This platelet count is normal so it doesn’t matter anyway.

Next we see there were smudge cells present. These are just broken pieces of WBC’s. This can be a sign of leukemia in people and sometimes animals but generally is because cells were broken during transport to the lab or during the blood smear. We know there are high numbers of lymphocytes so there are more cells around to create smudge cells. Not a big deal in this case.

Finally we see the ALP is elevated. This is a liver enzyme but is also found in bone, mammary tissue, and the intestines. It is usually elevated in puppies and kittens because their skeletons are growing so quickly. Not to mention we don’t usually become concerned unless a liver value is approaching 3 times its normal value.

As you can see interpreting lab work is much more complex than you might think. I do that entire process before making any phone calls or talking to owners. When you pay for lab work you aren’t just paying for the diagnostic itself you are paying for the expertise involved in collecting the sample correctly and in interpreting it.