IDEXX LaserCyteTM

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IDEXX LaserCyteTM
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LaserCyte Parameters

• LaserCyte Parameters
• Medical Reasons
• The What and So What
• Summary

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LaserCyte Parameters
Red blood Cells
White blood Cell
Platlets
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Red Blood Cells

• Is there evidence of anemia?
• Regenerative or nonregenerative with reticulocyte
  count
• Is there evidence of dehydration?
• Polycythemia

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Red Blood Cells

• HCT (Hematocrit)
• Percentage of the red cell population relative
  to the total volume of blood
• It is a calculation by the LaserCyte
• 40 59 dogs 29 50 cats
• Used to diagnose anemia or polycythemia
• RBC (Red Blood Cell Count)
• Actual number of RBCs in a given quantity of
  blood
• Average is 5.9 - 8.6 X 106 µL for dogs or 5 -10
  X 106 µL for cats

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Red Blood Cells

• HGB (Hemoglobin)
• A measurement of the oxygen carrying capacity of
  the red blood cells
• The LaserCyte uses four LEDs and photodetectors
  that measure Hgb concentration by at least three
  different wavelengths of light and two different
  aspirates, unlysed and lysed.

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Red Blood Cells
A retic count offers a quick and easy assessment
of an anemia state. A count, unlike a
percentage is not affected by dehydration.

• Retics
• The number of reticulocytes is a definitive
  indicator to distinguish between regenerative and
  non-regenerative anemias.
• The LaserCyte gives aggregate retics in the cat
• A retic count above 60,000 µL in cats and 80,000
  µL in dogs in considered a regenerative anemia
• Retics
• Percentage of reticulocytes in a given quantity
  of blood
• Average is 0.0 1.5 for dogs or 0.0 0.4 for
  cats

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Red Blood Cells

• MCV (Mean Corpuscular Volume)
• The mean volume of all the RBCs counted in the
  sample
• Smaller than normal is microcytic larger is
  macrocytic
• Used to indicate spherocytes, anisocytosis, or
  schistocytes all of which must be confirmed with
  a morphology exam
• RDW (Red Cell Distribution Width)
• Measurement of the variation of size with in the
  RBC population. Given as a percentage
• Used to indicate anisocytosis, also used by
  impedance analyzer users to indicate the presence
  of retics with MCV

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Red Blood Cells

• MCHC (Mean Corpuscular Hemoglobin Conc)
• The mean concentration of hemoglobin in the red
  cell
• Calculated by dividing the hemoglobin by the
  hematocrit and expressing the answer as a
  percentage
• Important in classifying anemias
• Normal ranges are 30.0 36.9
• MCH (Mean Corpuscular Hemoglobin)
• Mean mass of hemoglobin in each RBC
• Calculated by dividing the hemoglobin by the
  number of RBCs

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White blood cell data answers

• Is there evidence of inflammation?
• Acute, chronic or overwhelming
• Is there evidence of stress or excitement?
• High levels of glucocorticoids cause mild
  neutrophilia, lymphopenia and eosinophilia
• Is there a demand for phagocytosis or evidence of
  tissue necrosis?
• Elevated monocytosis is almost always seen in
  chronic inflammation

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White Blood Cells

• WBC (White Blood Cell Count)
• Total count of all White blood cells
• Reported as X 103 µL
• Indicator of infection (not diagnostic alone)

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White Blood Cells

• Lymphocytes
• White blood cell that produces antibodies
• 20 30 of WBC population
• Lymphocytosis Prolonged illness, chronic
  inflammation,
• Lymphopenia Acute inflammation, viral
  infection, stress, steroid therapy
• Monocytes
• Reported as X 103 µL
• Indicator of infection (not diagnostic alone)

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White Blood Cells

• Neutrophils
• Most common leukocyte
• Two classifications Banded and Segmented
• Engulf disease causing bacteria, viruses, and
  particles (phagocytosis)
• Eosinophils
• Involved in allergies and parasitic infection
• Usually only in circulation for about 30 min
• .1 1.5 X 103 µL normal range

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White Blood Cells

• Basophils
• Having the basophil and aids in identifying
• Systemic hypersensitivity
• Acute allergic reactions
• Mast cell sarcomas

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The Medical Reasons

• White Blood Cells

EOS
NEUTS
WBC
MONOS
LYMPHS
Variable
Increased
Increased
Acute Inflammation
variable
Decreased
Variable
Increased/ no change
Increased/ no change
Chronic Inflammation
Increased
Increased/ no change
Increased
Decreased/ no change
Increased/ Variable
Parasites
Increased/ no change
Variable
Decreased/ no change
Increased
Increased
Stress Leukogram
Increased/ no change
Decreased
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Is it a stress leukogram or inflammation?
Inflammation
Stress
Parameters
High
High
WBC Count
High
High
Neutrophils
Normal
Low
Lymphocytes
Normal
Low
Eosinophils
Slightly high
Slightly high
Monocytes
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3-part versus 5-part differential
5-part
3-part
Elevated neutrophils
Yes
No
Inflammation
Yes
No
Infection
Yes
No
Stress
Yes
No
Excitement
Yes
No
Steroid therapy
Decreased neutrophils
Yes
No
Parvo
Yes
No
Erhlichiosis
Yes
No
Overwhelming infection
Yes
No
FIV
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3-part versus 5-part differential
3-part
Elevated basophils and eosinophils
5-part
Yes
No
Parasites
Yes
No
Allergies
Yes
No
Mast cell tumors
Yes
No
Heartworm
Yes
No
Addisons disease
Yes
No
Parvo
Yes
No
Stress
Yes
No
Distemper
Yes
No
Cushings syndrome
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Platelet data answers

• Is there evidence of autoimmune disorders, occult
  infections or inflammation?
• Suspected coagulopathies?

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With LaserCyte, your platelet information
increases

• PLT
• Involved in clotting
• PLT is a platelet count
• Thrombocytopenia can be seen in Ehrlichia, FIV,
  FELV
• MPV
• MPV (mean platelet volume) aids in the
  identification of what may be causing a severe
  thrombocytopenia
• PDW
• PDW (platelet distribution width) is an objective
  measure of the degree of variability in the size
  of platelets and can indicate bone marrow
  response

Absolute countAvailable using the LaserCyte
analyzer.
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The CBC is a time-sensitive test

• Hematology samples are composed of living cells
  and should be analyzed as soon as possible
• To prevent cell distortions due to shipment or
  storage
• To prevent artifacts created by long-term
  exposure to EDTA

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Blood cells continue to develop and change

• Samples should be processed within three hours to
  avoid artificially increased Hct and MCV, and
  decreased MCHC
• Platelet counts should be performed within one
  hour after collection
• Red cells crenate, reticulocytes mature, and
  lymphocytes nuclei become distorted

Rebar A, et al. Guide to Hematology in Dogs and
Cats. Jackson, WY Teton New Media 200211.
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Which system is ideally suited for your needs?
Impedence
Lab
QBC? VetAutoread
LaserCyte?
Yes
Yes
---
Yes
RBC Count
Yes
Yes
Yes
Yes
PCV/Hct
Yes
Yes
Yes
Yes
Hgb
---
Request
only
Yes
Reticulocytes
Yes
Yes
---
Yes
MCV
Yes
Yes
Yes
Yes
MCHC
Yes
Yes
---
Yes
RDW
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Which system is ideally suited for your needs?
Impedence
Lab
QBC? VetAutoread
LaserCyte?
nRBCs misclassified
Yes, corrected for nRBC
Not corrected for nRBC
Yes, corrected for nRBC
WBC Count
Yes, absolute count and
Grouped with monocytes
Yes, absolute count and
Lymphocytes
Small-sized cells number and
Middle-sized cells number and
Yes, absolute count and
Grouped with lymphocytes
Yes, absolute count and
Monocytes
---
Yes, absolute count and
---
Yes, absolute count and
Neutrophils
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Which system is ideally suited for your needs?
Impedence
Lab
QBC? VetAutoread
LaserCyte?
---
Yes, bsolute count and
Elevated canine and bovine
Yes, absolute count and
Eosinophils
---
Yes, bsolute count and
Yes
Yes, absolute count and
Basophils
Yes, good correlation with clumped platelet
samples
Yes, optical signature,clumps do not interfere
with WBC count
Platelet Count
Yes, size only, clumps may go uncounted or
misidentified as WBCs
Not always, usually reports broad categories
(i.e., adequate)
Yes, absolute count
Yes
Yes
---
MPV
Yes, absolute count
Yes
Yes
---
PDW
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The Doctors view

• I have a QBC VetAutoread that is nearly paid
  off, why should I go in debt again for a new one
• The QBC Vet AutoRead is and was a good in-clinic
  system. However, as with anything the advances in
  technology now make it affordable and possible to
  practice the best medicine available right in
  your clinic.
• A five part differential is a must for diagnosing
  many very common diseases or states.
• allergies, parasitic infection, chronic
  inflammation, stress, feline asthma, systemic
  toxemia, and more.

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The Doctors view

• I let my lab deal with the equipment cost and
  maintenance, they get me the results I need in
  plenty of time
• As discussed, a CBC is a time sensitive test.
  Platelets clump, red cells change shape and size,
  bands change to segs, lymphocytes, neutrophils,
  and eosinophils can change size, etc.
• This immediate information is critical in many
  cases.
• Not only does the cells change, the animals
  condition changes between draw and results from
  the lab

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The Doctors view

• Other in-clinic analyzers are just as good,
  and cost about 5k to 8k less
• Laser Flow Cytometry is the standard in automated
  hematology.
• Other in-clinic analyzers interrogate cells based
  on size only. This can cause erroneous results in
  the case of artifacts, nRBCs, reticulocytes, and
  more.

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Summary (1 of 3)

• You need to show a Dr. why the LaserCyte is a
  good investment medically.
• Increased ability to diagnose common problems
• Immediate results mean immediate treatment and
  decreased effects from artifacts

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Summary (2 of 3)

• The LaserCyte is not meant to replace the
  reference lab, it is meant to give the Dr.
  reference lab results for their in-clinic testing
  needs.
• Do not try to compare to ref lab prices or say
  that they can now make more by doing test
  in-house.
• They will however, increase their testing volume
  by having ref lab accuracy immediately available.

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Summary (3 of 3)

• Do not try to sell the LaserCyteTM on price or
  testing volume.
• If the Dr. is already doing in-clinic testing,
  the LaserCyteTM will not make them more money
  right away, it will give them the ability to make
  more accurate and rapid diagnosis.
• If the Dr. is using the reference lab, the
  LaserCyteTM will be more expensive to use, but
  he will do more testing if he/she has the
  availability to do so.